Validation Therapy, Redirection

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I I've been my elder brother's caregiver, afflicted with Alzheimer's, since 2011. After his initial diagnosis of this devastating disease the "A" word has never been spoken. It was easier for him to just say, "I have a little of the Alzheimer's." It appeared he took the news better than I did, but he was probably unable, even at that early stage, to comprehend the severity, the word progressive, the journey ahead for everyone. The early stages seemed to be the toughest, him fighting reality, his loss of independence and memory; me, clueless, on what to do and say, my reactions to the new normal. I soon learned the doctor wasn't being silly when she said, "Get ready for a roller coaster ride." The first year of caregiving was my new full time position and I gave it my all, old work ethics still intact. Brother/sister dynamics made it a challenge. I educated myself by attending seminars and support groups; reading; reaching out to knowledgeable people; watching documentaries and movies. I have learned to just go along with his conversations and address what is being said, to believe something he sees as a possibility or even real, and that making up stories is ok. I realize, and this took time, that I could not reason or win one of his battles, conflicts or disappointments, the disease will win each and every time. I have had to adjust to make things easy for me, to take a time out, as the doctor said, and saw this would aid us both. On this journey I know I've made mistakes, still do, but I'm human. I have questions and seek answers. I shed tears still for the past and what lays ahead. I never stop believing in faith and prayers. Family, love and memories matter. God Bless All Caregivers.

My mother is 85 and in assisted living for about 4 months. I was her sole care giver and could no longer care for her. She was sleeping until 3-4 pm and getting up every hour or two to smoke and eat a sweet snack. She lost from 125 to 108 and woul not listen to me to get up or eat better. She was also a fall risk, usually falling daily. She is often hateful to me and calls for me to take her home on days she remembers how to dial the phone. I've used techniques doctors and nurses have suggested but she continues to beg me, threatens to kill herself and blames me for her being there. There are more days where she forgets how to walk and must use depends because she can not make it to the bathroom or forgets. I tried to find home care but in our small town it is difficult. So I do feel guilty about her not being home. How do I redirect her better when she asks to come home? I keep telling her that the dr wants her to be where she has people to talk with and to care for her. She smokes and it was difficult for the last month she was home. I had constant headaches from the smoke but could not leave her. She can go outside and smoke whenever she wants at her current assisted living home. Please help.

My dad has been diagnosed with dementia and I am working full-time with my kids still at home. My mom, sister and brother-in-law are caring for him full-time and are exhausted. They are having trouble understanding that he is not "faking" his symptoms and I have done a lot of reading about it on my own and don't believe he is. I have spent time with him and have tried to reassure him when he has had times of feeling confused and I try to tell him that it is okay and he is kind of eased through it. Lately my sister has been exasperated and I really do understand it since they are dealing with him full-time and I am not there. I just wish I could do more but just started a new job and am on probation with the job and can't miss any work and am just torn with what to do. I just needed to vent a little. I feel so badly for all four of them and wish things weren't this way. This article has helped explain about my dad's "humanness" remaining because I think that is where the confusion on their part is with thinking he might be faking. My husband and I have talked with other people who have had family members experience what my dad is going through and the symptoms are mirror images of each other and my father would have no way of knowing how to "fake" these symptoms. My family is so exhausted with the day to day care and his wandering around at night, etc., and I hate to try to be a know-it-all who isn't there. . . just feeling really sad and wish I could do more. I just feel so helpless sometimes. Thank you for this great article.

Validation is misrepresented. The information given is not correct. I feel the information given may damage caregivers' perceptions of Validation.

Thank you, RN '77! I also live in MN, and I am also trained in Validation (as a Certified Validation Worker). I am glad that this article included Validation so that people become more familiar with the term, but I am afraid that it has misrepresented Validation in part. But again, thank you for even including Validation so people are aware that it exists! If caring.com ever needs new articles or guest writers, I'd love to write an article about Validation to further increase public awareness. Please contact me ashley@hearttonesmusictherapy.com

Mu mom has been living with my husband andI for 11 months. She had a fall in her senior apt and doctor says she has onset dementia. I' m getting to the point with her that Im angry all the time. My husband is verbally out of control with her because he is so stressed.We are bordet low income both retired. money is issue to pay for temporary help once in while. don't know what to do. my mom is very mobile and promisd her would never go to nursing home money ti pay for

My mother, with dementia, is in an assisted living facility. Millie, her old dog (16 years) is incontinent and soiling carpet and Mother's bed. The problem has become so bad that it is creating a health hazzard for Mother. Management says dog has to go. We are considering having Millie put to sleep, but don't know how to approach Mother or whether she could understand the situation. Millie also has cataracts, arthritis, and is becoming hard of hearing. She is on special food, has to have medication twice per day and the staff must provide the care for the animal, as Mother is emotionally attached but can't tend to Millie's physical needs. Would it be ok to lie and take the dog out while Mother is sleeping and tell her that Millie died in her sleep? There is no good answer here. It is a no win situation. Losing the dog will break her heart and surely take my mother down another notch in her disease. She has lost so much already. It would be near impossible to find a home for Millie under the circumstances and time constraints. Would telling the biggest lie you have ever told to your mother actually be the kindest thing? Any suggestions would be welcome.

