Strength-Based, Person-Centered Dementia Care

Dementia (and Alzheimer’s) is one of the most prevalent issues we face in the coming years. The DAWN Method^® is a kind, strength-based, person-centered approach to caring for those with dementia and Alzheimer’s. In this article we will cover what dementia is and who it affects, the stages of dementia, and then we will introduce the DAWN Method of strength-based, person-centered dementia care. Our goal is to help you understand dementia as well as give you an introduction to a method of dementia care that will decrease stress for caregivers as well as for those experiencing dementia.

The dementia epidemic

7.8 million Americans…

Dementia is not only one of the most expensive health issues American families face today, but also the most prevalent. As the baby boomer generation ages, the incidence of dementia and Alzheimer’s is skyrocketing. The expense of providing long-term care in facilities is bankrupting families and putting a huge strain on both Medicare and federal and state Medicaid budgets. A cure is still in the future, yet dementia is already at epidemic proportions in the United States.

According to the Alzheimer’s Association, it is estimated that 7.8 million Americans have dementia in 2020 (5.5 of those have Alzheimer’s). In the United States, the number of people who will need dementia care is expected to increase by 35 percent by 2030 and 110 percent by 2050.

The high cost of Alzheimer’s & dementia care

The Alzheimer’s Association estimates that dementia will cost the United States about $305 billion dollars in 2020. They project that an additional 16 million people will provide approximately 18.6 billion hours of unpaid care, worth about $244 billion.

In order to preserve Medicare and Medicaid, and avoid impoverishing a generation of families, we need a way to help families postpone the high cost of institutional care for as long as possible. The DAWN Method does that. Using the DAWN Method, families can keep their loved ones at home longer, and avoid the behaviors that make looking after them so stressful.

What is dementia and what causes dementia?

Dementia is a condition, not a disease. Dementia means memory loss and progressive cognitive impairment (including the inability to remember steps in a task and the inability to understand why something has happened). It is not a disease, although it can be the result of a number of diseases such as Parkinson’s, Alzheimer’s, alcoholism, and heart disease. People experiencing dementia are often unaware that they are impaired, and do not understand that they need help.

Meeting the emotional needs caused by dementia

Cognitive impairment causes distress, not only confusion. We shouldn’t be surprised that people with dementia have difficult behaviors. The DAWN Method gives families and caregivers a way to respond to behaviors and provide care that meets their loved ones’ emotional needs.

Using the DAWN Method, we can keep our loved ones at home longer. Staying at home longer means not only a higher quality of life, but also less expense—to families, to Medicare, and to Medicaid.

A summary of the stages of dementia

People experiencing Alzheimer’s or dementia will progress through distinguishable stages of dementia, regardless of the type of dementia they are experiencing—if you look at dementia from the perspective of changes in functioning rather than as a progression of disease. (See our stages of dementia page for more detail.) By altering our perspective, the dementia path becomes more recognizable. And when we provide just enough care rather than force too many changes too quickly, care is accepted more readily and the person is safer.

Stage 1: Independence

We all begin the journey that is dementia at the beginning—with a few noticeable changes in our abilities. Likely we are living independently, and we can perform daily tasks and entertain ourselves with little, if any, help. We do our best to hide our growing memory loss and confusion from those around us, for what we fear most is loss of privacy and autonomy. Family and friends are likely to hear comments such as: “Thank you for your offer of help, but I’m managing just fine on my own.”

Stage 2: Uncertainty

We enter the second stage when we find ourselves unable to do something we always could before, like making coffee or doing a load of laundry, and the bewilderment erodes our self confidence. You’ll know your loved one has entered this second stage when they begin asking “When will I see you again?” Their confusion and frustration is now increasing; they lose things and make simple mistakes in judgment; they miss appointments and have no memory of entire days. They will now be more amenable to your help.

Stage 3: Follow the leader

Eventually we lose the skills needed to retain information long enough to exercise choice. We may appear to have become more complacent and easygoing, but really we need more help from our companions. We say things such as: “I’ll just have what you’re having” or “Anything’s fine with me—you choose.” Now we cannot track time, reliably read clocks or calendars, or consistently perform simple self care tasks. It’s important that our companions help us make good decisions so we can retain a sense of autonomy, and that they watch for changes in weight, hygiene, and sanitation.

