Category Archives: Hospital Professionals

Validation in Dementia Care: Thank You, Naomi!

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.

World Alzheimer Report: Private Sector Response

Let’s not wait for the public sector to develop plans to address the dementia crisis. The private sector can and should play a large role.

This expert is from the Alzheimer’s Disease International website referencing the World Alzheimer Report of 2019.

“The report reveals the results of the largest attitudes to dementia survey ever undertaken, with almost 70,000 people across 155 countries and territories completing the survey. It spans four demographic groups: people living with dementia, carers, healthcare practitioners, and the general public.”

Further, the analysis of the study was carried out by the London School of Economics and Political Science (LSE).

Specifically, some of the key findings of the report include:

  • Almost 80% of the general public are concerned about developing dementia at some point, and 1 in 4 people think that there is nothing we can do to prevent dementia
  • 35% of carers across the world said that they had hidden the diagnosis of dementia of a family member
  • Over 50% of carers globally say their health has suffered as a result of their caring responsibilities even while expressing positive sentiments about their role
  • Almost 62% of healthcare providers worldwide think that dementia is part of normal aging
  • 40% of the general public think doctors and nurses ignore people with dementia

Call to Action for Private Sector

In addition, the report lists several calls for action, many of which rest with local, state, and national governments and agencies thereof.  However, the private sector can do a lot to address the disheartening vital findings. People are hurting, suffering, concerned, and uneducated about dementia.

Conversations at my faith community are under-way about how to minister to persons with dementia and their caregivers. Educate citizens about dementia to demystify, normalize, and create an environment of understanding and acceptance.  This is an excellent place to start.

In conclusion, call upon local experts to help start the conversation within your circle of influence and ask questions.  Success will come with each small step.

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving for family and professional caregivers.  In addition, she is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.

Hospital Readmissions: Challenges for the Patient and Caregiver

Hospital readmissions can be costly, in terms of the effect on the patient being readmitted and the related expenses. The American Health Care Association (AHCA) established a Quality Initiative (Initiative) to support the level of care in both the long-term care and post-acute care settings. The Initiative aligns with programs underway by the Centers for Medicare and Medicaid Services (CMS) to address long-term care challenges and costs related to hospital readmissions.

CMS implemented the Hospital Readmissions Reduction Program (HRRP) to reduce payments to hospitals with excessive readmissions as compared to other hospitals. The program, which started in 2010 and began assessing penalties in 2012, reviews hospital readmissions within 30 days of discharge for six conditions: myocardial infarction, chronic obstructive pulmonary disease, heart failure, coronary artery bypass graft surgery, elective primary total hip arthroplasty and/or total knee arthroplasty and pneumonia.

While a person with Alzheimer’s disease or another type of dementia can experience many health conditions, the incidence of pneumonia can be particularly challenging. According to the National Institute on Aging, persons with Alzheimer’s disease can be prone to pneumonia in the later stages of the disease due to potential food aspiration. A person with Alzheimer’s disease is likely to be hospitalized during the disease.

Hospital stays for both the person with dementia and their care partner can be problematic and a source of agitation for several reasons. Moving a person with Alzheimer’s disease or related dementias from a known environment to one that is unknown will likely be disruptive for that person. If the hospitalization is the result of an emergency, both the person with dementia and the care partner will likely be more stressed. Also, transferring into a hospital setting provides several challenges. Typically the person will not know many of the persons providing care in the hospital. These staff members may not have experience, information, or understanding about the unique needs of a person with dementia related to their care. Information about the best ways to accommodate a person with dementia is needed, but even those accommodations may not be feasible. If a care partner or family member is not be available to stay the night with the person, additional challenges can result. The National Institute on Aging has a tip sheet for care partners preparing for potential hospitalizations. Following the NIA guidelines can help care partners plan, yet if the person with dementia or Alzheimer’s disease must be readmitted shortly after discharge, any challenges that occurred previously may occur again.

The Alzheimer’s Association created a policy brief to address reducing potentially preventable hospitalizations for those with Alzheimer’s disease or related dementias. Based on these guidelines, support for the care partner and the patient is needed, both in the home and community setting. The utilization of the strategies, outlined by the Alzheimer’s Association, National Institute on Aging, the Centers for Medicare and Medicaid Services and the American Health Care Association can have a positive impact on the care of those with dementia and their care partners to reduce potential costs and improve health outcomes related to hospital stays and readmissions.

Kathy Dreyer, Ph.D., is the Director of Strategic Projects at AGE-u-cate® Training Institute, which develops and delivers innovative research-based aging and dementia training programs such as Dementia Live® and Compassionate Touch®, for professional and family caregivers; kathy.dreyer@ageucate.com

The Importance of Education for Informal Caregivers

Members of the First United Methodist Church in Arlington Heights, IL attend an Eldercare Educational Program about Understanding the Continuum of Eldercare.

Today, family members and other private individuals provide the bulk of care for frail older adults. According to The National Alliance for Caregiving, approximately 34.2 million Americans have provided unpaid care to an adult age 50 or older in the prior 12 months.  The assigned dollar value of unpaid caregiving is a staggering $470 billion.

Informal caregivers are a critical link in the system of eldercare. The care and support that is provided delays, and may even prevent the need for institutional care. Equally, we must acknowledge the financial impact that the informal caregiving system has on our nation. Consider the increased stress on the Medicaid system without these caregivers.

The American Association of Retired Persons offers a terrific directory of resources available to family caregivers. There are many agencies, both public and private, that exist to provide resources for family caregivers. To that end, caregivers can access website links, pamphlets, resource guides, and a plethora of other informational sources.

Importance of Education for Caregivers

Yet, with all of these resources, so many family caregivers still feel lost and overwhelmed. I have observed many caregivers who don’t know what they don’t know.  In addition, it is paralyzing for them to know where to start.

Caregiver education should be a more robust component of our eldercare system.  Education that leads to increased knowledge is necessary so that people can feel empowered and access the correct resources.

Caregivers need to understand the process of aging.  As astutely stated by The Age-u-cate Training Institute, it is hard to care for someone that you don’t understand.  Consequently, when caregivers feel like they are in the dark, stress, and frustration ensues.  Therefore, helping caregivers to understand what is going on will better equip them to find the right resources and ask the right questions.  Knowledge is empowering.

To list, a sample of educational topics for caregivers:

Creating opportunities to provide knowledge will increase understanding and compassion, reduce stress, and strengthen the process of caregiving.  In addition, it will improve the relationships between caregiver and receiver.

 

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving for family and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.