My husband suffered with Alzheimer's.You mention leading them in a more positive direction.One night in the nursing home found him at glass door. He said to me our son was running back and forth across the door but would not come in. Relizing it was his own reflection he was seeing.I said you know Gordy he is always on the move cant't stay in one place long. He laughed and said to me "I sure do know Gordy" End of anxiety. I might add that to get into his world a little bit we both could laugh and enjoy each other for a while longer. Before he passed away he looked at me and said you know June I am happy.

My boss has early onset dementia and I don't know what to do. Although most of her work responsibilities have been given to others, she still insists on coming to the office every day. She is still driving and she calls the office 20 times a day to get directions home from where she is. I'm not in a position where I can change what's going on. Her family seems to be allowing her to do what she wants, when she actually should be working with a therapist or other professional on how to cope with her new diagnosis. I'm so anxious and stressed out, I am about to snap. This is really a giant problem and I have no standing to do anything about it. If someone has any ideas I would greatly appreciate it.

Validating what I hoped I was doing all along once I recognized and realized that my mother was going through this disease. I am grateful!

It is really good.I can see how redirecting their thoughts could be a big help.

This article has been very helpful. My mother was 90 on May 2nd, and has been in assisted living for over a year while I clean out her house, not an easy task, and will be taking her to live with me and my daughter in Myrtle Beach SC. We've arranged for additional home care assistance, but I will take all the advice I can get!

is it o k to bring people into the dementia patients room that they really like to vit to see if they recognize that person

It was very informative for me due to the fact that I lead in services on how to approach you residemt

I am taking a Personal Support Worker program and these re direct,validate are helpful..

When mystery see stuff and we don't should we validate

I just wanted to share a couple of helpful resources for those of you who might like to talk with someone about caregiving strategies (e.g. bathing, wanting to "go home", etc.), find support groups, etc.. One is the Alzheimer's Association-there are local chapters in each state, as well as a 24/7 Information & Support line staffed by social workers-not a machine. You can search by state at www.alz.org, or call 1-800-272-3900. Also, an amazing educator and trainer (who has been a caregiver many times over and an OT) by the name of Teepa Snow can be found on YouTube. You will discover videos that cover many care giver challenges-and from the perspective of the person with Alzheimer's or a related dementia. Hope this helps!

My mother was diagnosed with dementia about 6 months ago. We moved her to assisted living (against her will) but she thinks she is still in her house and the nurses and aides are people from some church bringing her food or checking on her. The biggest problem is she WILL NOT SHOWER. She will fight like crazy if anyone tries to force her to bathe. How do you "redirect" or "validate" that? She truly believes she has already showered on her own.. Help!

If validation and redirection don't work then oftenI find a lying often works. It's called the "Therapuetic lie" technique. For instance: I'm late for work and you're making me later! Get out of my way!!..."Dad I just recieved a call, the office is closed today and they said that there's no need to come in today!" Obviously that's not a PERFEcT example, but something along those lines can work as a last resort.

still the same answer as yesterday when I asked if validation & redirect don not work???

possible activities or other re-directs would be helpful as well!

If validating and redirection don't work, then what does the caregiver do?

I am not sure how to use validation in my situation. My mother thinks her home aide is dealing drugs in our apartment and has enemies that are in pursuit of the drugs that she thinks are on the premises.

These suggestions, especially, the first one, aren't helpful. My mother is in a nursing home and she wants to leave. She can't really be distracted. If she thought she was going to work and I suggested we eat first, at the end of the meal she'd still insist on leaving. I was hoping for a way to make her understand that she will not be safe on her own. I gently remind her that someone who can't remember that her parents have been dead for over 20 years is ill and that people are taking care of her because she's sick. "Allow your loved one a graceful exit and be mindful of his or her ego!" That's just flip/

Validating the person's feelings is essential. Agreeing with them is also good if their thoughts are safe and non-threatening. If they see a person in the mirror, you might say "How nice to have a friend over!' You can then redirect them to a happy task. Include them in daily tasks that they enjoy. They may hear music, or see a person sitting in a chair, or looking in the window. Just assure them that things are ok.

