Assisted Living Residents With Dementia Respond Best to Person-Centered Care

Have you ever forgotten where you put your keys? How did you feel when that happened? Did you feel frustrated or angry?

Some residents in assisted living communities feel that way every day. They may:

• Be frustrated because they cannot remember what they ate for lunch or their children’s names.
• Feel angry because simple activities such as getting dressed are not simple anymore.

Briefly forgetting where you put your keys is normal and happens to almost everyone. Forgetting what you ate for lunch, your children’s names, and how to complete basic tasks is not normal.

Dementia is not a disease process itself. Rather, it is a term that describes a group of symptoms that interfere with thought, behavior, and ability. These symptoms make it hard for the person with dementia to plan and perform tasks. They may cause personality changes and affect the way someone does things.

Due to brain damage, people with dementia may have trouble:

• Learning
• Remembering
• Writing
• Speaking
• Understanding others
• Understanding where things are
• Planning
• Performing daily activities

Person-Centered Care

To give good care to residents with dementia, you must use person-centered care. This is care that should focus on that specific resident’s needs and abilities.

Use these principles for person-centered care:

• Protect residents’ well-being, privacy, and dignity.
• Meet all of their needs when you can.
• Try to make them feel less alone.
• Show them respect.
• Let them do as much for themselves as they can.
• Give the care they need.
• Be kind and understanding with their loved ones.

The care you give must match the person. Know what they like. Know how they like things to be done. Know what supports they use and how they should use them. Be sure your residents have and use their walkers, canes, wheelchairs, or glasses. Involve the resident in his or her care as much as possible. It is important to always follow the service plan.

Promoting Understanding

It is often hard for residents with dementia to tell others what they want or need. They may have difficulty understanding what others are saying. Poor communication by caregivers can make the person’s life stressful.

They may not be able to keep up with a conversation. It may be even harder for them if the setting is noisy or busy. This can cause them to be:

• Frustrated
• Angry
• Nervous
• Confused
• Scared
• Sad

They may react with strong emotions. For example, they may strike out at you if you ask them to perform tasks with several steps.

People with dementia often use nonverbal communication. They use physical signs to show their needs, wants, and feelings. This nonverbal communication is expressed as behaviors, and all behaviors have meaning.

Finding the meaning behind the behavior is the key to understanding what the person is trying to say.

Show-and-Tell Communication

You can use show and tell to communicate with someone who has dementia. That means using both verbal and nonverbal communication. Show them what you mean by using your own:

• Body movements
• Gestures
• Facial expressions
• Relaxed posture

Combine showing with telling to enhance understanding. It is best to use your own short, simple words to explain what you mean. Residents with dementia will often watch for clues from you as they try to understand what you are saying.

What does this mean for you? It means that you should always:

• Smile and be friendly. Send the message that you are happy and enjoy being with them.
• Say the person’s name often. Use it to get their attention.
• Approach them from the front.
• Pay attention to how you look to residents. Be sure you seem calm and pleasant.
• Maintain eye contact with residents, if that is appropriate in their culture.
• Tell residents your name every time. Remember that residents with dementia may not remember you from one day to the next.
• Speak clearly and simply. Say, “Let’s take a walk outside,” instead of, “Would you like to come with me to go outside and see if we can find something pretty to look at?”
• Aim to have a calm, happy tone when you speak.
• Give residents time to respond. If they ignore you, leave them alone for a few minutes, then try again.
• Use words residents know, such as “spoon” instead of “utensil.”
• Notice the nonverbal cues residents send.
• Give clear directions. For example, say, “Mr. Jones, please sit in this chair.”
• Use show-and-tell methods. Remember that residents with dementia watch and listen to try to understand you.
• Be patient. Wait for their response.

A Supportive Environment

The environment for a person with dementia should be safe, secure, and supportive. With those goals in mind, you can:

• Adjust lighting to limit shadows.
• Use simple furniture with plain patterns.
• Have basic carpet with a solid color.
• Remove or cover mirrors if the reflection upsets the person.
• Provide signs or pictures with words to help residents find their own room or main facility areas.

Please Don’t: Actions To Avoid

When you are interacting with a person who has dementia, some behaviors don’t support person-centered care.

• Don’t talk in front of the person as if they are not there.
• Don’t speak louder or yell.
• Don’t rush.
• Don’t let residents be startled by loud sounds, if possible.
• Don’t speak to the person using elder speak, or baby talk. This means don’t call them “baby,” “sweetie,” “sugar,” or “honey.”
• Don’t use a sing-song voice the way you might with a baby or young child.
• Don’t argue.
• Don’t try to reason with residents who have dementia.
• Don’t yell, threaten, scold, or punish.
• Don’t ever use an angry voice.
• Don’t quiz the person to try to help them remember.
• Don’t sneak up on them or touch them from behind.

Make sure you provide person-centered care in everything you do. You may still have to try to manage difficult behaviors, so remember that most behaviors have a meaning. Try to identify the meaning behind the behavior so that you can implement the most appropriate interventions.