How do we do what’s right for each of them? Dementia Alliance’s Dana Vladescu teases out the puzzle.
The scenario:
Our mother has been living with us for two years and is now in the late stages of Alzheimer’s. We have recently taken in an eight-year-old foster child who needs lots of redirecting and help developing her social skills. Every time we try to discipline her with time-outs or by talking to her, our mom interferes, accuses us of being mean and generally undermines our efforts to help this young girl.
-Amanda Martin Werhan
Dana Vladescu, MSW, RSW, Manager of Clinical Services, Dementia Alliance, in Eastern Ontario, responds:
It’s important to acknowledge how complex and complicated a situation like this can be. This family sounds very caring and sensitive, considering they are trying to support two vulnerable individuals. Here are some steps to consider:
1. Gain a greater understanding of the mom’s behavior
In dementia care we use the term “responsive behavior” to describe how a person reacts to what is happening in their environment. They may lose their ability to use verbal language as the disease progresses and not be able to properly articulate what is bothering them. In this case, the mother is reacting to the presence of a new foster child. The family is dealing with change and so is the mother. Her behavior may seem inappropriate to others but to her it makes sense.
All behavior is a form of communication and the mother is trying to communicate something. She may believe this girl is her friend, or she might think she is a young girl still herself and want to play with the foster child. It’s difficult to know.
That’s why I’d suggest an assessment by the local Alzheimer Society in Canada; in the U.S. They can have someone come in and do a complex, multi-level assessment and look at all aspects of the mom’s life, from the physical, environmental, emotional and cognitive aspects, to gain a greater understanding of the mom’s situation.
This assessment will likely identify why this behavior is happening and can help lessen any triggers that are setting off the mom’s behavior. The Society will also be able to educate the family about how to deal with the mom’s responsive behavior.
2. Seek more supports for the foster child
The family might want to ask for support from their physician and/or local child protection agency to assist the foster child in her challenges. Keep in mind the child may be afraid of the person with dementia. If she’s been in a number of foster homes, she may have attachment issues. A psychologist may be able to help her with behavioral modification and teach her how to express her emotions in a healthy way.
3. Use distraction when things get tense
It’s important to remember that you can’t do behavioral modification with someone with Alzheimer’s—it just doesn’t work. It also doesn’t work to argue or try to convince the individual that what they believe is untrue or inaccurate.
In the moment of the crisis, distraction is key. The family could tell the mother that they are taking the foster child into her room to discipline her or that they are taking the girl for a walk so that the mother doesn’t witness the situation that triggers her. They could also try distracting the mother by engaging her in an activity she enjoys.
It also helps to remember that there’s a distinction between behavior that is annoying and behavior that is dangerous. In this case, the mother’s behavior is annoying, not dangerous. She is not being intentionally difficult. When caregivers are educated about Alzheimer’s, it becomes easier to understand the behavior of the person with the disease.
For example, a person with Alzheimer’s may ask the same question over and over — they do that because they simply don’t remember. Yes, it’s annoying to hear that same question asked repeatedly, but it’s not hurting anyone. The best strategy is to try other techniques — distraction, labelling items with pictures to help the person remember things, etc.
However, if the person’s behavior becomes dangerous to themselves or others, then immediate help is required. In this case caregivers should contact their local Alzheimer’s Society to find out what kind of crisis intervention is available in their area.
4. Consider what you can realistically handle
This family has taken on a lot. They may have to think about whether it’s realistic to care for both the mother and the foster child and they may have to make a choice about caring for one or the other. The assessments they receive from professionals will help them determine if they can continue to care for both of these people in their home.
More info
Our expert this week is Dana Vladescu, MSW, RSW, Manager of Clinical Services, Dementia Alliance, with the Alzheimer Societies of Hamilton, Halton, Brant, Haldimand and Norfolk in Ontario, Canada. To find out more about the amazing work this group is doing, go to http://www.alzhn.ca
Anne Bokma is a Toronto-based writer specializing in health.