Implementing dignity and respect in dementia care

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Ben Mandelbaum
Ben Mandelbaum

For many residents who have Alzheimer's disease or dementia, routine care is severely lacking. Although medical care usually is of reasonable standard, the quality of caregiver interaction with those whose mental capacity isn't what it once was leaves much to be desired. According to the Alzheimer's Society's Dementia 2012 and Dementia 2013 reports, a great deal of change needed to be made across the care spectrum for elderly individuals.

Perhaps this is not the case at your senior living community, but especially for those new to the field, for those who work in senior living but don't provide care to those with dementia, and for those with whom you work but are not directly associated with your community, an introduction or refresher to basic dementia care principles may be in order.

If you provide care in a formal care setting, you might find yourself wondering how, exactly, you and your professional staff can provide the quality of care needed by residents with dementia. These residents often may find it difficult to communicate, and their minds don't work quite the same way anymore, but those with dementia deserve the same quality of care shown to other older adults. Senior Planning Services, a Medicaid planning company, would like to share some thoughts on dementia care best practices.

Person-centered dementia care

Individuals with dementia deserve to be treated with care and respect, plain and simple. It's easy for some to assume that, simply because those who have dementia don't think as quickly as you do, they aren't worthy of as much attention. After all, they probably won't remember the interaction tomorrow anyway, and it's not as if they can tell anyone.

People with dementia often seem to be in their own reality. That reality isn't shaped the same way as yours, but it is real to them nonetheless.

For care providers to those with dementia, it is important to keep the focus on person-centered care. That is, respect the person to whom you are speaking as an individual with fundamental human rights. Whenever possible, avoid the use of physical and chemical restraints.

Remember the golden rule: treat others the way you wish to be treated. If you wouldn't want to be treated the way you're treating someone with dementia, then you probably need to revise your approach. 

Keep it simple

Consider for a moment how fast you have to think to participate in ordinary conversation. You have to process what the other person is saying and assimilate a reply, often quickly. For someone with dementia, these tasks are very difficult.

When you're speaking to him or her, keep your approach simple. Provide one piece of information or one instruction at a time and wait for a response before proceeding to the next one. In many ways, it may seem as if you are dealing with a small child: you need to give the person time to process the first thing that you've said instead of confusing him or her with too many instructions, too quickly.

This doesn't mean, however, that you should talk down to a person with dementia or use “baby talk.” He or she still is perfectly capable of understanding you; he or she just needs a little extra time to process what you've said. The individual might not be able to answer you clearly, but people with dementia are aware if you lack regard for them.

Remain neutral

Individuals with dementia often experience a strong sense of frustration or anger regarding their inability to express themselves or to follow what you're saying. They may say things that don't entirely make sense to you but that make perfect sense in their world. Instead of reacting strongly to these moments, remain neutral. Your lack of negative emotional response will help keep the person with dementia calm.

This neutrality often extends to your nonverbal communication. Avoid gestures or facial expressions that indicate negativity, anger or outrage. Be conscious of what gestures you're using. Although making a positive gesture — such as outstretching a hand to indicate that a person should follow you, pointing to an object you'd like him or her to pick up, or outlining sizes or shapes to help describe something — can help improve negative communication, negative ones will destroy the rapport you're attempting to build.

Remember, individuals with dementia are people. They have feelings every bit as intense as yours — perhaps more so because of the way they are trapped within their own minds. Treating them with respect and dignity might take a little bit more time and effort on your part, but it's the type of effort that should be extended to every resident in your care.

Ben Mandelbaum is chief operating officer of LTC Consulting Services and Senior Planning Services, with offices in New Jersey, New York, Pennsylvania and Connecticut.

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