By Vicki de Klerk-Rubin
I knock on Mrs. Fowler’s apartment door, knowing that she hates me. Well, not me but she hates that she needs help. Mrs. Fowler is 87 years old and what I would call, Maloriented. She’s oriented to time and place; she knows who I am (most of the time), but she is angry at getting older and dependent on others so she projects her anger onto me. She blames me for moving her good china teapot to the ‘wrong’ place. She sometimes accuses me of stealing money. I understand and can empathize with her inability to handle the fact that she can’t walk well anymore because her hips are so bad and she can’t have an operation because of her leaking heart valve. So, she sits at home, unable to walk, unable to go shopping, unable to care for her hygiene, unable to function as a ‘normal, useful person in society.’
This understanding helps me to feel empathy instead of upset or angry at her blaming. I breathe deeply, center myself, and gather my resources. When Mrs. Fowler opens the door, I make eye contact and with an ‘adult to adult’ voice tone say, “Good morning Mrs. Fowler. How are you today?”
Fowler: Not good, you’re here. (Turning and letting me enter the apartment)
Me: Ach, not good. It’s another busy body coming to your door! (Matching her voice tone and entering the apartment.)
Fowler: What do you want today from me?
Me: We made a plan last time. I was going to help you take a shower today.
Fowler: I already took a shower.
Me: Aha, you are on top of things! Well, tell me how things have been going for you?
Fowler: Terrible. I’m missing my good china teapot again. Someone’s been coming in here and hiding it.
Me: Where did you get that beautiful teapot Mrs. Fowler?
Fowler: My husband bought it for me for our 20th wedding anniversary. It was so expensive and I had wanted it for years. He knew just what I liked.
Me: He was a good man. How long has it been?
Fowler: (sadly) My goodness, he died a long time ago…maybe five years? (The reality is that he died 17 years ago, the day after she turned 70. She has declined since then.)
Me: What do you miss the most?
Fowler: He was a gentle man. He could put up with me (chuckling softly to herself). He looked after me.
Me: He looked after you. (matching her gentle voice tone)
Fowler: (turning and making eye contact with me) I know that you’re trying to help me.
Me: Yes, I would like to do that.
Fowler: Come on then, let’s do it together. (Marching towards the bathroom.)
The things that help me do my job AND build a trusting relationship with Mrs. Fowler are:
Take a breath, center and know I need to first build trust with her each time I work with her;
Make eye contact with her, without forcing it, make sure I am on eye level with her, not above;
Try to match her voice tone, honestly, without imitating in a false way;
Try to ask open questions rather than tell her what to do;
Do NOT confront her with ‘reality’ and instead flow with her.
The World Health Organization (WHO) estimates that 47.5 million people worldwide have dementia and that an additional 7.7 million new cases arise each year. Therefore, it is more important than ever that caregivers learn about the best evidence-based techniques when it comes to caring for loved ones experiencing Alzheimer’s disease and related dementias. The importance of effective communication, and the patience and empathy it requires, cannot be understated.
Vicki de Klerk-Rubin is a certified Validation Master Teacher, the Executive Director of the Validation Training Institute (VTI) and the daughter of Naomi Feil, the founder of the Validation method. Validation combines a humanistic theory, an empathetic, ‘person-centered’ attitude with verbal and non-verbal techniques which enhance communication with people who live with cognitive decline. VTI promotes the use of Validation throughout the world by supporting the 23 training centers and 430 Validation Teachers.