I'm not sure what state this originates but Minnesota is more advanced in the care of the cognitively declining. First of all, the use of the term "Dementia" is almost archaic plus, it hasn't been the 'social norm" to tell someone s/he has Dementia since the early1980's. To even try to explain Alzheimer's has a great deal to do with what stage the person is in to whether s/he could comprehend what is being explained. It's not like telling a person they can't have a Soda because they're Diabetic. I attended a workshop and purchased the book by Ms Feil not long after she developed the "Feil method". Your explanation of her concept is not at all close to it. I believe you misunderstood her that she said to "bluntly explain reality". If that were the case, there would be no point in any of her well-thought out ego saving method. Validation T. is to "say it's OK" 'where the person is at that moment' whether physically or emotionally: If the person is agitated, allow them to pace but pace with them. Repeat what is said, not as a question at first but after a while, "I can't find the dog, the cat, Rex , for example. Add in the questions " How old were you when you got the dog, etc.? What kind of dog was it (if you were supposed to know this ask carefully), 'did he do tricks? Then bring in statements of self worth-" I'm sure you took very good care of Rex", "I bet you took long walks with him." What this exercise is doing is assisting the person in redirecting themselves from the anxiety of the "lost dog" to the calmness of the "good dog owner" they were and usually a calm conversation will naturally take the place of the anxious pacing partially due to the natural symptom of short term memory. Which goes into the next part -redirecting. Because of the short term memory loss, when the person with cognitively declining individual does not keep bringing up the issue that the individual is perseverating on, that individual can have a chance to "lose" it. The individual is doing a fine job on her/his own keeping that thought alive- it is up to the other person (& it is best to keep it to ONE or 2 at the most to prevent more confusion) to "redirect". However, the example with the train and being late for it, actually, it is usually not that the individual is worried about being late for the train but what comes after- and has developed a very intricate scenario of catastrophe of what happens if the train is missed and this is what the anxiety is about- probably all the way to losing one's job and not being able to get another & support the family. So, to bring up the train is NOT going to be helpful. What needs to be done is to praise the individual for being so conscientious and caring bread winner and great employee, bring up perfect work record, talk about the job, what kind of person the boss is, as s/he is assisted to the kitchen table and served breakfast. This is redirecting. It has nothing to do with the other person being involved in the activity of getting the individual to work. This goes to the Validation Therapy pointers also: Do Not ever ask a cognitively impaired individual to tell you what they are "fearful of losing"? THINK ABOUT IT! Also, more than likely s/he is not hoarding either as this begins much earlier in life as a behavior. Someone who worked as a Secretary may like to have a 2 drawer file and could have the ads that come in the mail. (Occasional careful thinning will need to be done). A non functioning orwith preset auto call numbers (time& tempeature) cell phone to keep in one's pocket is another idea. There are baby dolls that are very life-like and even men respond tenderly. Look at photos of an individual's siblings at younger ages to see "spittin' images" of the next generations so don't be surprised to be called by an aunt's or uncle's name. For someone who has "sundowners" (more agitated in the afternoon or evening), take a walk around 2 PM in a quiet park, pathway, then keep TV off, lights minimum but still able to function. Someone who tries to go out or wants to "go home", take walks daily around the neighborhood, point out/comment on same "landmarks" so this becomes "home". Again, keep consistent, with same 1 or 2 persons when possible -helps to set memory in earlier stages. Often, when an individual wants to "go home" it's the feeling of what "home" is- security and safety- which s/he no longer feels. The definitions of Hallucinations and Delusions should have been discussed completely separately. Yes, they seem similar to the practitioner but not to the unexperienced and thus it's difficult to follow the information from this perspective. Again, the "solution" given is too vague (or, complex because of adding in the part about "talking one 'out of it'", if a person doesn't know what that phrase means may be doing this behavior anyway.) Dementia is not the only cause of Hallucinations -medications and especially anesthesia is a major culprit. There are DNA testing that can be done to determine if an individual is unable to process particular drugs especially anesthetics, pain, blood thinners and antibiotics. Unfortunately, Medical Insurance companies rarely pay for the testing but check into it before surgery especially. Anesthesia can have devastating effects on an older person without cognitive impairment and even worse on an individual with it. (I realize this doesn't fit in directly with "communicating" but it's important enough to add.) For Hallucinations, using Validation technique to find out the cause can be helpful but most important is the individual needs to feel and know s/he is safe. Asking what you can do to help is an option, being truthful. Don't be caught in a "lie". Because safety is important, attention may be needed by a qualified Geriatric Psychiatric Practitioner. This care needs to be accepted as equally important as if a loved one was experiening a cardiac arrest, stroke or any other incident and the care needed for those. One more thing- do not confuse PTSD episodes with Hallucinations. Many Vets can have flash backs especially as the memory declines backward toward those years, so be aware of this if a loved one is a Veteran. As for Delusions, more information could have been provided. Such as, if an individual's delusion is benign, there is nothing wrong with letting her/her keep it. It's not hurting anyone. However, if it impacts health as a dietary issue such as a delusion that an individual believes their food is being poisoned, let them assist with the meal or if they can, fix their own toast, sandwich. Bring them grocery shopping (when it's quieter if possible or to a smaller store), buy milk & juice in smaller bottles, same with fruit in single serve. Ask them what they want to eat for a meal from the food they picked out (usually if they are delusional, they have intact memories to this) so that it's made just before eating. The fear could stem from the anger of losing control, of the loss of independence, medication changing taste, not recognizing food or even just from a too-dry mouth as a side effect from meds- these might be starting points. However, do not ever say you know how an individual feels because you do not and s/he knows that because you are not losing your mind. Also, it's good to be sure to know if it is a delusion and not what it might be in the caregiver's mind. An example: "the black devils" to the patient was her pain as she envisioned it relating to pictures she had seen about her religion; to the doctor a delusion, to the African-American staff- a racial slur. It wasn't until "The Fifth Vital Sign" was added and a nurse talked to her about pain using a picture pain scale that 1- it was determined she wasn't delusional, 2 -the level of pain she was experiencing was realized, 3- the caring attitude towards her changed remarkedly and 4- she stopped screaming about the "black devils" once her pain was controlled. You can see I am passionate about this subject. As a RN my career was in Long Term Care and with many individuals having cognitive decline I found myself drawn this direction and this is where I chose to work. It doesn't takes special people to care for and understand the cognitively impaired, but it does take much patience and willingness to be on someone else's time and follow someone else's agenda much of the time. And, humbleness and a sense of humor. I appreciate the time and space to add my knowledge.

