Download the following personal care strategies (PDF)

Use momentum
If you know that a person living with dementia is resistive to personal care, set up a situation where you build momentum for saying yes to several tasks before introducing a task they typically say no to. That is, ask them to do a minimum of three things that you know they typically agree to, and then introduce the care task as item four. People are less likely to say no to something after they’ve been saying yes consistently.

Identify the function of the behaviour
All behaviours serve a function. The four most common functions are:

• To gain attention
• To escape or avoid a task that is uncomfortable, unpleasant or distressing
• To gain access to an item such as food, toys or activities
• For sensory stimulation because the behaviour itself feels good or reduces some form of discomfort

In this video scenario, for example, it appears that the function of the person’s verbal behaviour is to escape from personal care. And indeed, we see that it worked in that no care was provided. The person living with dementia was verbally aggressive, and the staff left them alone. This reinforces that to avoid personal care, all they need to do is be verbally aggressive.

The trick to unlearning this relationship between shouting and escaping from care, is to provide the person living with dementia with the escape they are seeking that is not contingent on their shouting. In practical terms, this means offering frequent breaks and rewards for short intervals of participation in care activities. Over time, the person will learn they can get a break without the undesirable behaviour, and they will stop doing it altogether.

Use simulated presence
To facilitate care, it may be helpful to play a video or audio recording of the person living with dementia’s family member or friend that relays a shared memory and asks the person to allow someone to provide care. A script can be developed in advance to maximize effect.

Use familiarity
Familiarize yourself with the preferences of the person living with dementia. Learn about their likes, dislikes and any topics you can use to build rapport and trust. Consider preparing a tip sheet or overview with that information and keeping it somewhere accessible. This document would outline topics of conversation, interests and things to avoid. Before entering the person’s room, you can take a moment to review the tip sheet. This can help with interactions and cooperation with tasks, instructions and demands. Use topics from the list described above to talk about activities, events or topics of interest.

Build rapport before care
Spend a few minutes chatting with the person living with dementia to establish some familiarity and connection. Building rapport, even routinely each day, allows the building of trust and feeling of safety, which can help increase cooperation with tasks and instructions. Use topics from the list described above to talk about activities, events or topics of interest.

Present a “first/then” contingency
Consider presenting a “first/then” contingency, using something the person living with dementia enjoys. In this scenario, if you know the person really enjoys coffee and cookies, after spending some time building rapport, you can then try to initiate care by letting them know what to expect next, followed by something they are known to enjoy. (For example, say, “OK, Mrs. P, I’m going to help you freshen up, and then I’ll get you a nice hot coffee with some cookies.”) A first/then contingency has been demonstrated to increase cooperation with tasks people dislike, if they’re immediately followed by a preferred or pleasurable item or activity.

Ask permission
Take a moment to ask permission before proceeding. Let the person living with dementia know what you are going to do, count to five first to allow them time to listen, understand and respond and then proceed. Do this for each step of care you are going to provide.

Let the person with dementia guide you
Wherever possible, do personal care at the time of day when the person living with dementia is typically most cooperative. A good strategy is to allow late risers to sleep a bit later and let them wake up on their own so as not to be disruptive. Capitalizing on a person’s own natural rhythms will optimize successful outcomes.

Choose your battles
If a person living with dementia is distressed by changing clothes, under certain circumstances, you may wish to allow them to stay in the clothes they are in. For instance, if they are resistant to putting on pajamas, you may wish to allow them to sleep in their day clothes and then put on fresh ones the next morning.

Consider trauma/reliving an abuse history
If a person living with dementia has experienced trauma in the past, the provision of care may trigger re-experiencing the trauma. Sexual abuse trauma can particularly be confused with removal of clothing. The key is to provide reassurance and emotional support by explaining each thing you are going to do before you do it. Try to use the same gender caregiver where possible. Consider uncovering only one body part at a time.

Occupy the person living with dementia’s hands
If a person living with dementia is prone to become physically abusive, give them a small towel to hold to keep their hands busy.

Play music
Play music during care to keep the person with living dementia calm and relaxed. Choose something they are known to enjoy. Sing with the music as you provide the care.

