Home > Caregivers, Strategies > Ten Commandments of Dementia Caregiving

Ten Commandments of Dementia Caregiving

Those wonderful people who have taken it upon themselves to care for someone with dementia, whether it be a professional caregiver or someone who looks after a friend or family member, often find themselves at a loss as to how to handle their charges.  There are all sorts of books and websites out there, and many of them provide helpful information, but when it boils down to it we are all individuals.  And what works for one person may or may not work for another.  This can leave caregivers tearing their hair out, at times, in their efforts to figure out how to address this or that problem that comes up.  There are a few basic principles, however, and knowing these will often be of great assistance.

1.  Being reasonable and logical will only create more problems than it solves.  If someone is acting in a way that doesn’t seem to make sense, our reaction is often to take time to explain why it is that he needs to change his behavior.  We often go to great lengths to try and make him understand the need for doing things the way we think they should be done.  But, more often than not, what usually ends up happening is that our loved one only gets more confused, or even agitated, because they no longer have the capacity to see things logically.  In this case, it’s often better just to state clearly and simply what needs to be done, or what will happen.

2.  Reality orientation can be just plain silly, sometimes.  After a certain stage, people with dementia tend to live in the here and now.  They tend to forget things like what day it is, or where they live, or that his mother is deceased.  And, in the long run, I’m not sure that’s really important.  I’ve worked in facilities where residents are drilled daily on what day and time it is, and what the name of the facility is.  But, what he really needs to be able to remember is how to get around in his immediate environment — how to find the bathroom, how to ask for help when he needs it, how to eat lunch when someone says it’s time to do so, and so on.  If he is looking for his mother, there’s no need to cause emotional turmoil by reminding him over and over again that his mother is dead.  Redirection is often the more effective means of dealing with such things.

3.  No one is a perfect caregiver.  There are going to be times when you make mistakes, or become emotionally frazzled.  But that doesn’t mean there is anything wrong with you, or that you aren’t fit for your job.  It just means you’re human.  Take a breath, give yourself some time to relax and take care of yourself, and resolve to do better next time.

4.  Sometimes a little white lie isn’t bad.  Here’s an example.  It’s not uncommon for persons with dementia, after a certain stage, to have misperceptions about their environment.  If it helps to let your mother continue to believe that she is a volunteer at the adult day care center, then there’s nothing particularly bad about that.  Eventually, she’ll get so used to going that she won’t question why.  And, too, if your father is reluctant to go to the doctor, perhaps you can just “coincidentally” drop by his office on the way to lunch.

5.  Bargaining doesn’t work.  In the early stages of the disease, it might help to leave lists for the person with dementia.  But there comes a point when the person’s memory just won’t allow them to benefit from such a thing.  And telling him, for example, that you can’t go for a walk with them right now but will when you get home from work won’t work.  Shortly after you tell him this, he’s going to have forgotten and will be pestering you to go for a walk again.  Here is where distraction or redirection does well.

6.  Doctors don’t really know it all.  You need to make it a point to tell the doctor about problem behaviors, or ask questions about how to handle symptoms.  Your doctor isn’t going to know, for example, that your father has been having trouble sleeping at night if you don’t mention it.  And, sometimes doctors need to get in on the matter of therapeutic lying as well.  For instance, it might work better to tell a person that the pill he is taking is for his memory, instead of an anti-depressant.

7.  You can’t do it all.  It’s alright to ask for help.  You need to have some respite time, and there are going to be tasks that you just can’t do by yourself, either logisitically or from a strength standpoint.  Be sure to have a support system ready, either through home health nurses or community volunteers.

8.  There are going to be times when you underestimate or overestimate what your loved one can do.  This is something that will come only with experience.  Sometimes it’s easier just to do something for your charge, but if you encourage him to do as much as he can by himself he will do better in the long run.  By the same token, don’t try to force him to do things that he is obviously having trouble with.  Knowing just how much assistance to provide is a slippery slope, and may vary from day to day.

9.  Tell, don’t ask.  Sometimes the person with dementia will lack decision-making ability, or he may lack the communication skills to express such things.  For instance, instead of asking what he wants for dinner, consider giving your father a couple of choices.  Too, think of when your children were little.  You probably didn’t ask, “Do you want to take a bath now?”  Instead you said, “Okay, let’s go take a bath.”

10. There are going to be times when you question that a person really does have dementia.  Especially in the early stages of the disease, there are going to be times when your loved one will appear to be perfectly lucid, without any problems.  It’s going to be easy to say, “Well, it was just a temporary lapse in memory.  He’s doing just fine now.”  But tomorrow, the same old problems may turn up again.  Some types of dementia are characterized by their inconsistency.

(Read the original article here.)

  1. December 29, 2012 at 8:15 AM

    Excellent advice. Thank you.

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