As a physiotherapist working with the elderly in residential care facilities, I am always reading, researching and discovering new approaches to care and the ways in which current methods can be improved. Recently I watched some You Tube videos that really resonated with me. They were made by an American Occupational Therapist and care consultant called Teepa Snow who works to help, support and guide the people who care for individuals with dementia.
Her philosophy seemed to reflect our ethos at Agestrong Physio. We passionately believe in active aging and care that is specifically directed at the people we treat. We work together with each individual, focusing on what is important to them and work out together how they can achieve their goals. The patient is in charge. We’re helping them to get the outcomes they want, rather than providing the care we think they need. Similarly, Snow talks about being care partners not care givers. Simply put, it’s the way I would like to be cared for when I need support, “we treat other people the way we would like to be treated” in the words of the educator Maria Montessori.
Positive Care and Dementia
It’s all about Positive Care. Snow trains and educates carers to look at each situation from the patient’s point of view. Through the medium of role play, she helps care workers gain a whole new perspective and an insight into residents with dementia. This understanding helps them do a better job. It’s an approach that I believe could really help improve care in all residential facilities.
The Pearl Within
Snow breaks down the different stages of dementia into six levels, which she compares to gem stones. She desribes an individual with advanced dementia to a pearl within an oyster shell. That metaphor still plays on my mind; it seems so incredibly appropriate.
Too often care-workers focus on the dull, outer shell of the oyster and forget the beautiful pearl within. The truth is that in every person, no matter how severe their cognitive decline, the pearl of their personality is still there. They still have the potential to have moments of connection and real joy, if we can find the way to shuck the shell.
Seeing it from the other side
The way to reach and respond to the person within, is to view things from their point of view. Dementia is about so much more than memory loss, everything changes: communication, understanding, confidence and self-esteem. By imagining how a particular situation must make an individual feel, we can understand their responses, empathise with their frustrations and ultimately make a connection with them.
Communication: Instead of correcting, contradicting and interrupting it’s important to facilitate each individual’s conversation and their reminiscences. Relating stories can make someone feel good and allow their brain cells to fire, even if the tale has been told many times before. If we challenge their comments, they may feel confused, embarrassed or angry. It’s understandable, just put yourself in their shoes. No one likes to be dismissed or made to feel foolish, I know I don’t. It’s so much better for their wellbeing to say ‘Tell me about it.’
A sense of purpose: All people need to be needed, it’s a critical part of a life worth living. Dementia can steal away the roles and responsibilities that make us who we are. By preserving a sense of purpose and providing activities that resonate with past experiences we can make a critical difference to the health and wellbeing of people with dementia.
Engagement not entertainment: Throughout life we work to achieve things, to make a difference. In a residential facility, too often the focus is on being entertained, being fed, being told what to do. It’s a very passive existence, with life happening to the individual instead of them being active participants. Snow compares it to being on a cruise ship, which is great for a couple of weeks but after that it can seem stifling and unsatisfying. Is it any wonder that people wander or become agitated?
Instead we can create a positive relationship, asking for each person’s opinion and preferences. Using terms like ‘Can you help me?’ and ‘What do you think?’ will make each individual feel valued and worthwhile.
Rediscovering moments of joy: Sometimes when carers are busy and focused on finishing the jobs on the to-do list, it’s easy to forget about the individual that’s being cared for. Washing, brushing teeth and feeding are important, but so are the times of engagement over music, photos or conversation. Too often the relentless concentration on the activities of daily living can mean there is little space and time for those magical moments of connection and joy.
The next time an individual with dementia seems upset, frustrated or troubled, think about how you would feel in their situation, with your comments misunderstood or ignored. Try going along with the individual in the moment, praising their efforts, acknowledging their skills and apologizing if you have made them angry, or treated them like a child. You may find that they’re calmed and comforted. You may reach that pearl inside.