Training Your Memory Care Staff – Q&A with Teepa Snow

During our How to Optimize Your Memory Care Using a Positive Approach webinar, presenter Teepa Snow, MS, OTR/L, FAOTA, received several questions about training staff working with residents with memory care needs. She wasn’t able to get to those questions during the webinar, but she took some time to respond below. Read more about the most frequently asked questions on training your memory care staff.

Q: What are some ways to teach staff to put themselves in the residents’ shoes?

A: One of the most difficult pieces to training staff in dementia care is developing their understanding of how the changing brain affects the person’s ability to experience and navigate the world around them. Even when you know something, because you read about it or it was told to you, you may not know it because you haven’t experienced it.

So how can we ensure that our caregivers not only know the information, but truly know the experience?

If you have never taken a virtual dementia tour, it can be a humbling experience. It can be an intense sensory experience that seeks to help staff appreciate the challenges of living with sensory processing changes that happen with many forms of dementia.

One of the really vital parts of having the staff put themselves in the resident’s shoes is to help them also understand their role in changing how life happens when someone is living with dementia. In order to have that happen, partnered experiences can enable each person to take turns helping and being helped.

When this is offered in a coordinated way, it is core to assisting staff in valuing the resident’s perspective. It also allows them to appreciate the importance of how they do what they do, for the resident’s sense of well-being and connection, in a very personal way.

In our Seeing It for the Other Side, Part 1, there are several times that I am asking the audience to partner up and see how it feels when you have limited vision. Someone touches you, but you don’t realize they are going to do it. Or you want something, but your words aren’t working. Offering an in-service where you use the video and pause to encourage learners to actually pair up and try it out can make it much more intimate and real for them.

Q: My organization is looking to add a memory care unit. From a staff competency perspective, what are the most important things we should focus on?

A: When we are offering families and residents something that is marketed and presented as a specialized dementia care location, then it is vital to deliver what you promise.

A staff member’s failure to demonstrate knowledge and skills that have been talked about will typically result in frustration and disappointment for family members.

More importantly, it will typically result in challenging situations and high rates of staff frustration and turnover, as well.

If we are seeking to provide state of the art care, it is critical to invest in shorter, interactive staff training sessions that use information and knowledge gained from video content in practical, simulated role-play sessions to foster the following skills:

• Getting connected and getting permission to begin a task in a functional and ability-based manner. In our Positive Approach to Care (PAC) community we call it PPA, PPC, and PAS. Use a positive physical approach (PPA), then make a positive personal connection (PPC), and finally use a positive action starter (PAS) that is matched to the person’s comprehension and ability.
• Getting to know and respect each person’s unique and special personality traits, preferences, routines, rituals, and stories. Use supportive communications strategies and our Me Sheet to help each staff member use what is learned and make sure a team approach to care is evident.
• Learning to work together as a care team that develops and implements plans, addresses issues and concerns in a timely manner, and communicates well amongst themselves and with families and residents.
• Using interaction skills to assist residents with care tasks and purposeful activities during each day that bring them pleasure and foster a sense of community.

Guiding and supporting the efforts of all staff, by being present in the care delivery areas, and community spaces, while demonstrating and building our skills, is a key way to reinforce and support our belief in the value of the skills we are asking them to use. The message is: Do as I do, not just as I tell you to do.

Q: What is your suggestion for learning more about client personal history if family is not interactive or willing to help with this aspect?

A: This is where building skills in making PPCs and using PASs can make such a difference. Positive personal connectors that are geared to match the other person’s verbal skills and use visual supports is a great way to gather info.

An example would be that I would bring in a copy of the free newspaper from my hotel, a USA Today issue. I pull a section, sometimes the one with the weather map in it. I fold under my arm, and approach and introduce myself to a resident sitting alone in the common area.

I then ask to share a couch or I sit in a chair next to the person, preferably to the right for most people (people prefer you on their dominant side).

If the person is able and willing to talk. I might say, “Hey John, I’m from North Carolina, and you’re from….” Leaving it as an open-ended phrase, seeking a filler.

It is very common for the other person to fill in the blank with information about their hometown or past. It’s called “fill in the blank” support. You can use it with a wide variety of seeking questions… First share about you, then ask “And you…?” Some possibilities are:

• “I have three kids, and you have…?”
• “I have never lived in a big city… You?”
• “I love spaghetti and meatballs, and you?”

If it turns out the person I am interacting with is not able to use many words, I will pull out my newspaper and turn it so that the weather map shows. I will look at it for a minute. Then look at my partner and show him the map, pointing to my home state with my finger, and saying “I’m from North Carolina.”

Then I will look at him and say, “You’re from…?” I might move my finger over the map in a questioning motion. I will look for a response in his gaze, pointing, or something else.

