In the early 2000s I was called into a meeting at work that lasted two hours but changed my professional perspective on dementia care.

At that meeting, our speaker was Naomi Feil. Mrs. Feil introduced herself by telling us her history. Born in Munich, Germany in 1932, her family immigrated to Cleveland in 1937 to escape the horrors of what Germany became and was becoming as WWII loomed. 

Her parents were the administrator and social worker at the “old age home” which became the pillar of the skilled nursing facility community that I was currently working in. The family lived in the facility, and Naomi spent her days and years with the elderly clients in their care. She grew up to become a social worker, and worked in the SNF where we were now meeting. In 1982, she wrote Validation: The Feil Method and my well-worn autographed copy is still part of my go-to treatment for those living with dementia. 

Validation therapy is a type of interactive cognitive therapy developed by Naomi Feil for use in older adults with cognitive disorders and dementia. It arose as a result of her experience as a young adult watching what she felt was the failure of reality orientation in this patient population. She developed validation therapy as a method of working with patients she described as severely disoriented. The basics are that caregivers should use a basic, empathetic attitude that respects and values those living with dementia, without judgment. 

For the first half of my career, when working with clients with dementia, we would re-orient them to their current surroundings and their current situation as a means of deterring dementia-related behaviors. One of my residents was looking for her father. “He’s coming to pick me up, and I have to wait here so I don’t miss him.” 

She was getting more agitated, and my reality orientation training told me that I had to tell her the date, ask her how old her father would be now, and get her to work through her delusion back to “reality”. When she realized that her father was dead, she began to mourn, and it wasn’t pleasant. “Do you mean my father is dead? How did I forget that? Did I go to his funeral? Where is my mother?” through tears and sobbing. 

Later that day she was back at the door waiting for her father. 

Why did I inflict this on her? How did my reality alter hers? I inflicted pain, and her reality didn’t change. 

Naomi Feil taught us to change our reality to match the client’s. The next time she was waiting for her father, I joined her and began to talk about him. “Is your dad a good dad? What’s his name? What does he do? While we’re waiting for your dad, let’s get some lunch and we can wait for him this afternoon.” 

The agitation stopped and she calmed down. The waiting and behavior resumed later that day, but validating her beliefs calmed her again. We kept repeating it as long as she needed it. 

You’re probably thinking that this is common sense so why are we talking about it? But as recently as last fall I heard a nurse yell from her seat at the nurses’ station to tell a resident that his kids are grown and he doesn’t need to get them from school. First of all, a disembodied voice yelling at you when you already don’t know where you are or who we are, has to be a nightmare. But telling him that his kids are grown when it’s not his reality and it’s not what he believes, causes an increase in agitation and behaviors. 

Imagine a voice telling you that you’re not who you are, and that you should sit down and be quiet. Twilight Zone, right?

Naomi Feil died on December 24, 2023 at the age of 91. Her work lives on and her legacy changed how we see ourselves and those with dementia in our care. If you want to see her in action, check out her YouTube videos. 

Try this one first: Naomi Feil’s interaction with Gladys Wilson will give you chills. Stepping into the reality of a non-verbal, eyes-closed, repetitive-motion resident broke open a gate and Mrs. Feil connected with Mrs. Wilson. It must be seen to be believed. 

Using the technique learned from Naomi Feil opened the gate for more than one of my clients over the years since I met her. She changed the way I treat dementia, the way I operate, and the way my staff operates. Knowing she’s no longer in the world was sad, but knowing who she was and what she did enriches everyone, especially those of us working with those who need us most. 

Jean Wendland Porter, PT, CCI, WCC, CKTP, CDP, TWD, is the regional director of therapy operations at Diversified Health Partners in Ohio.

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