How to Deal with Difficult Dementia Care Issues

Today I am here in Bridgewater at the Earth Angels Home Care office and we are carrying on our Caregiving Talk series with Earth Angels. I'm really happy to have Tamara Ballard (Client Care Manager with Earth Angels Home Care) back with us today. How are you Tamara?

Tamara: I'm fine thank you. It's nice to be back.

Jennifer: So today we're touching on a topic that I think a lot of people might be interested in. One of the questions that we hear a lot about with family and loved ones is dealing with difficult situations. So if your loved one is still at home and living with dementia or Alzheimer's or if they are in a nursing home and you're going to visit them sometimes there can be topics or things that come up that feel really challenging with family members to deal with.

Tamara: Yes. One challenge that we always hear about is when the client is home but they're always asking or saying ‘I want to go home’. The proper way to approach this is first you have to validate the fact that you’ve heard them. Repeat back: You want to go home. We have to remember which part of the brain this is coming from so make a fist; this is the limbic system of your brain.

This is where your deepest most memorable moments are in your brain. Think of it like the layers of an onion. The core of that onion is your deepest memories from your childhood and as you peel off the layers of that onion, those are your most recent memories. That's what is happening to the core of your brain, the limbic system. Your memories are kind of like peeling away and then there's that layering of space and time. That's in the core of the brain as well.

The person with dementia can picture the house they grew up in. They're not picturing the house they’ve been living in for the last 50 years. They're now picturing the childhood home in that deepest core of their memory. They're not recognizing their surroundings. Again, the way to approach that is to validate their concern. I would say to you ‘you want to go home’ and I continue to validate that by saying you want to go home. And then I could slip right into Hand-under-Hand and say “your home must have been very lovely. Can you tell me a bit about your home?” and that will get their mind on their home versus the repetitiveness of “I want to go home. I want to go home.”

Jennifer:  OK. Well you can see how challenging this is for loved ones if they are at home and they keep repeating that. And you know I think a lot of times people are patient but it's hard to keep answering that same question. The example that Tamara gave with that Hand-under-Hand technique is so powerful and just gives you a way of redirecting them and getting them to think about something else.

Tamara: Yes, so as you peel away the most recent memories, you're going back to those core memories that are there and those are the ones that are held on to the longest.

Jennifer: So validation is a really good example of something you could try yourself with a loved one. What other difficult situations do you see with your clients?

Tamara: Very good question. So often people living with dementia will put their most precious valuables, like their purse, away somewhere. They'll put their purse away because they don't want anybody to get it and then they'll forget where they put it. And they start accusing people of taking the purse. Again, you can validate them first. You want to mirror their emotion that they're displaying. If they're sad you want to be sad. If they're happy you want to be happy. If they're angry show that you validate that anger. Say “you lost your purse? That must be horrible” versus saying ‘you put your purse away somewhere.”

Jennifer: I wouldn't have thought of that. I would have thought if they were angry that you would stay calm.

Tamara: Teepa teaches us to stay at their level or just an octave below their level.

So again, it's important to match the emotion and validate what they're asking you. You could say “that would be an awful thing to happen. I don't like that. I don't like that your purse is stolen. We should just go see what we can do about that.” We know the purse wasn’t stolen but we're not going to change their mind so we just validate and look for the purse until we find it.

Jennifer: You know it makes so much sense when it's explained like this and again it’s not something I think is an automatic response when dealing with these situations.

Tamara: Just think about when you are upset about something. I think you just want to be validated that someone hears what you're saying.

Jennifer: It really is such a common sense approach. But something I think that probably takes a lot of practice and a lot of skill. I know a lot of people deal with this in their home and that's where Earth Angels Home Care comes in with your caregivers to assist.

Tamara: It takes a team to work with somebody living with dementia because these repetitive behaviors that happen consistently really wear on the caregiver. So you have to be able to tap out and say “Ok, Jennifer I need to take a breather. I need to step back. Can you step in?”

Jennifer: So it makes sense and we've talked about this before but all your caregivers are trained in Teepa Snow methods. And so they use the Positive Approach to Care when dealing with your clients.

Tamara: Yes and if you get yourself into a situation where somebody is accusing you of stealing their purse or taking something, it's important that you step back, take a time out, do deep breathing and get your cortisol level down so that you can help the person living with dementia. Recognizing when you need help is important and it can be challenging even if you've been trained.

People don't realize just how challenging it is. If you see somebody with a broken arm or a broken leg you see the cast and everybody runs to open the door or does whatever they can. With somebody living with dementia, you don't see the broken brain. You're looking at the person as if they were always the same but not understanding that the brain is broken so they're not doing this on purpose. They're doing the best they can with the skills they have left. We have to help them and support them.

Jennifer: What if they are accusing the caregiver of stealing the purse. Is it the same? Can you talk us through that example?

Tamara: Yes the same philosophy applies. I've often gone into a home where the caregivers are in the home and they've called to say “we're looking for the purse”. I go to the home and the caregiver will be searching every closet and the client living with dementia would be saying "the purse was here and those caregivers took it.” I validate her and say “yes, that's not very nice of them. That is awful. Let's see if we can find another purse. I know you have your hair appointment today. How dare people just come into your house and take your purse?” So you're really validating them and not telling them they’re wrong or saying “Oh don't be silly”. We always eventually find the purse and when we bring it out you say “oh look we found your purse. They must have returned it.”

Jennifer: Yes. Any other difficult situations you see a lot of family members deal with on a regular basis?

Tamara: It's always the repetitiveness that goes on. It doesn't matter how many times they repeat themselves. I’m going to validate them because they don't know their brain is broken. You just support them and focus on the skills they have remaining.

Jennifer: So that's really important and really powerful. I know it can be so challenging and hard for your loved ones to watch their family members go through this and travel on this journey when they do have Alzheimer's or dementia but certainly with the right kind of training and language you can help.

Tamara: Yes. And we just did a free dementia education workshop last Thursday which was very well received. We started with a few key messages because it's a lot and you're not going to learn everything in one day.

Jennifer: So you guys are planning to do these on a regular basis?

Tamara: Yes that's right.

Jennifer: So great to be able to attend that workshop with Earth Angels Home Care and get that kind of information firsthand or to ask any questions. If people have any questions they can call the Bridgewater office here at 902-530-6205 or 902-893-3553 in Truro.

Or stop by anytime and make an appointment if you have some issues or questions that you would like to discuss with Tamara -  if you're struggling with a loved one or have questions about how to deal with these difficult situations or just about the services that they offer here. I know that they are more than happy to talk and have a discussion about how to help you through that.

Tamara: Absolutely.

Jennifer: Well thank you so much Tamara. This was really helpful. Again, if you guys have any questions feel free to ask them or send them along and we'll be sure to get those answered for you. Thank you so much for watching and we'll see you next time. Bye.

*Transcript has been edited for brevity and clarity.

Call Earth Angels Home Care at 902-893-3553 in Truro or 902-530-6205 in Bridgewater to learn more about our services and how we can help you care for a loved one living with dementia.