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How to Convince a Resistant Elder to Attend Adult Day Care

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While caring for my elderly parents, I was often advised to enroll them in a local adult day care program. Well-meaning people explained that going to the adult day center would give my mom and dad a life outside of lying in bed and watching TV all day. They also emphasized that I would get a much-needed break while they were out of the house. As nice as that sounded, I must admit I quietly scoffed at these suggestions for months. I couldn’t even get my father to take a shower on a regular basis, so how was I supposed to get him to attend a senior center?

A year later (and at my wits’ end), I decided adult day care was worth a try after I toured the beautiful facility nearby. I pleaded with my father for weeks before he begrudgingly agreed to go. Mom, on the other hand, was open to the idea right away. At the end of their first day at the center, she giggled, “Oh, honey, guess what? I won some lovely new earrings at bingo!”

Unfortunately, my father had quite a different experience because he was determined to sabotage the idea from the start. I was so embarrassed when the staff told me they had spent that whole first day trying to manage him. He wouldn’t leave my mother alone, holding onto her too tight and touching her inappropriately (which he had never done before). Apparently, he threw his lunch on the floor during a temper tantrum and even tried to escape out a bathroom window. By the time I arrived to pick up my parents, the staff members were completely exhausted and sincerely doubted he would ever be a good fit there.

Although I did my best when initially pitching the idea of adult day care, it didn’t exactly go over well. Like most caregivers, I’ve spent ample time reflecting on mishaps like this one and thinking over all the other ways I could’ve handled things better. I’ve brainstormed a few different ideas that I think would’ve helped convince my father to attend the adult day center without causing a scene. Hopefully, these tips can help fellow caregivers who are interested in adult day care avoid the mistakes I made!

Introducing the Idea of Adult Day Care

The very first change I would make is to avoid referring to adult day care as such. For most people, the term “day care” evokes images of young children who can’t take care of themselves and require total supervision. Understandably, many seniors find this term condescending and infantilizing. Alternative names include day center, senior center and even “the club.” You know your loved one best, so try to find a term that would appeal to them.

I would’ve also tried to introduce the social worker from the adult day center to Dad on a social basis first. A few phone calls or even a home visit will allow a staff member to develop a commitment-free relationship with a senior in a safe space. If this goes well, then your care recipient will recognize at least one familiar face at the day center, which can help them feel more comfortable.

When it comes to actually getting a senior to go to the center, I think that framing it as an opportunity rather than an obligation can help immensely. For my dad, an invitation from one of the staff to assist with an activity or event would’ve made a huge difference in his willingness to attend. By giving my father a “job” to do or a volunteer opportunity and telling him he was needed there, he would have felt honored to go help out.

This approach can also work if you plan to drop by the local center for a low-key tour and introduction under the guise of saying hello to your “friend,” the social worker or an administrator. Again, communicating with a staff member beforehand about your loved one’s apprehension and personality traits can help them navigate the situation better. They can ask your loved one to pitch in with preparing and/or serving lunch if they enjoy cooking or request assistance with folding laundry—an activity my mother always enjoyed.

Helping a senior strike up a friendship with someone at the center and presenting them with an opportunity for an increased sense of purpose can be very valuable steps in convincing them to give adult day services a try.

Helping Seniors Adjust to Adult Day Care

One thing I especially regret is sending my parents to adult day care by themselves on the first day. I now understand how scary any kind of change can be for an elder, particularly for someone who is in the beginning or middle stages of dementia. My father was used to always being in control of his environment. So, when I dropped him and Mom off at the center, it completely overwhelmed him and he acted out.

If you anticipate any issues like the ones my dad caused, then it’s best to opt for a gradual introduction and transition to minimize stress and aggravation for everyone involved. In a redo, I’d be sure to go with my parents to the center as many times as needed until I was sure my father felt comfortable and safe enough for me to leave.

I know that one of the points of adult day care is to provide you, the caregiver, with a break, but easing into things will ensure this is a lasting option for respite care. My father almost wasn’t welcomed back after his chaotic first day at the center. To me, a little bit of hand-holding is well worth keeping all your options open.

The Benefits of Adult Day Care

Even though I went about introducing adult day care all wrong, eventually I succeeded in getting my father to accept the routine of going to “the center.” My parents finally had someplace to go during the day, friends to socialize with and numerous activities to look forward to. Best of all, the activities tired them both out so much that they finally slept through the night. This meant I got some sleep, too! The burden of caring for and entertaining them both during the day was dramatically reduced, along with my blood pressure.

It wasn’t long before my parents became shining success stories. They progressed so dramatically in their behavior and strength that even their doctors were impressed. I was delighted that they were emotionally and physically healthier than they’d been in years, thanks to the increased activity and socialization at the center.

Now, as I lecture all over the country about caregiving issues, I always emphasize the tremendous value of adult day care, what I consider the best kept secret in elder care. I smile each time I hear fellow caregivers express the same reluctance I once had: “Oh, Jacqueline, my loved one would never agree to such a thing!” But then I explain that, with a little extra creativity, effort and patience, adult day care can make a significant difference in the lives of even the most challenging seniors and the lives of their overwhelmed caregivers.

Source: AgingCare by Jacqueline Marcell

Validation Therapy for Dementia: Calming or Condescending?

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People with Alzheimer’s disease and other types of dementia often come to live in an altered reality that doesn’t mesh with ours. Their hallucinations and delusions may not make any sense to us, but their perceptions are as real to them as ours are. Dealing with this stark contrast can be difficult, but validation is often the kindest, most respectful way to handle the beliefs and perceptions that a loved one’s brain creates.

