Tag: gerontology

“But what if their reality doesn’t make any sense?”

I’m asked questions like this often. “What if what they’re telling you…just doesn’t make any sense? It can’t happen. If I Embrace Their RealityTM, aren’t I lying…because what they’re saying will never happen?” The short answer: no! If you’re doing what’s true for them, you’re doing the right thing. Once you know where their reality is (either by asking questions to get you there, like, “Where do you think your mom is?” or by listening carefully to what they’re saying in that moment) then you’re ready to Embrace Their RealityTM. “I need a cab!” Paul said, motioning to the phone. Paul was one of my residents, and, at the time of this story (circa 2014, 2015) his delusion was brand new. “Oh, where do you need to go?” I asked. “I’m sure we can get you a cab this afternoon.” “I’m getting married soon,” he smiled. “I need flowers…a cake…invitations…all those things!” I knew that this eighty-something-year-old man probably wasn’t getting married soon, but that didn’t matter. This was his world, and in his world, he was getting married. I smiled. “That’s great! Who is the lucky lady?” I asked. He announced her name to me with a big grin on his face. “She’s the most beautiful woman in the world,” he said. Suddenly, the concern over getting a cab was gone. Instead, he was focused on telling me about this woman he loved. “Are you married?” he asked me. I laughed, “No, I’m not,” I said, recognizing where this was going. “How old are you!” he asked. “I’m 25.” His eyes widened. “…And you’re not married yet?!” he exclaimed. “You’d better get hitched soon! A man needs a wife, and a woman needs a husband. I don’t want to be alone anymore.” Side note: I was only 25 at the time of this interaction and I didn’t get married until I was 31. It always made me laugh how quickly my residents became anxious about my marital status as a woman in my early 20s. If you’re interested in unsolicited relationship advice, hang out in senior living. I could have done a lot of things here. I could have said, “No, I can’t call you a cab…you have to stay here!” I could have said, “That doesn’t make sense, you aren’t getting married.” Instead, I took interest in his story, and it made both of our days that much better. I learned something about this man and was able to live in this beautiful reality that he had constructed. No, he didn’t end up getting married, but in the grand scheme of things the facts of that day didn’t really matter. Now, what if the cab issue kept coming up? This is where you EMBRACE HIS REALITY and use my little trick of “Delay, delay, roadblock, delay.” Examples: “Paul, let’s get lunch here first, and then I’ll call the cab.” “Hey, the weather isn’t looking great, can we go tomorrow?” “The cab is always late. Let’s get something to eat while you’re waiting.” Telling him “there’s no cab” isn’t going to end well.

September 5, 2021

“But isn’t dementia care sad?”

Another short story from my time as a Dementia Care Director “I am leaving for the day, because my young son is at home with a babysitter,” Agnes told me calmly. “But I just wanted to tell you that I had the best time today, this was just wonderful,” she smiled, motioning to the little kids running in the courtyard. We had just had an Easter egg hunt, and everything had gone smoothly. Families and staff members had brought their little kids into the courtyard to hunt for the colorful eggs we had hidden with the help of some residents. Agnes lived at our dementia care community, but she did not know that. Seeing the kids running in our courtyard reminded her of when she had a young son, and her brain created a happy story where she had to head home to greet him. “I have to make sure I get home and pay the babysitter,” she added. Agnes’ story was as clear and rational as anyone’s, besides the obvious fact that she couldn’t actually leave. She didn’t have anywhere to go, and had she left, Agnes would have found that her son was a grown adult, and her home was no longer where she thought it was. There is no doubt that dementia is a complicated, sad group of diseases. I like to think, though, that dementia creates a happy internal world for many of my residents. This world is populated by beloved people and things, because these are the memories that have stayed around. These memories aren’t merely memories for people with dementia—they are real, and present. No, dementia does not always create a happy world. When it does, though, that world can be just as rich and colorful as any story that you’ve ever read.

