Anna, an 86-year-old resident who lives in a memory care neighborhood, shows signs of stress as she paces back and forth in the hallway and in a loud shrill voice repeatedly calls out the name of her sister Jane, who lives hundreds of miles away. I observe Chris, a frontline caregiver, in the memory care neighborhood as the following events unfold, and I am grateful and inspired by his thoughtful response.
First, Chris gently calls Anna's name and asks if he may walk with her. Next, he tunes into her emotions by mirroring and matching her pace and the tone of her voice. Anna seems to relax a bit as they sit down together on the sofa in the living room. Chris makes genuine eye contact with Anna as he validates her feelings by asking her open questions about her sister, and he even asks a sensitive question: "What do you miss the most about your sister?" I can't hear Anna's response, but I notice that she begins to relax, her voice tone changes and isn't nearly as loud and harsh. In fact, as she finishes telling Chris a story about her sister, a few tears fall from her eyes as the corners of her mouth turn upward into a smile. I observe Chris as he excuses himself then quickly returns with a hairbrush in his hand. I hear him ask Anna if she would like to have her hair brushed and braided just the way her sister would brush her hair when they were young and shared stories. Anna nods yes and Chris begins to brush and braid her hair. Within minutes, Anna is relaxed with eyes closed as she hums a tune.
The approach that Chris used may not work 100 percent of the time, but it was a powerful and meaningful way to connect in that particular moment in time. Getting to know a person with memory loss enables us to discover their unmet need in order to know how to respond and is one of the keys to providing excellent memory care.
Time and time again, I am inspired and humbled by the caring and serving hearts of the frontline caregivers who work so carefully and closely with persons with memory loss. Thanks to their attitude of empathy, combined with their skillful methods of providing person-centered approaches in all they do, I have witnessed countless amazing outcomes such as the one described above.
I've been privileged to work among caring frontline team members in adult day settings, skilled nursing centers, memory care neighborhoods in assisted living communities, hospice and home care settings. The following elements indicate excellence in memory care and are a reason to celebrate the frontline staff who tirelessly works to improve the quality of life of persons with dementia.
1. Know how to enter the world of the person with memory loss. Caregivers don't use reality or expect the disoriented individual to live in the here and now. Just like Chris in the example above, they become time travelers who skillfully and seamlessly know how to enter the world and join the journey of the person with dementia. Rather than overusing redirection or telling therapeutic lies, they listen with empathy and validate the person's feelings knowing that those feelings are genuine and deserve to be heard and addressed.
2. Acknowledge that those with memory loss still have wisdom and are still capable of giving back. Instead of focusing on the losses, these caregivers always look for the strengths that remain. By showing their respect they bring dignity to the person with memory loss. They listen to their stories, reminisce about the past and always find hope for the future. They engage with the person with memory loss in enjoyable activities but also include activities that bring them meaning and purpose. I know of residents in assisted living memory care neighborhoods who are involved in ongoing community service projects such as making blankets for hospitals and homeless shelters, or dog biscuits which they donate to animal shelters. When the person with memory loss has the opportunity to still make a difference in the world through working on these volunteer projects, it gives them a sense of purpose, self-esteem and hopefulness.
3. Show genuine care and affection and a non-judgmental attitude. Persons with memory loss have emotional intelligence and can sense when someone genuinely cares. Frontline caregivers provide them with a sense of security which makes them feel more at home and at ease. There may be times when people with dementia may make comments or statements that can be negative or hurtful to the caregiver. Although it can be a difficult at times, these caregivers maintain a non-judgmental attitude, and always keep in mind that it is the disease talking, not the person, and they do their best to avoid taking those comments personally.
4. Pay attention to the details. The frontline caregiver is the first one to notice changes in condition such as a change in appetite, skin condition or general mood and cognition, and communicate them to the nurse or other medical practitioner so that appropriate actions can be taken.
5. Give family members and loved ones peace of mind. There is no doubt that family members depend and trust the frontline caregiver to provide the care their loved one with memory loss needs. They are often the first ones that families reach out to when they want to know about the details of their day. Family members can rest assured when their loved ones are being cared for by someone that truly knows their loved one's background as well as their unique needs and preferences.
Thanks to the caring hearts and serving spirits of dedicated frontline caregivers, individuals with memory loss can experience the best possible quality of life. Having a hand to hold and someone to listen can make all the difference in someone's day, especially when they are living moment to moment. So let's celebrate these caregivers today. Let them know the positive difference they make and how much they are appreciated!