Talking with Patients Who Have Dementia

A home health agency’s guide for caregivers working with dementia clients

In the world of administering home health care, some patients can be more difficult than others. Nearly every family has suffered through an argument with an aging parent over basic matters of fact, and every facility has stories about patients who lose their memory, say bizarre things, or behave eccentrically. Often these behaviors fall under the generic umbrella term of “dementia.” In this home health blog, we’ll review best practices for agencies and caregivers to prepare for communication and providing optimal care to patients who are in various stages of dementia.

Communication Essentials

As a caregiver, you cannot work in silence. You must communicate with your patient to do your job effectively. When an older patient has dementia, interactions may become frustrating, confusing, and difficult to manage. Patients with dementia can have both short-term and long-term memory loss, sometimes forgetting even their loved ones’ names. They might not recognize a caregiver whom they have known for a long time, or they may become easily confused. These gaps in cognition make life hard both for the patient and for the caregiver. In fact, cognitive decline in patients is correlated with healthcare workers’ stress and burnout.

Instituting effective training, education, and policies for your agency’s nurses and caregivers will give your staff a head start on dealing with the intricacies of managing patients with dementia. Caring for these patients requires a different style of communication. You could think of it as learning a new language. Here are three best practices for talking with dementia patients.

Best practice #1 – DON’T ARGUE

People suffering from Alzheimer’s do not like to hear the words, “Don’t you remember?” Of course, it’s natural to want to remind people who forget or to correct someone who says something you know is wrong. With dementia patients, pointing out an older person’s memory gaps and mistakes, even if you do it politely, can backfire. That’s because everyone (especially the elderly) wants to preserve their dignity. Usually, dementia patients understand that something is “off” or “not quite right” with their health or their thinking process, and that leaves them feeling insecure and vulnerable. When you point out their mistakes or contradict them, you aggravate those feelings and threaten their sense of self-worth. Resist the urge to correct a dementia patient, and avoid reminding them of what they forgot. Instead, make the patient “right.” Dignify your patient with these alternative techniques:

A. Reassure

You can always say “You’re right,” or “Good idea.” If they express an unrealistic fear, like someone stealing from them, say, “I’ll make sure they don’t do that.”

B. Take the blame

If they say, “Nobody told me about an appointment,” you can reply, “I’m sorry, I forgot to remind you yesterday.” It may feel weird to accept responsibility when you know it is not your fault…but it works.

C. Reflect their feelings

If a patient expresses an unrealistic fear, even if it seems ridiculous, show that you share their concern. A 90-year-old widow demanded to see her husband, who had been dead for several years. Her daughter replied, “I know, I miss him too, he was such a good man.”

D. Give a very short explanation

There is no need to provide a whole narrative. The key is to keep it short and simple, do not over-explain. When the patient repeatedly asks, “Where are we going,” you can repeat, “We’re going to the doctor.”

E. Distract

As soon as you have done any of the above, you can change the subject. For example, a patient asks, “Who are you?” Reply with your name, and then immediately pivot: “There is a party downstairs,” or “Would you like to play cards with me?”

Best practice #2 – PERFECT THE ART OF HOW TO ASK QUESTIONS

Some people are so uncomfortable speaking with dementia patients that they avoid saying anything at all. That is a bad idea; silence only reinforces the patient’s loneliness and isolation. On the other hand, some home health care givers may talk too much and rarely show an interest in their patients’ opinions or give them much chance to speak.

By asking good questions, you bring your patients out of their bubble and help them communicate. You also demonstrate that you are interested in them and that they matter. Depending on how you phrase a question, it can either be helpful or harmful.

The experts are somewhat divided on this issue. Some experts say regarding dementia that you should only ask yes/no, either/or questions. For example, “Do you want to eat fish or chicken?” They argue that by reducing answers to just two options, you avoid confusion.  Other sources recommend you keep your questions open-ended. That provides enough space for the patient to speak freely and at length. Actually, neither approach is wrong. When you are first getting to know a patient, ask them about their life and let them speak. Questions like, “What did you do for work?” or “Where did you grow up?” may give plenty of room for them to respond. In practice, we have found that these prompts do not have to be phrased as questions. You can always make a polite request: “Tell me about growing up on a farm,” or “I would love to know more about your children.”

That said, when you are intent on a specific task in the here and now, then switch to focused and direct questions: “Do you want this one or that?” “Take a walk now, or wait until four o’clock?” With only two options to choose from, patients find it easier to make up their minds without feeling stumped. As a caregiver, you make your job much easier this way.

Best practice #3 LISTEN!

More than anything else, people want to be heard and understood. Once you reassure your patients that you are not a threat and they come out of their shell, then it is important to listen. Do not interrupt; let them talk. Of course, listening does not mean you have to sit still or go blank. You can be an active listener and show the patient that you are present. Use your facial expression to show appropriate reactions to what they say. Nod your head and make humming sounds to voice agreement.

You may have to hear the same story many times. But try not to remind the patient that you have heard this story before.

Keep in mind that good listening does not have to be a painful chore. Take advantage of this listening time as a resource to gather useful information about your patient. Learn what they care about, including the names of their family members. Keep mental notes on their hobbies, or their favorite kind of music or cuisine. Later these notes will come in handy when you need to entertain (or distract) your patient. When they see that you remember, they will like you more. These techniques are useful for building a relationship with your patient.

The Takeaway

To sum up, your best practices strategies, and training, impart upon your caregiver staff to not confuse or contradict. Instead, use the aforementioned conversation techniques to make the patient “right” and avoid argument. In the beginning, ask open-ended questions, then switch to a binary question to focus on a task, and employ good listening skills to gather information and build rapport.

Most importantly, remember that your patient is a human being who deserves respect. Whether they are experiencing Parkinson’s, Alzheimer’s, or some other cognitive loss, they still have something of value to say. You can be their hero if you give them the dignity they deserve.

Other Related Topics

Staff retention and reducing callouts in homecare agencies

How to make your agency the expert on homecare

Best practices for home health agency intake

Increasing home health care patient engagement

Dealing with patients with mental health challenges

Resources:

Resist the urge to correct a dementia patient,

What some experts say regarding dementia