As a spouse or family member of someone living with dementia, you may often encounter “challenging behaviors”. These behaviors might include refusing personal care, increased agitation or anxiety, constantly repeating questions, and even delusions. Using “logic” such as “you need to take a bath”, “you already asked me that questions 10x” or “no one is there—what is wrong with you,” will not fix the behavior.
Take a step back. Sadly, the person living with dementia has a brain disease. They depend on you to use your brain.
- Slow down, respond and think. Don’t react
What you thought would happen, didn’t happen. It can be tough to stay calm when you’re surprised or caught off guard. What can you do?
First, stop reacting. Stop trying to correct, stop pointing out errors, stop trying to fix things. Stop raising your voice, stop pushing, stop saying “Remember? I already told you.” Don’t argue with them. Period.
Instead, repeat back the objection (pace based on their ability to process). “So you don’t want to take a shower, it that correct?” This technique, reflective, narrative language, helps the person living with dementia feel like you got their message. It helps you both acknowledge and validate what the person is feeling. Then, you can find out why.
- Be a detective, not judge.
We all feel the pressure of caregiving. For example, the family member has not bathed in a 3 weeks and smells. When they say “I don’t need a bath—I took one yesterday” you clue 1 and 2: their sensory (smell) function and time awareness are off (both common with dementia).
Take a step back and assess the situation. They can’t smell. Time is “overlapping”—they have showered a thousand times so they remember showering just not a precise date.
Now it’s time to figure out “why”. What might be driving their resistance to personal care? Does water bother them? Privacy? Are they fearful of falling? Do they have an unmet physical need (fluids, food, et)? Are their times when they are more receptive to showering (move to AM or PM)?
- Pieces of the Puzzle.
Being the detective means trying to understand the entire situation and seeing the situation from “their side.” “Pieces of the Puzzle” is a useful construct. In short, we need to think about what we can and cannot control that impacts their behavior.
Extrinsic “puzzle pieces” are factors we can control as caregivers. These include “time” (ie time of day (AM/PM), Stakeholders (who is helping, what are their skills with dementia, etc) and the environment of the person’s care (how they perceive the bathroom, shower, etc).
Intrinsic “puzzle pieces” are factors we must be aware of but cannot control. These include dementia type, the person’s history (who they were before) and overall health condition (vision issues, emotional and physical needs).
Often, resistance to care is rooted in the “puzzle pieces”—they want control, scared to get in the shower, tired, hungry, cold, want privacy, don’t like family members telling them what to do, etc.
In short, when we have caregiving challenges, WE need to step back and engage our brains. By shifting from reaction to reflection combined with knowledge, awareness and skills, care success can be achieved.
Benefits of Home Senior Care has been helping seniors and their families with Memory Care and Dementia Care for 14 years. Our ability-based approach is based on Positive Approach to Care®. We provide dementia care at home based on “where dementia care clients are at ” with their disease using a specialized dementia care plan v. a clinical-based (“what can’t they do”, what “stage” are they in) model. We help family members “shift focus” and help them to understand how the disease is impacting their loved one.