All posts by Ann Catlin

Family Caregiver, Hospital Professionals, Senior Care Professionals

Validation in Dementia Care: Thank You, Naomi!

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Validation helps caregivers step into the world of a person with dementia, creating understanding and empathy.

The most powerful communication tool I’ve learned is Validation. Created by Naomi Feil, Validation is a method of communicating with people with dementia. Stepping into the world of the elder leads to understanding, therefore easing distress.

I’ve distilled the concepts of Validation into two questions.  They help me respond to someone with dementia who is confused and distressed.  First, I ask, “What is this person’s reality at this moment?”  The answer gives me a clue into her world at the moment, and then I can be with her in her world.

Then I ask, “What is she feeling right now?”  I can’t see a motion picture of what’s going on in her mind, but there are clues about how she is feeling. What is her facial expression, body language, or voice intensity telling me?

Now comes the action part.  First, I reflect her reality and then acknowledge the feeling.

Let me illustrate with a story about a woman in a skilled nursing facility where I provided Compassionate Touch® sessions. At around four o’clock, she fretted about getting home to make supper for her family.  Pacing the hall, she asked everyone how to get back home. As time passed, the more anxious and upset she became. The staff was expected to take her to dinner at five o’clock, not an easy task when she was so determined to leave.

What is her reality?  It’s time for her to get home to make supper for her family.  In her mind, her family would be back soon, and she needed to be there for them. Now that I understood where she was at the moment, I could be with her in her world.  What is she feeling? She seemed frustrated and increasingly angry and fearful.

I walked with her, asking simple questions about her family and what they liked to eat for dinner.  I acknowledged her feelings, saying, “it’s so frustrating to be late.” I used humor, “my son thinks he will just starve if I’m five minutes late with a meal!” She nodded and laughed with me.  At one point, I reassured her with touch by gently stroking her back and holding her hand. She became more present in the immediate moment, and she let go of her fixation on getting home.

What created the shift in her was not so much what I said, but rather that she felt seen and heard, therefore, validated. We walked again, but this time to the dining room where she joined her friends for dinner!

How do you feel when someone validates you?

Ann Catlin, OTR, LMT: For twenty years, Ann led in the field of skilled touch in eldercare and hospice. She has nearly forty years’ clinical experience as an occupational and massage therapist. She created Age-u-cate’s Compassionate Touch program and now serves as a Master Trainer and training consultant.

Family Caregiver, Senior Care Professionals

Coping with the Emotional Toll of Moving a Parent to Assisted Living

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Family caregivers need support to handle the emotional toll.

My friend Lana is on the emotional roller coaster of moving her mom to assisted living. Coupled with holiday stress, it’s taking quite a toll. Like most seniors, Lana’s mom would rather live in her own home. However, her functioning declined to the point that she fell several times, leading to multiple trips to the emergency room. Lana fretted over the decision to look for another living arrangement for her mom. Fortunately, guidelines helped identify when it was time.

Assisted living may be called for if a senior has difficulty performing tasks of daily life, such as:

  1. Basic personal care tasks, such as bathing, dressing, toileting, eating.
  2. Paying the bill, handling the mail, preparing meals, cleaning, and transportation outside the house.

Furthermore, a worsening medical condition may lead to a lack of activity, falls, incontinence, and poor nutrition, as was the case with Lana’s mom. After yet another hospitalization, it was time; however, the emotional toll has been heavy with grief, doubt, regret, and guilt.

Author Liz O’Donnell offers these strategies to ease the transition.

  1. Give it time. It takes from three to six months to adjust.
  2. Ask friends or family to help.
  3. Expect setbacks. Ups and downs are typical. Allow yourself to feel discomfort with the fact you can’t fix it.
  4. Be a good listener of your parent’s concerns and feelings.
  5. Surround your loved one in familiar belongings from home. Limit new things. The situation is all new.
  6. Advocate for your parent to help build a team. Let them know who your parent is and what her preferences are.
  7. Set boundaries. Decide what you are willing and able to do and stick with it.

Finally, Kathy Dreyer’s recent blog post offers these words of wisdom from her own experience of managing the emotional toll of moving her mom to a facility.  “Let go of what you can. Acceptance can bring relief, whether it is in accepting help or accepting changes.”

What do you believe is essential to help ease the emotional toll of moving a loved one to long term care?

Ann Catlin, OTR, LMT: For twenty years, Ann led in the field of skilled touch in eldercare and hospice. She has nearly forty years’ clinical experience as an occupational and massage therapist. She created Age-u-cate’s Compassionate Touch program and now serves as a Master Trainer and training consultant.

