1. Communication and Validation Strategies for Residents with Dementia Presented by HomeCare Rehab and Nursing LLC

2. Communication Overview of Abilities –Common problem is an increase in verbal conflicts as ability to communicate decreases; word finding problems and losing the thread of a story. –Decrease in ability to censor self leads to more blunt, direct, and socially inappropriate comments. –Argue to protect pride, act defensive and less cooperative; refuse often. –Reading to follow directions is not reliable. Copyright © 2003

3. Communication Strategies –Get inside visual field (2-4 feet in front). –Keep verbal directions clear and simple; avoid “conservational speech” while guiding patient through a task. –Allow time to respond before asking question again- ask again exactly the same way. –Limit choices and open ended questions: Don’t ask: “What do you want for breakfast?” Ask: “Would you like cereal or pancakes?” Copyright © 2003

4. Communication Strategies –DO NOT EVER ARGUE! –Memory books may be effective with training if the resident values it. –Can learn schedule of activities if caregivers consistently remind them to use it. –Communication board may be effective to make choices- no more than 2 to 4 options. –Don’t hang a sign to improve safety or orientation. Copyright © 2003

5. Communication Overview of Abilities –Can name familiar items, can state own name, can say “you and I” appropriately. –Can speak in short phrases. –Talks to self frequently. –Repeats self, asks questions over and over. –Phrases may have meaning only to the patient. Copyright © 2003

6. Communication Strategies Get in visual field before speaking or touching (14 inches in front). Avoid asking questions that require more than yes or no. Show a positive response to all communication attempts. Stop what you are doing and make eye contact. Lower the pitch of your voice. Copyright © 2003

7. Communication Strategies Use distraction to answer repetitive questions once you have determined there are no other needs. Reassure often. Responds best to demonstrated commands. Assume that the person understands everything you are saying- don’t talk about them, talk to them. Scolding or lecturing is highly inappropriate and ineffective. Copyright © 2003

8. Communication Overview of Abilities May speak incoherently but sing a full song without errors. Uses one or two random words to communicate. Able to say “no”. May be able to identify body parts when touched. Uses gestures to communicate until very late stages (claps, points, waves). Copyright © 2003

9. Communication Strategies Keep cues limited to 2 or 3. Get in visual field (less than 12 inches directly in front of patient). Use all senses to engage patient’s attention. Lower your voice. Copyright © 2003

10. Validation What is validation? 1.Letting the patient know that you accept and respect their feelings. 2.Standing in their shoes- empathy. 3.Making them feel important and intelligent. Copyright © 2003

11. Validation How do we validate a patient? 1.Match the intensity of their emotions with your response. 2.Do not lie or belittle, let them know you hear them. 3.Do not try to orient a confused or frustrated patient. 4.Take opportunity to redirect them if they offer- don’t come up with an unrelated distraction. Yes: “It sounds like your father was very caring.” No: “Your father is dead. Did you see the weather outside?” Copyright © 2003

12. Communication Absolute No No’s 1.No parenting, disciplining, scolding. 2.No baby talk. 3.No arguing. 4.No negative body language (disgust, frustration, boredom, impatience). 5.No talking about patients in front of patients. Copyright © 2003

13. Communication and Validation Strategies for Residents with Dementia Presented by Sue Paul, OTR/L

14. Communication Overview of Abilities –Common problem is an increase in verbal conflicts as ability to communicate decreases; word finding problems and losing the thread of a story. –Decrease in ability to censor self leads to more blunt, direct, and socially inappropriate comments. –Argue to protect pride, act defensive and less cooperative; refuse often. –Reading to follow directions is not reliable. Copyright © 2003

15. Communication Strategies –Get inside visual field (2-4 feet in front). –Keep verbal directions clear and simple; avoid “conservational speech” while guiding patient through a task. –Allow time to respond before asking question again- ask again exactly the same way. –Limit choices and open ended questions: Don’t ask: “What do you want for breakfast?” Ask: “Would you like cereal or pancakes?” Copyright © 2003

16. Communication Strategies –DO NOT EVER ARGUE! –Memory books may be effective with training if the resident values it. –Can learn schedule of activities if caregivers consistently remind them to use it. –Communication board may be effective to make choices- no more than 2 to 4 options. –Don’t hang a sign to improve safety or orientation. Copyright © 2003

17. Communication Overview of Abilities –Can name familiar items, can state own name, can say “you and I” appropriately. –Can speak in short phrases. –Talks to self frequently. –Repeats self, asks questions over and over. –Phrases may have meaning only to the patient. Copyright © 2003

