Tag Archives: elder care services

Sensitivity Among Caregivers

Some people take on the role of caregiving when it doesn’t really suit them. I’ve seen staff members in care facilities who don’t understand the needs of people with dementia. In families, we can also be blockheads. Stress makes us gruff or impatient, and that helps no one.

Between the Pond and the Woods

On a recent visit to my mom’s activity program, I watched an aide cleaning up after lunch. She was angry at someone — could have been a staff member or someone with dementia — but it made no difference. Plates were flying into a basin, crashing into each other. Knives and forks clanged as she threw them. Noise like that upsets people who are impaired and sensitive to the slightest emotional rupture. I don’t know what this woman thought she was accomplishing. But the whole show was wrong for a setting where dementia patients were trying to transition from a meal to a group activity. If she had been a bratty teenager, you could banish her to her room. But these were the actions of an employed adult. Could better job training change this?

One of the most exciting elements of the recent New Yorker article, “The Sense of an Ending”, was its explanation of how one care facility revolutionized its approach to staff training. Dementia caregivers were asked to put themselves in the place of their patients. They “spooned food into each other’s mouths and brushed one another’s teeth….to be on the receiving end of activities that they performed for their charges every day.”  After these experiences, the education director at the care facility said, “You can feel how threatening it is to have something touch your mouth when you have not brought it to your own lips.”

This comment has lingered with me.  Sometimes when I feed my mom, I think something is cool enough for her to eat and believe she’s being difficult if she refuses it. Now I think more about how shocking a warm — or cold — spoon might feel if you can’t see it coming. I’ve also been guilty of trying to get her to eat faster when I’m busy. But she needs extra time to chew and swallow. Since she has no control over the other parts of the dining process, maybe slow eating is the only way she can retain some ownership of her meals.

I’m trying to stop more often and put myself in Mom’s shoes when helping her with intimate tasks. But how do you get poorly paid caregivers with minimal training to show that kind of sensitivity at work? Most of us spend our lives doing unto others what has been done to us. Now and then we are wise enough to add a bit of learned behavior to that basic recipe. But given the numbers of people likely to develop dementia in the coming decades, I think our society needs to require that Adult Day and Residential Care programs hire staff who have (at least) completed a Certified Nursing Assistant program and show sensitivity to the needs of those they help. Better training would improve the quality of care for dementia patients and might give family caregivers who rely on these services more peace of mind.

Changing the Dementia Care Model

If you’ve ever visited a dementia care site, you’re bound to wonder how things got the way they are. Not because it’s all bad, but because many features of both day and residential care programs don’t seem to benefit the patients. Reliance on drugs leaves many people barely alert and the aesthetics of care sites are often distracting for lucid patients filled with anxiety. Family caregivers may know better ways to treat loved ones, but they can’t always manage care during the long course of the disease. Finally, better alternatives are emerging!

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It’s exciting to learn that new treatment models are being used successfully in the field. In the May 20 issue of The New Yorker, author Rebecca Mead describes evolving care strategies that have provided residents with significant relief at the Beatitudes Campus in Phoenix, Arizona. Beatitudes describes its approach as one that “focuses on the comfort of the individual with dementia and empowers staff members to anticipate the needs of the resident.” Beatitudes trains professional caregivers to use a “person-directed approach to care.”

This strategy sits at the opposite end of the spectrum from most nursing homes. Even the finest, high-end dementia facilities organize everything — from administration of drugs, to deployment of staff — around the needs of the institution rather than those of the patient. Facility administrators might argue that people with dementia are often unable to communicate their needs when pressured for an explanation of what ails them. But staff members at Beatitudes engaged in deep study of their patients — and themselves — to create a service model that relies more on empathy than assumptions. Beatitudes caregivers took the extraordinary steps of spoon feeding each other and wearing incontinence diapers so they could learn what residents really experienced during a typical day.

After these experiments, lots of practices — including use of diapers — were thrown out the window. Staff members also began to realize something that most family caregivers learn early. Although words may fail dementia patients, “all behavior is communication.” This phrase is a mantra repeated by Tena Alonzo, Director of Education and Research at Beatitudes, who now uses quiet, calming methods for getting patients to disclose as best as they can what is causing their agitation.

The work of the Beatitudes Campus is based on ideas developed by British educator and psychologist, Thomas Kitwood.  Not long before his death, he published his 1997 theories under the revealing title “Dementia Reconsidered: The Person Comes First.” His ideas have been influential in England and Belgium. Details will be featured in future posts here. For now, you can learn more about Beatitudes Campus care concepts by clicking here for background on their training model. May you discover some ideas that buoy you up.