Tag Archives: Person centered care

Unravelling the Mysteries of Challenging Behavior

Challenging behavior is a catch-all term that, in the context of dementia, includes one or combinations of things like shouting, wandering, biting, throwing things, repetitive talking repetitive movements, destroying personal possessions and other objects without regard for whom it belongs, agitation and general anger, physical  or verbal attacks on others, waking others at night, making sexually inappropriate comments, disrobing inappropriately, and urinating or defecating in undesirable locations. This is not an all-inclusive list and I am sure you can think of many more examples that fit under the umbrella term of challenging behavior.

These behaviors are often surprising and disruptive, and we want the behaviors to stop, we do not understand them, and we see that the problem is with the person having the behavior…. but what we need to remember is the person who is living with dementia and is displaying the challenging behavior is really only trying to communicate an unmet need to us, and we are getting it!

As dementia progresses it limits and impairs the way a person once knew how to communicate, and their attempts to make us understand what they are seeing, feeling, smelling, tasting, or sensing. They may express themselves in a negative way, a way that we call, you guessed it – a challenging behavior.

Let us take a step back for a minute. Maybe if we thought of the challenging behavior as a form of communication we would not be so quick in trying to stop the behavior, maybe we would take a step back, and take time to understand the behavior and then realize it is a behavioral expression.

A person living with dementia may express through their behaviors what they like or do not like about whats going on around them, about their environment or what a caregiver is doing right or wrong for them and often without us knowing we are the cause of the challenging behavior. Mind blowing right!?

Let’s think about this example

Sally is a pleasantly confused woman who is a newer resident living in a memory care facility. She is unable to fully communicate needs verbally but if cued and given enough time she can complete most ADL’s without out hands-on assistance, she generally is very cooperative with staff. However, every morning staff has reported to their manager that when they are getting Sally ready for the day she will bite them when they are trying to assist her. The staff is now refusing to provide care to Sally in the morning because of her biting problem and they want to give her medicine to calm her down.

OK…Now let us think. What is the problem here? I’ll give you a clue…It is not Sally’s biting problem. If you said the staff’s approach you were correct, clearly Sally is not appreciating the help she is receiving in the morning to get dressed.    To understand why Sally is biting we need to try and figure out what she is is trying to tell us.

Here are some things to consider

  • Maybe residents feel they are being rushed
  • Maybe the staff is not giving clear one step directions
  • Maybe it is cold in the room and Sally doesn’t like being cold when she dresses
  • Maybe Sally doesn’t like to get up until 9 am and we are trying to get her up at 6


  • Maybe her behavior is because we don’t understand the uniqueness of Sally and we haven’t take the time to get to know her. If we had talked to her family, we would have discovered that Sally always got up, put her robe and slippers on, made her coffee and enjoyed a cup while reading the newspaper before starting her day.

In this case, Sally just wanted to follow her routine, a routine she had done for years, a routine that felt normal and safe. When caregivers came into her room to get her dressed Sally may have felt out of sorts because she was used to doing things a certain way, she may have felt uncomfortable not following her routine and she may have felt threatened if staff was trying to rush her or if she didn’t understand.

When we seek to unravel the mysteries of behavioral expression in dementia we are not only going to help our resident, but we will be helping ourselves! Start putting the pieces together to help create that person-centered environment we all long to be a part of.

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.  




Vitality, Joy and Celebrating the Excitement of Living

Screen Shot 2017-03-14 at 10.42.29 AMHow do you create a senior care community that truly enhances the lives of their residents?  By doing the right things for the right reasons.  Vitality, joy and celebrating the excitement of living was exactly what I felt from the time I entered the doors of Cherrywood Village Retirement Community in Portland, OR last week.

Never underestimate the value of a first impression.  As I drove up to the Village Center, around the 18 hole putting green and the  beautifully landscaped walking paths, I was looking forward with anticipation to what was inside.

A Village Center it was… with happy people visiting in the village cafe, some just wrapping up their daily work-out in the fitness center,  visiting and (I’m guessing) planning the rest of their day.  Would it be a trip to the in house movie theater, soda shop, art studio, enjoying some quiet time in the library or getting ready for the Irish dancers who would be performing that evening?

Vitality = Happy People

My first impression was that this was a happy place filled with happy people.  Residents mingled with staff as if they were family.   The Village Center was vibrant, inviting and a definitely a place that celebrated the excitement of living.

Vitality didn’t stop at the Village Center.  Their Parkview Memory Care is transformational.   The well designed “village concept” integrated a Snoezelen room, chapel, movie theater, always-open diner, and the absolutely awesome real 1951 Plymouth Cranbrook for residents to actually sit in and take care of in Wally’s Garage.    Imagine their residents actually getting to ride in this lovingly restored auto?  Residents were taking care of life like babies, fully engaging with attentive staff.  I can only imagine how overjoyed their families are to have their loved ones in such a vibrant community where, despite living with dementia, their mom, dad or spouse are still living a life of joy and purpose. That’s vitality!

