Cueing People with Dementia: How to make it work
The other day, a friend of mine, who is an Aging Life Care Manager in Virginia, tagged me in a Facebook post about care staff in an assisted living community changing into pajamas to signal that it is time for bed. She wanted to know what my thoughts, as a Gerontologist and Dementia Expert, were on it. This type of solution is a step in the right direction, in both assisted living and home care settings, but there are some challenges with it as well. In order to execute such an idea correctly, it is important to look at a few factors. So, let’s break it down!
In Assisted Living Communities
Many people are living in assisted living communities. The care we provide in assisted living communities will naturally be different than in the home. There are different challenges but also different opportunities. So, when employing these types of cues, we need to consider a few major points.
Perception Vs. Reality
The reality is that these caregivers are hired to help the residents. They clock in at a certain time, clock out later. They go home. They do not live there.
The perception is what the residents see these caregivers as. Some will see them as friends, family, or roommates. Others may understand the reality of their role: they are hired to help.
If there are residents who know they’re hired to help, they may be frustrated or dismayed by the fact that someone they hired is now wearing pajamas around the home. Can you imagine if you had a plumber come over to fix an emergency and at 8pm he switched into his pajamas? You may check your watch and say “Wow. I guess it is bed time.” But then you will likely also ask him why he is in his pajamas walking around your home.
The size of the community
In a larger assisted living community where there may be 25-50+ residents, this may not work as well. While many communities make great efforts to create a more home-like environment, the perception still leans toward an institution with hired help and hierarchy. Therefore, this may not work as well.
In a smaller assisted living community, or a group home, this may work. Most of the meals are made in a kitchen in the heart of the house with many residents around. The caregivers are often working hand in hand with residents to cook, clean, etc. They may even eat with them. So, in this type of setting, an idea like putting pajamas on to signal it’s time for bed, could work.
With dementia, one’s circadian rhythm could be off. Therefore, they may be up at night or asleep during the day. Additionally, their past experiences may dictate their sleep-wake schedule. Some go to bed at 7pm while others go to bed at 10pm. A thorough assessment including a person’s life history can help us understand their schedule.
It would be hard to determine what time to begin putting pajamas on because some residents may prefer to go to bed later while others earlier.
Making it work in Assisted Living
It is possible that an idea like this could work. Here is how:
- Make an effort to understand the perception the residents have. You can individually assess for this by asking questions or by monitoring responses and words. Sometimes a resident may say “This is my friend” or others may say “My daughter pays you.” This will indicate their perception.
- Assess each resident thoroughly. This includes personality, mental health history, occupation, previous and current lifestyle preferences, etc. A simple life story or cognitive assessment won’t do the trick. You’ll need more detail.
- In a larger community, perhaps you can create smaller groups of residents. For instance, if there are 5 residents who perceive the caregivers as their roommates their assigned caregivers can change into their pajamas and have the majority of interaction with them. Or, maybe the night owls stay with those in plain clothing.
- Consider what other signals represent “bed time.” Perhaps it is a dimming of the lights, or soft music, lavender scents. For some, it may be an evening movie. Again, a thorough assessment may help with that.
In the home with In-home Care
Not everyone is living in a community, however. These same concepts can be applied to in-home care whether you’ve hired someone or you are providing the care yourself. A client of mine was refusing care from hired caregivers. After collecting behavioral logs and conducting several observations, I noticed that the caregiver was not included in activities such as: dancing, singing, reading, or meals.
Perception Vs. Reality
By not including the caregiver, they were perceived as an outsider. The husband of my client began including the caregiver in meal time which allowed my client to engage more, build trust, and perceive her as someone that was a part of her life.
The size of the home and rooms in the home
Like in assisted living, the size of the home matters. Not because of population or personalities so much, but more so for comfort. This same client was using a very small bathroom, and even though she needed assistance she refused it. When we began using a larger bathroom for care, she was more open to having assistance.
Having too many people in an environment can also be overwhelming for someone with dementia. If it is time for bed or meal time but there are several people at the home, this can be distracting and stimulating for someone with dementia.
It was a challenge at first, but my client’s husband really wanted her to participate in a lot of activities. When we conducted a personality history review, I found that my client was introverted. She engaged with others only when it was necessary for her children’s school activities but chose to read quietly n her free time. Therefore, forcing activities is not beneficial. By forcing activities, we can break down trust making it harder to connect and therefore, provide care.
Making it work in the home
There are several ways we can improve care in the home.
- Include any hired caregivers in the family events: meals, parties, grocery shopping, etc.
- Gradually introduce the caregiver so the person with dementia can shift their perception to someone who is trusted rather than an outsider.
- Consider the environment. Close quarters may be more intimidating while space can provide enough freedom while also providing security and support for personal care.
- Have a thorough assessment of the person with dementia to determine the best techniques.
- This assessment can also help us understand the cues that will indicate transitions to the person with dementia such as: meal time or bed time.
As with all dementia care, it should be person centered. There is no “one size fits all” and what worked for your neighbor’s loved one may not work for your loved one. If you’re not sure where to begin, schedule a phone consultation.