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  • (music)

  • (music)

  • Narrator: Caring for Veterans with dementia can be both rewarding and challenging.

  • The VA has developed this training program to help you adopt a more positive approach

  • to address Veterans with dementia. In the following scenarios you will first see a

  • counterproductive way of approaching a Veteran followed by the preferred

  • positive approach of engaging the Veteran and addressing challenging

  • behaviors. By learning these positive skills and techniques you will not only

  • experience better outcomes, you will honor Veterans in the twilight years of

  • their lives.

  • (music)

  • Angela: You haven't changed yet?

  • Oh boy, it looks like we got work to do.

  • Let me get some things to pretty you up.

  • Okay now where to begin.

  • Mrs. Jones: No stop, no stop! That hurts!

  • Angela: I'm just brushing your hair. No big deal.

  • Mrs. Jones: That hurts! Ow! No!

  • (music)

  • Angela: Hello Mrs. Jones!

  • I'm Angela.

  • Looks like you're ready to get your day started.

  • Mrs. Jones, would you like to fix

  • your hair and put on some makeup?

  • Mrs. Jones: Okay

  • Angela: Great! Let's just walk over here so we

  • can find your hairbrush.

  • Here's your hairbrush.

  • Some lipstick.

  • What would you like to do first?

  • Do you want to brush your hair?

  • Mrs. Jones: Yeah

  • Angela: I like how you're fixing your hair it looks real nice.

  • What's next?

  • The color looks good.

  • What would you like to do next?

  • Sure, you can add a little blush. That will add a nice color.

  • (music)

  • Narrator: Grooming tasks can turn into a major hassle or be a source of pleasure for Veterans.

  • Approach and cueing make a big difference.

  • Systematic cueing involves giving step-by-step cues, increasing assistance

  • as needed based on the Veterans response.

  • See how the staff member begins with

  • visual and verbal cues and then only when necessary employs tactile cues.

  • Visual cues are typically easier to process than verbal cues.

  • Angela also uses hand under hand to get the Veteran's attention and guide her to a place that

  • is more familiar for grooming, such as a mirror and sink.

  • Notice how the staff member uses hand under hand for grooming tasks as well.

  • It allows the Veteran to be more engaged and lets the staff member know early if

  • there's a problem.

  • Giving positive feedback to the Veteran's choices also

  • keeps Mrs. Jones engrossed in the process.

  • (music)

  • John: Morning Mr. Hughes! Time to get ready for the day.

  • Need to get dressed for breakfast right? eggs and sausage this morning. Mmm...

  • Let's see what we got in your closet.

  • This will work don't you think Mr. Hughes?

  • Mr. Hughes: No. Stop!

  • John: Hey, come on I need you to settle down now.

  • Mr. Hughes: Stop!

  • John: You want to get dressed don't you?

  • Mr. Hughes: No!

  • John: Stop fighting me.

  • Mr. Hughes: Stop! Stop! Stop!

  • (music)

  • (music)

  • (knock on door)

  • John: Morning Mr. Hughes!

  • Oh, I forgot you prefer Willie.

  • I'm John.

  • Mr. Hughes: Hi.

  • John: I'll be helping you today.

  • I see you're already awake.

  • Great!

  • Can I help you with anything before breakfast?

  • Mr. Hughes: No.

  • John: Maybe we can start with changing your clothes.

  • Let me help you up.

  • There we go.

  • Good Willie.

  • All right, almost there.

  • Let's see what you have to wear.

  • Which shirt do you like? You want this one or this one?

  • Mr. Hughes: This one.

  • John: Which pants? This one or this one?

  • Mr. Hughes: This one.

  • John: Nice choice.

  • Ah.

  • What's next?

  • Let me help you take off your PJs. Let's start with your button.

  • Thank you for helping Willie.

  • Start with your right sleeve.

  • You're doing great.

  • It's hard with arthritis.

  • Okay.

  • Your right hand.

  • Good.

  • Thank you.

  • I like this shirt on you.

  • I really like the color.

  • There we go.

  • Good job Willie.

  • Mr. Hughes: Thank you

  • (music)

  • Narrator: This vignette demonstrates the value of the initial

  • approach as you engage with a Veteran.

  • As you saw in the first scene, John was not

  • able to establish much of a connection with the Veteran. Willie remained upset

  • throughout the interaction. In the preferred approach, John engages Willie

  • using the positive physical approach.

  • It's important to start some distance

  • away, maybe six feet. Lift your hand to your face like saying hi or hey.

  • Drop your hand as you approach keeping the palm open.

  • Pace yourself slowly.

  • Take about a step per second so you don't startle the Veteran.

  • Stay to the side of the person at arm's length

  • and accept the person's handshake.

  • You also want to get down to the person's eye level without leaning in. Once you have made

  • the connection in a supportive stance, offered the minimum assistance needed.

  • In the preferred approach, John also uses fewer words because people with dementia

  • may have trouble processing verbal information.

  • He provides the Veteran with

  • simple choices and opportunities for the Veteran to participate in the activities

  • consistent with the Veteran's level of cognitive function.

  • John also uses the

  • Veteran's first name, Willie, instead of Mr. Hughes because the staff have

  • assessed that is how the Veteran prefers to be called, by his first name.

  • By following these steps you engage the Veteran, respect their choices, and

  • increase the chance of a positive outcome.

  • (music)

  • Angela: Hello Mrs. Jones. Look at you still haven't touched your food. Well let me

  • feed you some lunch.

