Tag Archives: dementia care

Communicating with Terms of Endearment – A Big NO NO

Dear, Honey, Hun, Sweetie, Buddy, Chief, That’s a good boy, Let’s go potty now.  No, I am not talking to my 18-month-old, I am repeating terms of endearment and phrases I hear in memory care and assisted living every day. There is so much research behind the use of this type of language researchers refer to it as elderspeak. I know I am guilty of using terms like these and I know you are too but explore the impact it may be having on our residents.

Although our intentions are generally well-meaning, communicating in such a way with a resident conveys a message of vulnerability, frailty, and inferiority. In fact, communicating with terms of endearment can be viewed as a caregiver trying to control or take charge of the situation rather than providing help and support to their resident.   You may be thinking “this doesn’t matter to me, my resident has dementia, they won’t remember anyway”. And while it is true that your resident may have little to no short-term memory, they are capable of associating feelings with interactions. They will pick up on the tone of your voice and the inflections that you are using.

I feel it’s important to mention that not all residents will respond negatively to the use of elderspeak, but to keep things consistent for all our residents we should stop using terms of endearment, they can be viewed as belittling, condescending and can trigger negative behaviors.  Did you know that using terms of endearment with a resident could lead to a state citation?

Let’s talk about some negative and positive examples:

When helping Ann, a pleasantly confused woman, after lunch the caregiver says “Sweetie” let’s go change your shirt, you spilled juice all over it, and then we will go potty, OK Annie?” The caregiver reaches out her hand to guide Ann to her room and says, “that’s a good girl, come this way” While the caregiver only means to help Ann and show that she cares for her the impact of her words could have a negative effect on how Ann will respond to the care she is about to receive. She may pull away from the caregiver and the caregiver will think that Annie is just being resistive when really Ann is feeling disrespected or confused.

The caregiver’s tone and language may remind Ann of a time when she was young, and her mother would call her Annie when she was caring for her, it could help to create feelings of a safe environment for “Annie”. OR depending on where Ann is at in her current reality it may trigger negative feelings. She could be reminded of a time after she was physically abused by her spouse when he would use terms of endearment to control or belittle her, maybe he only called her Annie after a nasty fight. OR consider this Ann was a high school principal and the use of a term like this offends her! She demanded that her students and staff respect her and the education she worked hard to achieve, and they called her Mrs. Brown, never Ann and most certainly never Annie!

The immediate impact of Elderspeak may not always be apparent and we must never assume that using a term of endearment is appropriate. Always call a resident by their proper name and if they have a title like Dr. or Professor until you have gained permission to call them by another name. If they have a nickname that they prefer to be called it must be documented in their ISP. For example, John has been called Bub his entire adult life, this is ok! If fact Bub might respond negatively to be calling John.

Research has shown there are 3 main factors on a caregiver use of Elderspeak.

  1. Familiarity with the resident- The more comfortable we are with the resident the more likely we are to use elderspeak.
  2. Whether the resident has dementia- the level of dementia plays a huge role in our use of elderspeak, the further progressed the dementia is the more likely we are to use a term of endearment. Maybe we view the resident as helpless or frail and in our effort to show or convey caring we may use elderspeak.
  3. If the resident is alone with the caregiver or if there are others present during the interaction. In the presence of family, other residents, or other caregivers we are less likely to use elderspeak, maybe because deep down we know it is disrespectful and we are more aware of what others would think if we used endearing terms.

So, have you ever caught yourself addressing a resident with Elderspeak? I know I have. And the only way we can change this behavior is to be aware of it then stop it.

My challenge to you is to be more aware of not only your communication methods but of those around you.  Maybe you need to remind a co-worker, in private that they shouldn’t use endearing terms. Or you may need to be reminded yourself on occasion.  After you catch yourself using elderspeak you may need to apologize to your resident when you call her Sweetie and correct your actions by using her preferred name. I challenge each of you to focus on the strengths of your residents and not their inabilities or weaknesses. Remember that everyone has value and should be treated in a respectful way.

Emmy Kaczmarksi, RN is a Master Trainer for AGE-u-cate® Training Institute, Dementia Educator, Behavioral Specialist, and works at White Pine Senior Living in Hudson, WI.  


Award Wages for Aged Care Workers in Australia

Having just returned from Australia,  I’ll be devoting several upcoming blogs to my research and fact finding with how Australia is advancing in aging and dementia care, as well as dementia and age friendly best practices.  I found their award wages for aged care workers to be one significant difference from the US and worthy of discussion.

Award wages and workplace rights and responsibilities are managed by the Australian Government Fair Work Ombudsman. An employee’s minimum pay rate can come from an award, enterprise agreement, other registered agreement, or the national minimum wage.

Employees must be paid for all the hours they work including the time they spend in training, team meetings, opening and closing the business, and working unreasonable trial (what is equivalent to overtime in US) shifts.

