Welcome to It’s my turn to care, we know the challenges you face caring for someone with dementia. That's why each week we bring you tips, strategies, and most of all, support as you navigate your role as caregiver. Let's get started [00:15.6]
Dave: Hello and welcome to, It’s my turn to care: Secrets for the Dementia Caregiver. My name's Dave Parks and I'm the owner of Home Care Assistance and we're located in the Northern part of Tarrant County in the great state of Texas. It's our goal to bring you tips, strategies, secrets, and the support you need as you care for someone suffering from dementia. I sincerely consider an honor and a privilege to host this podcast and bring you some of the most knowledgeable and insightful people in the industry. And case in point, our guest today, Janet Standifer, she's a certified dementia trainer and consultant. You may remember she was with us just recently and talked about the brain of Alzheimer's disease and some of the changes going on in the physical impacts it has on us. She's been certified through a positive approach to care, which is a Teepa Snow training program. And it's one of the best, if not the best training for those that want to help others that are caring for those suffering from dementia. She also is a speech language pathologist of 38 years and she's worked with neurological disorders including dementia and we're excited to have her on the show. Welcome Janet to the show. [01:46.6]
Janet: Thank you Dave. This is exciting. I'm, I'm really looking forward to sharing some information to all of you on how to effectively communicate with someone who is living with dementia. And this particular moment is someone living with Alzheimer's disease and I've had the pleasure of not only working with people who are living with dementia but with their families and the caregivers and provide education training to health care professionals in the community. So important that we know how to communicate.
Dave: Communication is just so important. Just in general, it's always feels like nine out of ten problems that we have in family or running a company or with friends or colleagues almost always come down to communication and that's between people who for the most part don't have these physical, neurological barriers to go over. So I think this is a great subject. So I'm excited to hear how you can help us with that. So, [02:55.8]
Janet: And I'd like to preface a lot of what I'm going to talk about today. We can use with any relationship.
Dave: Okay — good!
Dave: So that what it’s like with my wife, right? My wife — she can't understand me. Now, assuming for a second that maybe she has Alzheimer's disease, but any sort of spouse, wife, I mean a husband-wife situation. So if she can't understand me, how can I communicate with someone who's suffering from the disease? [03:27.5]
Janet: Okay. First and foremost, know that you may have to change the way you communicate every day.
Janet: Because what works today may not work tomorrow.
Janet: And you have to be flexible. So those are just a basic, you have to be a detective and you have to look at the whole situation because a lot of times what they're saying is not what they're meaning. And we'll dig a little bit deeper into that, right now.
Janet: I'm always an educator. I like to talk to people about why it's important to do some of the techniques that I've been taught through Teepa but also have learned through my years as a speech pathologist. So this information I presented is based on all those experiences. But the first thing it's very important to understand is that we all take in information. With all of our senses, our five senses, we learned as children what those are. [04:20.6]
It's vision and hearing and touching and smelling and tasting. Keep in mind that when we develop a person develops dementia, those senses start changing. And we have to recognize that because we have to change our communication now. The first and most powerful sensory input is our vision. So if you touch your eyeball, that is what you're going to need to depend on. As a person's dementia progresses they lose the ability to comprehend, but their visual skills stay intact. So people with dementia pay more attention to what they see than what they hear, especially as it progresses. So what are we doing wrong? As someone who is taking care of someone living with dementia? And I mean the whole scope we talk, we tend to talk too much.
Janet: The person with dementia is focusing more on how we look, remember that? And second what was saying to them and when we talked about the brain earlier in one of the earlier podcasts that talked about how the left side of the brain is changing, where that person cannot comprehend language like they used to. So they're going to depend on how you look and your tone of voice and where you are in space, where you are physically with them. Third one is no touching— until you've really established that they see you and they hear you. Because if you walk up to someone and touch them first before they know that you're even there, what could happen Dave? [05:53.4]
Dave: Well I guess they could physically respond in some way. It could startle them.
Dave: It could scare them.
Janet: Exactly! So now you've set up a situation where how are we going to get out of this one?
Janet: We've created a situation that was negative.
Janet: Dementia robs skill before it robs the strength. So there's one of the techniques we use and positive approach to care. And in my workshops we teach, this is called ‘the hand in your hand.’
Janet: And this is a form of communication, especially when someone cannot talk and you are going to allow them to be with you versus you doing to them. It connects you together. I mean unfortunately you can't see on the podcast how to do it, but essentially you're going to hold their hand and support their hand and use this to help them not only with connecting but with dressing and eating and all the other daily skills that they need to do. [06:51.1]
I know that really important aspect of communication is how you're going to physically approach them. Have you ever walked in the mall and someone just walks straight right in front of you and stop?
Janet: What would you do? What would your first instinct do when you didn't know that?