June 20, 2021

6 Tips When Visiting Someone in Dementia Care

Well, this last year has definitely been…a lot. Visiting a person living with dementia in dementia care was already difficult, but this year really upped the ante. Let’s dive into some quick tips that work in-person, but then talk about what happens if you need to video visit. If it’s a video or phone call, have someone assist you. Know what time of day is the best time to visit—virtually or in-person! Learn how to say “Goodbye” for the day. Get to know the staff at the community. Bring or show off a surprise from home. Communicate with other family members or friends who are visiting the individual. 1. If it’s a video or phone call, have someone assist you. On the other end of the phone, someone should be there to assist. This means a staff member, the Dementia Care Director, someone like that—it’s going to be frustrating for someone with even mild dementia to facilitate a call. I’ve seen a lot of well-intended families buy their loved ones a phone…and then immediately regret that decision because the person doesn’t know how to use it, loses it everywhere, or, worse: calls the police or other family members at all hours. It might be best to leave the phone facilitation to the community. 2. Know what time of day is the best time to visit. There are certain times of day that a person living with dementia is more anxious, upset, and confused. Generally, individuals with dementia are more agitated later in the day. We call this type of behavior “sundowning.” Most people are tired by the late afternoon, and it’s no different for people with dementia. If you can, try visiting before your loved one sits down for dinner. This also goes for phone or video calls…plan ahead with the time of day! 2. Learn how to say goodbye for the day. I cannot emphasize enough how important this is. It’s heart wrenching to watch residents’ spouses struggle with this most of all. I often hear a loved one say, “Okay honey, I’m heading home now.” This is so confusing for the person that lives in memory care. He or she will respond, “Okay, let’s go home.” Many residents do not realize that they live apart from their spouse; let alone that they are in dementia care. This is the part where you use your Embracing Their Reality(TM) skills. Let your loved one know that you’re headed out to the store, or mention something else that you’ll be doing once you leave. Make sure to tell them that you’ll see them again soon. (This goes for the phone, too!) 3. Get to know the other residents. One of the most wonderful aspects about long-term memory care is that your loved one will make friends. Even though someone’s short-term memory is impaired, it does not prevent them from making meaningful connections with others. Some of the strongest friendships I see in long-term care are between roommates. “Hang on, I’ve got to go tell my roomie where I’m going,” one of my favorite ninety-year-old residents said to me the other day. Likewise, it’s important to understand that your loved one won’t get along with everyone in his or her community. If another resident is frustrating you, let them be. It’s not worth getting into an argument with someone you don’t know—especially someone who is memory impaired. Find a trusted staff member and ask for assistance. 4. Get to know the staff—especially the program or activity coordinator. It’s imperative to know the staff. The CNAs and other hands-on caregivers will be looking after your loved one and their needs. Make sure that you meet the person who runs your loved one’s activities each day. He or she will be better able to provide your loved one with meaningful interaction and activities if this person knows what your loved one enjoys. 5. Bring a surprise from home. Your visit will go smoothly if you have something to talk about with your loved one. Bring a couple of those prized tomatoes that you’ve been growing, the family’s favorite photo album, or even your dog. You’ll have a great conversation topic and you’ll engage with your loved one in a meaningful way. Again, this works via phone, too. You can lead the conversation even if that person doesn’t have much to say! Talk about what you’re doing and what you’ve been up to. 6. Communicate with other family members or friends who are visiting your loved one, even virtually. Figure out when other family members or friends are visiting or calling so you don’t overlap too much. It might be worth talking about a calendar where you can pick dates/times so that you aren’t overwhelming the person living with dementia. You should also ensure everyone is on the same page about where the individual is in there dementia progression!

March 28, 2021

“I don’t really remember it, but I know it’s there.”

