Dementia Care Insights:

“I want to go home.”

Q: What do I do when my loved one keeps saying they want to go home to be with their mom, even though they are home and their mom passed away years ago?

A: This is one of the hardest moments. You’re not alone in this. Even though the words are clear, the meaning underneath them may not be.

When someone living with dementia says they “want to go home,” they may not be talking about a physical place. They may be expressing a feeling- wanting comfort, safety, familiarity, or connection. The response that feels supportive will be different for every person. The key is knowing your person and understanding what might bring them a sense of comfort.

Start by gently reflecting what you hear: “Ah… you want to go home.” Then get curious: “Is there something about home you’re missing?”

If they can’t tell you more and simply repeat, “I just want to go home,” that’s okay. You can meet them where they are: “Got it. You just want to go home.”

From there, instead of trying to convince them that they are already home, try connecting with the feeling behind those words. What does “home” mean to them?

For some people, home might mean a favorite chair, a familiar song, a cup of coffee or tea, a certain routine, a meaningful object, or the feeling of being cared for. For example, if you know your loved one finds comfort in their afternoon tea routine, you might say:

“For me, when I get home, I like to make myself a warm cup of tea. Either English Breakfast or Chamomile. How about you?”

(Wait for their reply.)

Then you might continue: “Hmmm… talking about tea, I’m going to make myself a cup. You seem to know about making a good cup of tea. I could use your help.”

And within that shift in environment and focus, you can continue the interaction and connection focused around the familiar routine of afternoon tea, “Which mug would you like- (hold up 2 mugs) this one, or this one?”

You are not ignoring what they said.
You are listening for the feeling underneath the words.

And that’s often where connection begins. When we get curious about the true meaning behind the words.

Is it Normal Aging or Something Else?

It can feel overwhelming to know when to be concerned about changes in a loved one. When most people hear the word dementia, they immediately think “memory.” But here’s the important part: it’s not just about memory.

Changes in the brain can show up in many different ways—how someone communicates, navigates their day, or responds to the world around them. Understanding the difference between typical aging and something that may signal a deeper change can help you feel more grounded in what you’re noticing.

One of the trainings I lead focuses entirely on Normal vs. Not Normal Aging. Below are a few key distinctions to keep in mind:

What Can Be Part of Normal Aging:

• Occasionally forgetting a name or a word, but being able to describe it, with the word often coming back shortly after

• Mixing up the day, month, or even year, but recognizing the mistake and correcting it

• Making minor mistakes with everyday tasks (like forgetting to turn something on or off), but noticing and understanding the risk

• Misplacing items and feeling frustrated, but being able to retrace steps or ask for help to find them

• Getting turned around when driving somewhere new or in challenging conditions (like bad weather)

• Changes in visual field of about 20-30 degrees, beginning around age 75

What May Signal Something More:

• Difficulty following conversations or understanding directions

• Confusion about time, place, or year that doesn’t self-correct

• Noticeable changes in behavior, mood, or personality, such as lack of inhibition

• Placing items in unusual locations and not remembering doing so

• Getting lost when driving to familiar places

• Repeating the same stories or questions within a short period of time

• Inability to manage medications

• Significant word finding challenges, using nonsense words, or dropping words in speech (a, the, -ing, -ed)

• Motor or movement changes such as moments of “freezing” or difficulty initiating movement

• Experiencing hallucinations or delusions

If you’re noticing changes and wondering what they mean, you’re not alone. These moments can feel uncertain, but they are also an opportunity to pause, look a little closer, and get curious about what might be behind them.

If you have concerns, talk with your loved one’s doctor and bring specific examples of what you’ve been noticing. This can help guide the conversation and ensure the right next steps are considered.

Understanding the difference is not about jumping to conclusions—it’s about knowing when it may be helpful to take the next step.

-Colleen Nolan M.S., CCC-SLP, PAC CDT/L, CDP

Dementia- It’s more than loss. There is JOY!

A visual sometimes shared by Teepa Snow and the Positive Approach to Care® (PAC) community in trainings is a donut. Why? This donut is a reminder: in the world of brain change and dementia we often focus on the hole, what is lost, while forgetting to see all that remains.

When we look at the colorful whole of the donut what do we see? How does our perspective shift? For me, there is a whole lot of color, space. How about for you?

Scenario 1:

Someone living with Lewy Body Dementia who usually functions between an Amber and Ruby GEMS® state, but like all of us humans, her rhythms fluctuate. If you referenced many of the dementia rating scales typically used, she would likely be placed in the “later stages.” But this is where those labels can do us a disservice and cause us to miss meaningful moments.

Does this individual “make sense” in traditional terms of language and communication? No. But does she crave connection, relationship, and belonging? YES. So what does my time with her look like? Reflecting back her words. Meeting her where she is in how she is processing language in that moment. To an outsider, our “conversations” might make no sense at all. But if there were no sound, what you would see is smiling, laughter, ease-CONNECTION. JOY!

Scenario 2:

Someone living with Alzheimer’s type dementia who usually functions between a Diamond and Emerald GEMS® state, but again, this fluctuates (think of when you may not have gotten enough sleep or have not eaten in a while-what is your brain state like in those moments?). We all have rhythms and changing brain states throughout the day.

This individual struggles with word finding, sustained attention, and cognitive overload. During one of our sessions, upon my arrival she exclaimed, “I have an idea. Let’s make banana bread!” “YES!” I said. What happened from there? No notable word-finding challenges, the ability to sustain attention for over 30 minutes, dual tasking: mixing while having a conversation. Were there adaptations and supports? Yes. But was she able to make banana bread and experience purpose, connection, and joy? Also YES.