  • Here we go just mixing it up.

  • Now, take a bite.

  • Yum. Isn't that good? Come on now you know you need to eat for strength.

  • Hey Jasmin. You must be done checking vital signs.

  • Looks like I'm gonna be late to the staff meeting.

  • I'm still with Mrs. Jones who is taking her sweet time with lunch.

  • Come on honey, hurry up!

  • (music)

  • (music)

  • Angela: Hello Mrs. Jones.

  • I'm Angela.

  • May I join you for lunch?

  • Lunch looks pretty good. We have soup, salad, chicken, and dessert.

  • What would you like first?

  • Let's try the soup first.

  • Will you pick up your spoon?

  • Were you trying to have some soup? Here it is.

  • Let's try together.

  • Looks like you enjoyed it. You ready for another sip?

  • Looks like we can keep going.

  • (music)

  • Narrator: Veterans with dementia retain more abilities than many may realize.

  • Your approach and nonverbal behaviors can make a big difference.

  • Because abilities can vary day to day, can vary day to day,

  • you should assess the Veteran with each encounter.

  • In the second scene, the staff member uses simple questions, directions, and

  • systematic cueing to figure out what level of support the Veteran needs.

  • Rather than simply feeding her, the hand-under-hand technique provides a

  • better eating experience as you help the Veteran become more engaged with eating.

  • Watch how well this hand under hand positioning works.

  • make sure to approach from the Veterans dominant side. Offer your hand palm up,

  • slide your thumb next to theirs and wrap your fingers under their wrist, then use

  • your fingers to grasp the spoon or other items. You may need to adapt for Veterans

  • with a hand deformity or dysfunction.

  • (music)

  • Mr. Hughes: Have you, have you seen my mother?

  • John: No, I don't believe I have.

  • Mr. Hughes: I need you to help me find my mother.

  • John: Remember, I told you I have not seen your mother.

  • I don't think she knows you're here.

  • Mr. Hughes: I need my mother!

  • You're not my mother!

  • Get away from me!

  • Where is my mother? I need my mama!

  • (music)

  • (music)

  • Mr. Hughes: Have you seen my mother?

  • I need my mother.

  • John: You look upset. Can I help you?

  • Mr. Hughes: I need my mother. Do you know what my mother is?

  • John: Let me come around so I can help you, okay?

  • Mr. Hughes: Yes.

  • John: How about we go look in your room, okay?

  • Okay.

  • It's alright, you're alright.

  • Here we are back in your room.

  • Do you have a photo of your mother so that I can see what she looks like?

  • Oh, I wonder if she's here?

  • Oh...

  • Mr. Hughes: This mama.

  • John: What a wonderful picture. You all look so happy.

  • Is this your mother?

  • Mr. Hughes: That's mama.

  • John: Look at that beautiful background.

  • All those flowers.

  • Thank you for showing me the photo Willie.

  • Mr. Hughes: Thank you.

  • John: Tell me, what are some things you enjoy doing with your mother.

  • Mr. Hughes: Oh, mama taught me how to play the piano.

  • John: Really?

  • Mr. Hughes. Yep.

  • John: Would you play a song for me?

  • Mr. Hughes: Oh, I'm not that good anymore.

  • I can't play.

  • John: I bet you're better than you say. Let's go the recreation room and

  • find a piano. I'd enjoy hearing you play.

  • Which way is the rec room again?

  • Mr. Hughes: This way.

  • John: Uh-huh. You're right. Let's head this way.

  • (music)

  • Narrator: In our first example, you saw how quickly a Veteran's distress can escalate and

  • become out of control. That's because Veterans with dementia

  • often cannot tell you exactly what is wrong, so it's best to follow these steps:

  • Show the Veteran you share their concern. You will need to do some detective work

  • to figure out the underlying problem and stay positive, send the message that you

  • can help. Also see how the staff member uses positive physical approach skills

  • and hand-under-hand technique to guide Mr. Hughes to a more familiar activity

  • that he thinks will reassure the Veteran.

  • These skills also allow the staff and Veteran to make a connection without confrontation.

  • Notice how John also engages the Veteran with positive verbal interactions as he works to redirect the

  • Veteran to a less distressing topic. The Veteran is able to enjoy family memories,

  • play the piano, and use abilities not yet affected by the dementia.

  • All of this turns what could be an argument into a more gratifying outcome.

  • (music)

  • Mr. Smith: We took a trip to DC and we toured inside the Capitol and the Lincoln Memorial.

  • All those museums downtown. Oh grandkids!

  • (laughing)

  • Oh they wore me out.

  • But it was a good trip. It was me and my family.

  • I never realized that Lincoln Memorial--

  • Gloria: Excuse me Mr. Smith, can you stop for a moment?

  • Mrs. King us having a difficult time. Jamal, I need some help here

  • What's wrong?

  • Are you angry?

  • Do you want to leave the room?

  • Jamal: Hey, how can I help?

  • Gloria: Just help me get her out.

  • Jamal: Yeah sure, no problem.

  • Mrs. King: No, let me go!

  • Gloria: We need more help here hurry! Call the charge nurse.

  • Jamal: Hey Ms. Robinson can you get out here please? We need help!

  • Gloria: Mrs. King, settle down. It's okay.

  • Jamal: Come on now you okay.

  • Mrs. King: Let go!

  • (music)

  • (music)

  • Mr. Smith: We took a trip to DC and we toured inside the capital and the Lincoln Memorial