Sadly, this is a tough concept for many adult children and spouses of people with dementia to absorb. Most people’s initial reactions to an off-the-wall remark are to refute or correct it. Years ago, this kind of “reorientation” was widely accepted, but the downfall is that it only works on individuals who are capable of rational thinking. Dementia patients lose this ability as the disease progresses and can become agitated or upset when their concept of reality is challenged. Thanks to the work of one woman, jarring reality orientation techniques gave way to the gentler practice of validation in dementia care.

A Dementia Care Pioneer

Naomi Feil MSW, ACSW, was born in Munich in 1932. She grew up in the Montefiore Home for the Aged in Cleveland, Ohio, where her father was the administrator and her mother was the head of the social service department.

Feil earned her master’s degree in social work from Columbia University in New York and then began her own career with the elderly. Between 1963 and 1980, Feil grew increasingly dissatisfied with the traditional methods used to work with severely disoriented elders, so she developed a new technique aimed at acknowledging and accepting their irrational perceptions of reality.

Her first book, “Validation: The Feil Method,” was published in 1982. Although validation was slow to catch on with medical practitioners, by the mid-nineties Feil’s method began to gain popularity. Since then, her technique has gradually become accepted by most geriatricians, geriatric psychiatrists, social workers, nurses and other health care providers as a crucial tool in dementia care.

My Experience with Validation Therapy

I personally witnessed this transition of medical thought as I struggled to care for my father after he was suddenly thrown into dementia due to a botched brain surgery.

My family was completely caught off-guard by this new development and we initially just tried to muddle through. I quickly found that the only way to help Dad relax and retain any sense of self-esteem was to agree with him no matter how deluded his thinking was.

 I agreed with the “fact” that he’d earned his medical degree, even though a reality check would show that WWII had interrupted his studies and prevented him from realizing this dream. I even went so far as to create a faux medical diploma to hang on his wall at the nursing home, which helped for a while.

Then he became convinced that he had received an invitation from Lawrence Welk to be a guest conductor on the TV show, which of course was airing as reruns on PBS since Welk was long deceased.

I bought Dad a conductor’s wand and numerous big band CDs to play in a stereo. He was thrilled. Dad watched the Welk reruns, merrily directing the band whenever he felt up to it. I made him a certificate of thanks from Welk for Dad’s “services” and hung that on his wall as well.

And on it went.

I knew nothing of the validation theory during these early years, but I did know my dad. I could not put this intelligent, well-read man through the horror of correcting his thinking daily when he was no longer able to comprehend why he was wrong. I knew that I needed to get into his world, which was instinctive to me, perhaps because I’m a rather whimsical person by nature.

Years later, I learned that there is a word for my approach to Dad’s altered realities: validation. This technique is now accepted as a practical way of working with people who have dementia. It helps reduce stress, improve communication, reinforce self-esteem and infuse dignity into dementia care. It increases patients’ happiness because they aren’t continually being told that they are wrong and confused by truths that they cannot understand.

The idea of validation stems from an empathetic attitude toward our loved ones and a holistic view of them as individuals. We learn to effectively validate their thoughts and experiences by making ourselves see the world through their eyes.

Isn’t “Lying” to Our Elders Demeaning?

Understandably, my mother had difficultly validating Dad’s altered beliefs about himself and the world. This was the man to whom she’d been married for over half a century. She felt that she was being disrespectful when she placated him by agreeing with his delusions.

I understood why Mom had trouble joining Dad in his world, but I also witnessed the agitation and emotional pain he went through as Mom valiantly tried to make him rejoin reality when he simply couldn’t. She eventually gave up and tried to “play along,” but she was never very convincing. I can’t fault her for that.

Validation Lends Dignity and Respect

Some of us have been told by our parents to never treat them like children when they get old. No one believes more than I do that treating an elder like a child is unacceptable. There is, however, a big difference between raising and educating a child and validating an elder who has dementia.

Children with normal developmental abilities are able to learn and grow intellectually and emotionally. As they gain experience, they gradually understand more and more about people and the world around them. Therefore, gently correcting a child is our job as parents who strive to help them develop and become well-adjusted.

The reverse is true of someone who has dementia. These individuals gradually lose their ability to understand the world as others see it and interact with it appropriately. The disease changes how the brain works and processes information, creating warped perceptions that they cannot differentiate from “true” reality. This is just one way that caring for our elders is different from caring for children.

If we, as dementia caregivers, continually “correct” their thinking, we are chipping away at any self-esteem they have managed to retain throughout the course of this disease. A caregiver’s commitment to honesty and accuracy often comes from a good place, but it can be demeaning, even cruel, for a patient to endure.

Validation is not about treating someone as a child. It’s about respecting the person with dementia and how they see the world. It’s about overcoming our own bias. It’s about adding some dignity to the last years of our elders’ lives by accepting that maybe there is more than one way to look at things.

Yes, there are times when validation doesn’t work, so we lean on redirection and distraction instead.

“No, Dad, you can’t drive right now because I misplaced the keys. Let’s go see if there’s some music on TV.”

“No, Mom, there isn’t a war happening here in town. That is going on far away from us and we’re safe. Let’s change this news channel to Discovery and see what’s on.”

“I’m sorry you’re seeing bugs crawling on your bedroom walls. That must be very upsetting. I’ll call the exterminator and we can go have a cup of tea in the living room while we wait for them to show up.”

Dementia presents countless challenges that call for stellar patience and every tool at our disposal. It may seem backwards at first, but validating your loved one, rather than correcting them, is life-enhancing for both of you. It’s an expression of kindness and respect that will help them feel heard and prevent you from starting unnecessary arguments you will never win.

Source: AgingCare