Caring for people with dementia can be a challenge. Sometimes bathing, feeding and transferring are a battle.  However, a new approach can help make communication and care easier for both workers and residents.

I recently wrote about the inspirational dementia care consultant Teepa Snow, who advocates a very positive approach to caring for elderly people living with dementia.

She believes that the more care-workers understand what is going on inside a resident’s head, the easier it is to feel empathy and offer them real help.

“Once you understand how human brains work, you can be much more effective at helping people with brains that are dying,”

I’m on your side

Sometimes care can become a conflict. But even with agitated individuals, it doesn’t need to be that way. In any challenge, we need to take the resident’s side, so they feel we are an ally not an aggressor. We need to recognise that a person with dementia is doing the best they can in difficult circumstances. If something just isn’t working, we need to change our approach and find out what can be done differently.

The right approach

Our bodies are hardwired to protect ourselves from perceived danger, this fight or flight response is maintained even in pretty severe dementia. We need to bear this in mind so that we don’t startle or scare residents. Non-verbal cues are incredibly important for people with Alzheimer’s, by using this we can help any interaction run smoother from the outset. When approaching a resident with dementia we should:

Approach from the front, so they can see you coming. Remember that in Alzheimer’s the field of vision narrows dramatically, Snow said:

“Visual data is the primary, foremost and preferred entry system in the human brain, the most complex sensory wiring we have. We so poorly address it as an issue in dementia, and yet it drives a lot of behaviour. When your brain starts dying, you give up the edge of your vision and keep the middle.”

– Take it slow. Approach at a leisurely pace, something like a second a step will give them enough time to understand and adjust.

– After you’ve approached, stand to their side. If you’re right in front of the resident it can seem confrontational, instead stand to the side.

– Their dominant side hold their motor memory. Choose to stand at this side, which is usually the side they use to write, to put them at ease.

– Crouch down. By staying low you’ll appear less aggressive and intimidation.

– Don’t grab their hand, instead offer yours for them to take. Hold hands palm to palm, with their palm facing down. The gentle pressure on this part of the hand has been shown to be calming.

– Call them by name to establish a connection.

Bathing without battles

When an individual has Alzheimer’s washing can be a struggle. Teepa Snow suggests we see things from their point of view. When you do that, it’s easy to see why someone may feel uncomfortable, unwilling and unhappy about being bathed. Taking your clothes off with someone who may seem like a stranger, being pushed around, getting wet and cold and feeling exposed and vulnerable. Frankly, it’s not surprising that they may fight to keep their clothes on.

By considering this, and making changes we can bathe without battles:

– Always use the right approach, so that you start off on a positive footing. Remember to stand on their dominant side.

– Don’t stand too close or try and take hold of their arm suddenly. With their narrowed field of vision, you may frighten and shock them. Instead, stand a couple of feet away and explain what going to happen in simple terms, with actions so that they can fully comprehend.

– Make sure the room is warm, it doesn’t matter if you get a little hot and bothered so long as they feel comfortable.

– Ensure there aren’t lots of people around. If it’s just the two of you, it’ll help them retain focus and will feel a little more private.

– If undressing is a struggle, place a warm towel, fresh from the dryer over their shoulders and their lap. This will help them feel safe, decent and warm so that the whole process can become easier.

Feeding and drinking

As dementia advances, feeding and drinking can become more of a problem. Aspiration pneumonia is a real risk.

– Using the right approach described previously, crouch at their dominant side and place your arm around their shoulder to create a connection.

– Explain, using eye contact and actions, exactly what’s going to happen.

– When you’re encouraging someone living with advanced Alzheimer’s to take sips it’s important to focus your attention entirely on them, watch carefully to see that they’ve swallowed each sip.

– If they have forgotten to swallow, it can help to hold the cup against their lips without giving fluid. This is a ‘dry swallow’ and can stimulate them to swallow the liquid in their mouth.

– By carefully watching, monitoring and stimulating the swallow you can help prevent aspiration.

I recognise that many excellent and devoted care-workers use these methods either instinctively, or having been taught some of the techniques during training. But I really believe that Teepa’s real insight into living with dementia is valuable.  It can offer all of us working in residential care a more empathetic and ultimately effective way of communicating and of caring.