(music)
Narrator: Caring for Veterans with dementia can be both rewarding and challenging.
The VA has developed this training program to help you adopt a more positive approach
to address Veterans with dementia. In the following scenarios you will first see a
counterproductive way of approaching a Veteran followed by the preferred
positive approach of engaging the Veteran and addressing challenging
behaviors. By learning these positive skills and techniques you will not only
experience better outcomes, you will honor Veterans in the twilight years of
their lives.
(music)
Angela: You haven't changed yet?
Oh boy, it looks like we got work to do.
Let me get some things to pretty you up.
Okay now where to begin.
Mrs. Jones: No stop, no stop! That hurts!
Angela: I'm just brushing your hair. No big deal.
Mrs. Jones: That hurts! Ow! No!
(music)
Angela: Hello Mrs. Jones!
I'm Angela.
Looks like you're ready to get your day started.
Mrs. Jones, would you like to fix
your hair and put on some makeup?
Mrs. Jones: Okay
Angela: Great! Let's just walk over here so we
can find your hairbrush.
Here's your hairbrush.
Some lipstick.
What would you like to do first?
Do you want to brush your hair?
Mrs. Jones: Yeah
Angela: I like how you're fixing your hair it looks real nice.
What's next?
The color looks good.
What would you like to do next?
Sure, you can add a little blush. That will add a nice color.
(music)
Narrator: Grooming tasks can turn into a major hassle or be a source of pleasure for Veterans.
Approach and cueing make a big difference.
Systematic cueing involves giving step-by-step cues, increasing assistance
as needed based on the Veterans response.
See how the staff member begins with
visual and verbal cues and then only when necessary employs tactile cues.
Visual cues are typically easier to process than verbal cues.
Angela also uses hand under hand to get the Veteran's attention and guide her to a place that
is more familiar for grooming, such as a mirror and sink.
Notice how the staff member uses hand under hand for grooming tasks as well.
It allows the Veteran to be more engaged and lets the staff member know early if
there's a problem.
Giving positive feedback to the Veteran's choices also
keeps Mrs. Jones engrossed in the process.
(music)
John: Morning Mr. Hughes! Time to get ready for the day.
Need to get dressed for breakfast right? eggs and sausage this morning. Mmm...
Let's see what we got in your closet.
This will work don't you think Mr. Hughes?
Mr. Hughes: No. Stop!
John: Hey, come on I need you to settle down now.
Mr. Hughes: Stop!
John: You want to get dressed don't you?
Mr. Hughes: No!
John: Stop fighting me.
Mr. Hughes: Stop! Stop! Stop!
(music)
(knock on door)
John: Morning Mr. Hughes!
Oh, I forgot you prefer Willie.
I'm John.
Mr. Hughes: Hi.
John: I'll be helping you today.
I see you're already awake.
Great!
Can I help you with anything before breakfast?
Mr. Hughes: No.
John: Maybe we can start with changing your clothes.
Let me help you up.
There we go.
Good Willie.
All right, almost there.
Let's see what you have to wear.
Which shirt do you like? You want this one or this one?
Mr. Hughes: This one.
John: Which pants? This one or this one?
Mr. Hughes: This one.
John: Nice choice.
Ah.
What's next?
Let me help you take off your PJs. Let's start with your button.
Thank you for helping Willie.
Start with your right sleeve.
You're doing great.
It's hard with arthritis.
Okay.
Your right hand.
Good.
Thank you.
I like this shirt on you.
I really like the color.
There we go.
Good job Willie.
Mr. Hughes: Thank you
(music)
Narrator: This vignette demonstrates the value of the initial
approach as you engage with a Veteran.
As you saw in the first scene, John was not
able to establish much of a connection with the Veteran. Willie remained upset
throughout the interaction. In the preferred approach, John engages Willie
using the positive physical approach.
It's important to start some distance
away, maybe six feet. Lift your hand to your face like saying hi or hey.
Drop your hand as you approach keeping the palm open.
