Why Skilled Care in Dementia Matters
“Skilled dementia care.” When you hear that phrase what does it mean to you? For me I thought I knew what skilled dementia care was until I went through my certifications in Teepa Snow’s Positive Approach to Care®. These certifications totally changed my world. The skills I learned were true “ah-ha’s” that answered so many questions that my previous trainings had not.
My name is Colleen Nolan and I am a certified speech-language pathologist with over 20 years of experience in my field. Prior to working in the dementia space, I worked in the pediatric space, most often within the disability and neurodivergent space. I worked within the world of Augmentative and Alternative Communication (AAC), which was a true passion as it illuminated the fact that, even if someone cannot communicate with you verbally, that does not mean that they do not have a desire to communicate. Communication and connection are innate human needs. I spent much of my early years fighting for children who could not communicate verbally, but who DID communicate and wanted to communicate. Who were often inadvertently “punished” for their communication attempts- be it a misunderstanding that their behaviors WERE communication, or that their AAC devices would be removed from them if they were interrupting class. This is a situation in which I would have to remind educators, that removing someone’s AAC device is the same as taping a child’s mouth shut. Just because we can remove and silence an AAC device does not mean it is appropriate.
OK- so I have gone off on a tangent here, but stay with me. I promise it is all related. Similar to my work with nonverbal children who often had to resort to behaviors to communicate, I was observing the same thing when I pivoted into the dementia space. Even if these individuals were still speaking, their brains were dying, so those language centers were no longer working the way they should, and, well, cue the “behaviors.” I myself knew deep down there was something more, but even I found myself completing misunderstanding, mislabeling, and inadvertently causing more harm. Because that’s the thing right? Most of us have no intention of causing harm, but we often do inadvertently due to our lack of knowledge, training and skill.
Now, being an SLP, I am used to having to take continuing education courses to maintain my licensure. Most are lectures that strictly involve learning, but no practicing or application of skill. With the Positive Approach to Care® certification courses, there are very few slides. Limited lecture. It involves ACTIVE learning and participation as well as skills training and PRACTICE. Hands-on, in the moment practice. Repeated practice. And when the in person training is complete- there is more PRACTICE at home. Videotaped. Reviewed with a mentor over a series of weeks before certification is received. How does that translate into my work with those living with dementia and their care partners? Using my knowledge and skill to educate and guide. To teach these same skills to others.
Let’s put it into a potential situation:
A care partner shares frustration regarding their loved one living with dementia, “She gets so agitated and angry with me. I go into her room to wake her up and she immediately starts screaming and yelling at me. I speak calmly and tell her to calm down while stroking her hair, telling her she is safe and that it’s alright and she hits me! I tell her ‘It’s me! It’s your daughter,’ and she says she doesn’t have a daughter and for me to get out of her house.”
Whew! That’s a tough one, right? When you read this do you think to yourself that this daughter is trying to cause harm? No. She clearly loves her mother and is doing the best she can. The missing link? Knowledge and SKILL. Let’s look at this again with the daughter having a level of knowledge and skill around brain change and how to adapt/adjust:
I knocked on mom’s door and called her name like you said. When she didn’t respond, I walked towards the bed and knelt down at arm’s distance and called her name again. When she didn’t respond, I placed my flat hand on her knee joint with some pressure. When her eyes opened I said, “Hey Alice. It’s Jane. I like your bedspread. That looks nice and warm.” (allow time for Alice to respond) “Alice, it’s time to get up (use gestures). Would you like help getting the covers off or do it on your own?”