Thank goodness we are gradually coming out of lockdown and we can start to welcome back our residents’ friends and families. They are, after all, an important part of the team and their absence is likely to have had a detrimental effect on their loved ones.
Being isolated from families and having routines disrupted has caused many residents with dementia to become withdrawn and low in mood. Without the stimulation of regular visits and social activities it is likely that cognitive skills have declined, and a degree of independence is lost. Families are likely to notice a deterioration and this is upsetting for them. We must do what we can to welcome them back, prepare them and help them re-build relationships and get the most out of their time with their loved ones.
The skills of communicating and getting the most out of a relationship with someone with dementia may have become second nature to us, but families often have little or no experience and training. They find it very hard to visit a loved one who may not recognise them, doesn’t want to interact or reacts with aggression. It is so easy for them to take it personally and get upset. They may cut their visits short or find it easier to just stay away and rely on telephone updates, fearing that they are causing upset by being there.
It is natural for families to want to bring the person with dementia into their world. They talk about their grandchildren, show photographs and talk about recent events. Sadly, this can sometimes be overwhelming for someone with dementia who cannot easily connect with the present and feels more comfortable with longer term memories. We need to encourage families to try to live in their loved one’s world. They won’t have the conversations they once had, but they may be able to connect on a more emotional level. It is important to focus on the skills that their loved one still has. Memories from way back can be rekindled through life story books, photographs and music. Encourage visitors to bring objects with them that may spark conversation. A favourite scarf, a recording of familiar music or postcards from a childhood holiday. It is important to take things slowly and don’t ask too many questions. However, although memories may have faded, often intellect remains and asking advice can help the person with dementia feel valued and part of your world.
If communication skills have deteriorated over the past few months due to lack of stimulation and low mood. We can encourage visitors to connect through eye contact and touch. A gentle touch on the arm or knee will help to get their attention before they speak and reduce startling. Confabulation can be difficult for families to understand and can be misconstrued as “telling lies”. Arguing with someone with dementia rarely ends well and if we can help families understand that this behaviour is just an attempt to interact when language abilities are confused, they are more likely to join them in their reality rather than correcting.
If a resident becomes angry or frustrated with visitors, this can be upsetting for them. It is important for you to help relatives to understand that it is not personal and is part of the frustration of the illness. The more they understand, the easier it will be for them to empathise and try to defuse the situation. It may be that a change of scenery will do the trick and the good news is that they may not remember it in a few minutes, so the visit can resume when things have calmed down. It would be a shame for visitors to leave and go home feeling upset because they have misunderstood a situation.
It is great to welcome families back to our Homes. We need them and they need you.
Care home visits are able to resume in England as long as local authorities and local public health directors say it is safe. While many care homes have been creative to allow visitors to carry on seeing their loved ones, these don’t replace the traditional face to face visit. To allow face to face visits safely, care providers should ensure to collect details and maintain records of visitors on their premises to support NHS Test and Trace. QCS have created a free visitor form that can be sent out when booking visits or can be completed on arrival.