Understanding Dementia Care in Nursing Homes
Are nursing homes doing enough for dementia residents? Understanding dementia care is essential for improving residents’ lives. In this week’s episode, nursing home abuse attorney Rob Schenk welcomes guest Dr. Natali Edmonds to talk about the challenges and best practices in dementia care in nursing homes.
Schenk:
Caring for nursing home residents with dementia stick around
Hi out there. Welcome back to the nursing home abuse podcast. And my name is Rob. I’ll be your host for this episode. We’re gonna be talking about some of the ways in which nursing homes can provide care to residents with dementia. With dementia, but we’re not doing that alone. We have the fantastic Dr.
Natalie Edmonds with us today to guide us through this conversation. All right. As I mentioned, we are not going to be talking about the intricacies of providing care to residents with dementia alone. We have perhaps one of the most leading experts in dementia care with us today.
And that is Dr. Natalie A. Edmonds. Dr. Edmonds is a board certified geropsychologist specializing in helping families cope with the challenges of caring for a loved one with dementia. She currently has the number one dementia training channel on YouTube, and her videos have been viewed over 17 million times.
You can learn more about careblazers at careblazers.com. And we are so happy to have Dr. Edmonds on. Dr. Edmonds, welcome to the show.
Edmonds:
Thank you so much for having me.
How do nursing homes provide dementia care that is personalized to each resident?
Schenk:
So obviously in, in nursing homes, there’s going to be a good portion of that nursing home population that have issues with dementia with cognitive capacity and care for those individuals because everybody deserves great care.
Becomes very important. And I’m so happy to have you on because you’re an expert at this. You’re an expert of, in, in caring for and being with people that have dementia. So one of the first questions that I would have for you is why is it important in your opinion? To have personalized care, individual care of somebody with dementia, as opposed to, Oh, this resident or this person has dementia, it’s going to, they’re going to get the same plan that the next person has.
Like, why is personalization so important?
Edmonds:
It’s important because at a very basic level, every person with dementia is different. Just like every person is different. There are different types of dementia. There are different symptoms of dementia. And Each person’s going to have different motivators, different ideas in their own mind, their own reality that’s going to be different from the next 50 people with dementia.
It’s always a big challenge, like lots of questions that I receive are how do we get somebody with dementia to bathe? Or how do we get somebody with dementia to eat or accept our care? And it’s never going to be a blanket statement. It’s always going to be let’s take a look at dementia.
What we think this person is going through. What are they showing us? What are they trying to communicate? When does this happen? There’s never going to be a one size fits all approach. Sometimes I say it’s like thinking about somebody with low vision. We have, we can line up all kinds of people with low vision, but their prescription is going to be different.
And if you try to give somebody with poor vision a prescription that’s not right for them, we can make things a whole lot worse. And so that’s at a very basic level why personalized care to the specific person is important. We want to be working with the individual and treating that individual person versus treating the condition.
Schenk:
So I guess what I hear you say is that it’s important to understand someone’s perspective, their unique clinical condition, what is perhaps provides irritation to them, maybe what scares them particularly specifically, because that would in turn affect The plan of care, for example,
Edmonds:
Exactly. If we think about bathing, somebody might not want to bathe because they don’t trust the person that’s trying to take them into the bathroom.
Somebody else might not want to bathe because they might have a risk like a fear of falling or they might be really cold or they’re scared of the water or they’re just not sure what to do or the bathroom environment looks stark and cold and or they’re scared of the reflection in the mirror. Like we can take one situation that Many people with dementia struggle with which is bathing and then there can be a hundred different reasons why That symptom is showing up.
And so we have to think about okay, what could it be for this person? Let’s pay attention to their body language. Let’s pay attention to their What they’re saying where they’re looking, so that’s going to be the clues that we’re looking for when it comes to Personalized care.
Schenk:
That’s a fantastic example where, okay, that person’s plan of care that doesn’t want to take a bath is because it’s Randy doing it.
So write down that Randy doesn’t give the person baths and the next person it’s a dignity issue or it’s a temperature issue and make sure that person has cold water and warm blankets.
Edmonds:
You got it. I know a lot of people talk about let’s make a spa day, but if we’re talking to the 85 year old man, who’s been a farmer his whole life, we’re not going to recommend a spa day to get him into the bathroom.
What are some strategies to create an engaging environment for nursing home residents with dementia?
Schenk:
Okay, that makes sense to me. So let’s bridge, bridge that gap a little bit. How do you, how would you typically go from, I don’t know this individual personally, to now I know this person doesn’t want to take a bath because of temperature, because it’s randy, or because they were a farmer.
Like, how do you go from zero information to having the information that’s personalized to make a personalized care plan.
