By Jim Gross, Executive Director, Ecumen in Owatonna
One of our memory care residents here at Ecumen in Owatonna often shifts from speaking English to speaking Dutch. It’s not all that unusual for dementia to transport people deep into their past to the native language that was spoken in their homes growing up.
What’s unusual in this case is that we are fortunate to have a staff member who speaks Dutch. By communicating in Dutch, she’s helped create a special connection with this person, which often has a calming effect when dementia-related behavioral issues arise. The therapeutic impact is so striking that we are ordering the Rosetta Stone program so others who work with this person can learn key phrases in Dutch and also make closer connections.
I was thinking about this last week when my colleagues and I were in a workshop led by Maria Reyes, one of Ecumen’s quality improvement nurses who has played an instrumental role in bringing holistic dementia care to Ecumen nursing homes and significantly lowering the use of antipsychotic medications. She led a session on adapting this approach, which we call Awakenings, beyond nursing homes to assisted living communities such as ours.
This story of our staff member and resident moving naturally from English to Dutch struck me as an elegant metaphor for what Awakenings is all about. The staff member was literally speaking the resident’s language but, more significantly, she was also speaking the “language of dementia” of this individual. Whether the communication is in English or Dutch or any other mother tongue, the language of Alzheimer’s and other dementias can be foreign and highly individualized. To give the best care, we have to learn each individual’s language that is deeply rooted in each individual’s past. Even if everything is in English, we still have to know the person to know the deeper meaning of what they are saying—if we expect to communicate in ways that truly connect and calm.
We are just beginning our Awakenings journey here at Ecumen in Owatonna, but based on our time with Maria, and hearing firsthand about the experiences of our colleagues at Ecumen Prairie Lodge in Brooklyn Center, who have helped numerous assisted living residents experience new calm, we’re very excited about the possibilities of helping transform America’s culture of Alzheimer’s care, whatever the residential setting.
While Awakenings started as a way to reduce antipsychotics, it’s mostly a human-to-human relational effort, rather than a “clinical” protocol. It’s about maximizing the ability that is within all of us as human beings, regardless of a diagnosis like dementia. It’s about learning the likes and dislikes of the people in our care and working to make deep, meaningful links that create those precious moments of connection that bring happiness.
During the training session, one of our nurses shared how she was taught in nursing school (not all that long ago) to routinely correct dementia patients. For example, when a person says, “I’m going to go to breakfast.” and it’s actually 2 p.m., the response would be something like: “No, it’s not time for breakfast, it’s 2 p.m. in the afternoon.” It’s a natural response that most people would give in this situation. But now we see how wrong that “teaching” was.
It’s very clear that when you participate in the reality of dementia residents, you have a much better chance of keeping them calm and focused. “Corrections” have the potential to agitate. Now our mantra is: if it’s 2 p.m. and a person wants breakfast, they get breakfast. If a female resident believes I’m her mother, well then, I’m her mother. Why stoke feelings of fright or anger? With a little retraining, it’s much easier and far more therapeutic for me to join the dementia resident’s world than try to force her to enter mine.
We are so looking forward to this Awakenings journey because we have a pretty good idea what the rewards will be. Caring for the person as an individual—not just providing care—profoundly touches the heart. It invokes deeply moving feelings--like the feeling when the resident was alone in her world speaking in Dutch and one day got an answer in Dutch.