Current dementia care most often has “controlling (unpleasant) dementia behaviors” as its goal. 

But I would like to suggest that we can do better; that an approach of “managing the environment” is the right goal.  

Let me see if I can explain.

When our approach is that of controlling dementia behaviors, it puts us in a position of responding to the behaviors.  The problem here is that behaviors are not the problem in dementia.  Behaviors are the symptoms; emotional needs (caused by the cognitive skills that dementia takes away) are the problem.  

Which is why the right goal is meeting those emotional needs, which regularly extinguishes the need for folks to “have a behavior”.  It makes sense then, that the essence of good dementia care is managing the environment versus controlling dementia…or its behaviors.

Take my friend Chester, who has advanced dementia.  He can get really angry, really fast.  But because I know him, his life history, his family, and because I know how to use the tools of the DAWN Method, I understand that his anger is mostly an expression of his grief (over the skills he is losing), and of his frustration (at diminishing ability to do the things he used to do).  And because I have skillfully created a situation where he is comfortable in my care, I can allow him to express his anger (we all need the time and space to express our anger!).  After a bit of time of expressing his emotion, and me being a safe place to do that, his emotions settle, and we can do something else.  If I were to try to control his anger, I would end up very frustrated, and so would Chester.  I might get punched in the face.  But the problem would not be Chester’s behavior; it would be that I did not create an environment in which it was safe for him to feel and express his emotion.

I find this same pattern with nearly every one of my companions with dementia.  They need a dementia-safe place to express their emotions.  A place where they will not be judged or embarrassed when they say something that does not make complete sense.  A place that feels safe and feels comfortable; where they feel successful and where they have learned through experience that I am a trusted companion, that with me it is happy times.  

This is what good dementia care looks like: where we use skillful (but not rocket science so anyone can learn these skills!) tools to create an environment that meets the emotional needs, accommodates the cognitive losses, and helps our friends with dementia feel ok.  

It is simply not possible, nor fruitful, to control dementia behaviors.  It is, however, possible, and highly fruitful, if we manage the environment to help it become a safe place for folks losing so much.

This, then, is good dementia care: managing the environment to help it become a comfortable, successful, happy place for folks to be who they are with whatever skills they have or do not have.  

Funny; I think we would all like to live in a world like this.

Learning every day,

Jill

©Jill Couch