One of the simplest and most effective analogies that I have ever heard used to describe dementia was that if you liken a person’s brain to a regular set of traffic lights – the average person processes thoughts in ‘green’ and ‘red,’ but living with dementia is like being stuck in ‘amber.’
Changes in the way that the brain works can result in major changes in the way that a person with dementia understands and delivers communication, leaving many important thoughts stuck somewhere between an idea, and a response within the mind.
As expected, living day-to-day life in a state that teeters between confusion and being lost in translation takes an enormous toll on a person’s emotional wellbeing which can often result in adverse physical and emotional occurrences that are often categorized as ‘behaviors.’
Caring for a person who is living with dementia requires a level of patience and understanding that goes far beyond anything that most people could fathom, but there has been talk recently that the majority of ‘behaviors’ in aged care settings are the result of poor communication and a lack of understanding between staff and their residents.
Gerontology Consultant and former aged care facility manager, Nicole Smith, made waves online recently stating that many experts believe that up to 85% of aged care residents “behaviors” could actually be responses to their living environment and the way that they are being treated by staff.
Nicole sat down with HelloCare and shared her thoughts on why she believes that the majority of negative reactions that we see from people living with dementia have more than our ability to understand them, rather than their ability to understand us.
“People in aged care environments are moved in at a time of their life when they have a reduced cognitive capacity, at an age where they might not handle change very well,” said Nicole.
“We then expect these people who have often been taken from the most familiar surroundings and trusted people in their lives and expect them to just fit in with what we do, rather than adapting to their cognitive state.”
Nicole believes that labeling certain resident actions as ‘behaviors’ removes any examination of the circumstances that potentially cause them, and that poor understanding and communication between an aged care staff members and people living with dementia are the most common cause of these reactions.
“Imagine being woken up at 4.30 am because you have soiled yourself and have a complete stranger trying to take your clothes off and give you a shower. This person has just woken up, they are often confused, they don’t know the person undressing them,” said Nicole.
“A poor reaction to this circumstance can get written up as a verbal refusal of care.”
“I’m not only speaking from an academic perspective because I worked in aged care for 14 years and I have seen all of this. I have worked it, I’ve lived it, and I’ve breathed it.”
“Unfortunately, the majority of these so-called ‘behaviors’ are caused by the way that staff is communicating, or not communicating with those that they care for.”
Lack Of Communication or Information?
One of the best assets that someone caring for a person with dementia has, is their ability to understand and adapt to that person’s needs.
Unfortunately though, developing this kind of understanding takes time, which is a resource that most staff do not have an abundance of.
Staff cutbacks within the aged care space are well documented, which is evidenced by the constant stream of speculation regarding mandated ratios.
Even though aged care staff is often pressured to perform their duties under extreme time restrictions, Nicole Smith believes that this is compounding the problem rather than the entire cause.
“Absolutely time plays a role, I’ve heard the statistics around 6 minutes to shower and dress a resident, but to be honest it is not just a factor of time,” said Nicole.
“If you don’t have a good culture within your workforce, and people with the right temperament who have been specifically trained in dementia, the chances are that you would still be seeing these reactions even if you had 20 minutes per individual in the morning.”
In her role as a manager of an aged care facility, Nicole incorporated regular staff duties into her daily routine as well as making the decision to spend two full days of each month on the floor with staff, performing regular duties like changing continence pads, mopping floors and assisting with feeding at mealtimes.
Actively participating in these duties gave Nicole a better understanding of the issues that her staff faced, but also allowed her to lead by example in terms of the type of communication and the way in which she interacted with residents.
According to Nicole, the lack of understanding can not be blamed on the staff themselves, as the circumstances that lead to poor care outcomes like dementia behaviors are actually a result of poor training and leadership from management within facilities.
“This is not the staff’s fault, facilities and management need to get engaged and get out on the floor to motivate and lead their team to provide the type of communication and care that they want,” said Nicole.
“Management need to be leaders, not bosses. They need to be engaging in culture change programs like the Butterfly Program, the Eden Alternative, and Montessori.”
“Unless you are actively engaged in a culture change program, prepared to spend money on education, and modeling the type of care that you want your staff to give – you can’t blame the people on $23.00 per hour for not giving the right care.”
“The foundations of caring for an elderly person starts with their training, and we need to train staff to care with compassion and empathy first and foremost, and then ensure that they have the knowledge required to do a great job”
“There should be no registered nurses working in aged care unless they have a postgraduate degree in dementia, or they are working towards one, and all PCA’s should have significant dementia training alongside their Certificate 3 and 4 credentials.”
“Carer’s are the pillars of every aged care facility, in fact, they should probably sit at the top of every organisational chart due to the impact that they have on the lives of residents.”
“It is absurd when you consider the number of people living with dementia in aged care, that there is no legislation that dementia training be a part of a PCA’s requirements.”
“We have to make this industry more esteemed to garner respect. And then we can reduce ageism and ensure elderly people are being treated the way in which they should be.”