Teepa Snow

Dementia changes everything. This means that we need to change everything we do in order to keep everyone, residents and staff, safe and in a setting where they can shine. 

This also means organizations need to change their approach, from the bottom up and the top down. This type of culture change doesn’t happen overnight, but it is possible. One mind at a time. The first one that has to change is ours.  

Better dementia care training will lead to better care for residents and increased job satisfaction for employees. 

Why better dementia care training?

Dementia is extremely complex and changes every single care task. Most training programs, whether it’s a nursing school or a CNA program, will ensure students are able to provide standard care. Graduates will be able to dress a wound, check blood pressure and administer medication. 

However, when it comes to training about dementia, well, that is treated as a completely separate thing. Employees may watch a video, possibly even one of mine, but they aren’t asked to do anything, to adapt what they’ve been taught to be successful with a person living with dementia, or be coached on how they can improve. 

Dementia care training, really good dementia care training (not the type where the instructor just turns on a video and walks away), puts the focus of interactions on the relationship instead of the task. By focusing on the relationship first, communication is adapted so that both people are on the same page, consent is asked for and given in a way that is understood by both parties, and tasks are completed successfully on the first try. This, in turn, reduces the frequency of resistance and refusals, resulting in a better overall experience for staff and residents alike.

Unfortunately, many people think that dementia causes anger and aggression, but that is simply not the case. What actually happens is that most people, including care staff, don’t understand the changes in language, visual processing, sensory-motor skill, thinking ability and speed happening for the person living with dementia, and therefore don’t adjust their approach. Care staff try to get a task completed on someone who is unaware of what is happening or why. 

If someone were to try to do something to me on a private or intimate area of my body or my face without my permission, you better believe I’m going to react with something less than politeness! When this happens, a report needs to be written up and the person is labeled as combative. Everything changes for a person living with dementia, which means their care providers need to adapt as well.

 Quality dementia care training will: 

  1. Create an accurate awareness and understanding of dementia.
    • Dementia is an umbrella term covering more than 100 different forms of neurodegeneration.
    • Each type of dementia will affect different parts of the brain in a different order and possibly in a different way. Knowing which dementia a person is living with can help care staff recognize how best to support someone.
  2. Build knowledge of what will happen when dementia is present.
    • Dementia is progressive and ever-changing, so care staff need to know how to observe a person’s abilities in the moment and know how to adapt.
    • Having tools to help with identification and awareness of what skills remain throughout the progression will make a difference.
      • The GEMS State model, based on the Allen Cognitive Scale, helps people understand current abilities combined with cues and supports that can help.
  3. Teach hands-on skills supporting the knowledge and awareness gained.
    • Knowing something and doing something correctly are two different things. Quality dementia care training will help care staff with the what, why, and the how-to in a care setting.
    • I have developed the Snow Approach, a collection of hands-on skills, which has proven to be effective in reducing resistance and refusals, while improving relationships.

Why is this quality dementia care training different?

Since we were old enough to be aware, we understood that a doctor, nurse, or other healthcare worker was going to do something that we may not like, but it’s for our own good. We were aware of what was happening and why. 

For most people in long-term care settings, staff aren’t specifically trained to deliver care in a way that a person living with dementia understands or consents to. Staff are often told to “Watch out for him, he’ll hit you” by others who have already had that experience, without looking at their own actions as a trigger. 

When a person is living with dementia, it affects their awareness and interaction with their surroundings. Parts of their brain are failing, but other parts are still working. With a proper awareness and knowledge of what is happening for that person, and skills that support their current abilities, we can help them understand what is going to happen. 

With a better understanding of what dementia actually is, care staff are able to see residents as people first, not tasks (or even problems) to be dealt with. Given proper training and follow-up coaching, care staff can enter interactions expecting a pleasant experience, fewer refusals, less resistance and fewer reports — which lead to more time on the floor.

When the focus is on the relationship, and the care staff allows the person living with dementia to set the pace, everyone walks away happy.

Should we have dementia care training even if my facility doesn’t have a Memory Care unit?

Yes! There are two major reasons to invest in quality dementia care training, even if you don’t have a memory care unit or dementia specific area in your building:

  1. A study showed that a majority of older adults with probable dementia were unaware that they were living with the condition. Also, receiving a diagnosis isn’t as easy as it is for other conditions. Chances are, you have someone living with dementia in your building whether or not you are designated as such.
  1. When the focus of the training is building and preserving the relationship, the training goes beyond dementia. In addition to dementia, the Snow Approach has shown to be very successful when working with a neurodivergent audience. Respecting someone’s abilities and adapting our approach to their preferences creates a better experience for everyone.

Unintended consequences

As a society, we rely predominantly on verbal exchanges to relay information. Unfortunately, with dementia, those words often aren’t understood, as language comprehension is one of the first skills to be lost.

One of the things taught with the Snow Approach is adapting our communication techniques to match the strengths of our partner. Focusing on the relationship is not just about care staff working with people living with dementia, it is also about how staff interact with each other, how management interacts with staff, and how a relationship-focused environment permeates through the entire organization. 

Final thoughts

Word can spread very easily about a work environment. When employees enjoy their job and are happy to go to work, word gets around. The three biggest factors to make this happen are:

  • Setting your employees up for success with quality training
  • Developing skills through coaching and reflection 
  • Putting the focus on the relationship first, in every interaction 

When proper training and follow-up coaching are available in an environment that allows for trying new things, staff don’t see themselves as trying to survive the day, but rather, they will be thriving in something they are confident in and believe in.  

Teepa Snow is an occupational therapist with more than forty years of experience, and one of the world’s leading advocates and educators for anyone living with dementia or other forms of brain change. Her company, Positive Approach to Care (PAC), was founded in 2007 and is now collaborating to improve dementia care in more than thirty countries worldwide. Teepa is also is the author of the new book,  Understanding the Changing Brain: A Positive Approach to Dementia Care

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.