By Oran Aviv
This week many of us were horrified hearing about the care house in the UK, where police were called in and sprayed and tasered a 93 year old resident. Sadly after being hospitalized, the man died 3 weeks later.
This tragedy may have been prevented had the staff and police been trained in Validation or another way of communicating with people living with dementia so they could have understood the reason behind his behavior and acted accordingly.
We are reminded again of the importance of understanding the behavior of someone who is living with dementia.
Validation to Understand Behavior
Validation is a method developed by Naomi Feil to understand and communicate with people who are living with dementia. The Validation Method is based on
The Validation Theory
The Validation Empathetic Attitude
The Validation Techniques
There are eleven Validation Principles. Validation Principle #5 is:
“There is a REASON Behind the behavior of very old maloriented and disoriented people”
Nancy Brown explained this principle very well in our last webinar, How to Communicate Despite Memory Loss. that we need to first rule out a possible physical reason for the behavior.
For example perhaps the person is
· Hungry
· Tired
· Cold/hot
· Wet
· In pain
· Has a UTI, vitamin deficiency or other illness
If we rule out that there is not a physical reason for the behavior, then we can use Validation techniques to help us discover what the other person may be feeling. In this way we can try to understand what might be causing their behavior.
Most often there is a need that is not being fulfilled. For example we may understand that this person needs:
Even the most challenging behaviors are a form of communication - perhaps the only means they have to let us know something is wrong. Often there is a need that is not being fulfilled. For example we may understand that this person needs:
· To feel safe and secure
· To feel useful
· To feel loved
Once we discover the need behind the behavior, we can find ways to make the person feel safe, or useful or loved. It's all about accompanying our client where they are in the moment. With time and applying Validation techniques, the behavior will lessen or cease all together.
The Need for Training
The news this week from the UK was horrifying and sad.
A nursing home called in police because a resident was threatening staff with a knife. The “perpetrator” was 93-year-old Donald Burgess. He had dementia, was in a wheelchair and had one amputated leg due to diabetes.
Despite his condition, officers used pepper spray, tasered him and handcuffed him. Sadly Donald, who was hospitalized after this incident, died 3 weeks later.
Hopefully this will lead to mandatory training for officers to understand how to work with this vulnerable population, but my first reaction to this story was how did the staff not recognize this man’s needs that caused this situation to even happen.
I tried to find out if Donald was always an aggressive person, and found an article where his neighbors were interviewed after the tragedy and talked about the Donald they knew:
“He was a sweet, sociable person.”
After Donald’s wife died, his leg was amputated.
“But after his leg was amputated, he only came back for one night before he had to go to a nursing home.”
“He must have developed dementia after going into the care home because he was always fine when he was here. We liked him. He was a friendly old fellow. I think his wife’s death hit him very hard.”
So how did a sweet sociable man so quickly become a threat that needed police to intervene?
Think about what this poor man endured during such a short time: He lost his wife,
He lost his leg
and then he lost his home.
These losses would be devastating for everyone, but often an older person has more difficulty finding coping mechanisms to deal with losses. These losses could easily lead to depression, confusion, and cognitive decline.
I can imagine this man in his state believing that staff at the home were his enemies. In his mind he might blame them for taking him from his home. Since his home was a place where he could still feel his wife’s presence - he might also have felt they took his wife from him too. With this anger he might also have begun blaming the staff for everything even cutting off his leg!
Could it be that Donald was not threatening the staff, but in his mind was perhaps protecting himself, fearing that they may take more away from him? Sadly, if so, he may have been right.
Donald also didn't have any children who could share in his grief. What Donald needed was someone who cared. Someone who could listen to him and allow him to express his anger, his sadness, his frustration, and his fears.
If just one person had validated him regularly for a few minutes, I’m sure he would have felt differently knowing one person understood him and cared.
A Validation worker could have allowed this man to talk about his wife and reminisce about her and their time together. This may have helped him overcome his grief. Through Validation he could have expressed his anger at being taken from his home or could he could have told of his sadness or anger at losing his leg which made him lose his physical independence.
I am sure this situation could have been prevented because we now know how Validation has prevented escalation of violence when the person is understood.
There Is Better Care
In a recent blog post I shared the wonderful work going on in the Diakonissen Speyer Care Homes in Germany. In these homes people with dementia do not regress to a state of being nonverbal because they are validated by all of the staff at these homes.