An entry-level Aged Care Worker with less than 5 years of experience can expect to earn an average total compensation of AU$44,000.  An Aged Care Worker with mid-career experience which includes employees with 5 to 10 years of experience can expect to earn an average total compensation of AU$46,000.  An experienced Aged Care Worker which includes employees with 10 to 20 years of experience can expect to earn an average total compensation of AU$46,000.  An Aged Care Worker with late-career experience which includes employees with greater than 20 years of experience can expect to earn an average total compensation of AU$48,000.

Although the healthcare and aged care systems differ from the US, I found that we are all experiencing the same challenges of a rapidly growing aging population.   Workforce shortages, rising costs and changing policies are certainly a global concern.

Employee turnover in Australia is less significant than the US.   While this is  likely due to higher wages,  they also have in place required  training for all care workers, of which dementia care is included.

In late 2016 Dementia Training Australia rolled out Dementia Essentials which is delivered by Alzheimer’s Australia nationally.

The three-day course provides attendees with extensive knowledge of dementia, as well as focusing on person-centred practice, communication strategies, developing appropriate activities, and responding to unmet needs.

AGE-u-cate’s Dementia Live™️ and Compassionate Touch® programs have been overwhelmingly received in Australia and we are excited to be working with providers from across the country in expanding our presence in the coming year.

I learned that while we differ in how our “systems” work we all want to deliver high quality care to our aging populations.  We all have challenges and are learning and growing from each other.

Next blog I’ll be talking about Australia’s amazing Men’s Shed program, so stay tuned!

Pam Brandon is President/Founder of AGE-u-cate® Training Institute and a passionate advocate for older adults and those that serve them.


Shifting Gears…What Might Happen if We Try Something New!

I have always been a proponent that if something is just not working well, shifting gears may be a solution.  Let’s face it – everything is changing fast these days, so much so that it seems as if technology  leads the pack in shifting gears at every juncture of our daily lives.

Shifting gears often is related to moving from one level of activity to another;  taking on a new course or direction that results in change.  And hopefully that change is positive.  

Elder care today is more and more becoming about caring for someone with dementia.  Why the shift?  Because we’re living longer and the reason so many more people are getting dementia is simply for that reason – as we age the probability of cognitive impairments increases.  So, if we shift gears in terms of thinking about elder care in terms of caring for someone with some level of cognitive impairment, could care for that person change… for the better?

Most certainly our focus as a nation and world is clearly focused on dementia care as the public health crisis of our generation.  Because of this, there has never before been such a concerted effort in shifting gears to new models of care, most often referred to as person-centered or patient-centered care.

Will shifting gears alone be the impetus for deep culture change?  Certainly those of us passionately advocating for vast changes in care for our older adults and those that serve them hope that enough of us will collectively make a difference.  By bringing the human side of caregiving to the forefront, rather than taking a secondary role to the medical model of care, change can certainly be deep and wide.

This shift in gears requires a shift in our thinking.  Taking a new course means taking risks, accepting that not every decision is going to be the right one, and that it is a continual process of trying new approaches until outcomes improve for everyone, especially those we are caring for.

Pam Brandon is President/Founder of AGE-u-cate® Training Institute.  AGE-u-cate develops and delivers aging and dementia education for professional and family caregivers that results in transformative change.  



Empathy Training for Dementia Care – A Strong Foundation Tool

AdobeStock_121846321Neurological research substantiates that human beings appear to be “wired” to be empathetic.  In other words, we all have an innate ability to be empathetic.   Would empathy training in dementia care  provide a strong foundation tool for front line staff to help improve the quality of life for those living with dementia?

Empathy is the ability for one to walk in someone else’s shoes.  To experience their world so as to gain a deeper understanding of what he/she is experiencing.  For those in dementia care, stepping into their world is often especially challenging, as behaviors and emotions can change rapidly and unexpectedly.

The “AHA” moment is HUGE when a care partner can feel the frustrations, anxiety, fear, helplessness and aloneness that living with dementia often perpetuates.  This opens a care partner’s eyes, thus propelling them to draw on this innate sense of empathy.  When care partners receive empathy training it becomes a strong foundational tool to build on critical skills that empower care partners, especially when helping someone who is living with dementia.  Some of these critical skills included:

  • The ability to deeply and with understanding of their reality
  • Learning to read and understand body language
  • Freeing oneself from creating perceptions or judgements by focusing on care partner’s feelings instead of your own
  • Accepting the reality of the moment – good, bad or indifferent
  • Avoidance of ever being “right” or having to prove a point
  • How to use such powerful and simplistic tools that have exponential benefits, such as touch, music, nature and art to help respond to behavioral expression
  • Allowing silence to build engagement without words
  • Gaining an inside-out perspective of living with dementia
  • Tapping memories that are still alive and impactful for the person living with dementia

Pam Brandon is President/Founder of AGE-u-cate® Training Institute.  Creator of the Dementia Live™️ Experience that powerfully simulates what living with dementia might be like, Pam is passionate about creating transformative change in elder care.