Pace yourself slowly.
Take about a step per second so you don't startle the Veteran.
Stay to the side of the person at arm's length
and accept the person's handshake.
You also want to get down to the person's eye level without leaning in. Once you have made
the connection in a supportive stance, offered the minimum assistance needed.
In the preferred approach, John also uses fewer words because people with dementia
may have trouble processing verbal information.
He provides the Veteran with
simple choices and opportunities for the Veteran to participate in the activities
consistent with the Veteran's level of cognitive function.
John also uses the
Veteran's first name, Willie, instead of Mr. Hughes because the staff have
assessed that is how the Veteran prefers to be called, by his first name.
By following these steps you engage the Veteran, respect their choices, and
increase the chance of a positive outcome.
(music)
Angela: Hello Mrs. Jones. Look at you still haven't touched your food. Well let me
feed you some lunch.
Here we go just mixing it up.
Now, take a bite.
Yum. Isn't that good? Come on now you know you need to eat for strength.
Hey Jasmin. You must be done checking vital signs.
Looks like I'm gonna be late to the staff meeting.
I'm still with Mrs. Jones who is taking her sweet time with lunch.
Come on honey, hurry up!
(music)
Angela: Hello Mrs. Jones.
I'm Angela.
May I join you for lunch?
Lunch looks pretty good. We have soup, salad, chicken, and dessert.
What would you like first?
Let's try the soup first.
Will you pick up your spoon?
Were you trying to have some soup? Here it is.
Let's try together.
Looks like you enjoyed it. You ready for another sip?
Looks like we can keep going.
(music)
Narrator: Veterans with dementia retain more abilities than many may realize.
Your approach and nonverbal behaviors can make a big difference.
Because abilities can vary day to day, can vary day to day,
you should assess the Veteran with each encounter.
In the second scene, the staff member uses simple questions, directions, and
systematic cueing to figure out what level of support the Veteran needs.
Rather than simply feeding her, the hand-under-hand technique provides a
better eating experience as you help the Veteran become more engaged with eating.
Watch how well this hand under hand positioning works.
make sure to approach from the Veterans dominant side. Offer your hand palm up,
slide your thumb next to theirs and wrap your fingers under their wrist, then use
your fingers to grasp the spoon or other items. You may need to adapt for Veterans
with a hand deformity or dysfunction.
(music)
Mr. Hughes: Have you, have you seen my mother?
John: No, I don't believe I have.
Mr. Hughes: I need you to help me find my mother.
John: Remember, I told you I have not seen your mother.
I don't think she knows you're here.
Mr. Hughes: I need my mother!
You're not my mother!
Get away from me!
Where is my mother? I need my mama!
(music)
Mr. Hughes: Have you seen my mother?
I need my mother.
John: You look upset. Can I help you?
Mr. Hughes: I need my mother. Do you know what my mother is?
John: Let me come around so I can help you, okay?
Mr. Hughes: Yes.
John: How about we go look in your room, okay?
Okay.
It's alright, you're alright.
Here we are back in your room.
Do you have a photo of your mother so that I can see what she looks like?
Oh, I wonder if she's here?
Oh...
Mr. Hughes: This mama.
John: What a wonderful picture. You all look so happy.
Is this your mother?
Mr. Hughes: That's mama.
John: Look at that beautiful background.
All those flowers.
Thank you for showing me the photo Willie.
Mr. Hughes: Thank you.
John: Tell me, what are some things you enjoy doing with your mother.
Mr. Hughes: Oh, mama taught me how to play the piano.
John: Really?
Mr. Hughes. Yep.
John: Would you play a song for me?
Mr. Hughes: Oh, I'm not that good anymore.
I can't play.
John: I bet you're better than you say. Let's go the recreation room and
find a piano. I'd enjoy hearing you play.
Which way is the rec room again?
Mr. Hughes: This way.
John: Uh-huh. You're right. Let's head this way.
