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Caring for those with Dementia Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

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Page 1: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Caring for those with Dementia

Sheryl Bagshaw, MBA, SSW, CVWCertified Dementia Practitioner

Cognitive Interventionist

Page 2: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist
Page 3: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

How do I deal with his/her behavior? How do I get through to him/her? What is the trick to understanding dementia?

Dementia questions most often asked:

Page 4: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

How do I communicate with someone with dementia?

How do I deal with behaviors?

In other words:

Page 5: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Let’s start by talking about

BEHAVIORS

Page 6: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Managing negative behavior using a learning behavior model that includes triggers, behaviors, and consequences (reinforcement or punishment)

Relies on manipulating triggers, setting boundaries, and providing reinforcements

May affect identity and self-esteem Assumes specific cognitive abilities such as

awareness, judgment and reasoning

Behavior Management and why it does NOT work:

Page 7: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Is the demented person aware of his/her behaviors?

Can the person with dementia manipulate his/her own behaviors?

How disruptive is the behavior? Is it ok to allow the individual to be

demented? And, most importantly…

Questions to ask ourselves:

Page 8: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Whose Behavior Needs to be Managed?

OURS!!!

Page 9: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Not listening Impatience – the more you hurry, the more

time it’s going to take Arguing – Join their journey Not explaining Expecting them to act/behave a certain way

(Allow them to be demented) (They are not in our world – we are in THEIRS)

Trying to get them to do something that is not their idea

Primary External Cause of Agitation: Caregiver Approach

Page 10: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

So what approaches to behaviors DO work?

Need-Driven Behavior ApproachAnd Validation

Page 11: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Normal needs + abnormal conditions = disruptive behavior

Uses the environment and individual strengths/preferences to meet and prevent unmet needs

Assumes that behaviors are not abnormal, deliberate, or good/bad

Behaviors do not need to be resolved, needs do and then behaviors will cease

BASICALLY…

Need-Driven Behavior Approach

Page 12: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

ALL Behavior = Communication

NEEDS!

Look for the NEED and you will know how to respond to the behavior!

Page 13: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Maslow’s Hierarchy of Needs: A

ct.

Esteem

Love/Belonging

Safety/Security

Physical

Page 14: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Medical Needs:

Physical

Care Needs:• PAIN• Constipation• Infection• Oxygen• Blood Sugars• Sleep Disturbances• Med Interactions

• Hot/Cold• Hungry/ Thirsty• Continence• Tired• Over/Under- Stimulation • Movement

Page 15: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Safety/Security Needs:

Safety/Security

• Looking for a family member• Thinking they are being poisoned• Thinking people are stealing• Want to go home • Hiding things• Feeling unsafe/paranoid• Unsure of others• Locking/barring doors• Elopement risk

Page 16: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Love/Belonging Needs:

Love/Belonging

• Space invaders• Use a lot of physical touch• Sexually inappropriate• In the middle of everything

Page 17: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Esteem

Esteem Needs:• Looking for something to do• Ask if they can help• Pick up familiar items• In the middle of everything• Negative self-statements

Page 18: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Self Actualization Needs:Act.

• Looking for something to do• Ask if they can help• Pick up familiar items• In the middle of everything• Negative self-statements

Page 19: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Bridging the Behavior/Communication Gap:

ValidationEmpathy

Reminiscence

Page 20: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Validation:- Is a method for communicating with those with dementia- Uses listening skills, empathy, reminiscing- Helps individuals with dementia to feel heard and validated- Gives demented individuals a sense of esteem/worth- Shows that another’s feelings/ communications are acknowledged and respected- Sees behavior as a form of communication

of needs

Page 21: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Validation Method:- Ask questions – who, what, when, where (stay away from why)- Reflective listening – repeat back what they say in the form of a statement or a question- Ask the extremes – “what’s the worst thing about ______”- Ask the opposite – “what if (the opposite) were true”- Use ambiguity – s/he, they, it- Empathize – “that must be _____” (name that emotion)- Reminisce – “has there ever been a time when ____”- Match/mirror emotions/actions (non-verbal)- Use eye contact/touch

Page 22: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

The best way to explain VALIDATION is by using examples of some of our communication failures with demented individuals and showing how we can use validation to improve them.

Page 23: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

1. Arguing with them

Example: Day of the week

Validation: Don’t Argue!“WE are in THEIR world” – it only frustrates them when we try to bring them back to ours. Method: Ask questions

Page 24: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

2. We approach them wrong and/or don’t communicate

Example: Moving a resident

Validation: Approach is everything.“Be on their level.” Method: Eye contact, Empathy

Page 25: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

3. Reassure them/don’t let them express emotions (sympathy vs. empathy)Example: Patient wanting to leave (blocking the entryway)

Validation: Allow them to safely express emotions. “The cat ignored becomes the tiger.” Method: Empathy, Need

Page 26: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

4. We assume we know the problem and how to fix it

Example: Resident angry about his money.

Validation: Look deeper“Look for the need.” Method: Reflective listening, Ask the extremes

Page 27: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

5. We fail to see the world from their view.

Example: Patient who needs a brief change.

Validation: Perception is reality.“It has to be his/her idea.” Method: Look for the need

Page 28: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

6. We lie to them

Example: “Where is my husband?”

Validation: Therapeutic Lies are harmful“Demented individuals have it within themselves to solve their own issues.” Method: Ask ?’s, Reminisce

Page 29: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

7. We bombard them with information

Example: Doctor’s appointment

Validation: Keep it simple, overstimulation is not good“Overstimulation, like boredom, causes anxiety.”

Method: Matching, ambiguity

Page 30: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

8. We expect them to remember things

Example: “You remember…”

Validation: Keep self-esteem intact.“Has there ever been a time when...” Method: Reminisce

Page 31: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

9. We don’t stimulate them

Example: Henry

Validation: All individuals have worth and deserve our attention.“Music is to the soul what words are to the mind.” Method: Reminisce, music

Page 32: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Henry

Page 33: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

10. We don’t listen to the non-verbalExample: Gladys

Validation: Communication is 70% non-verbal.“Please hear what I’m not saying.” Method: empathy, music, touch, eye contact

Page 34: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Gladys

Page 35: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

Communicating with someone with dementia is about:1. Accepting their realities2. Listening3. Validating their experiences4. Sharing their emotions5. Simplifying your communications6. Looking for the need7. Asking for their input8. Providing appropriate stimulation9. Reminiscing10. Being honest/truthful with them

Page 36: Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

If you want to learn more about communication, Validation, and other dementia issues, you can access my website:

www.dementiaassist.com

(You can also find dementia assist on Facebook)