Working as an occupational therapist with individuals with dementia is challenging when it comes to finding effective techniques for connecting with the client and enabling them to reach their maximum potential. So it was a pleasant surprise when I recently had the opportunity to partake in a Dementia Capable Care seminar with other therapists in my cluster. I was educated on effective communication, treatment planning and care techniques to bring out the best ability to function in persons with dementia, enabling me to create more rewarding and successful outcomes for my clients.
Shortly after I took the class, a client with dementia was referred to OT services due to her continual refusals of bathing and her aggression once she was in the shower. Although the case seemed challenging, I was eager to apply the new information and strategies that I had learned to my new case. Immediately, I wanted to discover the causes of the behavior. Was it that the resident was feeling frightened, vulnerable or cold? I knew that my skilled observation and my ability to build a strong rapport with the client were essential to finding the necessary information.
I spoke with the patient about family, friends, her current living environment, likes and dislikes, etc., to gain an understanding of her life story. I took this information, together with my knowledge of her Allen cognitive level, and began to devise a plan to reduce the triggers of the difficult behaviors. After skilled observation, assessment, communication and consultation with the resident, with members of the interdisciplinary team and with the patient’s CNAs, it appeared the negative behaviors were forming as a result of the patient having a lack of control, and her difficulty transitioning quickly to a new task. When the client was approached for a shower, there was a demand for immediate performance. Due to the client’s dementia, she had the belief that a shower was just taken the day before; she had no understanding of why it was required again. It also was observed that the client had no time to prepare for the shower, as the approach was too sudden. Because of her cognitive impairments, she required time to transition to the new task and benefited from context cues. In learning about her values and beliefs, it became clear that the client also was very modest in front of men and would deny any bathing task that would include the male gender.
Using what I knew about my client and the techniques learned in the Dementia Capable Care class, I began my approach with the critical step of rapport building, as gaining the client’s trust was critical. Our visits always started with a conversation about the day or how the client was doing, before any mention of a shower. The client was seen approximately an hour before the shower was to occur to give her a sense of preparation, and to decrease any feelings of anxiety due to being rushed.
During our visits, I consistently acknowledged the client’s concerns and took note of facial expressions and body language, offering a positive redirection if negative behaviors or actions began to occur. In addition, I visited the client even on days a shower was not required, so I would not be negatively correlated with a shower each time. We used a calendar as a visual aid, and I asked the client to select and mark down days and times at which she would be most comfortable taking a shower. She was given a choice of shower rooms, clothes and any other particulars she would prefer in order to make the environment pleasant.
The client responded well to these measures as well as to my positive attitude and smiling face. She even reported to me during one session, “Although I do not want to shower right now, I can’t say no to you,” as a result of us building a trusting, respectful relationship. The client’s false beliefs were not battled, but rather redirected to a positive action.
by Chantal Thomas, OT, Sonoma Healthcare Center, Sonoma, CA