Caring Mistakes

 

 

Carers generally have good intentions for the person with dementia but do sometimes get it wrong. This page is a comprehensive master list of common mistakes that occur when caring for a person with dementia. It is not about appointing blame but more so finding positive solutions. These mistakes and solutions have been discussed and developed in conjunction with the members of the Dementia Downunder Support Group and are updated regularly.This page is a fast reference guide for anyone in a caring situation requiring a positive quick fix.

Not going with the conversation and being disagreeable.

solution – adjust to their reality. Find out where they think they are by asking questions. 

Sweating the small stuff.

solution – go with the flow and just ignore those little mistakes and errors. Does it really matter? 

Arguing with residents.

solution – Always take the blame for everything. There is no point in arguing with a person with dementia….ever! 

Correcting the person about reality all the time.

solution – adjust to their reality. Find out where they think they are by asking questions and go to this place with them. Look for clues.

Too much noise at mealtimes.

solution – make a conscious effort to limit noise and clanging. Play some soft familiar music during mealtimes. This should be the highlight of their day.

Talking to other carers when assisting with meals, when focus should be on the resident.

solution – stay focused on the resident at hand. Mealtime is not the time to be socializing in front of residents. 

Talking loudly at the resident because you think they won’t understand.

solution – never treat people as being stupid. Know the resident and what volume works best for them. If you get it wrong you will be patronizing them.  

Ignoring their feelings.

solution – adjust to their reality. Find out where they think they are by asking questions. 

Taking what they say to you to heart. 

solution – just roll with any insults or name calling. Ignore them as you need thick skin to be an effective carer. The person with dementia can often not control what they say or may be verbalizing their frustrations.

Not having patience or a sense of humour.

solution – you needs patience in abundance. Breathe during difficult times and count to 5 before acting. Keep things light and fun where possible. 

Always ask when doing an activity 

solution – everyone should have choices with activities and people with dementia are no exception. Just because the person enjoyed that activity for 20 years does not necessarily mean they want to do it now.We need to adapt to their wants, not the other way round.Perhaps limit the choices to two.  

Not giving people a choice.

solution – everyone should have choices and people with dementia are no exception. 

Believing the person is misunderstanding deliberately.

solution – this will cause you great stress. The person genuinely is not capable of understanding. Allow for this and things will improve. 

Moving the person without explaining what is happening.

solution – make contact with the person (eg touch them) – and advise them slowly of what you are about to do. This will make them feel safe. 

Shovelling food into their face at meal times.

solution – be wary of their swallowing pattern and do not patronise or bully the person into eating the food. be patient and understanding. 

Dressing them in an unco-ordinated fashion eg mismatching socks.

solution – always provide dignity by making the person look as good as they can be always. Ensure clothes are matched and in good order.

Not working in a way that supports a ‘strengths’ based approach.

solution – We we need to set up people for success so they can feel good. If they fail all the time they will feel depressed and sad. Tailor activities to their abilities. 

Becoming angry when the person with dementia does something wrong.

solution – never get angry at a resident. They do not do things on purpose. stay calm and smile and take the blame.  

Using the word ‘remember’.

solution – this is a hard habit to break. imagine everyone asking you to remember things and you simply can’t. This is a negative state of mind and is best avoided. Try “The time we….” or ” Have you ever…”.

Showing your frustration when trying to hurry the person up.

solution – you always need to stay as calm as possible. Be patient and understanding. 

Not treating the person as an individual.

solution – never assume the person wants to go along with everything. Give them choices and cater your speech and activities to the person and where they are with their stage of dementia.

Not introducing yourself.

solution – Look the person in the eye and slowly tell them who you are with a smile. They are reading your body language. Try and wear a badge with your name on it if possible.

Making noise when they are watching tv.

solution – keep quiet. allow the residents to watch tv in peace. They may need to concentrate to watch the tv and any distractions can be annoying for them.

Saying “You already told me that!” all the time.

solution – repeating negative things to the person will make them feel negative and down. As carers we need to accept repeated sentences as part of the dementia and just be patient. 

Telling the person how tired you are.

solution – The person with dementia often can feel a burden on others. By telling them how tired you are will just increase this burden. Perhaps save these thoughts for others. 

