I worked 25 years in long-term care as a CNA, Activities Coordinator and as a home health aide.
What the Heck do I Know?
In 1986 I started working in my first nursing home, as a Certified Nursing Assistant. In 1995 I received certifications in Gerontology and as an Activity Coordinator. In 2008 I re-located to Southern California. I was unable to find a job in long term care, so I went back to school and became a Drug and Alcohol counselor. I worked for 5 years helping people who suffered from co-occurring disorders (for example: people who suffer from both addiction and bi-polar disorders) although I enjoyed worked in the addiction recovery field, I missed working with the elderly. Recently I have returned to caring for the elderly. This week I had an assignment to do a 1:1 with a woman with Alzheimer’s. The woman is in a Nursing Home. All I had to do is watch her and make sure she didn’t get up without help. I was told by staff that she was “combative and very confused. She doesn’t know what she is saying.”
The assignment went rather smoothly. My client was not combative with the nursing staff while I was present. It isn’t that I am a “supper” care-giver. It is just that I have learned a few “tricks” over the years, when working with people who are memory impaired. I thought that I would share a few of them.
“Validation Breakthrough” by Naomi Feil
I suggest that you read the wonderful book “Validation Breakthrough” by Naomi Feil, if you work with people who are memory impaired or if you have a loved-one who is memory impaired.
I took a class when I was in college that used this book as the text book. This book absolutely changed the way I communicated with my clients.
Maslows Hierarchy Of Needs
Everyone has basic needs: Physiological, Safety, Love/belonging, Esteem and Self-actualization.
Even when people have difficulty communicating and/or their memory fails, them they are still human and they still have the same needs.
People need people
Humans are social creatures. We need to interact with others. Frequently when a person is confused, when they speak they make no sense. SOME caregivers tend not to talk to the confused person. SOME caregivers tend to just bark orders at the confused person. In the above mentioned book (Validation Breakthrough) a technique is outlined called “Validation”. It shows how to pick out key words and repeat them back to the confused person. The book also explains how to mirror facial expression, tone of voice and emotions. At times it might help to present the opposite facial expression, tone of voice and emotions. For instance when the confuse person appears afraid or mad it might help if the caregiver uses a soothing voice and a concerned facial expression. When these techniques are utilized the care giver is able to establish rudimentary lines of communication with the confused person, thus fulfilling some of the Psycho-social needs of the confused person.
This is an example of how one of these validation conversations could go:
Confused person: You rodeo on nurse tree. (The confused person looks upset)
Caregiver: Rodeo? (The care giver uses a concerned facial expression and voice)
Confused person: always dig roller my. (But this time the confused person smiles)
It does not matter that the conversation made no sense. What does matter is that the confused person had a chance to connect with another human being. Most importantly the confused person smiled!
At times a hug can make things better as long as both the caregiver and memory impaired person is comfortable with hugs. It is always important to pay close attention to the memory impaired person’s body language to make sure that they are comfortable with being hugged or touched.
I also learned through my experience, that sometimes you can get to know the confused person through these seemingly nonsensical conversations. Years ago I took care of a woman that whenever she need to go to the bathroom she would say words that had to do with water, like sprinkler, river and snow.
It helps to know or learn the memory impaired person’s history, routine and what they like to do for fun. If a person worked the night shift for most of their life, they most likely won't sleep well at night. If a person never liked bingo when they were living at home, they won’t suddenly think bingo is the greatest game ever when they inter a nursing home.
However it is very beneficial for the memory impaired person to have their time occupied.
No matter what age we are, we all have the need for safety. Could you imagine if every five minutes or so you were in a different place with people you didn’t know around you. I bet you would be scared. That is what it is like for some memory impaired people. It sometimes helps to remind a memory impaired person that they are in a safe place and they will be taken care of, whenever they become afraid.
Everyone needs to feel like they belong. Most people don’t want to be a burden. A caregiver should be mindful of their state of mind when they work with others. When you are having bad day, be mindful of the impression you give when you are providing care. If you are stressed and rushed when caring for a memory impaired person they will pick up on this and sometime they will react to the caregiver’s demeanor. When I worked in a nursing home I noticed that when we were short staffed there where more incidences of the patients “acting up”.
Whenever possible it is a good thing to have familiar things around the memory impaired person. Things like pictures, books, a chair or a favorite bedspread in the room can go a long way to helping the memory impaired person feel like they belong.
Memory impaired people should never be treated as if they are children. Just because their physical and mental status has diminished they still should be treated with respect.
She tells the same story over and over!
When the memory impaired tells the same story over and over, many times it is because there is some issue they are trying to work through. Even if they find they find a solution to the issue they will forget the solution and repeat the story again.
When they share the story ask questions, learn as much as you can. Find out what, when and where. NEVER ask why, if they knew the why they wouldn’t be repeating the story over and over.
There was a lady that lived in the nursing home I worked in when I first started college. Every evening after dinner she would try to leave the nursing home. She would become combative with staff when we tried to stop her from leaving. She would yell at us that she had to get to Berkley, to take care of her parents. Reality orientation would only upset her more.
One morning I sat down with her and talked to about her life. I learned that she lived with her parents until she was in her 50’s. She met a man, fell in love and moved away. A couple of years after she moved both of her parents passed away with in a short time of each other. The lady felt that if she had not moved away her parents would not have passed away because she would have been there to take care of them. I also found out that her parents where very happy she had a good life with a good man.
That evening after dinner the lady tried to leave and go to Berkley. I told her “You did the best you could for your parents. They were very happy that you were happy. Your parents would what you to be happy now.”
The lady said to me “Do you really think so?” I told her “Yes”
She then said “OK, can I go watch TV?”
Every night that I worked, we would have basically the same conversation, with the same result. When the other staff members picked up on what I was doing they would tell the lady the same thing after dinner when she tried to leave. It worked for the other staff members too.
Mom doesn’t even know who I am.
Most memory impaired people have short term memory loss, so in other words they are stuck in the past. That is why they might call your son by your name, and not recognize you at all. It isn’t because the memory impaired doesn’t love their family and friends.
The more time you can spend with the memory impaired the more familiar you will be to them, even if they don’t remember that you are a family member or friend. Just go with the flow and get them to talk about their past.
Please leave a comment
Larry Rankin from Oklahoma on September 14, 2015:
I've had to deal with this firsthand. Great analysis.
Dora Weithers from The Caribbean on August 17, 2015:
I am the caregiver for an Alzheimer's victim, and I want you to know that you have made some very relevant points here. Thank you very much.
North Wind from The World (for now) on August 17, 2015:
Great tips. It is hard to deal with elderly people who forget but patience is key. I know that there are some who just need a bit of caring and sympathy and some who just want company and they are happy. I knew a few who tried to run away as you described and, just as you said, there was always a reason why they did what they did but it could not be expressed. Assuring them always helped.
Even when they forget, we should not forget that they are our elders and we should give them the respect that they deserve.