Making a connection in dementia care

When working with or developing a relationship with someone who has Alzheimer’s dementia, you must step into his or her world to join the journey, which is unlike any other. Trying to pull someone into the world of reality only sets everyone up for failure.

Connections make a difference in the lives of those with dementia. Until that connection is made, their days will have less meaning. Let go of your expectations. As the dementia progresses, the individual’s development regresses unlike how our children and grandchildren grow and progress in life.

What is each person’s greatness? What brought the people you care for great joy throughout their lives? Many times, people stop doing their greatness in the beginning stages of the disease because it frustrating for them.

A good time to reconnect them to their greatness is during the middle stages of the disease progression. At this time, people with Alzheimer’s do not think anything is wrong with them. In other words, they do not remember that they do not remember. Putting the person’s greatness back into his or her hands may possibly trigger a memory on how to do something. When we engage our residents or family members, the quality of life improves so that they are not just vegetating in the world of dementia. Once they withdraw into that world, it becomes increasingly difficult to bring them back.

MOMENTS OF JOY

No matter how hard we try, we cannot return short-term memory to individuals with dementia, but we can take hold of their long-term memory and create moments of joy. Those moments create a better connection, building a better relationship all around.

People often try to reason with someone with Alzheimer’s disease. Reasoning fails. You cannot force someone into your reality, so you must join him or her in that world. When you do this, everyone wins.

Telling a man who worked construction all his life that he does not have to work anymore creates mistrust. It is better to tell him that the heat has slowed down the project and he does not have to go in today. Then, offer to fix him some iced tea.

People with dementia wake up in a strange place every morning, with staff or family telling them that they are okay. No, they are not okay. They might be looking for their children and you tell them that their children live in another state. "No, they don’t!" is the reply you'll receive. The resident will keep looking for them, crying, not trusting you. The person with dementia may think he or she is 35 years old when he or she actually is 85. How will you know when you find the right answer? Just look at the person’s face and reaction. Don’t look for a perfect reaction, but a better reaction. Good dementia care is comfort care.

MAKING CONNECTIONS

Think of a duck. It paddles and paddles trying to get somewhere. When you have to come up with a “great” response, you, too, are paddling like a duck underneath the water, where no one can see. You provide the “perfect” calm response. As said by Michael Cain: “Keep calm and unruffled on the surface but paddle like the devil underneath!”

When making connections, remember these important communication techniques:

• Speak slowly in low-pitched tones.
• Enunciate.
• Listen.
• Keep it simple.
• Give one task at a time.
• Avoid negatives such as don’t, can’t, won’t, etc.

To illustrate: If a resident with Alzheimer’s is wearing someone else’s sweater, don’t say: “That’s not yours! You need to take it off.” This tone is not comforting; it creates discomfort. Instead, say: “Here, try this sweater on. It is much warmer.”

More communication tips:

• Never assume something will not work.
• If a person’s speech is unintelligible, never act as if you cannot understand what’s being said.
• Keep talking even if the individual cannot respond; that’s what makes a connection.
• Use touch to draw the person’s attention to you.
• To make a quality connection, stop, get down to the person’s level, make eye contact and compliment, compliment, compliment. What you say is still important in making him or her feel his or her own greatness.

Remember that negative behaviors often reactions to an unmet need and we must find the cause—for instance, hunger, thirst, tiredness, pain, etc. Do not scold and do not correct; residents with dementia are not children.

Join their journey and make that special connection each and every moment of each and every day you are with them. Create “moments of enjoyment” for them, for their families and for yourselves. Remember, people with dementia live in the moment, and we must join their moment each day to make a meaningful connection.

Diane Mockbee is a board-certified activity director/consultant. With more than 24 years’ experience in long-term care, she was appointed director of operations for the National Association of Activity Professionals Credentialing Center in 2010.