Edmonds:
I love that question. That’s great. So for starters, I would say we have to, as the caregivers, stop labeling behaviors and stop interpreting them. Like sometimes we will look at somebody and think they’re refusing or they’re resistant or they’re combative or they don’t want to.
We immediately put these labels. On the behavior they’re doing and as soon as we do that, we close ourselves off to what could actually be happening. So we have to, anytime there’s a behavior that we want to change, we have to just start thinking about it as this is a situation, not a behavior. Because there’s more than just a behavior happening.
It’s a whole situation happening and this is some sort of communication. And if we could just step back and do that, we can get a whole lot further. Just try to think, okay. What are they doing, literally describe the behavior, rather than you think you know what they’re doing describe it, where would that make sense, and what kind of part of life would somebody be doing that behavior, where are they looking, what kinds of what are they showing emotionally, is it fear, is it anxiety, is it anger just trying to get a sense of what’s going on in that person’s perspective, that’s literally what I do, it’s almost like step back and observe, rather than feeling we’re trying to change them right away.
If we could focus on trying to understand them before we try to change them, we’ll have so much more success in trying to change them. So it’s the observation, gathering data, almost like a detective. That’s one of the very first places that I would start.
Schenk:
It’s that’s such a, that’s such an interesting viewpoint in terms of it’s not helpful to label.
It’s more helpful to literally describe. And that’s important, at least in a nursing home setting in my experience, because you’ll see a nurse note and it’ll say aggressive behavior at dinner. But. In reality, it’s, Miss Johnson took a spoon and threw it and, but we would never know that or, and it’s, and if at the end of the day, you might discover, okay, this person is overstimulated because they’ve come into a room that has 30 other people in it, and that’s the reaction.
It’s not aggressive behavior. It’s something entirely different and we would never have gotten there. If it had been, we would have gotten there sooner had it been observed and documented correctly as opposed to labeled. So I think that’s an important point that you make.
Edmonds:
Yeah, you hit the nail on the head there.
I don’t think those terms should even be allowed in any kind of record keeping because it doesn’t tell us exactly what happened. And it certainly it, to me, a lot of times when we use these words and these labels, it’s just an excuse for not, for us not having to do the work to figure out what’s going on.
What are some ways staff can receive training specific to dementia care in nursing homes?
Schenk:
And I think that I can speak for you when I say this, but we’re not. We’re not casting like blame or being disparaging to the nursing staff of these places. Typically they’re overworked. They’re working hard And you’re in you’re doing what you got to do. So it’s aggressive behavior At least you got that on the paper, I guess right but in the ideal world It’s this person was observed doing this and this so so speaking of that Do you have any opinion or what’s your understanding as to what would be good training, like not just documentation of what’s happening with someone with dementia, but like in general for caring for people with dementia, what are, what’s some training that you would recommend, like what, if it’s books, if it’s in services, if it’s classes, if it’s seminars,
Edmonds:
Yeah, I think this is a big issue.
We don’t even have, not every state even has requirements to go through dementia specific training for people living in nursing homes, which I think is just crazy. I know there’s lots of laws and process to potentially be passed, but a lot of people working in, Nursing home facilities are learning hands on the job.
So you’re right. They do have a really difficult task. And yes, they’re overworked and underpaid and all of those things. I don’t think that I think it’s a big system issue. I don’t think that’s I don’t think that’s an excuse, because we have people in there who actually need lots of help and everything we’re talking about here in terms of Okay, how do we approach these behaviors?
How do we think about it? How do we bridge the gap from, Kind of having an idea to making things happen. It’s nobody’s, it’s like a big system fault, where we’ve just accept, this is our standard of care, I think is subpar. In terms of training though, you’re really looking for, I love training that’s going to give people a formula to follow, to help them become a decision maker, to help them go through what is actually happening.
There’s never going to be. Like a book that you can pick up and go to it and it’s going to tell you all the answers about what to do in every situation. Do we have books that are great? Yes, absolutely. But we have to teach people how to be critical thinkers, how to be able to observe an environment, how to be able to look through clues and prioritize and triage.
What’s the first step to take? I think teaching the creativity and critical thinking is really important. In terms of places to get that training, I’m not familiar with all of the different courses and programs and trainings. I know people put them out there. I know they exist. I know the 36 hour day tends to be the gold standard for a book, on how to work with people with dementia.
Ideally, it’s nice if, A nursing home has consultants on staff that they can consult with when it comes to difficult situations to work with staff on, this is how I’m approaching it, this is what I would look for, let’s give this a try, how did it work? Okay, that didn’t work, let’s tweak this is the reason I’m doing it.
That would be ideal if nursing home staff can have basically behavioral consultants to come in and work on some of these difficult cases and then in doing so, you’re literally training the staff on what to do in the next step. What to do in the When the next person has an issue there’s never going to be a training, I think, that’s going to be able to cover every single situation, every single possibility.
