Caring for residents with dementia in a long term care setting requires an ongoing awareness of both their needs and identification of strategies that will facilitate the resident’s participation in their daily care. Caregivers must avoid offering too much assistance thereby creating an attitude “learned helpless” and conversely, expecting too much from the resident. This may lead to feelings of anxiety, frustration, depression and combativeness. It is important for therapy to offer their expertise to the interdisciplinary team and immediate caregivers in identifying baseline function and developing strategies that work best with each individual resident.
Hands-on care strategies are methods of facilitating optimal resident participation and combined with other therapeutic techniques can have a positive impact on the dementia resident’s ability to perform functional tasks.
• Rescue Strategy: Caregiver begins a functional task with the resident. If the resident is resistive, another caregiver steps in and “rescues” the resident. The resident often responds positively to being “rescued” and will complete the task
• Hand-over-Hand: Caregiver places their hand or hands over the resident’s and offers assistance while guiding the resident’s hand into and through the task i.e. feeding, brushing teeth, etc. This strategy can also be used as a reminder of the task when the resident has stopped in the middle of the activity. Hand-over hand movement may help the resident start again
• Mirroring: Caregiver models the expected response desired from the resident. For example, the caregiver pretends to brush his/her teeth, so the resident can reflect back, or “mirror” the activity by actually brushing their own teeth. Residents will sometimes observe other residents, such as at mealtime, and then copy what they are doing.
• Chaining: Caregiver initiates a functional task, enabling the resident to then take over at some point and complete the activity. For example, the caregiver places their hand over the resident’s while they hold a fork, sticking it into a piece of meat, and starting the movement towards the mouth. The resident is able to continue to the mouth without assistance.
• End Chaining: Caregiver carries out the completion of a functional task and does not reinitiate it again, allowing the resident to take over. For example, resident has lost interest in brushing teeth. Caregiver places toothpaste on the brush, dips it in water and places in the resident’s mouth. The caregiver withdraws his/her hand and leaves the toothbrush in the resident’s mouth. Resident may respond by bringing their hand to the mouth and performing the task. They have effectively responded to “end” of the task.
Our goals with dementia residents’ may not always be to significantly improve independence in functional task performance due to cognitive decline, however, clinically, we can utilize compensatory strategies to address safety issues, reduce inappropriate behaviors and teach caregivers to structure daily care routines to enable the resident to perform at their highest level of independence.