APPROACHES          Three of us were sitting side-by-side, relaxing in easy chairs after lunch: my friend, who lives here in the memory care wing, flanked by me on one side and her visiting (and incidentally completely cognitively abled) husband on the other. The facility’s marketing person was giving a “tour” to a few people. As the group passed us, one of the visitors bent down in front of the husband and very sweetly said, “Hi, how are you?”     Her tone of voice clearly suggested that she thought the husband was an impaired resident as well. A little too sweet, condescending and demeaning. She meant well, trying to “connect” with a person she assumed to be disabled. Most of us have a tendency to change our tone to someone we perceive as being weak and vulnerable, forgetting that nobody wants to be pitied, as this tone would suggest.     Many of us have a hard time distinguishing between compassion and condescension. In group caregiving situations I often witness this kind of subtle condescension from both staff and visitors. (I’d like you to imagine yourself on the receiving end of cutesy tones and baby-talk.) * * *     As caregivers and family members we have a lot more control than most of us realize over situations and interactions with memory-impaired people. A person with Alzheimer’s typically will react rather than be proactive. As a rule of thumb there’s always a reason for the impaired person’s agitation, aggression, or other "difficult" behavior. In my experience, most of these problems come not from a person’s dementia or Alzheimer’s disease, but rather from what we do and how we act, as caregivers. Everyone one of us has a gamut of feelings, although Alzheimer’s people often cannot articulate theirs. When something is frustrating, disturbing, or scary, they may have no other way of expressing this than with agitation.     Care giving involves performing tedious routines on a daily basis. Under these circumstances it’s hard to remember that while these may be routines to us, to the demented person for whom we’re caring this may be a brand new and even frightening experience. For example if we’re caring for someone in a wheelchair we probably move it countless times during the day and it wouldn’t occur to us to warn the chair occupant. After all, she ought to be used to it. However, can you imagine how it feels to have “the rug” yanked out from under you? Try it sometime. Sit in a wheelchair and have someone move you without warning – it feels very insecure and I suspect a person never really gets used to it. So, please become accustomed to letting the person know what you’re going to do. Just a brief remark: “I need to move you, okay?” * * * APPROACHES - A PRIMER (Let’s assume you are caring for your mother.) Empathy. Your Mom needs reassurance from you in various ways that she’s safe, loved, and respected. When she does something that feels odd to you or she repeats the same question over and over again, she needs for you to remember that she has a brain disease (Alzheimer’s or another dementia,) and cannot help herself. I often hear people suggest that their loved one is “doing it on purpose to annoy me” – trust me! They are not! They don’t choose to forget or to be confused. It’s a disease. If you give her a chance, she’ll do her best. Patience. If Mom has a negative reaction and she gets anxious, confused, or agitated, try again in a calm gentle voice. It may help if you remove yourself from her line of sight and start over again, this time at half the pace. She may have felt under pressure; she needs more time to do anything and everything, whether it’s eating, changing clothes, or using the bathroom. For instance, I will routinely suggest a bathroom visit before taking my Alzheimer’s friend for a drive and of course we have to stop and chat with everyone we pass to let them know why we’re wearing coats and where we are going. Inevitably she’ll want to use the bathroom again in the last minute. So what would take you and me four minutes, may take forty-five minutes for my Alzheimer’s friend and me. I have become accustomed to allowing at least an hour extra for any excursion. There’s no such thing as a quick trip to the corner store. Everything is a major event and I choose to make it as positive as possible. A short drive to the doctor’s office will take us on a sight seeing tour past the Harley Davidson dealership and down a side street with lots of speed bumps, where we can exchange weird exclamations with each bump. Being of use: Your mother may be able to help out around the house. It’s likely to require extra patience on your part, because she may take three times as long, but having her involved in ADLs (Activities of Daily Living) can be enormously important to her wellbeing. The better she feels, the easier your life will be. Approach: Start by asking if she has time to help you with something. Throw in a remark about how good she is at whatever you’re wanting her help with. (But remember to keep it “real” and normal sounding. It’s very easy to sound patronizing when we praise someone.) Let her know: Keep Mom alerted to your actions with her, especially if you are about to do something that may disturb her equilibrium. After getting her attention, briefly tell her what you’ll be doing. If you’re starting a whole series of actions, mention only the immediate one. First you want to make sure to get her full attention. If she’s asleep, you want to avoid startling her. You can stroke or pat her arm and say, “Excuse me, Mom, sorry to wake you, but I’m going to be noisy” - Or whatever fits with what you need to do. Exception: The exception to this rule is when Mom has special problems with necessities, such as bathing or toileting, in which case you’ll still want to let her know what you’re doing, but you tell her step by step: “I need to move you.” Or “I need you to get up, okay?” and then: “We’re going to walk down this way.” You’re alerting without letting on what your ultimate goal is (= getting her into the shower or changing her brief.) Eye contact. Make sure you make eye contact before you say or do anything. You can usually tell that she’s with you and chances are good that she will hear you, especially when you need her cooperation with an action, such as moving her chair or wheelchair; straightening out blankets, pillows or bedding; putting on or removing a piece of clothing or shoes; buttoning something the person is wearing; performing a grooming action, such as combing hair or wiping hands. Diversions Situations: Mom may suddenly decide that she ‘needs to go home immediately, because her mother is waiting for her.’ or she suddenly gets agitated for no reason that’s apparent to you – or she insists that she has to go to the bank right now – or she insists that someone has stolen her furniture – You need a diversion quickly, because none of these situations is likely to be resolved with reasoning. Ideas for diversions: Asking for her help (folding clothes, sorting mail, holding something) Acknowledging and delaying: “I’d be glad to help you find your mom right after we’ve had lunch (or made the bed, finished the dishes, taken the trash out)” Singing one of her favorite songs Simple remarks work well with a finicky person: Oops, your hair is messy, shoestrings untied, you wanted to change your outfit, Or “ that reminds me: and then use one of her favorite jokes or funny lines (see below) Humor. Not only is laughter really good for your health, but laughter is crucial for anybody involved in care giving, whether giving or receiving. I recommend that you amass a collection of funnies. I use this material for the pure pleasure of it or as an instant diversion. Example: Mom is giving you a really hard time about her bath; you can break her train of thought by interjecting: “Good thing we’re not in Florida where it’s against the law to shower naked.” (from “Stupid Laws”) Web sources for funny quotations and stupid laws:             Dumb laws      Funny Quotations