Dave: Paying attention. I get irritated and then I try to avoid them so, but if I'm not paying attention completely are, if I'm looking at my beautiful wife or something, then I'll probably run right into them. [07:22.0]
Janet: Exactly! And push them or push them away.
Dave: Right! Right.
Janet: And I see this more than not in it's unintentional and unknowingly, but someone coming behind, someone whose with dementia, in a wheelchair and they grabbed them around the back and they hug them and they singing out and they have a hand in their face and they are hit.
Janet: And now they're saying they're combative. We have to be careful because most of the time our approach is what's created a problem, a combative problem.
Janet: So you always, remember we talked about the five senses, you always want to first go in the front and know where their visual skills are. If they're in moderate stage of the Alzheimer's, most likely their binocular vision. You have to go straight in the middle. Make sure they see you, you raise your hand, you tell them your name. Now they look at you. You walk that six feet, you walk closer about three feet from them. [08:19.3]
Hold your hand out. If they hold their hand out to you, they are now welcoming you in their space. Now you can touch them. Now you are, they’re relaxed. Come around, sit on their side, get at their eye level and start talking to that person, compliment them, say something nice, and you've developed a wonderful rapport. You can even do this to your own mom, your own dad. Because if we startle them that they no longer have their senses to understand, “Oh, I hear a noise, let me look around and try to find them,” that's not going to happen.
Janet: You have to create an environment that they're open now to communicate in a positive way. [08:59.2]
Dave: So these sound like such simple things. And so this is such powerful information and it's not hard. It's just like you said, it's just different.
Janet: It is different. But if you think about it, we all of us like to know first who's talking to us, who are you?
Janet: I hear you, but who are you before we feel comfortable. And there are the basic fundamentals of any form of communication. And— no one likes to be taken by surprise, but when now you have brain changes happening, you no longer able to reason and rationalize what's happening around you. So you're going to remember that limit system we talked about in my other podcast, fight-or-flight syndrome.
Janet: If you got scared, you're going to do the first thing you’re either going to fight or you’re going to flight. When you tell me that about them all, I'm either going to run away or I'm going to stand there and defend myself. So it's extremely important you look at how you're touching them and how you physically approaching. [09:59.3]
So now let's say, Oh, we have a great, but now we're talking now when everything's fine and dandy, then all at once I say, “Mom, go get your sweater we are going outside” and she looks at me and says, “No! I'm not doing that. Quit treating me like a child.” Now what do we do?
Dave: Yeah. We see that happening.
Janet: First impulse to say, “I'm not treating you like a child, mom.” I just, you start explaining yourself.
Dave: Right. That's right.
Janet: Nope, can't do that. Some of the things I've learned through my training is get very good at using ‘I’m’ sorry’ in phrases. You somehow what you said unintentionally created that moment of uncomfortable in this, if I can use that term with mom. So you just look and say, “I'm sorry mom. I was trying to help” and leave it alone. Dont, explain. Don't say anything. “I'm sorry. I made you angry.” [10:53.8]
You be the person to stop right there in the track. So what happened? And another way to approach mom, instead of telling her what to do, remember she's your parent. You're not. You're her daughter. So she's going to try to hold on to that control. And you need to respect that. Say, “Mom, I love to go outside. I love for you to come with me.” And most likely she's going to say, “Okay,” it's the way you asked. It's a way you deal with what you want. You have to change your verbiage and the way you approach her.
Dave: So let me tell you what I did with my mother and you tell me if I handled this correctly.
Dave: So she was suffering from dementia, both my parents were. So one night I was visiting her and she's a twin. She's an identical twin, and her sister's name is Frankie. So Frankie lives in Virginia. My mother lives when, when she was alive, she was in Atlanta, Georgia. So she insisted that Frankie was coming to visit her that night and she wanted to go look for her. So instead of arguing that there was no way Frankie was coming to visit. [12:07.1]
Janet: Well, right, right.
Dave: Instead of arguing that, I said, okay, let's go look for her. And I knew that after a while she would get tired and she would give up. So we must have walked around. She was in a memory care unit, so we must have walked around about 20 times before she got tired.
Janet: Well, she got exercise too.
Dave: Yeah, exercise and then she finally got tired and then she dropped it.
Dave: So is that the right way to handle that type of situation? [12:33.8]
Janet: Yes. There are so many different ways to handle a situation like that and that’s definitely one of the better ways. You respected what she said and you followed through what she wanted and it all worked out. And you can always say, you know another thing, the way would be, “You know what? I think she's working right now. We'll have to call after she's finished working.” There's so many different ways.
Dave: Oh sure. Yeah.
Janet: I've had responses. Well, that's mine. I said, no. What you're doing is getting in to their reality.
Janet: You're making them comfortable. That's what we have to do. We have to understand. We have to put ourselves like in your mom's place. What would make her feel comfortable?
