Every person is different, and each person has their own likes, dislikes, and needs. A person who is living with dementia is also a unique individual.
Although you may often see lists or rules that tell you how to talk or act with someone who is living with dementia, they are general and do not consider the individual. These lists treat the condition rather than focusing on a person’s uniqueness and preferences. These generalized lists can also be harmful as I wrote in Break the Dementia Mold.
To be able to understand people who are living with dementia, especially those who have difficulties explaining their needs, we must explore various ways to help. This can lead to making mistakes.
To give person-centered care, you will most probably make mistakes on your way to finding the best care for your client or loved one. I’ve learned to accept that making mistakes is part of the learning process to help.
You Learn from Mistakes
When I teach validation techniques, I always tell my students that making mistakes is part of the learning process. Naomi Feil developed her validation method by learning from her mistakes.
Validation is a method of communicating with disoriented, very old people. Naomi Feil grew up in an old age home, where her father was the director, and her mother was the social worker. The residents in the home were Naomi’s friends and because of this unique living situation, Naomi developed a very special relationship and understanding of older people.
Naomi became a social worker and returned to work at the same home she grew up in. She felt that the methods she learned to communicate with older people who were living with dementia were not working. If she tried to redirect an older person who was sad or frustrated, it would only result in a temporary solution. Naomi saw that soon after, the older person would feel sad or frustrated again.
Naomi, through trial and error, looked for a better way to communicate with older, disoriented people. She made many mistakes along the way, but through her mistakes she developed her method and became one of the pioneers of person-centered care for people living with dementia.
My Dreadful Mistake
This week while working with a new client I made a dreadful mistake.
My client sits hunched over in a wheelchair with her eyes closed and makes some sounds. She is disconnected from everything and everyone in the room.
My client is at a stage where she has almost totally withdrawn from the outside world and has entered her own private world. This happens when a person’s present reality is so difficult, often because no one is connecting with them, that the person prefers to retire to their own personal world.
Naomi Feil, the creator of The Validation Method explains in her book Validation, The Feil Method
“These people need someone to listen, to validate their feelings. If no one listens, they withdraw to vegetation. With no stimulation from the outside world, they become one of the living dead in nursing homes.”
In validation, we work to keep the line of communication open to prevent this deterioration.
This week when I worked with my client we had a break-through. When I validated this older woman this week, she responded. My client opened her eyes and looked at me for the very first time! She also showed facial expressions for the first time. I continued talking to her and I slowly tried to touch her. Touch is a technique we use often in this more advanced stage of cognitive decline to connect.
My client responded positively to my touch on her hands, so I decided to try some gentle hand reflexology to connect more deeply with her on a non-verbal level.
Because older people’s skin is often very dry, I usually use a light cream when I give hand reflexology. I massaged a small amount of cream in my own hands and then touched my client’s hand which she responded to well. However, when I began touching her left arm, my client’s reaction was one of terror! For whatever reason, the feeling of the cream on her arm triggered what I can only call a gut-wrenching response.
There can be numerous reasons for this older woman’s reaction. The cream on her skin could have triggered a memory of a past physical abuse or even a recent traumatic experience involving her arm. The staff was not aware of anything that could have led to this response, but I was able to warn them to be careful when touching this woman and perhaps not touch her arms.
Obviously I was very surprised and disappointed that our session ended so abruptly. Upset, my client withdrew. Does this mistake mean we should not use cream on our clients? Of course not. Each person is a unique individual, and we must learn what are their likes and dislikes. There is no way to work with individuals who have difficulty communicating and not make some mistakes in understanding them. It is a learning experience to find the best person-centered care for the individual we are working with.
Make Your Mistake Positive
I first learned to work with people who had dementia through an activities course I took for volunteers. We learned about the different types of dementia, how to work with someone who has dementia, and we learned various activities we could do with people at various stages of dementia. After the 9-month course, we were assigned to different families and visited weekly over 10 weeks. We helped find activities that those living with dementia would enjoy doing. We would than show their family members or caregivers how they could continue to do these activities with the person who was living with dementia.
While I was on my 2nd 10-week volunteer work with a family, a friend asked if I would be interested in giving reflexology to her father who had dementia.
I gladly accepted thinking this is exactly what I have been waiting for. Combining reflexology with all the knowledge I learned about working with people who are living with dementia. I expected the session to be amazing…
I went to the house of my friend’s father and from the moment I entered and until I left, I made every possible mistake with my friend’s father. It was as if I forgot everything I had learned. The session was a complete failure, and I came home feeling very upset.
I decided to write down all the mistakes I made so that others would not make these same errors. I wrote an article called The Practitioner’s Guide to Working with People Who Have Dementia. It was published in several Reflexology Magazines around the world. That was in 2009. It was the first time I published an article and gave me the confidence I needed to write more articles and which lead to these weekly blogs I now write.
A section of this article was later used in the eBook I wrote, Hands-on Dementia for Family Caregivers, A step by step guide to learn 3 reflex points to help your loved one and yourself.
Taking a series of mistakes and turning them into a positive learning experience was a real win for me and something I had not done previously. Before this experience, I probably would have sulked and lost my confidence to try giving reflexology again to someone who has dementia. What a loss that would have been!
Accept a Lifetime of Mistakes
When people are fortunate enough to live to be very old, Naomi Feil, the creator of The Validation Method explains that these very old people must deal with a new stage or struggle in of their life. Just like adolescents need to adjust and rebel to their changing from children to adults, a very old person needs to adjust to the issues associated with aging and death.
Naomi Feil, based on Erikson’s theory, explains that at this stage, the very old person reviews their life and sees all the good things they have done as well as all the mistakes they made during their lifetime. They look at what they have done and at what they wished they had done. If a person can accept the mistakes they made and accept the choices they made, they can feel comfortable with how they led their lives.
If a very old person is not able to overlook their mistakes and does not accept the choices they made during their life, this can lead to despair. According to Naomi Feil’s theory, these are the people who will regress and withdraw. These are the people who are often diagnosed as having late onset Alzheimer’s. They are stuck with unresolved feelings that must be expressed.
Therefore it is important that we learn to accept our mistakes as well as deal with any unfinished business before we reach old age to prevent possible regression and withdrawal.
No one likes to make mistakes, but when we understand that our mistakes can lead to effective change, we can accept them as something positive. ---
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