We blame Dementia for functional loss in people living with Dementia. It doesn’t have to be this way.
Maria Montessori is famous for revolutionizing child development and education, but people of all ages can benefit from the Montessori approach, especially when learning new things. Applying Montessori principles to Dementia Care doesn’t infantilize people living with Dementia. Similarly to children, it empowers them to be independent and creative. For people living with Dementia, each day is an opportunity to rebuild, discover, and learn, and it’s on us to support them. If we embrace this growth mindset, imagine the possibilities.
For too long, we’ve allowed Therapeutic Nihilism to stifle Dementia care and innovations. As Dr. Cameron Camp explains, Therapeutic Nihilism is a belief that those with Dementia cannot learn new things. All failures are attributed to Dementia, and there isn’t anything we can do “because they have Dementia.” There’s no question that living with Dementia is challenging, but it doesn’t need to be a living death sentence that we surrender to. Our loved ones deserve more than that.
Word finding, cognitive recognition, and memory degenerate over time, especially during later stages, and we accept this as inevitable with Dementia. This is a self-fulfilling prophecy. There’s no question that Dementia is a massive, life-altering challenge, but we need to rise to the occasion by offering the best Dementia care possible. This means re-examining past truths and finding opportunities to innovate. Care should be as unique and spirited as our loved ones are. We need to embrace and adopt a habilitative model of Dementia care, which focuses on the strengths and abilities they still have, not throw our hands up “because they have Dementia.” What does this look like? Empowering them to perform tasks themselves and supporting them IF they screw something up, instead of assuming they will.
In the words of Maria Montessori, “What you do for me, you take from me.” Dementia takes so much away from our loved ones; we shouldn’t join in.
This doesn’t mean compromising their safety – we aren’t throwing them to the wolves – rather, we are rebuilding independence in a supportive environment so we can be partners in their care, not providers. A Dementia diagnosis is not a no-knock warrant into their lives. Not sure what they need today? Ask them. Give them the dignity of choice. Their logic may seem a bit convoluted compared to our linear way of thinking, but it makes sense to them. We need to respect their wishes and meet them where they are in order to promote a sense of self-worth.
What if we reframed “Person-Centered Care” to “Person-Centered Assistance”?
Instead of doing everything for them, we help them achieve their goals and tasks. “Care” implies invalid status, but “assistance” assumes functionality with a little help where it may be needed. If we listen to them without prejudice, we could discover alternate methods of teaching new skills. Methods that encompass tactile and demonstrative instruction rather than verbal instructions. Methods that allow a person living with Dementia to carry on with skills that they’ve spent a lifetime honing. For example, allow a person who has always enjoyed cooking personally or professionally to assist in preparing a meal instead of assuming that Dementia would possess them to harm themselves or others. Under our current model of Dementia care, these concerns overshadow patient development. In our zeal to provide safety, we’ve put them in a functional straight-jacket that feeds the disease.
Adopting an assistive, habilitative approach to Dementia care doesn’t mean tearing down everything we’ve built over the years; it means building upon it. We can view behaviors through a different lens and identify which ones are a response to unmet needs. Human needs go deeper than food, clothing, and shelter. They include socialization, self-esteem, emotional safety, and self-satisfaction. We have to ask ourselves a tough question – are we meeting all of these needs and empowering the growth of the individual? Or have we given in “because they have Dementia”?