(music)
Narrator: In our first example, you saw how quickly a Veteran's distress can escalate and
become out of control. That's because Veterans with dementia
often cannot tell you exactly what is wrong, so it's best to follow these steps:
Show the Veteran you share their concern. You will need to do some detective work
to figure out the underlying problem and stay positive, send the message that you
can help. Also see how the staff member uses positive physical approach skills
and hand-under-hand technique to guide Mr. Hughes to a more familiar activity
that he thinks will reassure the Veteran.
These skills also allow the staff and Veteran to make a connection without confrontation.
Notice how John also engages the Veteran with positive verbal interactions as he works to redirect the
Veteran to a less distressing topic. The Veteran is able to enjoy family memories,
play the piano, and use abilities not yet affected by the dementia.
All of this turns what could be an argument into a more gratifying outcome.
(music)
Mr. Smith: We took a trip to DC and we toured inside the Capitol and the Lincoln Memorial.
All those museums downtown. Oh grandkids!
(laughing)
Oh they wore me out.
But it was a good trip. It was me and my family.
I never realized that Lincoln Memorial--
Gloria: Excuse me Mr. Smith, can you stop for a moment?
Mrs. King us having a difficult time. Jamal, I need some help here
What's wrong?
Are you angry?
Do you want to leave the room?
Jamal: Hey, how can I help?
Gloria: Just help me get her out.
Jamal: Yeah sure, no problem.
Mrs. King: No, let me go!
Gloria: We need more help here hurry! Call the charge nurse.
Jamal: Hey Ms. Robinson can you get out here please? We need help!
Gloria: Mrs. King, settle down. It's okay.
Jamal: Come on now you okay.
Mrs. King: Let go!
(music)
Mr. Smith: We took a trip to DC and we toured inside the capital and the Lincoln Memorial
All those museums downtown. Oh grandkids!
(laughing)
Oh, they wore me out.
But it was a good trip. It was me and my family.
I never realized that Lincoln Memorial--
Gloria: Excuse me. Mr. Smith, can we pause for a moment? Mrs. King is
having a difficult time.
Jamal?
Can you take over the group while I help another Veteran?
Jamal: Oh sure, no problem.
Hi guys!
Hey once things get settled we'll start again, okay?
Gloria: Would you move over one chair?
Are you upset?
What's bothering you?
Will you walk with me and tell me more?
Jamal: Now, where were we?
Mr. Smith: I was just telling them about the trip to DC. The Lincoln Memorial...
Gloria: Thank you for coming with me.
Is anything hurting you?
Um...maybe a snack is a good idea?
Would you like an apple or jello?
Oh, some fresh air sounds like a great idea.
Let me help with the door.
Why don't we sit there for a minute and we can have lunch?
Mrs. King: Okay.
Gloria: That was a good idea to come out today. It's such a nice day.
Mrs. King: Feels good here.
(music)
Narrator: Often Veterans who are distressed cannot tell you what is wrong.
You see how quickly distress can escalate when a Veteran is confronted or overwhelmed by stimulation.
It's best to attend to the distress away from the group.
If you find yourself in a group situation where a Veteran becomes distressed get help
so you can address the distressed Veteran in a one-on-one manner.
Then use the same techniques as shown in the previous scene.
Let the Veteran know you
share their concern, do some detective work to figure out the problem, and send
a message that you can help.
Notice how Gloria involves staff member
Jamal to lead the group while she attends to Mrs. King.
Without disrupting the group further she guides the Veteran away from the group so she can figure
out what is wrong.
At the same time she provides the Veteran an opportunity to
move away from an overly stimulating environment.
Gloria uses positive verbal interactions and acts on a series of hunches about
common unmet needs like pain or hunger until she picks up on the Veteran's cue
that she wants to go outside.
For Veterans in distress, use positive
physical approach and hand-under-hand technique.
These skills allow the Veteran
and staff member to make a connection, feel on the same side, and tuned in to
cues on what underlies the distress.
You turn a difficult group situation into a
positive outcome and provide our Veterans with excellent care.
(music)