The approach we currently use to care for people with dementia in the United States has a name. It’s called appropriate care. It hasn’t been very successful, though, for when we think of dementia care in America we think of people who are both difficult to take care of and unhappy, and their families and caregivers are exhausted.
We began using the appropriate care approach decades ago—back when the poor, elderly, and senile were cared for in poor houses and nursing homes. Appropriate care is really a general term that applies to any treatment in which the expected clinical benefits outweigh the expected negative side effects.
Today, in our care facilities, medical staff and aides typically use the appropriate care approach. Part of appropriate care is a technique called reality orientation. Staff members correct the residents’ confusion about what is true and real. People who have dementia are often confused about reality because they are losing their memory and their ability to use their rational thought processes.
Reality orientation, or the correction of someone’s confused beliefs, is what well-meaning family members and caregivers tend to use at home as well. It seems like the right thing to do because we believe in telling the truth. In America, we revere integrity. However, just as we do for children, whose cognitive development is limited, we need to make allowances for people who have dementia. We need to adjust what we say to allow for their growing cognitive impairment.
This is a very different approach, one that works far better. It’s called habilitative care.
When people have dementia, it changes their version of reality. They will never regain their memories or become better at using the rational thought functions they are losing. They often have problems differentiating between dreamed and real events, and soon lose the ability to track the passage of time. The result is that those experiencing dementia increasingly have their own personal versions of reality.
When caregivers demand that their charges accept the caregivers’ reality, the result is either fear or anger: they are fearful if the caregiver can convince them that their brains are giving them the wrong information, or angry if they cannot be convinced. This approach seems entirely nonsensical to me. Why would a caregiver want to cause someone with progressive cognitive impairment to be angry or afraid?
When we can accept the altered sense of reality that someone experiencing dementia cannot avoid developing, and make their experience of the world more comfortable, we are being kind. We are being habilitative. To be habilitative means to take responsibility for dealing with your loved one’s inability to comprehend reality and manage the environment so they can stay safe and comfortable.
The term to habilitate was coined by Joanne Koenig Coste and is described in her book Learning to Speak Alzheimer’s (she defines being habilitative as “to make capable”). The DAWN method provides a set of tools and techniques to put habilitative care into action at home.
The DAWN method enables any family member or caregiver to recognize and respond to the emotional needs and emotional distress caused by dementia. It’s the emotional distress that growing cognitive impairment causes that results in what we call dementia-related behaviors, the behaviors that make living with or working with people who have dementia so difficult.
Why do we go to the expense of locking up or medicating our loved ones rather than identifying and dealing with their emotional distress? Meeting someone’s emotional needs is so much more effective, a simple kindness. People really can be happier and more comfortable.
At DAWN, we are devoted to helping families and caregivers understand and provide habilitative care, using simple tools and techniques to help their loved ones develop a sense of security and peace in dementia.