Consider temperature
Make sure the room is warm and turn on a space heater if necessary. Heat the towel or wipes you will be using for care. Turn on the shower and get it warm before bringing the person living with dementia in.

Be ready
Prepare all care supplies and lay everything out before you start care provision so that once you start, you can be efficient.

Download the following tips for giving medication (PDF)

Offer choice
Give the person living with dementia a sense of control and independence by offering them a closed-ended choice with a maximum of two options. For instance, you might say, “Which pill do you want to take first, this one or that one?” Or “Would you like to sit here near the window or by your bed while taking your medication?” Or “Would you like to take your pills now or in 10 minutes?” Offer the person a choice of what to take their pill withs. You might ask, ”Would you like juice or water?” or “Apple or orange juice?” or “Apple sauce or pudding?”

Give a heads up
Inform the person living with dementia of what is going to happen before it happens. For example, if medication is scheduled for 4 p.m., inform them at 3:45 p.m. that you’ll be coming back in 15 minutes so they can take their medication. You may even want to set an egg timer for 15 minutes and tell them that when it rings, you’ll be back to give them their medication.

Provide a written schedule
For people living with dementia who can read and appreciate a schedule, create a schedule that outlines the activities of the day. Include things such as mealtimes, toileting, showers, recreational activities and medication times. Allow the person to hold onto the schedule and refer to it as needed. Be consistent and make sure you stick to any schedule you provide. Make sure the written schedule is tailored to their unique needs – for example, use large enough font, contrast, text that is clear and written in their preferred or first language, and consider the use of pictures or images to illustrate the scheduled activities.

The following videos depict scenarios in which caregivers use strategies to help manage challenging behaviours.

https://youtu.be/BDy0WcSN8sQ
https://youtu.be/aT5GIrLA9eQ
https://youtu.be/jBesHdt_qeM

Download the following personal care strategies (PDF)

Use momentum
If you know that a person living with dementia is resistive to personal care, set up a situation where you build momentum for saying yes to several tasks before introducing a task they typically say no to. Ask them to do a minimum of three things that you know they typically agree to and then introduce the care task as item four. People are less likely to say no to something after they’ve been saying yes consistently.

Identify the function of the behaviour
All behaviours serve a function. The four most common functions are:

• To gain attention
• To escape or avoid a task that is uncomfortable, unpleasant or distressing
• To gain access to an item such as food, toys or activities
• For sensory stimulation because the behaviour itself feels good or reduces some form of discomfort

In this video scenario, for example, it appears that the function of the person’s verbal behaviour is to escape from personal care. And indeed, we see that it worked in that no care was provided. The person living with dementia was verbally aggressive, and the staff left them alone. This reinforces that to avoid personal care, all they need to do is be verbally aggressive.

The trick to unlearning this relationship between shouting and escaping from care, is to provide the person living with dementia with the escape they are seeking that is not contingent on their shouting. In practical terms, this means offering frequent breaks and rewards for short intervals of participation in care activities. Over time, the person will learn they can get a break without the undesirable behaviour, and they will stop doing it altogether.

Use simulated presence
To facilitate care, it may be helpful to play a video or audio recording of the person living with dementia’s family member or friend that relays a shared memory and asks the person to allow someone to provide care. A script can be developed in advance to maximize effect.

Use familiarity
Familiarize yourself with the preferences of the person living with dementia. Learn about their likes, dislikes and any topics you can use to build rapport and trust. Consider preparing a tip sheet or overview with that information and keeping it somewhere accessible. This document would outline topics of conversation, interests and things to avoid. Before entering the person’s room, you can take a moment to review the tip sheet. This can help with interactions and cooperation with tasks, instructions and demands. Use topics from the list described above to talk about activities, events or topics of interest.

Build rapport before care
Spend a few minutes chatting with the person living with dementia to establish some familiarity and connection. Building rapport, even routinely each day, allows the building of trust and feeling of safety, which can help increase cooperation with tasks and instructions. Use topics from the list described above to talk about activities, events or topics of interest.