Arguing about their change in food taste.

solution – arguing should not occur anywhere in dementia care. The person’s food tastes will change and we need to embrace this and adjust with them. Keep testing different foods to remain current with their dementia changes. 
Going out for the day without spare clothes for ‘accidents’.

solution – planning is a really important part of dementia care. Having spare clothes and items that will help when things go wrong will keep your stress down and make things better for the person with dementia. When in doubt, pack extra.

Assuming everything going wrong is due to dementia.

solution – dementia care is often about elimination. Things often go wrong and we need to eliminate pain, medication side effects, toileting, urinary tract infections (uti’s) etc before we can categorically say that the person’s dementia is the only definitive cause.

Excluding the person from day to day tasks. 

solution – Everyone needs to feel a sense of worth. adjust to their reality. Find out where they think they are by asking questions.

Over medicating so you can get a break.

solution – Leave medications and dosages to the experts and follow their instructions carefully. Keep in close contact with medical staff and advise how the person is going.

Forgetting to look after yourself as a carer.

solution – Many of us get caught up in the world of caring as we are doing our best for the person with dementia. Like the instruction on a plane about “putting on your oxygen mask before helping others”, the same applies with dementia. You need to look after your health first to be a better carer for the person. Take respite when required.

Talking over the top of people.

solution – this is rude whether you have dementia or not. By talking over the top of the person you are confusing them and also disrespecting them. Allow the person with dementia to get their words out.

Not living in the moment.

solution – understand where the person is at (they often draw on long term memories and regress back to younger times in their life). Look for clues and signs of where the person with dementia believes they are at. Once you can grasp this concept you will be able to communicate so much better. We need to adapt to the person and always remain flexible. 

Not including the person in family events.

solution – Try and include the person in as many events as you can. Even if they cannot grasp the concept or may do some embarrass things at the event, they can feel the sensations of that event and this will make them feel good. If the person becomes distressed or overwhelmed at the event you may need to take them to a quieter environment.

Not reading to them or doing any reminiscence.

solution – Photo albums are invaluable tools to start conversations. Read these with the person often to ignite memories. read the newspaper or books to the person with dementia so they can continue to be involved with everyday current events, but just delivered in a verbal manner. 

Not allowing the person to feel safe and re-assured.

solution – touch, warm tone of voice and positive re-assuring words are required often for people with dementia. They are often frightened and worried as they may not know where they are, or why they are there. The more you can comfort the person the easier it is to manage them and also makes them feel better which is most important.

Using the tv as a babysitter all day.

solution – carers can take the easy way out by putting Andre Rieu or something similar on the tv all day. The residents enjoy the show but they also need variety to awaken different feelings. Residents need some exercise as well and activities to participate in. Keep things interesting and purposeful where possible.

Doing activities without a purpose.

solution – Plan activities in advance so you can have that genuine purpose as a key element of the activity. The resident will probably do an activity without a purpose but may be bored doing so or find it understimulating. It always is best to work out the purpose of the activity before doing it. 

Not giving them some alone time.

solution – Everyone needs some time by themselves to reflect on life and create their own independence and time for personal thoughts. People with dementia are no different. 

Not watching for signals that may indicate pain or a want to go to the toilet.

solution – Be alert and fine tune your body language reading skills. If someone is fiddling with their belt or fidgeting in that region be aware that this may be a non verbal cue that the person needs to go to the toilet. Be tactful and dignified if you detect this and ensure you do not embarrass the person.

Not respecting the person’s modesty

solution – Place a hand towel over their laps or give them one to hold over themselves . Be aware of when the person may be feeling self conscious. Hold a towel up and even turn your head away at key times to make the person feel their privacy is not being invaded. Imagine what it feels like to be stripped naked and washed by two strangers?

Rushing daily tasks

solution – Take time to wash the person’s hair carefully. Make an effort to present them as well as possible. As we know most places are understaffed and as a result basic tasks are rushed leading to bad outcomes for both the resident and staff. A few extra minutes making the person feel comfortable will allow you to manage the person so much better. Have fun with tasks to make them more positive.