Stage 4: Clinginess, or clingy dementia

We become clingy when we have lost our rational thinking and memory skills to the point that we can no longer interpret what is happening around us and we no longer feel secure. If we have learned that our homes are safe, we may still live alone, but we tend to follow our primary caregiver from room to room or need constant reassurance, for we are living in the three-second now—trapped in the present without the past or future. Now we need help with even the simplest tasks and most people are strangers to us. Routine and consistency are critical, and knowing we are safe is essential to maintain our emotional well-being.

Stage 5: Overnight care

We can no longer be safe or feel safe overnight when our ability to understand what is happening around us is gone, hence our ability to recognize risk. We now need someone during the night if we wake and for all but an hour or two during the day—someone to lead us through tasks and find appropriate social and sensory stimulation for us. We still benefit from an hour or two alone to enjoy privacy and autonomy, but we have lost the ability to initiate activities to keep our brains active and engaged and sleep well.

Stage 6: Fulltime care

When we have lost the ability to understand the world around us, or recognize the people in our lives, we are in the final stage of dementia. We have not lost ourselves, however, nor are we lost to our loved ones, if they become our memory keepers and storytellers—if they tell us who they are, who we are, whom we love and who loves us with love rather than concern or sorrow. Because we cannot learn new things without rational thinking or memory skills, we do best with routine, consistency and a peaceful environment. However, we still need our loved ones and the sensory stimulation that is beautiful to us.

This is a summary of the stages of dementia I have watched my clients go through here at DAWN. (Again, to learn about each stage in more detail, see our detailed description of the stages of dementia.) They reflect changes in functioning rather than a progression of symptoms or pathology. When we watch for and respond to peoples’ changing ability to function and their emotional needs, customizing the level of care accordingly, they are more apt to accept care and less likely to put themselves at risk through resisting help.

What is strength-based, person-centered dementia care?

Here at the Dementia & Alzheimer’s Wellbeing Network (DAWN^®), we’ve discovered something really special. We’ve found that although our clients lose some cognitive skills, they never lose all their skills. In fact, with dementia, we keep our primary thinking skills and continue to live in the present—fully able to enjoy beauty, emotions and companionship. There are strengths in dementia, and both you and your loved one will benefit when you understand how to provide strength-based care. You will be able to keep your loved one home longer, with fewer behavior problems, and your family will have less stress and expense.

The seven tools of the DAWN Method^® of dementia care

The first three DAWN tools help people who have dementia develop a sense of security. The last four tools enhance a sense of happiness or wellbeing. When caregivers use the first three tools, their loved ones and clients begin to develop a sense of security and become more emotionally stable. The last four tools can be used to enhance wellbeing in minutes and have lasting results.

Here in Idaho, where I and my caregivers have used the DAWN Method for over ten years, the change in our clients’ moods and behavior is remarkable. Instead of descending further into an inner world marked by fear and frustration, they become increasingly relaxed and remain engaged with the outer world in an intuitive way. The following diagram is how we picture the tools of the DAWN Method:

The first tool, mood management, is central to DAWN, person-centered dementia care. It is the beginning—the constant and renewable energy source that supports the other tools. Without a positive mood, our efforts in the other six areas would be short-lived. Once we, as caregivers, know how to establish and maintain a positive mood, we can begin creating an enduring sense of security in the two areas most vital to someone undergoing cognitive impairment: living with confusion and being cared for by others. Then, while we’re seeing our loved ones and clients’ sense of security growing, we enhance their lives with the four components of wellbeing. Once all seven of the DAWN tools are in use, the relationship between us—the caregivers—and our loved ones and clients becomes a thing of beauty.

What we believe

At the DAWN Method, we believe in preserving dignity and autonomy through aging in place for as long as possible. We do this by training families and caregivers to meet the emotional needs and rational thought losses caused by dementia.

Sign up for our newsletter and free video series

Sign up for our newsletter and receive our free 3-part video series, “Preparing for Dementia” as well as monthly tips about how to care for your loved one experiencing dementia.

Next steps…

• Are you a family? Go to our “Caring for someone with dementia at home” dementia roadmap.
• Are you a professional caregiver? Check out the Dementia Care Specialist Certification course.
• Are you an agency or a facility? Explore our DAWN Partner dementia training program for caregivers and staff.

FAQs about dementia and person-centered dementia care