While I was there, I learned more about the nationally recognized Generations community founded by Wendell White.  Mr. White grew up caring for the elderly, so his passion and vision for creating a place for seniors to live fully was learned at an early age. Now the White children are leading the organization in carrying out the vision their father has established.

Generations has an envious high employee longevity.  Their relationship-based management practices speaks volumes of their respect and investment in each and every employee, whom after talking with them, say “this is an incredible place to work.. they really value us.”

Here are Generations’ core values:

  • world class excellence for the residents and employees they serve
  • create environments that enhance lives
  • celebrate the excitement of living
  • excellence in the stewardship of our communities
  • honore the goals and missions of our campus partners

This company lives their values.  They do the right things for the right reasons for their residents, employees, and the communities  they serve.

Is it a winning model?  You bet it is!





You Know What They Say About the Weather…Wait Five Minutes

Dramatic Image of Scruffy Man Freezing in Cold Weather

At least that’s what they say here in Texas, when it’s 80 degrees one day, and hitting the freezing mark the same night.  We’ve barely had a winter to speak of this year, so my recent trip to experience the Boston blizzard was an adventure and a treat.  So what does the weather have to do with aging and dementia you ask?

Yikes –  I think it’s a great analogy!  Have you walked the floors of a Memory Care Community lately?  The sun is shining and people are happy.  But wait 5 minutes… maybe 5 seconds… and the weather  can all change.  The blizzard can move in quickly and chaos panic and disorder can soon be the order of the day.   Time for deep breathing and some quick meditation.    Person centered care… what’s that?!

I love the term  PERSON-CENTERED THINKING. That takes person-centered care to a whole new level.  To me, person-centered thinking implies that our first response, our actions, our thought process is focused on another’s well being.  When we have tools in our belt that allow us to respond to behavioral expression that look like rain, snow, blizzard or tornado – we’re ready.

Are we equipping our care partners in senior care with the right tools to weather the storms?  

I’m going to venture to guess that most of “us”, because we’re all in this together, could do a better job.  After all, there is always room to grow, right?  Innovation, creativity and the will to want to be better at what we do is a part of life.  We all want to be better equipped to weather the storms.

That blizzard that hit Boston a week ago was followed by a bright beautiful sunny day.  Everyone got back to work and life.   I was able to do what I had travelled there to do (training), flew home the next day….

…and the storm hit again!

For information on the University of Minnesota’s Person-Centered Thinking program:





Person Centered Care: The Art of Authentic Listening

Authentic listening leads to empathetic, person centered careWith today’s emphasis on person centered care, communication skills are essential. Any senior care or hospice professional regularly interacts with people with communication challenges stemming from brain injury, stroke, hearing loss; Parkinson’s disease or Alzheimer’s disease.

If we were to take an honest look at how we normally listen we would see something like this:  We appear attentive and listening to the words the other person is saying.  We may be distracted by our thoughts about what we are hearing while already forming our response.  Or we may be having little (or big) judgments about what is said.  Most of the time we are more involved with our own experience than that of the other person.

Develop the Qualities of Authentic Listening

Listening from the heart requires self awareness and a willingness to expand your comfort zone.   Intend to listen more authentically. Here are some tips for how to become an authentic listener.

  1. First of all, quiet your mind. Our minds are in constant motion due to distractions that compete for our attention. Quiet the mental chatter and open a space for deep attentiveness.
  2. Listen without judgment. Judgment is reacting based on our own past experience. We react because our personal triggers get pushed resulting in judgment. Awareness of your triggers opens communication. Simply receive without judgement.
  3. Commit to patience. We live in a rushed world. We tend to move on to the next thing rather than attend to what is in front of us. True communication can’t be rushed. Be patient.
  4. Remain in the moment. Let each moment of the interaction unfold without trying to steer it a certain way or without preconceived ideas about where the conversation is going.
  5. Listen first, and then respond. Our tendency is to mentally form our response while the person is still talking. Focus first on what the person is conveying.
  6. Be honest. If you are unable to fully attend it’s better to say so than pretend you’re listening. When preoccupied, tell the person you care but you can’t give your full attention right now. This is acting with integrity.
  7. Listen with your eyes, rather than just  your ears. Observe the non-verbal message. What is body posture telling you? Is voice tone consistent with spoken words? What’s the facial expression saying?
  8. Be comfortable with silence because it leads  to powerful communication. Silence allows the heart to connect and builds trust and empathy.
  9. Lastly, receive the gifts of authentic listening. When you listen from the heart you enter into a mutual experience of giving and receiving. Let the experience uplift you.

Authentic listening is not about doing anything. Therefore no formulated response. No need to fix anything or to make the person feel better. But rather it’s about being with the other person while caring about his or her experience. In conclusion,  Rachel Naomi Remen tells us, “Listening is the oldest and perhaps the most powerful tool of healing. It is often through the quality of our listening rather than the wisdom of our words that we are able to effect the most profound changes on the people around us.”