Lets pick up where we left off, in the “Communication Domain” of Habilitation Therapy. First, a quick recap of the first two domains:
- The physical domain: What was once familiar can now be frightening. Analyze the physical environment to reduce the chances of that.
- The social domain: Structure activities, enough to keep the dementia sufferer active, but maximize the probability of success in activities.
- The communication domain:
- Do not count on short-term memory in your communication.
- Never use the word no. Say yes, then redirect.
- Go to the reality of the dementia sufferer, do not try to bring them to yours.
- A critical point is made by Dr. Raia: “As they decline and lose capacities, part of what is also lost is the ability to self-soothe if fears become overwhelming.” Be attuned to situations that may cause fear and avoid or alleviate them quickly.
- The bottom line in the communication domain is that we must “listen not so much to the misused words and muddled sentences, but to the driving emotions behind them.” Accept those emotions as real and valid and be creative in your response.
- The functional domain: This is a critical area that, in my view, touches on all of the others. That is because it involves “excess” disabilities, over and above the physical and cognitive impairments. The excess disabilities are the result of the individual’s “emotional reaction to the disease”. Those emotional reactions become additional hurdles to the overall goals of supporting the dementia sufferer. Below is a long excerpt dealing with one of the most difficult areas for many folks with dementia — bathing. It is an excellent lesson for caregivers:
One should begin by spending at least five minutes just talking and building rapport. This is what I call the “spend five and save 20” rule. Proposing an activity as a question (“Would you like to take a bath?”) too often leads to a resounding “no.” Assist the person with verbal cues, using a technique called “chunking,” which involves a series of short, simple, calmly stated commands, such as “come with me,” “unbutton your shirt,” “take out your arm.” Schedule bathing when the person is in the best frame of mind, most alert, and cooperative. If necessary, provide hands-on assistance, mindful not to let water pour over the person’s face and eyes, which can be frightening. Wash the hair and the face at a different time. Showering for a patient with Alzheimer’s disease is best done from the feet up, stopping at the neck, rather than working from the head down.
- The behavioral domain: The core of this domain is the concept that “we cannot change the person’s behavior directly, but only indirectly by changing either our approach technique or the person’s physical environment.” This is, frankly, the concept with which most family members have the greatest difficulty, whether consciously or not. Wanting the loved one — or the patient or client — to be restored to “normal” (rehabilitated). Instead of wishing, we need to analyze behavior and find the underlying drivers, then deal with them. I hope you read the full paper, because you will love Dr. Raia’s case study on this domain.
Dementia can be almost as much of a challenge for the caregiver as for the person who has it. I think you will find the Habilitation Therapy approach to be a very positive one for both.
Best wishes. Bert