Something important for me (or anyone who supports this person) to know: she used to bake all the time. It was her love language. But given challenges with executive function (e.g., following a recipe) and short-term memory (e.g., “Did I put that ingredient in already?”), she has not baked in quite some time. This moment illustrated that with the right supports and a little patience, she could reconnect with something she loves, and in doing so, experience joy, purpose, and meaningful connection.

So, to circle back the to colorful donut- when we look at the whole donut, not just the hole, it opens us up to what remains and shifts the experience for everyone. It allows for the JOY!

PAC™disclaimer: PAC™ Certified Dementia Educators (PAC CDE/L) are not employees of Positive Approach, LLC. The opinions and views expressed by PAC™ Certified Dementia Educators (PAC CDE/L) do not necessarily reflect the opinions and views of Positive Approach, LLC or any of its employees. Positive Approach, LLC is not liable for any actions by PAC™ Certified Dementia Educators (PAC CDE/L)

Why Skilled Care in Dementia Matters

Skilled Dementia Care: What Does It Really Mean?

When you hear the phrase “skilled dementia care,” what comes to mind?

For me, I thought I knew exactly what it meant until I went through my certifications in Teepa Snow’s Positive Approach to Care® (PAC). Those trainings completely changed my perspective. The skills I learned weren’t just interesting, they were the kind of “ah-ha” moments that totally change you. Those moments where all the pieces truly start to fall into place. You can immediately relate them to situations you have encountered and see how you can use these new found skills going forward.

A Little About Me

My name is Colleen Nolan, and I’m a certified speech-language pathologist (SLP) with more than 20 years of experience. Before stepping into the dementia space, I worked primarily in pediatrics supporting children with disabilities and those who are neurodivergent.

When I made the shift to dementia care, I immediately noticed something familiar: many individuals who struggled to express themselves resorted to behaviors to communicate. Even those who could still speak were not always making sense because the parts of the brain responsible for language processing and speech were, well, dying. What often followed? Behaviors that many of us misinterpret. Moments of distress.

My message as an SLP has always been “all behavior is communication,” and I’ll be honest, I often misinterpreted too. Despite my background and training, there were moments I found myself misunderstanding, mislabeling, and sometimes even causing unintentional harm. Not because I didn’t care, but because I didn’t have the right tools.

That’s the thing, isn’t it? Most of us never set out to cause harm, but without the right knowledge, training, and skill, it can happen.

Why PAC™Training Was Different

Most of my past continuing education courses followed the same formula: hours-long lectures, slides, and theory. Rarely any practical skills training. PAC™ training was different.

It was active, hands-on, and practical.

• Minimal lecture, maximum practice.

• In-the-moment role play.

• Repetition and feedback.

• Real-life application with video review and mentoring before receiving certification.

This approach didn’t just give me knowledge, it built skills I could actually use in my work with people living with dementia and their care partners. And now, my goal is to pass those skills along to others because the current culture of care needs to shift.

Let’s Look at a Real-Life Example

Here’s an example of a common story I might hear from care partners:

“She gets so agitated and angry with me. I go into her room to wake her up and she immediately starts screaming. I speak calmly, stroke her hair, and tell her she’s safe, but she hits me! I tell her, ‘It’s me, your daughter,’ and she insists she doesn’t have a daughter and tells me to get out of her house.”

Oof! Can you relate? When you read this, do you think the daughter is trying to cause harm? Of course not. She loves her mom and is doing her best.

She has awareness that what she is doing isn’t working. But what’s missing? Knowledge and skill.

Same Scenario, More Skill

Here’s how that same moment might play out when the daughter has some training in PAC™:

“I knocked on mom’s door and called her name like you suggested. When she didn’t respond, I walked toward the bed, knelt down at arm’s distance, and called her name again. When she still didn’t respond, I placed my flat hand with gentle pressure on her knee joint. When her eyes opened, I said, ‘Hey Alice (pause). It’s Jane (pause). [pointing].’ I gave her a moment to acclimate. Then I pointed to the window: ‘Ooo, Alice (pause), it’s morning (pause).’ Next, I showed her the robe: ‘I got your robe (pause). Want to put it on? (pause) Or use the bathroom first?’”

Do you see the difference?
The daughter is now equipped with a process, a rhythm, and practical skills that honor her mom’s reality instead of colliding with it.

Why It Matters

That’s the heart of skilled dementia care. It’s not just about being calm, kind, or patient. Those things are important, but unfortunately they’re not enough. Skilled dementia care is about learning and practicing specific techniques that actually work with a changing brain.

And it matters across all situations: skilled care communities, hospitals, doctor visits. If everyone involved in the care of the person living with dementia has a basic level of skill in how to adapt and adjust interactions and communication; how to see behavior as communication of an unmet need; how to pause, reflect, the ripple effect would be unmistakable- less distress, more ease.

It’s about moving from frustration and conflict to connection and cooperation. It’s about putting relationship first.

And it’s about giving care partners the confidence that they can do this and they don’t have to do it alone.

PAC disclaimer:

PAC Certified Independent Trainers&Consultants are not employees of Positive Approach, LLC.

The opinions andviews expressed by PAC Certified Independent Trainers&Consultants do not necessarily reflect the opinions and views of Positive Approach, LLC or any of its employees.  Positive Approach, LLC is not liable for any actions by PAC Certified Independent Trainers&Consultants.