Habilitation Therapy for Dementia

Those of us in elder care and home care, including at Support For Home, know that there is no magic wand when it comes to supporting folks suffering from dementia.  There is no cure for most forms.  Most meds prescribed simply have palliative effects.  Within that context, finding effective approaches is absolutely critical.

One approach which appears to be consistent, logical and effective is Habilitation Therapy.  Paul Raia, Ph.D., is Vice President of the MA / NH Chapter of the Alzheimer’s Association.  He published a very good paper on Habilitation Therapy in Virginia Commonwealth University’s “Age in Action” journal.

The entire paper is worth reading, but some high points are set forth below:

• The name of the therapy is carefully chosen.  The goal is not to “restore” or rehabilitate people with dementia, “but to maximize their functional independence and morale.”
• The goal of this therapy is “to bring about a positive emotion and to maintain that emotional state over the course of the day.”
• Habilitation Therapy focuses on five “domains” or areas of “opportunity to bring about a positive emotion…”
  • The physical domain: In this area, the caregiver is focused on reducing potential for fear and disorientation.  An example is a woman with dementia, presented with too many choices of clothing.  the solution is to provide only a couple of choices, presented in  a way that makes the dementia sufferer feel empowered to choose.
  • The social domain: The key in this area is “structured activities.”  Activity is critical to avoiding negative psychological symptoms, but the activities plan needs to be “failure-free”.  That means careful thought applied to avoid frustration.
  • The communication domain:  With the decline of verbal skills for folks with dementia, what is needed is “increased use of body gestures, demonstrations, signs and pictures.”  One critical tenet of the therapy is “never to use the word no.  If the patient wakes up at 4:00 a.m. and wants to take a walk outside in a rainstorm, one should say, ‘Sure, let’s do it.'”  Then redirection is applied: “Sure, let’s go walk in the rainstorm, but before we go, I need to have a cup of tea and a sandwich.  My favorite kind of sandwich is turkey.  What’s yours?”  A critical concept here is that we do not try to bring a person with midstage dementia “to our sense of reality; rather, the caregiver must go to where the patient is.”

There is more to this critical social domain, and we will pick it up  and continue in our next post.  In the meantime, what is your favorite sandwich?  Would you help me make one?  Best wishes.  Bert