Hedwig Neu, who is the head of Diakonissen Speyer, and a Master Validation Teacher, spoke at the Validation First World Congress about their facilities for people living with dementia.
Hedwig told about a situation where a resident at one of their care homes became violent and struck one of the members of the nursing staff.
The nursing staff were upset and felt the resident was too aggressive. The staff wanted a doctor to admit the resident to a psychiatric clinic and have him be put on medications.
Hedwig said “This would have been terrible.” I find it amazing that putting someone on medication is considered a failure at facilities that use Validation.
The Validation worker who worked with this man at this care home explained that this man had a great need of autonomy and self-determination and that the member of the nursing staff had approached the resident too quickly.
They discussed the situation with the staff and explained that they must approach this gentleman more slowly and observe well.
There was never another outburst of violence by this resident.
Vicki de Klerk who interviewed Hedwig Neu summarizes what happened.
“Something so simple, like how quickly you approach another human being can make a huge difference.”
Imagine if the staff at the nursing home in the UK had used Validation.
Embrace Silence
Sometimes the reason behind a behavior can be very simple.
Last week the staff at the Senior Day Center told me there was a new visitor who did not communicate at all. They thought this man did not understand what was going on in the activities at the center and suggested that he might do better in a different memory room with people who were less verbal.
I took this lovely gentleman to another room where it was quiet so we could talk. I was surprised to discover that not only was this man verbal, but he was very bright and witty.
All that this man needed was for someone to be quiet for long enough so that he could organize his thoughts and answer! Because he did not answer immediately, the staff thought he was non-verbal. They simply did not give him the time needed to reply.
It’s not easy for us to sit in silence. We tend to feel that we need to fill in silence with chatter. If someone is slow in answering, we often try to complete their thoughts for them.
Completing someone’s words is rude, especially for someone who is living with dementia who may need more time to register what has been said plus more time to organize what they would like to reply.
It is so important to be aware of sensory changes that happen with age and with dementia. By understanding these changes, you can adapt to make it easier for the person with dementia to understand and be more independent.
Don’t Assume
One of the mistakes we often make is to assume what the reason is behind a behavior, rather than be open to accepting other possibilities. Most of us want to find the reason quickly, but it is important to reset our default priorities from quickly finding an easy answer to giving ourselves more time to explore other reasons.
I have written about my pets before, including one of the examples in my blog post Is Old Age is an Illness? I’d like to share a more recent story about my dog Sandy to explain why we should never assume what is the reason behind a behavior.
Sandy, who just turned 15, had been having difficulty getting up from a sitting position, especially on a tile floor. Recently she regressed.
Sandy went from running freely in the fields to not being able to walk without falling. She lost control of one of her hind legs. Sadly, what had been just a muscle issue in her leg, became a neurological one after an acupuncture treatment that went wrong.
Medications, supplements, and physical therapy (and reflexology) have helped her. Today, two months later, Sandy can walk up to one kilometer without falling.
However, during her rehabilitation, Sandy had also developed a strange symptom of suddenly curving her body. She bent sideways from her right ear to her hip making walking even more difficult. The professionals felt this was also due to a nerve issue, just like the loss of control of her hind leg after the acupuncture treatment.
After several weeks of this strange nerve issue, I realized that Sandy was infested with fleas including the area behind her ear. Once we bathed her and got rid of the infestation, the side bending totally stopped..
That neurotic side bending movement may have been from Sandy trying to scratch her ear but couldn’t because she didn’t have control of her leg!
It’s important to always be open to other reasons and possibilities for behaviors and not assume it is due to a specific cause.
It is so easy to blame age, and illness or dementia in general for a behavior. Always put on your detective hat and check what might be other possible reasons when you explore the reason behind a behavior.
In summary -
Validation helps us understand the reason behind a behavior. Once we understand the reason, we can work to fulfill the need that causes a behavior. Training in Validation can help with communication and can even prevent difficult or dangerous behavior. Sometimes the reason behind the behavior may be very simple. Don't miss it and don't assume the reason. Be a detective and investigate what the reason may be. ---
Please contact us if you would like to arrange a Validation workshop or webinar for the staff at your facility: oran.handsondementia@gmail.com
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