Senior Care Professionals

Quality of Life in Nursing Homes—What Matters Most?

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Individual preferences determine if one feels they have a high or low quality of life.

Nursing homes often stress that they strive to maximize the quality of life for those elders who reside there. Over the years I’ve heard the term quality of life so many times that it seems rather vague now. Has it become an overused phrase that lacks a meaningful context? What is it anyway and how do we know when we’ve achieved it for anyone other than ourselves?

Quality of life is hard to define, therefore we all have our ideas about it. For one it may be associated with physical function or being pain-free. Yet the next person may stress having regular connections with family or friends. And still a third will say it’s having a clear mind and being able to engage in spiritual practice. The most basic definition I found states says that quality of life is “how good or bad a person’s life is.” I find that sufficiently vague to be meaningless.

So if the quality of life is subjective, then what matters most to individual residents in long-term care? One research article tells us that “The majority of the elderly people evaluate their quality of life positively on the basis of social contacts, dependency, health, material circumstances, and social comparisons.”  Other researchers found that “dignity, spiritual well-being, and food enjoyment remained predictors of overall nursing home satisfaction.”

An especially exciting publication called Quality of Life: The Priorities of Older People with Cognitive Impairment reports that nursing home residents most value:

  • Frequent contact with family
  • Privacy and being able to spend time alone
  • Socializing with others, including staff and visitors
  • Being active
  • Having meaningful activity
  • Engagement in religious or spiritual practices
  • The staff treats them with respect
  • Feeling like staff members see them as individuals

In conclusion, there are many layers of daily existence to take into account when trying to measure if a person’s quality of life is at a high level or is lacking. The bottom line is that we really can’t judge it through our lens; however any attempt to know the person is in the right direction.

If you work in long term care, what’s something you do to help ensure each resident’s quality of life?

Ann Catlin, OTR, LMT: For twenty years, Ann led in the field of skilled touch in eldercare and hospice. She has nearly forty years’ clinical experience as an occupational and massage therapist. She created Age-u-cate’s Compassionate Touch program and serves as a Master Trainer and training consultant.

Senior Care Professionals

Dignity in Elders in Long Term Care: Three Ways to Foster It

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Foster dignity to improve quality of life.

Respecting a sense of dignity in elders living in long term care is vital to their quality of life. Dignity is the state or condition of being worthy of honor or respect, both of oneself and others. An organization called the National Consumer Voice designates October as Resident’s Rights Month to focus on and celebrate awareness of dignity, respect, and the rights of each resident. The 1987 Federal Nursing Home Reform Law requires nursing homes to “promote and protect the rights of each resident” and stresses individual dignity and self-determination.

How can we foster dignity in those we serve? I offer three ways to shape our attitudes and actions.

Focus on the Individual. It is looking past the “story” of the disease or condition. A person’s point of view, physical, emotional, or cognitive state changes many times over a lifetime. However, the individual exists through all these changes. Many think of old people as “former people” but each is still who they have always been. Pay attention to the person inside. I’m saddened when a resident’s room has no personal belongings, as opposed to someone whose room is full of things reflecting what’s important to them. Encouraging individual expression in the resident’s living space helps us to relate to them as a person.

Watch Your Language. Words matter and shape our attitudes, beliefs, and even actions. Some words used in long term care are cringe-worthy. At the top of my list is “lockdown” to describe a secure memory care unit or neighborhood.  I’ve heard staff and family members say it. “She needs to be in lockdown.” The definition of lockdown refers to the confinement of prisoners and an emergency measure because of a threat. It’s hardly fitting for people living with cognitive impairment needing a secure, supportive environment! Karen Schoeneman offers suggestions for changing the language of long term care to one that is more respectful.

Convey a Positive Tone of Care. Balancing proficiency in our skills with the human side of care isn’t easy. A study of elders’ perceptions of caring behaviors revealed that technical competency, combined with caring expressions of empathy, most conveyed dignity-conserving caregiving.

With this in mind, I try to act from the belief that our elders deserve to live a life with dignity. Some days, I succeed more than others. What do you think is essential in fostering a sense of dignity in those you serve?

Ann Catlin, OTR, LMT: For twenty years, Ann led in the field of skilled touch in eldercare and hospice. She has nearly forty years’ clinical experience as an occupational and massage therapist. She created Age-u-cate’s Compassionate Touch program and serves as a Master Trainer and training consultant.