Present a “first/then” contingency
Consider presenting a “first/then” contingency, using something the person living with dementia enjoys. In this scenario, if you know the person really enjoys coffee and cookies, after spending some time building rapport, you can then try to initiate care by letting them know what to expect next, followed by something they are known to enjoy. (For example, say, “OK, Mrs. P, I’m going to help you freshen up, and then I’ll get you a nice hot coffee with some cookies.”) A first/then contingency has been demonstrated to increase cooperation with tasks people dislike, if they’re immediately followed by a preferred or pleasurable item or activity.

Ask permission
Take a moment to ask permission before proceeding. Let the person living with dementia know what you are going to do, count to five first to allow them time to listen, understand and respond and then proceed. Do this for each step of care you are going to provide.

Let the person with dementia guide you
Wherever possible, do personal care at the time of day when the person living with dementia is typically most cooperative. A good strategy is to allow late risers to sleep a bit later and let them wake up on their own so as not to be disruptive. Capitalizing on a person’s own natural rhythms will optimize successful outcomes.

Choose your battles
If a person living with dementia is distressed by changing clothes, under certain circumstances, you may wish to allow them to stay in the clothes they are in. For instance, if they are resistant to putting on pajamas, you may wish to allow them to sleep in their day clothes and then put on fresh ones the next morning.

Consider trauma/reliving an abuse history
If a person living with dementia has experienced trauma in the past, the provision of care may trigger re-experiencing the trauma. Sexual abuse trauma can particularly be confused with removal of clothing. The key is to provide reassurance and emotional support by explaining each thing you are going to do before you do it. Try to use the same gender caregiver where possible. Consider uncovering only one body part at a time.

Occupy the person living with dementia’s hands
If a person living with dementia is prone to become physically abusive, give them a small towel to hold to keep their hands busy.

Play music
Play music during care to keep the person with living dementia calm and relaxed. Choose something they are known to enjoy. Sing with the music as you provide the care.

Consider temperature
Make sure the room is warm and turn on a space heater if necessary. Heat the towel or wipes you will be using for care. Turn on the shower and get it warm before bringing the person living with dementia in.

Be ready
Prepare all care supplies and lay everything out before you start care provision so that once you start, you can be efficient.

Download the following redirection strategies (PDF)

Feeling disoriented is very difficult for a person living with dementia. As we saw in this scenario video, a possible outcome is when people intrude into areas that are not where they belong. Whether it be another person’s room, a locked linen cupboard or even the nursing station, intrusiveness can be very disruptive to others. It can be especially difficult to redirect a person living with dementia who has a belief that you cannot disprove.

Here are some things you can try to help redirect person with dementias to other areas.

Use redirection with a creative reason
Ask the person living with dementia to come with you because you need to show them something in the hall or because you need their help with something outside. Provide them with a purposeful task related to what they’re currently doing. For example, you might say, “Oh wow, you have done so much tidying! Come with me – let’s go get a laundry basket so you can fold and put away the rest of your clothes,” or “Let’s go put everything you’ve collected into the trash.”

Use distraction
Once you have successfully used redirection and the person living with dementia has followed you, use distraction. This could include talking to them about an entirely different topic while you’re walking, showing them something else of interest, leading them back to their room or another area, or engaging them in an entirely different activity to help pass their time. For example, you can turn on the radio, bring them to an activity or help them to get seated in their room with a newspaper.

Orient with something personally meaningful
To avoid similar situations in the future, consider placing personalized and familiar items, symbols, pictures and signs on the entrance to the door of their room. This might include a bright name tag with their name on it, a large bright arrow pointing to their door, a picture of items or topics that they enjoy. For example, it could be a picture of flowers, their family dog, a family photo or a photo of themselves. Remember, the items or pictures should be unique to the person living with dementia, and you must consider their ability to see and recognize the various items placed in their environment.

Avoid reality orientation
Do not try to convince the person living with dementia that they are not in their own room. This will simply escalate conflict. Reality orientation will not result in increased cooperation and typically leads to more frustration.

Use body language
Approach with a calm, friendly demeanour (with your shoulders relaxed and arms open, for example).

Use validation
Thank the person living with dementia for completing the task they are currently engaged in. Remember, in our scenario, he thinks he is tidying his room, which is a routine, long standing behaviour. Acknowledge what they are currently doing as a positive behaviour.

