Tag Archives: Person centered care

Personhood and it’s Value in Dementia Care

Quite simply, the definition of personhood is the quality or condition of being an individual person.  At the core of personhood is the self- who we are are, our values and beliefs.  It’s who makes us who we are.  Being able to recognize the “self” of personhood is key to understanding and practicing person-centered care for persons living with dementia.

Professor Thomas Kitwood was a pioneer in the philosophy of person-centered care from the University of Bradford in England and in the 1990s, connected the beliefs and values of person-centered care specifically to dementia care. His work and research gave voice and credence to the need to realign dementia care practices to a model oriented to the “personhood” of the individual living with dementia.  Although he passed away before his research was complete, his valuable work, and has been built upon throughout the world as the basis and model for providers of dementia care services, advocates and certainly the continued research on this topic.

Personhood doesn’t go away as dementia progresses.  The individual within is what makes up who we are.  In many ways, dementia does change one’s judgment, memory, sensory abilities, language, mood, and behaviors.  But what makes them who they are doesn’t change – it’s their personhood.  Unfortunately, too often our society, families and even professional caregivers treat someone living with dementia as if they have lost who they are.  When we ‘discount’ that person’s selfhood (or personhood), it alters how they think of themselves in the world, their relationships, security, and purpose.

Humans are born to relate, connect and bond.  These needs remain for a lifetime, yet far too often when someone has even mild dementia, others treat them as if those inner needs that keep them whole, are simply not important.  Sadly, those who are often the most vulnerable to this reaction are families.  The root cause of not respecting one’s personhood is often fear,  denial or the need to suddenly take control.  Losing one’s personhood robs them of the ability to hang on those basic human needs – to related, connect and bond.

Respecting one’s personhood in dementia care means that we must move into their world.  Join them where they are, in the moment, with no expectations other than to connect with the individual within.  When doing so, we are practicing person-centered care and their personhood.

Pam Brandon is President/Founder of AGE-u-cate Training Institute and a passionate advocate for older adults and their caregivers.  Pam is the creator of the internationally acclaimed Dementia Live awareness and training program and worked with recognized expert, Ann Catlin in developing the Compassionate Touch program.  

 

 

 

Are we Confusing Life Enrichment with Activities in Dementia Care?

What exactly is the meaning of Life Enrichment?  

Quite simply, Life Enrichment it is the act of bringing purpose and joy to persons living with memory loss. As dementia progresses, engaging in a life skill or routine task becomes increasingly challenging, and seniors need the support of someone who can adapt activities so they can still feel a sense of accomplishment, success and enjoyment.

How do Activities differ?

In senior care,  Activities are the entertainment, planned events, exercise classes etc. that are posted on weekly and monthly charts for anyone who is able to join in.

So, the question then is, are we too often confusing Life Enrichment with Activities?   

Too often, the answer is yes.  These are not the same, although they often intersect.  Person-centered or resident-centered care models must focus on the individual (life enrichment), as opposed to the whole (activities).    While activities are important to everyone living with dementia, those activities must bring purpose and joy to the individual, giving them a feeling of accomplishment.

When we fulfill the purpose, joy, accomplishment needs of an individual, we have a life enrichment model.  For each person, that may or may not coincide with the activities that are offered to all the residents.

Digging Deeper into Life Enrichment

The needs of persons living with dementia change, sometimes daily or even hourly.  Resident-centered care starts with understanding who they are now,  and their life story, allowing us to capture the who, what, why, when and how of their life.  Why is this so critical? Those long-ago snapshots allow us opportunities to engage with that person’s memories that are still intact.  Persons with Alzheimer’s disease and other forms of dementia will most likely retain those distant memories of their younger years while short-term memories fade.

When we take the time to dig deeper,  we discover the person they once were – and still are!  Let’s look at an example:

Kate came into memory care with mid-stage dementia.  She was listless and had no interest in taking part in the Activities that were offered daily.  On the surface, you would think Kate was depressed and had no interest at all.  After a life history assessment and talking with her family, the staff learned that Kate was a landscape architect, master gardener, and avid hiker!  No one would have guessed coming in that Kate had such an interesting career and such knowledge and passion for gardening.

What might life enrichment look like for Kate?  Spending time in the community’s outdoor garden, possibly taking part in garden activities with assistance, certainly photos of projects that she designed as a young architect would capture memories and spark conversation.  How about finding out where some of her hiking adventures were and finding  National Geographic and Travel shows that she might engage with?  Perhaps your community hasVirtual Reality programming in place.  There are tremendous products now that literally transform life experiences for persons with dementia. A memory basket of gardening items, tools that she used in her career and personal photos of her gardens, hiking adventures and certainly her projects could all be kept in a place where staff and families can access easily to engage in quality time together.

Kate may not find any interest in the Activities offered, but that doesn’t mean Life Enrichment has been sacrificed.  For Kate, what gives her purpose, joy, and feelings of accomplishment are not found in the activities area.  That’s okay!  We’ve found the sparks with Kate, and maybe our activities can incorporate some of her needs, but we are certainly not relying on our Activities program to provide Life Enrichment to her as an individual.

For more information on reminiscence training and other innovative dementia programs, please visit http://www.AGEucate.com

Pam Brandon is President/Founder of AGE-u-cate® Training Institute, the creator of the Dementia Live® simulation experience, and Flashback™️ Reminiscence Training.  She is a passionate advocate for aging adults and those who serve them.  Pam may be contacted at pam@AGEucate.com

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

Or

  • 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.  

http://www.AGEucate.com

 

 

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!

 

www.generationsllcwww.snoezelen.info