So it’s more about helping the staff member get go through a process. Here are steps to follow to get it, but they’re going to have to tap into their own creativity. And I also think something that most trainings miss that I think is really important is training staff on managing their own thoughts while working.
So if. If staff members are going in and they’re overwhelmed and they’re confused and they’re having to deal with all of these tasks yet in their minds, they’re thinking this is never going to work. And I know they’re going to give me a hard time today. And, their own thoughts.
This is true for every human. I’m not just talking about staff at nursing homes, but our own thoughts make things more difficult for us. And so if we could staff members on, okay, I know there’s something out there that’s going to work. Today’s going to be one step closer to figuring it out. We would not only feel a lot better, but we would actually have a lot more success in getting closer to the results that we want.
That’s something I believe firmly. It’s like a very basic psychology thing. I wish everybody was taught on every job, but especially on. Hard jobs where the answers are not going to be really clear in a book that you pick up.
Schenk:
And I think we’re going to be asking a lot. Like we’re doing good just to have dementia training, let alone psychological training like that that mindset training, I’m sure it’s be very difficult.
Edmonds:
Exactly. So I know that’s not like a great answer to your question. It’s perfect. It’s great.
Schenk:
So you provide expertise with respect to people that. That are perhaps providing care to a loved one in their house one on one with a loved one. And then there are professional caregivers dealing with 10 or 15 individuals that, that are not related to with dementia.
What are some of the differences in those care, other than the numbers, obviously, but what are some of the differences in approaches to those two separate situations?
Edmonds:
Yeah, they both have unique challenges. I’d say for family members caring for a loved one at home, even though it’s one person, there tends to be a really big emotional component to it because it’s usually a loved one, somebody you’ve spent years and years with, and you’re watching that relationship change, you’re going through lots of grief and loss that wouldn’t be so typical from a professional caregiver standpoint.
You’ve also, It’s just you. If your loved one is wandering it’s a 24 7 job, essentially. You’re always on, you’re always thinking about their safety, and you’re also trying to juggle all of the outside. requirements, appointments, resources, keeping other family members up to date.
It’s just a lot for one person, but I think the biggest difference I would say is the huge emotional component of just losing somebody you love right in front of your eyes. In terms of professional caregiver caregivers, it’s really hard because you’re like you said it you’re dealing with more than one person.
And like we just talked about, if all 10 people had trouble bathing, it could be for all 10 different reasons. And so trying to keep in mind. Okay, how does this person like it? What’s the best approach for this person? How do I tweak it here? And constantly being able to shift is really difficult. Not to mention, they’re not only dealing with all the regulations and their boss or their supervisors and other staff members, they’re dealing with all the family members to coming in who have questions, who want help.
Schenk:
It might not be very happy about it. So yeah.
Edmonds:
Yeah. And so a lot of the people coming to them from the outside, family members, a lot of times when they’re having interactions, they might not be so pleasant. So you’re doing a hard job. You’re trying to do the best that you can and you’re getting it from all angles.
I think it’s really hard for them to.
How important are activities and social interaction dementia care in nursing homes?
Schenk:
So speaking of providing care to multiple people with dementia what does, in, in your opinion, what does the. The social component, like what does social activities and doing things and having interactions with other people, how does that factor into the care and basically it’s the dignity of caring for somebody with dementia.
Edmonds:
Yeah, I think it’s important. We, We want to do whatever we can to keep the person with dementia engaged in pleasant events, but because it’s an individual person, what they like and what they can pleasantly engage in is going to be different than someone else. Not everybody’s going to enjoy playing cards or playing bingo.
So having a variety of different things, and also being able to adapt those activities To the person with dementia’s abilities, so they might not be able to, golf anymore, but maybe they can watch golf or talk about golf or flip through a golf magazine or, do a putt in the, activity center.
So I think just having a variety of different activities that you can do, but based on what you know about that person, what they’ve been interested in the past and trying to bring that in is really important.
Schenk:
I see. Are there any I think you mentioned that there’s maybe like a system when you’re trying to figure out a particular issue that you’re wanting to address with somebody and then from there you have creativity or whatever, but is there a particular acronym that you use like step or, think or whatever it is.
It’s okay, if somebody is doing this boom. And you go through an analysis. Yeah.
Edmonds:
Yeah for me I would start with, like I mentioned, stepping back and gathering the information about what’s happening. For me, it’s like the ABCs. We have the A, which is antecedents. What’s happening right before the behavior?
Like I mentioned, it’s never just a behavior, it’s a situation. There’s people around, there’s something that just happened, there’s noise, or maybe lack of stimulation. It’s gathering as much information as you can about what happened right before what we would consider a behavior. the big challenge happened.
