Quality memory care visits

When it comes to improving the quality of visits between families and residents with dementia, a little education can go a long way. Many families struggle with feelings of guilt, anxiety and awkwardness when they visit loved ones with cognitive decline. Family members can feel frustrated by an inability to hold a “current time” conversation, the unexpected reactions to physical contact and the fact that their loved one may shift between recognizing them and viewing them as strangers.

As memory care professionals know, current memory care best practice is to “meet residents with dementia wherever they are,” rather than forcing them to accept a current time or reality. But family members often need help adjusting to this new reality. Helping families build a new relationship with their loved one while letting go of an old one can help ease anxieties and improve the quality of visits.

Adjusting to the new reality

Having a family member with dementia requires families to come to terms with an unusual type of loss, since their loved one is physically present but is different and distant—perhaps even unwelcoming. “It can be a real struggle for families to accept this new reality,” says Jodi DiRaimo, resident engagement director at the Lighthouse at Lincoln, a memory care community in Rhode Island. “It’s unfortunate, but not everyone in the family always gets to a level of acceptance.” She recommends sending resident photos or updates to families who may need extra help and encouraging them to come to support groups or family meetings. “They need to understand that she is still their Mom, but it’s a new relationship now. She can’t change, so they have to,” DiRaimo says.

Caregivers play a key role in reminding families how important an ongoing relationship with their loved one is, even if the resident doesn’t remember who the visiting faces are, adds Amelia Schafer, vice president of programs for the Alzheimer’s Association of Colorado. “Even if [residents] can’t recall how they relate to you, the family can still bring great joy to their lives.” And, families also can help caregivers and activity directors interact more productively with residents by providing unique insights into the personality of the resident before the disease.

One of the best ways caregivers can assist families in their visits is to guide them to a conversational path that doesn’t include asking questions based on current time. Quizzing a person with dementia on what they had for lunch or who visited yesterday often results in frustration for everyone, explains Carmen Bowman, a long-term care educator in Brighton, Colo. Trying to force the resident to orient to a specific point in time is counter-productive and just doesn’t work, she says.

Instead, caregivers should teach the family how to share conversation without worrying about what timeframe the resident’s memory is in, DiRaimo advises. “Whether that moment is in 1920 or 1940 doesn’t matter because what’s important is to meet them wherever they are.”

Helping families learn to “quilt a conversation” encourages them to let go of wanting specific answers and gives residents a chance to participate and engage instead, adds Joshua Freitas, reflections and engagement manager for LCB Senior Living, headquartered in Norwood, Mass., and author of The Dementia Concept (2015). Freitas recommends that families bring in a magazine or book with pictures relating to something of interest to the loved one as a conversation starter, and then allow one memory to prompt another.

Using storytelling instead of fact identification also can help the family engage with the resident, Shafer adds. “Instead of bringing an old friend to visit and insisting the resident remember who she is, try telling a story about [that] friend when you were growing up and there may be something that triggers a memory,” she says.

Visit variety is key

For those with dementia, no conversational method works every day. It’s important to show families more than one way to connect, and it can help to vary the visit setting, Bowman notes. “I watched a wife come to visit her husband and they sat in the exact same place where he sits every day. And then neither spoke,” Bowman says. “We need to encourage our families to engage and not just sit with their loved one and be sad.”

Even simply going outside can be a new opportunity to engage. “Putting on a coat, hat and mittens gives you the chance to talk about the weather or what they may remember about past winters,” Bowman says. “When you come back in, you can do the same thing. And what a nice moment to sit by the fireplace with a hot chocolate and talk about whatever comes to mind.”

Families and residents tend to feel an innate need to feel useful, Bowman adds, recalling a husband who volunteered to set up a nearby room for church services while visiting his resident wife–and then his wife started helping him. “And imagine the joy it could bring if the resident known for making the best cinnamon rolls ever could share that again with her family,” Bowman says.

Sensory outreach is especially helpful for those with dementia, including reflection baskets filled with family photos, puzzles, personal recipes or whatever speaks to the resident’s interests, DiRaimo adds. “We live in a sensory world, and the basket is filled with tangible and tactile items. It can be used to give families something to engage in with the resident,” she says.

Many families fail to realize that not all visits have to involve conversation. Back rubs, massages, manicures and holding hands are all ideas for valuable family interaction. Listening to music together also is great because it doesn’t rely on memory facts, Schafer says. “All they have to do is enjoy it. And you never know; it can lead them to clapping, tapping their feet or even dancing together.”

Planning for visits

The care team can help families prepare for a visit, but it’s important first to understand what the family’s goal is, Schafer adds. “Some may not be looking for conversation but rather a chance to help take care of their loved one,” says Schafer. “If sundowning happens in the late afternoon and [the resident] gets agitated or upset, a visit from a family member could be comforting. And for most facilities, right before and after dinner is a busy time for staff, so they could also help the transition to the evening routine,” Schafer says.

Remind families to leave their own day at the door when they come to visit, DiRaimo adds. “Dementia residents pick up on others’ emotions, and when families are positive, that helps evoke positive emotions for the residents.”

Keeping the number of visitors to no more than two or three at a time and keeping the conversations simple work best, Freitas suggests. And always focus on what the residents can do, not on what they can’t, he urges. “Reminding families to introduce themselves helps take the stress away from residents if they don’t know who you are or why they should know you,” he adds. Keep it simple, he says, such as, “Hi mom, it’s Joshua just stopping by to see you.”

Families should know it’s OK to bring the kids, and caregivers should be ready to help prepare younger visitors what to expect, Schafer says. “Children bring life into a community and can often be more understanding and accepting than adults.”  

When a visit ends, saying goodbye can also trigger behaviors or emotions for residents, Freitas cautions. It’s better to be positive by saying something like, “I enjoyed our visit and I hope you did too,” or “It’s time for you to eat dinner but I’ll see you tomorrow,” he adds. The timing of the goodbye also can be important, DiRaimo adds. “One great way to handle this is for one of the staff to tell the resident they need the resident’s help with something, so it gives the resident the chance to say goodbye first,” she says.

|Other tips for visiting from the Alzheimer's Association |

Encourage, encourage

Even when family members say it’s too hard to see their loved one like this, caregivers need to remind families how important their visits are to their loved ones, Schafer says. “Giving positive feedback helps them understand that it really does make a difference.” Bowman agrees, saying, “We always assume that those suffering from dementia don’t know who we are, but perhaps instead we should assume that maybe they do, at least on some level.”