Janet: At that point in time? It’s the way of dealing with it. [13:17.6]
Dave: Yeah, so a lot of issues are that people really, the loved one, the one that's caring for someone with dementia, the daughter, the son, the brother, the husband, the friend, they start to realize, well, maybe they don't remember who I am. Can you talk about that a little bit? So does the mother, let's say the mother's the one suffering from Alzheimer's in this example, and the daughter goes and sees her as often as she can. Maybe it's every day. Maybe it's once a week, but she forgets her name. Does she still know that that's her daughter? [13:53.4]
Janet: He, that emotional memory is still there. She's knows. Let me read back up. She knows that she is someone that she feels comfortable around.
Dave: Okay— okay.
Janet: That she loves. She may not be able to put the label daughter on it.
Dave: I see.
Janet: But she recognizes that this is the person that I want to be around. Does that make sense?
Dave: Yeah, yeah.
Janet: Versus someone that she's had a really bad experience with, she will recognize that person I had a bad experience with.
Janet: Even though it may not know her name or the background she can, that emotional memory is still there.
Dave: So is it important, for someone to remind the person suffering that like when I'd see my Dad, is it appropriate to say, “Hey Dad,” you know, cause I was from out of town so “Hey Dad, it's Dave, I'm your son.”
Dave: I mean, is that appropriate? [14:48.24]
Janet: That's okay. Yes.
Janet: You just don't want to correct him. You know, if he says, “No you're not,” you let it be.
Janet: Does that make sense?
Dave: Yeah, yeah absolutely.
Janet: And if he still does accept that say, “Well dad, I just want to tell you I love you.” Just do not get into the argument again and he might remember you 15 minutes later
Janet: Which is a very, that happens more than not.
Dave: I hear this, I hear this a lot when I'm visiting folks, not so much if they're in their own home, but it's not exclusive to communities cause I do hear it some when they're in their own home. But sometimes in communities, you know they say they want to go home, but that is their home.
Dave: Right? So how should the caregiver react in those situations? [15:36.3]
Janet: Okay. This has so many meanings to it. I wish I could answer a black or white answer, but I'm want to give two scenarios. What we have to understand is there are a lot of unmet needs that we have to figure out. Home can mean, make be an unmet need. It may mean I don't feel comfortable here. I missed something familiar.
Janet: I'm unhappy, I'm hurting, I'm in pain. Just think about when we're home, how do we feel when we think about home?
Janet: How do you feel Dave when you think about home?
Dave: So I feel comfortable. I feel secure. I feel like I'm happier there. I don't feel anxious about, about stuff. I feel like I have more freedom. I can do more in my own home, then I might in public kinda thing. [16:30.5]
Janet: Exactly! So it could mean “I want to go home,” which means a place that they grew up when they were a little children.
Janet: It could mean “I want to go home,” tt means I'm not happy here. It could be up with. So we have to figure out what does that mean.
Janet: How do we approach it? And I've used this many times while we're trying to figure out what that means. Well let's talk about home. Do you live in a big house? Yes, I do. Well, what color is your room? And then we start talking about the house and then next thing I start talking about something that I can relate to. And next thing you know we are on another topic.
Janet: And sometimes that's all that needs to happen. It gets them off of that topic. But it allows us time to find out is there something more going on here than just wanting to go to a physical place? [17:21.6]
Dave: Right, right, right. So we're running a little low on time. So are there two or three things no matter what someone remembers that you would want to make sure they took away from the podcast today?
Janet: Okay. One is the is understand that as the Alzheimers progresses, we have to use more visual cues than speaking.
Dave: Right. Hmm…hmm.
Janet: Very, very polite. Lots of gestures and facial expressions, structure your loved one's environment where they're successful that they feel needed and comfortable and very familiar. Be respectful of who they are and what they are. You're not their parent, you're the person providing care. You are their partner.
Janet: And partners work together. You don't do to, you do with. The person living with dementia is generally reacting and not responding. So you have got to be the person to get control over the situation without them knowing that you are taking over control. Make sense? [18:33.2]
Dave: Yeah…..Well I wish we had more time and so if someone wanted to get in touch with you, Janet, for more information, how would they do that?
Janet: Okay. There are three different ways. One is direct contact with my phone number and that number is (817) 901-4658 I do have an email, it is HIPAA supported, that's firstname.lastname@example.org and I have a website and you can reach it through jstandiferconsulting or Dementia in Perspective in either one of those will allow you to get into my website and I have an email. You can actually email me from that website as well. [19:16.2]
Dave: Okay, great, so just want to remind folks that you can always get in touch with Home Care Assistance at (817) 349-7599. Our website is HomeCare AssistanceFortworth.com and our podcast has its own website called ItsmyTurntoCare. Thanks so much for listening and we will talk to you next week.
Janet: Thank you very much.
Dave: Thanks Janet. [19:44.5]
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