Then I might follow up with, “Whew… it is going to be hot in North Carolina today. You like it hot?” At the same time, I’m fanning myself and wiping my forehead.

Even if the person is not able to use any words, I can use gestures and motions to seek their willingness to come along.

We can go to a window and I can show them various cars, plants, objects, colors, directions. Using a “this or that” gesture and questioning look, I watch the person to see which of either they pick. I follow it up with a comment like, “You like the red one? Me, too!”

Over time as I gather more and more information in small amounts and share them out with other staff members, we can build a profile that reflects at least some current preferences and likes or dislikes.

Q: My staff often feels overwhelmed by wanting to help everyone at once. What are some things we, as managers, can do to prevent them from burning out?

A: It sounds like you have a great staff. They seem to be heart-first people who are very good at being in the moment and helping residents as things happen.

The challenge with this group of helpers is that they are not always terrific at planning out a day or making sure that all the regular assignments are completed in the allotted time.

That sense of always being behind or “not done” can really wear people out. Time management and working as a coordinated team can be a bit more of a challenge.

This may be an opportunity for you to provide the sort of support and guidance that can create a bit of balance and structure.

What if you take a look at who seems to have a skill set and rhythm that work well for people who are living more in the Ruby State. They may spend a good amount of the day either sitting or walking, their ability to do things with their fingers for skilled manipulation is limited, and their gross grasp and desire to move about and look at things might be variable.

Most of the individuals who are living with this ability set can still dance, sing, pray, and follow your general lead, but they will need major amounts of help to complete any self-care tasks and to know what to do when. They will also need safety monitoring. By matching someone who needs this type of support with someone who is good at it, it is possible that the staff member can, with your help, begin to plan out how to develop a flow to the day.

What’s great about this group of folks needing care is that they are not very fussy about what happens when, as long as they are having a good time in the moment. With your help, staff members may be able to better plan out the day.

They may begin to recognize that by looking at the group, rather than just working with selected individuals, they can get folks settled into either walking, rocking, singing, or resting while they help one person at a time.

Having a partner from housekeeping, laundry, or dietary areas can provide that eye to oversee how things are going while the other staff partner completes some simpler tasks that can be done without close attention to detail. That person might also be able to offer a sing-a-long, a warm blanket, a cloth to hold or fold, a hug, or encourage someone to “wait just a minute” while providing help until you return.

As a manager you may be able to look for the win-win situations and the bigger picture ideas that realign personnel, by recombining and reconsidering who does what with whom, where, and when. You can also check in and ask staff how they are doing, with three ratings:

• Thumbs up,
• Thumbs neutral
• Thumbs down

Checking in at various times throughout a shift can help you pinpoint what is working and what is not working well for them, so you know where to focus.

Q: Do you have suggestions for how to empower my staff to handle family frustrations and the family member’s behavior?

A: Family frustration is a typical part of residential care. It may help to make sure staff have a clear understanding of probable reasons that families are feeling the way they are.

It is critical to appreciate that many families never thought it would come to this. They thought they would be able to manage the person’s care until death parted them.

When placement occurs, for many people, it is the first time that someone besides themselves have taken care of their person. It is the first time someone may have seen their person naked, wet, incontinent, angry, scared, sad, or lost.

It may be that they didn’t want this to happen. Or they may have wanted this to happen a long time ago, but others demanded that they keep the person with them for longer than they wanted.

The stories and feeling are varied and sometimes extreme.

Family secrets may be revealed or stories told that are not true.  In addition to losing my person to this location, family members may also feel that they are losing their job, their relationship, and that they now have a new job and responsibility.

It will be important to monitor staff behavior and actions to determine whether their person is getting his or her fair share, what they need, what was promised. Staff may well feel they are living under a microscope.

Many family members feel that they are paying a great deal and have been promised exceptional care. They have only had the experience of providing care 1-to-1, so this situation is totally different in so many ways. It is not unusual for individuals to be resentful, fearful, angry, and demanding. The condition of dementia has changed everything, and they are grieving both loss and change.

Here are five steps you can walk through with your staff to help them work better with frustrated family members.

Step 1: Take a deep breath, and then let the breath go. Acknowledge that this is surely going to be hard!

Step 2: Know that you can make a difference. The same skills you are using to help the person living with dementia—getting connected, getting permission, offering support and opportunities to try things together—can make all the difference.

Step 3: Be prepared for frustration and possibly disappointment and anger. Be willing to offer a sincere apology for causing the person to be angry, for disappointing the family member. Ask them to tell you more about what they are so angry about.

Step 4: Recognize that it might be important to provide a supportive presence in some family situations. The presence of an authority figure can sometimes help a family member to feel listened to, better than when they are talking to a staff member, simply because they need to feel important.

Step 5: Celebrate the little changes, the little improvements!