18. Communication Strategies Get in visual field before speaking or touching (14 inches in front). Avoid asking questions that require more than yes or no. Show a positive response to all communication attempts. Stop what you are doing and make eye contact. Lower the pitch of your voice. Copyright © 2003

19. Communication Strategies Use distraction to answer repetitive questions once you have determined there are no other needs. Reassure often. Responds best to demonstrated commands. Assume that the person understands everything you are saying- don’t talk about them, talk to them. Scolding or lecturing is highly inappropriate and ineffective. Copyright © 2003

20. Communication Overview of Abilities May speak incoherently but sing a full song without errors. Uses one or two random words to communicate. Able to say “no”. May be able to identify body parts when touched. Uses gestures to communicate until very late stages (claps, points, waves). Copyright © 2003

21. Communication Strategies Keep cues limited to 2 or 3. Get in visual field (less than 12 inches directly in front of patient). Use all senses to engage patient’s attention. Lower your voice. Copyright © 2003

22. Validation What is validation? 1.Letting the patient know that you accept and respect their feelings. 2.Standing in their shoes- empathy. 3.Making them feel important and intelligent. Copyright © 2003

23. Validation How do we validate a patient? 1.Match the intensity of their emotions with your response. 2.Do not lie or belittle, let them know you hear them. 3.Do not try to orient a confused or frustrated patient. 4.Take opportunity to redirect them if they offer- don’t come up with an unrelated distraction. Yes: “It sounds like your father was very caring.” No: “Your father is dead. Did you see the weather outside?” Copyright © 2003

24. Communication Overview of Abilities –Common problem is an increase in verbal conflicts as ability to communicate decreases; word finding problems and losing the thread of a story. –Decrease in ability to censor self leads to more blunt, direct, and socially inappropriate comments. –Argue to protect pride, act defensive and less cooperative; refuse often. –Reading to follow directions is not reliable. Copyright © 2003

25. Communication Strategies –Get inside visual field (2-4 feet in front). –Keep verbal directions clear and simple; avoid “conservational speech” while guiding patient through a task. –Allow time to respond before asking question again- ask again exactly the same way. –Limit choices and open ended questions: Don’t ask: “What do you want for breakfast?” Ask: “Would you like cereal or pancakes?” Copyright © 2003

26. Communication Strategies –DO NOT EVER ARGUE! –Memory books may be effective with training if the resident values it. –Can learn schedule of activities if caregivers consistently remind them to use it. –Communication board may be effective to make choices- no more than 2 to 4 options. –Don’t hang a sign to improve safety or orientation. Copyright © 2003

27. Communication Overview of Abilities –Can name familiar items, can state own name, can say “you and I” appropriately. –Can speak in short phrases. –Talks to self frequently. –Repeats self, asks questions over and over. –Phrases may have meaning only to the patient. Copyright © 2003

28. Communication Strategies Get in visual field before speaking or touching (14 inches in front). Avoid asking questions that require more than yes or no. Show a positive response to all communication attempts. Stop what you are doing and make eye contact. Lower the pitch of your voice. Copyright © 2003

29. Communication Strategies Use distraction to answer repetitive questions once you have determined there are no other needs. Reassure often. Responds best to demonstrated commands. Assume that the person understands everything you are saying- don’t talk about them, talk to them. Scolding or lecturing is highly inappropriate and ineffective. Copyright © 2003

30. Communication Overview of Abilities May speak incoherently but sing a full song without errors. Uses one or two random words to communicate. Able to say “no”. May be able to identify body parts when touched. Uses gestures to communicate until very late stages (claps, points, waves). Copyright © 2003

31. Communication Strategies Keep cues limited to 2 or 3. Get in visual field (less than 12 inches directly in front of patient). Use all senses to engage patient’s attention. Lower your voice. Copyright © 2003

32. Validation What is validation? 1.Letting the patient know that you accept and respect their feelings. 2.Standing in their shoes- empathy. 3.Making them feel important and intelligent. Copyright © 2003

33. Validation How do we validate a patient? 1.Match the intensity of their emotions with your response. 2.Do not lie or belittle, let them know you hear them. 3.Do not try to orient a confused or frustrated patient. 4.Take opportunity to redirect them if they offer- don’t come up with an unrelated distraction. Yes: “It sounds like your father was very caring.” No: “Your father is dead. Did you see the weather outside?” Copyright © 2003

34. Communication Absolute No No’s 1.No parenting, disciplining, scolding. 2.No baby talk. 3.No arguing. 4.No negative body language (disgust, frustration, boredom, impatience). 5.No talking about patients in front of patients. Copyright © 2003