You might also try:

• Playing some music and dancing with them out of the room
• Inviting them out of the room to participate in an activity that they find personally meaningful like painting, ball toss or a concert
• Telling them, “You’ll have time to tidy up your room later. Right now, it’s time for us to get ready for lunch,” and using the Gentle Persuasive Approach gently, guide them out of the room

Download the following tips for giving medication (PDF)

Here are some strategies you can try when a person with dementia does not want to take their medication:

Use the first/then approach
Find something (like an object or an activity) that the person living with dementia really likes and offer it to them as a reward for engaging in the task. In this example, let’s say Mrs. Reilly really enjoys coffee and cookies. To apply the first/then approach, you would spend some time building rapport and then initiate medication administration by letting her know what will come next, followed by the thing she is known to enjoy. For instance, you could say “Ok, Mrs. Reilly. First, I’ll give you your medicine, and then I’ll bring you a nice hot coffee with some cookies.” Be sure to offer verbal praise for agreement with the task. A first/then approach has been demonstrated to increase cooperation with non-preferred tasks, if they’re followed by a preferred or pleasurable item or activity.

Offer choice
Give the person living with dementia a sense of control and independence by offering them a closed-ended choice with a maximum of two options. For instance, you might say, “Which pill do you want to take first, this one or that one?” Or “Would you like to sit here near the window or by your bed while taking your medication?” Or “Would you like to take your pills now or in 10 minutes?” Offer the person a choice of what to take their pill withs. You might ask, ”Would you like juice or water?” or “Apple or orange juice?” or “Apple sauce or pudding?”

Give a heads up
Inform the person living with dementia of what is going to happen before it happens. For example, if medication is scheduled for 4 p.m., inform them at 3:45 p.m. that you’ll be coming back in 15 minutes so they can take their medication. You may even want to set an egg timer for 15 minutes and tell them that when it rings, you’ll be back to give them their medication.

Consider preferences
Familiarize yourself with the person living with dementia’s preferences, likes, dislikes, and topics you can use to build rapport and trust. Consider preparing and making this information available to all staff in the form of a tip sheet or overview that can be kept somewhere accessible, outlining topics of conversation, interests and topics to avoid. Take a moment to review this before you enter their room.

Build rapport before starting care
At eye level with the person living with dementia, spend a few minutes chatting to establish some familiarity and rapport. Building rapport, even routinely each day, can help increase cooperation with tasks, instructions, and demands. Use topics from the list described above to talk about activities, events or topics of interest.

Provide a written schedule
For people living with dementia who can read and appreciate a schedule, create a schedule that outlines the activities of the day. Include things such as mealtimes, toileting, showers, recreational activities and medication times. Allow the person to hold onto the schedule and refer to it as needed. Be consistent and make sure you stick to any schedule you provide. Make sure the written schedule is tailored to their unique needs – for example, use large enough font, contrast, text that is clear and written in their preferred or first language, and consider the use of pictures or images to illustrate the scheduled activities.

Consult speech and language pathology
For some people living with dementia, there could be an underlying medical reason behind the refusal to take medication. For instance, as disease progresses, they may develop trouble swallowing whole pills which may go undetected by staff. It’s a good idea to rule this out by referral to a speech-language pathologist to do a swallowing assessment. If necessary, a recommendation may be to crush the pills and mix them in food such as jam, yogurt, pudding or coffee. Sometimes spreading the jam over a piece of toast or a muffin can be very successful.

Use familiar staff or a second person
It is always a good idea to use staff who are familiar to the person living with dementia for optimal results. Consider having someone who is more familiar approach them to take their medication. In this case, while the staff takes some time to regain familiarity through increased contacts and building rapport, have a second person, who is familiar to the person living with dementia, present at the time medication is given. Have this familiar person “re-introduce” the newer staff to help build familiarity.

Investigate contributing factors
The person living with dementia’s misunderstanding of the staff person’s intent could be caused by a language barrier, psychosis or simply cognitive decline caused by disease progression. It is a good idea to investigate these potential contributing factors to behaviour and consider alternatives such as translation cards, translation devices, picture communication tools or visual supports.