WALK A MILE IN THEIR SHOES

When caring for a person with dementia, it’s easy to focus on practical tasks and not have time to think about how the person is feeling. Understanding situations from their perspective can make you a better carer. Words: Christina Macdonald

One of the many struggles I used to have when caring for my mother was putting myself in her shoes. I would spend so much time focusing on things that needed to be done I would often forget how she must be feeling and whether or not I was handling situations appropriately. When you care for a person with dementia, you focus on practical tasks like washing, dressing and feeding the person. You want to make sure the person is wearing the right clothes so they are warm enough or not too hot, and that they are eating wholesome, nutritious meals. So you tend to become the ‘parent’ of the relationship and it’s not uncommon to end up instructing the person to ‘eat your dinner’ or ‘keep your coat on’ if they have reached a stage where their judgement has become impaired. You start to feel a bit bossy!

Slow down
Of course it’s important to focus on getting things done. However, it’s also important to avoid being too clinical about certain tasks and to show empathy where possible. This can be difficult, especially when you’re busy and juggling other aspects of your life while meeting the person’s needs. But if you can find a moment to slow down, be patient and carry out daily tasks with compassion, it will improve your relationship with the person with dementia and make them less likely to get angry or upset.

Each situation is unique of course, but I can give you a recent example from my own experience. My mother is no longer mobile and when she needs to use the bathroom, she has to be transferred from her armchair to a wheelchair. During the transition process, she gets upset and is often known to lash out at carers trying to lift her or encourage her to try and stand up.

Keep talking
Communication is key. If carers try to lift her without communicating what they are doing and why, she will naturally get angry. When you think about it, this makes perfect sense. She doesn’t understand why she needs to be moved to a wheelchair. She only understands that she’s being handled, lifted, assisted – call it what you will – by two carers, both of whom are invading her personal space. She feels violated and becomes angry. She also feels threatened. Her behaviour then becomes unpredictable.

However, with a little bit of communication, the outcome might be completely different. I recently watched mum lashing out at some less experienced carers who were trying to move her. I asked them to move away from her for a moment. Then I explained to mum what we were about to do and why. I said: ‘Mum, in order to take you to the toilet, we need to move you from the armchair to the wheelchair. Is it OK for us to do this?’

She nodded.

I continued to break it down for her. ‘To help you stand up, so that we can move you to the wheelchair, I need you to hold onto the walking frame. Is that OK?’

She nodded and put her hands on the frame.

I then continued to explain what we needed to do next and that the physical contact was necessary in order to help her stand up.

Again she was compliant. We gently helped her get to her feet. And transferred her to the wheelchair with no fuss. Breaking down tasks like this takes time and patience. But if it works, it can help avoid upset for everyone.

I’m no expert. I’ve just worked out what makes mum tick. If she understands why we need to do something, she’ll accept it – on some days. On other days, she’ll refuse. If she refuses, we’ll give her time and space to come round. When she’s calmed down, we’ll try again to transfer her. It’s about knowing the person well and putting yourself in their shoes. Barry Sweetbaum from SweetTree Home Care Services explained it to me brilliantly one day when he described a person with dementia’s possible perspective on personal care: ‘Most of the challenging situations occur because we create them,’ he told me. ‘If you walk into my house and we’re having a nice chat, but I don’t know you very well, and then you tell me to get undressed and get into the shower, I am not going to be very happy. We need to speak to person and ask what they would like.’

If you’re facing aggressive behaviour, then take a step back. Wait for a while. Give the person time and space. It might just do the trick.