This is very helpful for me. My husband is having a difficult time changing his behavior towards his Mom now that she has Alzheimers. This artical will help him understand what she needs to hear, how he can make it easier for her.

I stumble thru this daily and drop the ball quite often. I feel so all alone in the day-to-day negotiation of this strange mine field where the topography keeps flipping and rotating without warning!

Great artc;e ... interesting to go deeper into the responses and needs of the patient. Eating a problem? Creating "safe place" for the ego & emotions

Hi ipoe47140, I'm so sorry to hear about the pain you and your husband have been going through. If you would like to get advice about how to improve or help cope with your husband's change in behavior, you can go to our forums and chat with other Caring.com members who are in a similar situation: http://www.caring.com/forums. I hope that helps. Good luck -- Emily | Community Manager

Most of husband's time is spent wanting to go home when he is home..I can redirect but when the distraction is done..he goes right back to wanting to go home. I have questioned him about where home is and he doesn't know. he has lived in this area all his life and has only 2 childhood homes. he says neither of them are home..He is not interested in anything that requires participation. he used to golf, fish, bowl, camping, traveling, reading, etc. and now nothing. I think he is depressed because he is distraught at night especially. I have to watch what meds we give him because some of them make him more anxious..He is so distraught and thinks he is no good, even tho i reassure him repeatedly, that he is almost crying and he was never a cryer..He did have a mild stroke a month ago and he is worse mentally, but recovered a lot physically. I do not know what to do..

What if the patient keeps saying, "take me home; I can't sleep here" - even though she is home and has lived in her home for 50 years. Just this morning she went to the bathroom (she had to ask where the bathroom was; she couldn't remember) and a few minutes later I went to check on her and she was outside in the freezing cold. My question is: if I tell her, "ok we will take you home", then who's to say she won't get up in the middle of the night thinking she will just leave and go home on her own? What are we supposed to do? Everyone in my family has a different opinion.

Your articles are extremely helpful; looking forward to more articles, especially on more activities we can utilize for dementia/Alzheimers individuals or in groups. I have been using cards for sorting, ordering, colors, math facts (adding, subtracting, multiplication. Giving instructions also keeps patients alert for following directions. What do you think about having computers available. Some of these patients used to be quite nimble at using them before coming to a facility. I think facilities underestimate the abilities of dementia patients.