Imagine a speaker so talented that she can speak for two hours to a mostly senior citizen-aged audience of 300 about a subject as depressing as dementia and keep them laughing most of the time, and at all times fully engaged in her message.
Teepa Snow was invited by Park Ridge Health and Mountain Home Care to do just that in two presentations at the Biltmore Baptist Church in Arden, “Learning the Difference Between Confrontational and Supportive Communication,” and “Understanding Yourself as a Caregiver: What Do You Need to Keep Going?”
A common misconception is that all dementia is Alzheimer’s, which is only one of 110 different forms of dementia. Snow said that for every one of them the person will be robbed of their skill before losing their strength.
“Right now, across this nation, one in five families are dealing with some form of dementia. Four out of five will fall apart before it’s all over. Within 15 years one out of every two families will have a member with dementia,” she said.
When a Person Living With Dementia’s (PLWD) personal space is breached for the purposes of grooming or feeding, the PLWD may become defensive.
“Human beings are built in such a way that there is a very different sensation if you touch yourself than if someone else touches you,” Snow said. To demonstrate to the audience how this works, they were asked to divide into pairs where one person would act as a caregiver and the other as the PLWD.
“So what I want you to do is for one of you to just face front, and the other go to one side of your person and gently groom your partner. Light moving touch stimulates a human being in very different ways than slow strokes do. By the middle of the disease, a lot of what we do involves light moving touch. Next I want you to go to the other side of your person and start grooming from that side. Then I want you to face your person and start fiddling and messing with them from the front. I want you to experience left, right, and straight on.”
The auditorium echoed with an awkward uncontrollable laughter as this activity played out. The point of this exercise was to demonstrate that 90 percent of people prefer to be approached from their dominant side.
“So if they’re right-handed, they will be more comfortable if you’re on their right side. That is because our bodies usually have skill on one side, governed by a specialized brain. It’s called ‘hemispheric specialization,” she said.
Snow said bodies follow suit and have skill on only one side, so everyone has a preferred eye, a preferred ear, a preferred chewing surface in our mouths, a preferred hand for doing things and a preferred foot. “You like one side better than the other for skill. Your non-dominant side is for strength and stability. When you pick up a jar of peanut butter you will hold it in your non-dominant hand and twist the lid with your dominant hand.”
Some of the challenges faced in caregiving are because we’re trying to do things to people, not with people. “As a caregiver, I must understand that I am now the skill you’re missing, but I can’t do it to you, I must do it with you. Since the thumb, index and middle fingers are our fingers of skill, and the ring finger and little finger are our fingers of strength, I want the ability to enfold my dominant hand within yours and use my fingers of skill to guide you.” With this “hand-under-hand technique” the PLWD’s brain remembers the motion of brushing their hair, fastening buttons, etc.
“The mouth is by far the most sensitive part of the human body. I have to trust you a lot to have you put things in here,” said Snow. Feeding and brushing teeth for someone else pose a special challenge she addresses with her trademark humor. “How many of you let somebody else brush your teeth every day? How many of you think it would be a good idea? How many of you don’t want anybody else in your mouth?” Almost everybody laughed and raised their hand. “You barely tolerate the dental hygienist, and only go there twice a year. It’s not your favorite place to go. Some of us would rather have children than go see the dentist, it’s only the 18 years afterward that convince you were wrong.”
Snow said that when the PLWD engages in the activity of brushing teeth, with assistance, it changes everything because the subject has the power of choice as long as their brain is still interested in that message. People experiencing middle stage dementia have a change in their visual field that Snow compares to tunnel vision or looking through binoculars. Peripheral vision no longer functions. PLWD may lose the ability to hear vowels. And just hearing the consonants may sound like gibberish. Speaking in a higher volume doesn’t help if their hearing has not otherwise failed.
Snow demonstrated with members of the audience and role play how a worst case scenario unfolds in conversation, and then a more favorable outcome to a leading question from a patient with age related memory loss. They may think people have been talking about them behind their backs because they don’t remember what they said about themselves. To avoid an escalating conflict Snow instructs caregivers to use the key phrase, “Tell me about it.” This way, nobody is encouraged to lie and it opens the door to the PLWD calmly telling their story.
Snow’s mother-in-law lived with Snow and her husband when she developed dementia. One day Snow came home from work and found her husband totally stressed out because his mother had urinated nine times in the chair throughout the day. “My 6’2” 180 pound husband, a quiet man, is standing shouting at her, and has his mother by the forearms.” She might have accusingly shouted at him, “Are you nuts?!” Instead, first she stepped out on the back porch, closed the door, and worked on breathing.
The diaphragm is one of the biggest, strongest muscles in our abdominal area. Taking a few deep breaths sends a rush of oxygen to our brain. “When we’re stressed we tend to tightly clench our jaw and forget to breathe out. You suck air in and hold yourself rigid and tight so you don’t lose composure. Unfortunately, you actually think you are oxygenating your brain. But ohhhhh you are not! The longer you stay like this the more cortisol you are releasing, the more adrenaline you are getting, and you are deoxygenating your brain.” A few deep breaths will cause the cortisol level to drop immediately and reduces stress. When Snow stepped back into the house she asked her husband in a nonjudgmental way, “What’s going on?”
“Here’s something you might want to know about dementia. When it comes to yes or no questions, people with dementia will say ‘no’ seven out of ten times. They say no to maintain status quo because they don’t want to get in situations where they feel out of control. When I ask if you have to go to the bathroom and start to take off your pants, you say, ‘no thank you, maybe later.’ Those are the sweet ones. That’s a nice way of saying no.” With others the sharp response might be, “What part of ‘I said no’ did you not hear? I don’t need to and I’ll do it when I’m ready.” A better strategy is to find an excuse to go to another room, and while you’re already up ask if they want to visit the bathroom.
Looking for moments of joy is at the heart the heart of Snow’s mission, and keeping a sense of humor in the face of difficult situations is one way she does this. Snow neither looks nor sounds like the late comedienne Phyllis Diller, but her impeccable comic timing is unmistakably similar. Accordingly, not even “potty humor” is off limits.
Snow related that elderly women raised rurally from a generation that helped men work the fields were not accustomed to wearing undergarments beneath their dresses because it was easier to just squat in an open area to do their personal business. “When grandma got dementia she did not feel the need for underthings. Yeah, she found trashcans to be quite helpful. We learned to line them and put kitty litter in them. If you use a red liner it draws their eye, just in case you’re curious. I like trash cans near doorways cause’ it’s a lot easier to clean up than the radiator. Men most frequently stand in front of the window and pee into the air conditioner because with binocular vision they think they’re outside.”
Her care strategies and techniques integrate what is known about brain function and changes that happen in cases of dementia with therapeutic approaches to foster positive outcomes, modified environmental supports, and altered task expectations that match retained or available abilities of people experiencing some form of dementing illness. Snow teaches about the value of connection when primary verbal communication and interaction abilities are altered. Learn more about Teepa Snow and her Positive Approach to Brain Change (PAC) at TeepaSnow.com, or contact Jean McGuire with Mountain Home Care at 828 684-6444. McGuire is a PAC independent certified trainer in Snow’s techniques.
By Mark-Ellis Bennett