Techniques and Choosing the Right Dementia Care

January 23, 2020Mikki FirorUncategorized

Whether it’s a client, a resident, a patient, or a family member with dementia: they’re all people first and black and white thinking in dementia care is putting the dementia symptoms in front of the person.

I remember when LinkedIn was strictly a professional platform. Since opening Trovato, I have spent more time on LinkedIn reading and interacting with others. I was familiar with “trolling” that occurs on Facebook but did not expect it to be this way on LinkedIn. A few months ago I posted an article on LinkedIn about using the “Stay Away” method when moving someone with dementia into a dementia care/assisted living community. Some people were insistent that this method could never work under any circumstance and that it was cruel.

Not only that, I have seen others post videos, articles, posts, or comments reprimanding certain dementia techniques, putting down other dementia experts, arguing with one another on posts declaring their way is the best way and other ways are completely ineffective or outdated. It can also get pretty heated and completely lack professionalism.

Techniques for dementia care

Throughout the years, professionals have developed many different techniques. Some are more involved and require extensive training, such as Naomi Feil’s validation therapy, while others can be learned through a you-tube video fairly quickly, such as Teepa Snow’s hand under hand technique. However, we are doing dementia care a disservice. In the fight to establish ourselves as experts we are forgetting that for every diagnosis of dementia, there is a human living with it.

While there are many techniques, let’s look at the top three that I see used: 1.Lying (also known as “therapeutic fibs,” “gentle lying,” “friendly lies,” “filbets,” etc.) 2. Joining their reality and 3. Validation.

Lying

This is pretty straightforward. You lie to someone with dementia. You tell them something you know to be untrue. This is different than joining their reality, which we will discuss next.

I generally (not always) advise against lying because it’s usually used incorrectly. Today, I lied to a client. She asked me why I cared if she had water (she was not happy) and I told her that her doctor wanted her to drink more water. That’s a lie. But I know this client. I’ve ben working with her for a while and she said “Oh, then I’ll drink it.” I didn’t come right out of the gate with a lie. When we teach this technique first, then it becomes a go-to. But I have found that the risk of harm is often worse than the chance of benefit.

Can this technique be helpful, absolutely! Do I personally believe it should be a go-to technique? No. Do I use it? Sometimes and only when I’m sure it’s absolutely appropriate. Today, my client who was going days without drinking water, urinating, or having a bowel movement, drank water because I lied to her. So, at times it can be a good technique to use.

Joining their reality

When someone has dementia, his or her time period or reality may be different than ours. My grandfather, who was not diagnosed with any type of dementia (thought h may have been at a later time, if he lived longer), experienced delirium while in the rehab after recovering from a broken femur. While I was visiting him, he was very distressed and insisted that he get on the train to go see his coworker, Nelson. He kept screaming for Nelson and demanding that the train keep moving. If the “train” stopped, he would try to pull out his catheter.

My reality

My long time retired grandfather is in a wheel chair in rehab recovering from a broken femur.

His reality

He is working for the National Cash Register Company and he is on the train to get to Ohio where he needs to meet Nelson at the department store to fix a cash register and he is running late.

Was this beneficial? Absolutely. However, I didn’t have the experience I have now and I spent hours pushing my heavy grandfather around that nursing home pretending he was on a train, until my dad came and took over that duty. This isn’t realistic for most caregivers at home, or in a community. Joining their reality is great and beneficial in many ways, but it is impractical when used alone.

Validation

There is a whole certification for Validation Therapy. It focuses on using empathy, reflection, and asking questions. The goal is to validate the person’s feelings while getting down to the root cause. For instance, with my grandfather, one may use validation therapy to calm him down by saying “I can see it’s urgent you get to Ohio to see Nelson.” Then they would continuing to ask questions to understand where the worry and urgency is coming from.

I am not certified in validation therapy, but I use validation as a technique in my tool kit. It can be very beneficial in understanding root causes for challenging expressions, hallucinations, repetitive questions or actions, etc. However, in a situation where a person is a physical harm to themselves or others, such as my grandfather is pulling out his catheter, validation may not be appropriate at that moment. First, you may need to use another technique to deescalate the situation, ensuring safety, before using validation. Other times, validation may be just what is needed to deescalate.

Choosing techniques

There are many more dementia techniques; some are better than others in certain situations and with certain people. When we’re working with people with dementia it isn’t just about the individual with dementia but also those providing care. So, choosing the right technique will depend on a lot of factors. The most common factors that contribute to use of the technique are:

1. Personal history
2. Personality of the person with dementia
3. Personality of the person(s) providing care
4. The physical environment
5. Mental illness
6. Comfort level of the person attempting to employ the technique (how well can they use it?)

In my article on the “Stay Away” method and when I discuss techniques with families, I admit that not all techniques will work for everyone and we may need to fail at one technique and adjust before we find what works best.

I have found that my clients’ family members or professional caregivers are experts in their own regard. I find great value in asking which techniques they use and why. I enjoy brainstorming with them and I have found that this method of coaching is not only appreciate, it is more effective for learning the technique and can also result in finding a solution more quickly.

Choosing a dementia consultant or dementia care

Many communities, home care companies, and families are beginning to work with dementia consultants. The advice that I would give when choosing a dementia consultant is to be wary of those who think in black and white. When it comes to dementia, there is never black and white. Dementia is colorful.

If you notice that a person or company completely denies a specific technique or expresses that there is only one technique that works, they may not be able to think outside of their box. This close-minded thinking may indicate that they are not able to fully see your client/resident/family member as a person. Therefore, it could be detrimental first, to the person with dementia, but also to your company’s profits, your employee’s satisfaction, caregiver burnout, your bank account, or your family’s well-being.

A challenge for dementia professionals and families

While we all have preferences on techniques use with people with dementia, we also have to be flexible and open-minded. Rather than arguing via comments on a LinkedIn post, send a message and request a phone call. More than half of communication is non-verbal and you may learn something new that could help your practice and your clients.

I’ve made it a priority in the last 2 months to connect with other dementia experts, especially those who offer a technique or service I am unfamiliar with or have differing opinions. The dialogue has changed my dementia practice for the better and has resulted in new connections nationwide.

I challenge all dementia professionals to reach out to 3 colleagues to discuss techniques, beliefs, and best practices for working with people with dementia. If you’re open to having a conversation with someone, leave a comment here.

I challenge families to interview dementia professionals, home care companies, or communities and have a dialogue about their preferred practices. Listen for open-mindedness and flexibility. You’ll learn more about the philosophy of the company or person you are hiring and decide whether it aligns with your beliefs and values. You can also gain more insight into the personalities and see if they’ll clash or compliment yours. This is important in choosing a long term care plan.