Using the No big deal mindset for repetitive stories and questions from someone with dementia.
Several years ago, I was the director of a dementia unit. It was 5:00pm, I had a support group to facilitate in 1 hour, 3 shifts to fill, and about 10 emails to respond to. It was starting to storm so I walked to the back of the community to lock the door to the courtyard. On my way back to my office, a resident left the common bathroom. It was obvious he was unsuccessful in toileting independently. I caught a glimpse of the bathroom and recognized he had made a great effort to do so, but failed. It was a mess and both he and the bathroom had to be cleaned up. This is where I needed to use the “No Big Deal” Mindset.
Making it a big deal
Here is how it may have gone down with my resident and me if I made it a big deal:
Me: Oh my gosh! Mr. Smith! You’re a mess. Oh gosh. Don’t move. Don’t move. You’re making a mess everywhere! *Waves to a caregiver* Come here! We need to get Mr. Smith cleaned up right now. Please take him to his room. Oh my gosh! How did this happen? Why wasn’t someone in the bathroom with him?
Caregiver: Mr. Smith! You know you can’t go to the bathroom alone. Come with me. We have to clean you up.
But that doesn’t help anyone. When we make this kind of thing a big deal, we:
- Embarrass the person with dementia, which breaks our rapport.
- Weakens the morale of the staff and fosters a fearful culture.
- Leads to staff burnout.
- Raises our own blood pressure!
What is the “No Big Deal Mindset”?
The “No Big Deal mindset” (“NBD Mindset”) is having that chill attitude towards any challenge that pops up with dementia. It’s knowing that no matter what, it will work out and therefore, staying calm is the better option.
Instead of making it a big deal, I used the NBD Mindset. I grabbed a pair of gloves, waived over an employee, handed them a pair of gloves, and asked them to take the resident into his room to get ready for dinner. Then I got on my hands and knees and started to clean the bathroom. When I finished there, I went down the hallway and started cleaning up the rest of the mess made along the way.
My employees, who were serving dinner to the other residents, kept telling me they would do it and that I was dressed too nicely to do that, I had work to do, it was after 5:00pm, etc. But it wasn’t a big deal. My resident was happy, my staff was supported, and my work still got done.
Prepare yourself for the NBD Mindset:
Olympic athletes use visualization before their events. This helps them experience winning in a physical sense before it has happened. So, I advise my clients and trainees to get physically prepared for the NBD Mindset. This will make the execution more successful. Here is how you physically prepare yourself:
- Take a deep breath. In through your nose for the count of four, hold it for a count of seven, breathe out for a count of nine. If you can’t do it for that long, just take a deep breath in through your nose and out through your mouth.
- Roll your shoulders back and relax your posture.
- Say it in your head (or out loud if appropriate) “No big deal!”
Problematic Behaviors and Expressions
Families and professionals often reach out to me for help managing challenging behaviors. Sometimes, the behavior or expression is something that is problematic, which I define as something that is harmful to that person or someone else. If a person with dementia is physically aggressive toward someone then that is considered a problematic behavior. Repetitive questions or behaviors can be problematic, but more often they’re tiresome or annoying for the recipient. So ask yourself:
- Is this harmful to the person?
- Is this harmful to someone else?
- Is this just frustrating or tiresome for me?
Why are they repeating things?
First and foremost, we all repeat stories. Have you ever been so excited about telling someone a story that you start so fast and then about 10-15 seconds into the story they say “I know. You already told me.” What does that do to your excitement? It totally shoots it down. You’re probably feeling a little embarrassed and not so great. No one likes that feeling.
I have noticed that as we age, we get more excited about sharing stories. Whether they’re from our past or something recent. For someone with dementia, the repetitive stories and questions may come from the emotional aspect. It could be something that really upset that person or something that made them really happy. So, they may not remember that they’ve told you but they do remember the experience because of the feeling behind it.
How do I tell them they’ve already told me?
After a presentation recently, someone asked me, “My dad repeats stories over and over. I asked him if he wants me to tell him he’s repeating the story and he said he does, but I feel bad. What is the right way to handle this?” As I mentioned before, it never feels good when someone interrupts your story and says, “you already told me this.”
Here is the NBD mindset: Finish the story for them while matching their emotion. For example, if they are excited about the story you may say “Oh! That’s right! And then this happened!” in an excited tone.
If possible, you can continue engaging and connecting with the person by finding an activity associated with this. For example, if they are telling you their wedding story, you can look at photos together or talk about a loved one’s wedding that is coming up, or your dream wedding.
What if their repetitive story or questions come from anger?
I have a client who lost an item, believes it was stolen, and then it was found again. The story he believes does not match the reality. Frustrated, many people try to explain what actually happened but that isn’t his reality so it makes him more frustrated.
When I visited with him, he started to talk about this. He was going on and on about it and how he wanted it to be handled differently. This comes with a few steps.
Step 1: Apologize. This is an underused and underrated technique. I like to keep it simple “I’m sorry that happened. It shouldn’t have.”
Step 2: Restate. You can use this technique in a lot of situations “So, you would like this to happen and you’d be satisfied?”(This also works very well if the person has any kind of narcissistic tendencies in addition to dementia).
Step 3: Reassure. Offering comfort that you believe this won’t happen again is good. But avoid lying and keep it simple. For example: “I am confident that this won’t happen again.”
Step 4: Redirect. You can redirect to something more enjoyable and less frustrating for that person. “Right now, why don’t we take a walk around the community together.”
It may come up again and you may have to go through the steps again. Be patient with yourself. It takes practice getting this down and executing the steps correctly.
Can you stop a repetitive behavior?
It is possible to change a repetitive behavior. Sometimes, the behavior comes from an unmet need and through some investigation, we can determine that need, meet the need, and therefore resolving the behavior. However, that can take time. So, it’s best to use the NBD mindset while trying to determine and fulfill the unmet need.
If the behavior is problematic, then you may want to consult with a dementia expert.