How to give the gift of giving

Forest meadow with orange flowers and fogThe DAWN Method is an approach that teaches caregivers to look for the emotional needs that lead to behaviors for people who have dementia. We teach caregivers to first recognize and meet their loved ones’ security needs, so they can feel safe even though they are confused, need others to care for them, and cannot manage their own moods. But we also teach caregivers to enhance their charge’s sense of well-being. One of the essential components of well-being is to feel valued — to have a role and be needed and appreciated in relationships. When dementia strikes, keeping this intact takes conscious effort on the caregiver’s part.

Being able to give gifts can be an important aspect in feeling a sense of value. So how can we help our loved ones who have dementia enjoy taking part in the holiday season? Eventually, as dementia progresses, the awareness of gift giving will diminish, but until it does we need to help them feel successful in expressions of love and generosity.

Make choosing gifts easier

When someone is losing memory and rational thought, keeping track of dates, names, and facts becomes increasingly difficult. We as caregivers should take care of these functions. You might begin by sitting down together and compiling a list of the people your loved one would like to give something to, then identifying what that would be for each person.

Reserve the actual purchasing for another day. Go shopping together, list in hand, and address one person at a time, checking off each name as you go. Treat finding each gift as a separate task that can be successfully completed. It will probably be best to tackle the list on more than one day.

We’ve found with our clients that selecting one gift for all the women and another for all the men makes the task easier to comprehend. One of our clients felt very successful and fulfilled by sending each woman in his large family a scarf and each man a sweater. We were careful to buy the gifts at a major department store and slipped gift tags into the boxes so the recipients could exchange them as they wished. Our client could never recall what he’d sent as gifts, but he benefited greatly from going through the process of selecting, purchasing, wrapping, and mailing each parcel to his widespread family, with his caregiver.

Be a teammate

This is another opportunity to help your loved one avoid the withdrawal into passivity that results from recurrent failure. Selecting and preparing gifts is a process, one that includes multiple steps and provides repeated opportunities for experiencing success.

So, our goal is not to have all the presents wrapped and ready to mail or distribute on time. It is to see our loved one or client enjoy each step along the way — to have experienced joy in selecting, wrapping, and sending gifts. If the parcels you manage to complete are sent late, but your loved one has experienced the endorphin rush that accompanies accomplishment, you have succeeded spectacularly.

Focus on one step at a time

Dementia truly is the time for measuring success in terms of how enjoyable a task is rather than its completion. When people are losing rational thought, they lose the ability to prioritize actions and information, as well as the ability to follow directions and multiple steps in a sequence. Always focus on the single step at hand.

When we think of the holiday season as a journey, rather than a series of events, we can discover moments of beauty all along the way.


When you must move someone who has dementia (Part 5)

Orange sunflower[Part Five of a Five-Part Series]

Having an escort changes isolation to inclusion in assisted living

Families often move loved ones into assisted living so they can enjoy more social interaction. As people grow older while living in their own homes, it becomes more difficult to get out. When dementia is part of the picture, that isolation is intensified. The obvious solution would seem to be a move into an assisted living facility, where there are people their own age and scheduled meals and activities.

But often people with dementia become further isolated after a move into assisted living. Why? Moving people with dementia takes away two very important tools that support their ability to function (see my blogs in early September on the value of mindlessness), so we want to ensure that moving them does produce the increased social involvement hoped for. To make sure it does, we need to keep two things in mind.

Introvert or extrovert?

It’s important to realize that most of us are more introverted than extroverted. Introverts tend to function better and feel more comfortable in one-on-one situations or on the edge of the room when in a group. Being put into a group and expected to take part can cause someone who is introverted to shut down and withdraw rather than join in.

Also, being in a group does not preclude loneliness. We often feel less lonely when alone but free to follow our own inclinations than when in a group or crowd. The extrovert may see an opportunity to join in and have fun, but the introvert needs accommodation to not become more separated.

So, if your loved one is more introverted than extroverted, think carefully about what types of activities allow individual interactions rather than group interactions and help him or her form friendships with other more introverted residents.

Notice or escort?

All assisted living facilities offer a notice service. You can pay for your loved one to be notified of meals, activities, and events. But keep in mind that what you are paying for is a staff member who will knock on the door and alert your loved one, nothing more.

Being notified of events is rarely sufficient for the person with dementia. Dementia takes away the ability to track time and the ability to plan – to bring to mind the one or two steps needed to attend. So, when someone with dementia is notified that lunch will be in ten minutes, s/he is not likely to be able to initiate using the bathroom, grabbing a sweater, heading down the hall to the dining room, and choosing a seat at a table.

Instead, ask the nursing director to build into your loved one’s care plan an escort to meals and selected activities. S/he will schedule a staff member to knock on the door and help your loved one get ready to attend, then walk with them to the activity. You should expect to pay for this service, for it takes scheduling and more staff time on the part of the facility.

When we move people with dementia into a care facility, we need to be careful to provide supports that enable them to truly enjoy the benefits we expect to be providing. This concludes my five-part discussion of how we can make moves easier on people with dementia.


When you must move someone who has dementia (Part 4)

Fall leaves with frost[Part Four of a Five-Part Series]

At DAWN, we believe in preserving dignity and autonomy and allowing people to age in place for as long as possible. However, it is not always feasible to keep someone who is experiencing dementia at home. Here are a few more tips about how to make a move from home into a care facility less distressing.

Develop security in others before the move

If your loved one has been living at home with dementia for some time, it is likely that his or her sense of security is met exclusively by family members and being in the home. All too often, as the ability to take part in conversations or succeed at errands and tasks falters, people become isolated. It’s not that anyone intends that this happen, it simply will occur unless someone is available who knows how to facilitate conversation and maintain connections for people experiencing memory loss and confusion.

Here at DAWN, we begin working with new clients by introducing a caregiver as a friend and companion to spend time with in the community. When a client is facing a move, this becomes especially important. As they spend time with us, our new clients learn that they are safe. They accept being with us in the car even though they can’t recall the way home because we always bring them back safely; they stop being afraid to meet people they can’t remember because we manage conversation for them and destigmatize memory loss; they run errands with us or eat out without fear because we chatter about what’s happening and what will happen next.

When the time comes to move from home into a facility, we continue our visits and outings so that our clients experience continuity and routine. With a sense of security that extends beyond just family members and the home, it is much easier for someone with dementia to acclimatize when a move becomes necessary.

Give the sense of your continued presence

Having dementia means losing the ability to learn new things, such as how to do a task or recognize new faces or names, but we don’t lose our ability to learn entirely. Because dementia doesn’t seem to affect the intuitive thought processes, people with dementia continue to learn from their experiences. Please understand that our loved ones don’t stop experiencing things just because they can’t recall or recount them.

This makes it very important that we spend time with people with dementia immediately after a move into a new home or care situation. If we don’t, they will associate the move with abandonment, something that is very difficult to unlearn.

During the first few weeks after a move, you want your loved one to learn that you will continue to be present in the new home and that when you’re not there, you’ll be returning soon. You don’t have to be there for every meal, but be there more often than not. Help your loved one find tablemates that s/he is comfortable with. Escort your loved one to activities and then make arrangements for the facility to continue to provide escorts when you are not there. Be ready to pay for the additional service.

If you are primarily present at first, when the new surroundings and routine are still strange and scary, your loved one will internalize the knowledge that you are still part of their life. There is no greater gift you can give to someone with dementia who is experiencing a move.