We were playing a “fill in the blank” game. I had gathered six of the residents in the front hallway of the Skilled Nursing Facility, in the hopes that more would join as they walked by. My little trick worked, and soon I had 10 people gathered around, engaging in the game. This fill-in-the-blank book is one of my absolute favorite things to do with people who have dementia. It never ceases to amaze me how many of the residents can recall lyrics, sayings, or phrases that they know. Sometimes, a lyric will even inspire everyone to start singing. Julia stood next to me. She was a thin, pleasant woman of 86 years old. Julia loved dancing, which I had recently learned, and particularly loved anything with a fast beat. Julia’s dementia was fairly progressed, so it was challenging to hold full conversations with her. She always responded to your questions or comments, but sometimes the response was about something completely off-topic. In this game, however, Julia was a master. “You ain’t nothin’ but a…” I started. “Hound dog!” the group said, and Julia, faithfully on my left, also added quietly in my ear. “A penny saved…” I started. “Is a penny earned,” the group responded. Julia touched my arm to get my attention. “I don’t really remember it, but I know it’s there,” she said, pointing to her head. What a great way to describe the complexities of dementia care, I thought.

February 10, 2017

What is dementia-positive design?

BEFORE: First two photos in the set AFTER: Third photo in the set Dementia-positive design is not a concept that gets talked about frequently enough. It’s the idea that because people with dementia live in a different world than we do, we need to be able to adjust their environment accordingly. I think that the best example of this is Hogeweyk, a “dementia village” in Weesp, Netherlands. Hogeweyk is set up like a little town. There’s a bank, a grocery store, a post office, and more. The people who live there have dementia, and they go about their days in a normal way, because they are treated normally. The caregiving staff actually “work” in the shops and in residents’ homes, but they do not treat the residents as if they have a problem. I love this concept, and I have done my best—wherever I am working—to use these same principles. I have created nurseries for baby dolls, pet shops for stuffed animals, and, above, a “5 & Dime” soda fountain counter in a skilled nursing facility. People with dementia do not only need great physical care, they also need an environment that fits where they believe that they are living. The 5 & Dime space I created fits their world-view: for many of them, it is not 2017. What they see around them now is familiar, comforting, and normal.

February 4, 2017

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December 28, 2016

Loneliness & soup

I was killing time at the grocery store. Really, I was also hungry, but I would’ve been eating at my house if my friend wasn’t at a nearby doctor’s appointment. And so, I was stuck in an unfamiliar part of town, waiting for him. And so I ended up in the Giant Eagle grocery store. And then in their Self-Serve Soup & Salad area. I stood behind a very petite woman in her 80s as she poured hot soup into a to-go container. I glanced at her cart. It had another to-go container, presumably of salad, and then something else small. That was it. She finished filling up her soup container and paused, putting it down slowly. She glanced around. I watched as this small, fragile-looking person walked up to the sales counter and stood behind a woman in line about twice her size. She popped up onto her toes, trying to see around the other woman to the sales counter. I looked back at her soup, sans to-go lid. She seemed overwhelmed, ignored by the sales counter, and wandered back to her soup debacle. I held up a lid. “I read your mind,” I smiled. “Oh! Yes,” she said, taking it from me. “Thank you,” she smiled, and put the lid on top of the soup container. She moved it around. She flipped it over. She pushed it down, her arthritic hands and fingers struggling. “Do you want me to help you?” I asked. “Please,” she agreed. “My hands…” the woman began. I snapped the lid on with relative ease and passed her the container. She smiled. “Thank you very much.” The woman walked away, pushing a big cart full of three items. I found myself hoping that she had a friend or spouse waiting at home for her; or that, perhaps, this was only the beginning of her shopping trip, that she would get more items. More items, it felt like, would justify that big cart. Or maybe it would somehow make it less sad. I love working in dementia care, but I find myself wanting to do something for these older adults who live in isolation, dementia or not. Loneliness is an epidemic in the aging community.

September 28, 2016

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September 14, 2016

“You look like a wicked broad!”