Not allowing access to outside areas

solution – A lack of daylight/ sunshine can lead to depression , sleep issues , less vitamin D production, plus osteoporosis . Everyone has the right to access the outside world and enjoy the environment. Try and take the person outside as often as possible providing it is in a safe and calm environment. 

Being too forceful and uncaring

solution – Sometimes complacency can set in and the role of caring becomes a chore. The person with dementia can feel this dynamic. Always try and obtain eye contact when communicating and use a soft warm tone where possible. Explain what you are about to do before doing it. This will reduce ‘shocking’ the resident. Imagine you are caring for a close relative at all times, this will lift your standard of care. Be wary of the person’s reactions and feelings and react accordingly. If you treat the person like a nobody, they will react negatively towards you and will be more difficult to manage. 

Using generic terms of endearment (eg “Sweetheart” & “Dear”)

solution – Everyone loves to be called by name whether they have dementia or not. It is more respectful and friendly to use the person’s name. It also lets the person know that you are actually talking to them. This will allow for better communication all round. 

Using a slow, high pitched tone of voice

solution – Some carers actually believe they are helping when they talk to a person with dementia in a slow high pitched ‘song like’ pattern. This can come across quite condescending and disrespectful to the person. They are adults who have trouble unlocking their thoughts, they are not children and should not be treated this way. 

Being careless with straps on hydraulic lifter

solution – Be very aware of men’s nether regions when placing the lifting straps near their groin. Imagine the pain as the person is lifted up by this area? Perhaps place a towel in between for extra comfort (and modesty) to enhance the lifting process. Be aware of strap placement on limbs such as shoulders. This can cause the person to be ‘chicken winged’ and their full weight will be carried on that shoulder and possibly dislocate it. Good preparation and technique will ensure the person is calmer and happier when lifted. 

Not providing dignity at all times

solution – During times of potential embarrassment eg.incontinence it is very important to make the person feel as dignified as you can. Cover up any soiled sheets or clothing and shield the person from other residents if they are in disarray or inappropriately dressed. If you notice the person may have had an accident discreetly take them to a private area without others knowing and attend the situation. Never make comments of the odour or mess, and discreetly freshen room and open windows without making the person feel any worse than they probably already do. 

Doing everything for the person

solution – This is a very easy mistake to make. It is best to allow the person to do as much as they can for themselves to ensure they retain their self esteem. It is ok to assist with holding forks and knives etc but try and do it ‘together’ where possible. Spoon feeding the person like a baby when they can actually do it themselves is counter productive. It is best to do things with them, not for them.

Not thinking about the person’s comfort at night

solution – Imagine you are in bed on a cold night and your blankets are all on the floor and you can’t get them. This would be uncomfortable and distressing. Likewise on a hot night and having winter blankets on the bed. A person with dementia may not have the insight to remove a blanket, which means they will ‘cook’ in the bed. As carers we need to think for the person with dementia and make the best decisions for that overnight sleeping duration. 

Leaving a person unattended outside

solution – Even with good intentions you may place a person in a shaded area outside, but maybe causing unintentional harm. As the sun moves the shade may also disappear and the person with dementia may eventually be ‘cooking’ in the sun. Provide a hat and or/an umbrella for shade and perhaps a cool drink to eliminate the chance of the person dehydrating. 

Not considering the person’s posture

solution – When lifting a person into a Princess chair or placing a person in an arm chair be aware of their posture. The person may be in that position all day and this is where pain sets in. The person may react with agitated behaviour and it could have been avoided in the first place by ensuring the person’s posture is correct. 

Bursting into the person’s room without knocking

solution – It is always good manners to knock, wait, call out the person’s name and ask if it is ok to come inside? Sometimes they may not answer you and you need to enter anyway, but in this case do so in a slow and discreet manner. Be aware the person may be undressed or in an embarrassing situation. It is your role to handle the situation with discretion and dignity. 

Ignoring people that can no longer communicate, go silent or are disruptive

solution – It is often easier to ignore people because they don’t complain or are a hindrance to activities. It is important that we treat everyone equally and give everyone some attention where possible. Find different ways to connect with each person and acknowledge them with their name and a friendly sentence or two. Even if you know they will not respond, it may make them ‘feel’ good and give them some self worth.