And then the B is actually the behavior. So describe it. We’re not judging it. We’re not interpreting it. We’re not labeling it. Describe literally what they did. And then the C is the consequence. So what happened after that behavior? What did you say? What happened around? And whatever we did, whatever that intervention was, our response, did it make it worse?
Did it make it better? How long did it last? Because now we’re getting feedback to on how did, when we responded. How do we think it, worked? Did it, did we want to tweak something in the future to make it different? So it’s like the ABCs of just gathering the information, and then based on that, I always encourage just to make more creativity for people and not get stuck in just a very narrow viewpoint, is to come up with a list of Possibilities you think could be going on for that person.
What are all the reasons you think this person may have thrown the fork across the dining hall? And just write them down and I always say never filter. It could be something so strange that doesn’t make sense to us. It’s totally okay. Just what are all those reasons and then just choose one reason. And then test it out.
I think she threw the spoon across the room because she has a hard time grasping the spoon. And it’s harder and harder for her. So how would I test that out? Okay, I could test it out by giving her a spoon with a bigger, thicker handle. Maybe that would help. Or I could test it out with only finger foods at the next meal.
Okay, did it help? Did it not? And oh, that didn’t help at all. Okay, what’s the next item that I thought maybe it could be? And so you just, it’s like a detective. You just go through and you start testing these different hypotheses. And every time you test something and it doesn’t work, you’re just one step closer to figuring out what will.
It’s like the detective doesn’t give up after their first hunch wasn’t true. That’s a simple, maybe a simple formula people can follow to try to go through. And it gets easier and easier. The more you do it, the more like you start working your brain in that way. the easier it is. I know sometimes, especially for professional staff, they think I don’t have time for this.
I’m already overwhelmed. I’m already doing all of these things. And I like to say you don’t have time not to do these things because otherwise, like when we don’t figure out the root cause of the behavior, we don’t figure out at least how we can calm them down quicker or get back on task. That’s going to take more time.
You’re going to be constantly trying to handle these, disruptions or difficult moments versus The little bit time up front can save you so much on the back end.
Schenk:
I’ll start with some massive thunder strike next to my house. It’s funny that you mentioned that because my, my wife naturally thinks that way and we have a toddler.
And so it’s always like, Why did he behave in this specific instance in this? And she’s, she does that. She’s testing like, all right let’s give him, strawberry yogurt instead of blueberry yogurt and see if we get the same result. She’s she’s just built that way. So I get what you’re saying, but it can be hard for people that aren’t built that way.
And I’m not built that way. So I have. Go ahead. Sorry.
Edmonds:
I was going to say, I think also a good tip is we’re always so focused on when things are going wrong, when things aren’t going right. But if we could start training ourselves to notice like, Oh wow, that meal time just went smoother.
What happened? Start catching them when things are like peaceful and nice. I think we would start coming up with a lot of ideas too and start putting together the pieces.
What resources are available for families to stay informed and involved in the care of their loved ones with dementia in nursing homes?
Schenk:
Dr. Edmonds, this has been fantastic. Tell us how, tell us what resources that you have. I know that you have an awesome YouTube channel, but tell everybody how they can get the information that you’re providing.
Edmonds:
So absolutely. YouTube channel is the best free way to get information. We put new videos out every single week on a bunch of different topics. We have a free Careblazer survival guide whether you’re caring for. a spouse or partner or a non spouse or non partner. You can download that for free.
It’s over 60 pages. It walks you through the formula we would teach. So if I were to, to go into a nursing home and try to work through a behavior, it’s in there in that guide people can download completely free. They can go to our website, careblazers. com. They can also reach out to us if they ever want support at careblazers.com. Somebody on our team can give them the download if they want.
Schenk:
That’s fantastic. And it really is. If you’re watching this or listening to this Dr. Edmonds YouTube channel is just amazing. So I would recommend everybody go check it out. And Dr. Edmonds, I know your time is valuable and I really appreciate you coming on the show and sharing your knowledge with us.
Edmonds:
Thank you. It’s my pleasure.
Watch related podcast episodes discussing non-drug interventions for dementia, or how families can help keep residents safe.
Schenk:
Okay. Folks, I hope that you found this episode educational and entertaining. If you have any suggestions for potential guests that you would like for me to talk to, please let me know. If you have any topics that you would like for me to cover, please let me know that as well.
If you’re watching this on YouTube, please be sure to subscribe, hit the notification bell and comment, perhaps make it a good comment. New episodes of the Nursing Home Abuse Podcast every Monday. Everywhere you get your podcast from as well as YouTube and on our website, nursinghomeabusepodcast.com. And with that folks, we’ll see you next time.
Guest Info:
- Dr. Natali Edmonds LinkedIn
- Careblazers
- Dementia Careblazers on Instagram