Joan was the second British woman who had lived in one of my dementia care communities. She had moved to the US after meeting her husband, an American soldier, in World War II—a story similar to the one that I heard from my first British resident. If you asked Joan, she could still tell you the story. “We met at a dance,” she’d offer. “They used to do these dances so that we could meet young American soldiers.” You’d ask her how her husband was at dancing. “No, he wasn’t any good. Americans can’t dance,” she’d reply, a shadow of a snarky smile crossing her eyes. That was my favorite thing about Joan: her sense of humor. Her moods were unpredictable, but she was always funny—and she knew it. Her humor was stereotypically English: dry, sarcastic, witty. I’d often tell her that I studied abroad in Bath, England. and this delighted her. Of course, the story was always new, and so was her reaction to it. “Ah! Bath. Yes, a nice little city,” she’d offer. Joan often responded well to me over other staff members. So, one day, when it was time for dinner, I offered her a seat. Joan was in a particularly bad mood that afternoon, though, and was not interested in sitting down. “No, no, no,” she repeated. “I do not want to sit down. I won’t do it.” “It’s okay, Joan, we’re about to have dinner,” I said, gently. “No,” she responded, then looked up at my face. “You look like a wicked broad…” she snapped at me. This really cracked me up. I’d never been called “a wicked broad” before, and I started to laugh, showing my teeth. Joan paused her criticism of me. “…with beautiful teeth!” I started to laugh even harder, and that snarky smile began to cross Joan’s face; she was enjoying this bizarre interaction. “I want your teeth,” she continued. “Please give them to me.”

September 3, 2016

A Tough Conversation

Usually, when a visitor to our community tries to “correct” one of my residents, I jump in and try to save the conversation. For example, if a resident’s daughter is visiting and says, “No, mom, don’t you remember, dad died years ago!” I will try to swoop in and change the interaction so that no one gets upset. When that same conversation is between two residents with dementia, though, I’m kind of stuck watching it happen. The interesting thing about working in a community that’s in a small town is that many of the residents knew each other from years ago.** Two of my residents, Ellen and Isabelle, are related by marriage. **Distantly related—cousins, in fact—but still related. Ellen is very high-functioning. She’s living in our Memory Care because she needs reminders, cues, and other help to keep her safe. Up until recently Ellen was actually living by herself in an apartment, but that was very dangerous. Isabelle can do most things for herself with cueing and assistance, but her short-term memory is awful. **She can’t remember anything that happened more than three minutes ago. **This makes the pair’s interactions difficult to listen to. “Ellen! What are YOU doing here!” Isabelle cried excitedly, spotting her cousin-in-law in the hallway. “I live here, my room is right down the hall,” Ellen replied, trying to be kind about it.** She knew that Isabelle’s memory was poor—she just didn’t realize that her own memory was impaired, too.** “Hey, Ellen, can you get someone to call my husband, Jim?” Isabelle asked. “I want him to come pick me up.” Ellen paused. I could tell that she knew Jim was dead, but she was mystified by Isabelle’s current state of mind. “Honey…I don’t think Jim can come pick you up today,” Ellen offered, slowly. “He’s probably busy,” she tried. Isabelle shook her head. “Nah, he’s retired! Can you call him for me?” Ellen sighed. “Honey…Jim is dead. My husband is dead too. I’m sorry…but don’t you remember? We went to their funerals together.” “What!” Isabelle yelled. “Jim isn’t dead! I just saw him earlier today! He drives a truck,” she reasoned. “No, Isabelle,” Ellen said, growing impatient. “He died years ago.” “Ah, you’re crazy, Ellen!” Isabelle shook her head. “Jim isn’t dead.” Ellen gave up. “Okay, Isabelle,” she said. “I’m going to go to dinner now.” Isabelle paused. “Hey!” she called up the hall. “Ellen! Can you get someone to call my husband!”

August 22, 2016