The Skill of Redirection and it’s Importance

Sometimes you may feel that the behavior of a person living with dementia is like the behavior of a child. And sometimes you will feel like treating them like children to change their troublesome behavior. You raise your voice and shout, “Don’t do that, we have to go, get ready, and how many times have I told you . . .”

Believe me, this won’t work, because your loved one is not a child. A child is in a learning stage of life. A person living with dementia is in a progressive state of mental decline. Their time for any significant learning is long past, and you must understand this when dealing with them. Arguing or barking instructions will not get the results you are seeking. Blaming and shaming won’t work either.

Rather, you must develop the skills of redirection, validation, and positive re-enforcement to change their direction and focus. Understanding this is crucial to coping and managing your loved one. Often, bad behavior arises from confusion, being over stimulated, a change of environment, or our triggering their negative response, even when we don’t realize we have done so. You can’t tell them to just stop it; you must gently move their attention to something else, maybe something that will provide them a purpose or make them feel useful.

Yes, it is easier said than done, which I can confirm from my own experience. My husband Albert was combative and was Baker-acted more than once from communities that simply did not want to or did not know how to deal with him. Often, I observed, their methods only made matters worse, escalating his combative behavior.

Here’s an example. One morning I was told that Albert was frantic and that they were about to ship him off to a psych hospital. I rushed to the ALF where he was living to see what was going on. Albert was fixated and frantically pacing up and down the hall. Their way to handle this was to have a huge orderly pacing up and down behind him, just inches away, hovering over him like he was a dangerous man. I felt that any fool could see that this kind of intimidating supervision would make even a sane person frightened and anxious. There were several things they could have done differently to have a better outcome. Rather, they dismissed him after only night in this facility!

The first step in understanding techniques of redirection is to learn not to do things that contribute to your loved one’s stress and anxiety. Don’t ask “What’s wrong?” They don’t know what’s wrong, and if they do they probably are not able to articulate it. Such questions only draw attention to the negativity of the situation.

Instead, try to draw their attention to something they like, maybe offer them a treat, limit stimulation, play calming music, suggest a small task that will make them feel useful. If they like to go for a drive, try to get them out of the house and into a different environment. Try to turn their attention to the things they like.

I knew a woman at an assisted living facility who loved to wipe tables, and if asked to do so, she would pitch in and help the staff after every meal. She also liked to sweep the floor. When she arrived at the ALF she was a very agitated woman, but helping her feel useful and giving her a ritual she enjoyed made her much calmer and more manageable. She was a person that needed to keep busy, she had been that way her entire life.

To achieve this we had to know who she was and what she had done in her life. We tried to look at her as a person, not a problem. The cornerstone of Person-Centered Compassionate Care is to learn the person, respect the person, and look for their abilities, not their disabilities.

It was not until I placed Albert in a small private ALF in Hernando County, owned by Joan and Tony Clarke, that I learned the greatest redirecting skill of all. Looking back, it seems so obvious and simple, some of you may scoff at the idea. Joan and Tony told me that the best therapy for a person living with Alzheimer’s or dementia is LOVE.

I was very skeptical that they could follow through with what they were telling me. I had seen nothing of this kind of attitude for almost a year. What made them any different? What could love achieve with a person who did not seem to understand anything? But they insisted: “We are going to love your husband through this.” Your search is over, this will be the last time you have to move your husband.

It was true, and it worked. They told Albert they loved him, they did not yell, they allowed him to begin to trust, they demonstrated it with frequent hugs, and he lived there quite peacefully until his death, with very few behavior issues. This was the difference between treating an adult with dementia with kindness, dignity and respect, rather than as a willful and naughty child.

When I became an administrator of an ALF memory care community, I took Joan and Tony as my mentors and as my model. I used this technique with the residents in my care. It was truly amazing to see the transformations happen. Showing them frequent attention and affection, giving hugs, talking to them quietly, and offering them treats. Those who are not huggers can be satisfied with just a touch on the forearm and a few kind words.

Does it really work? Yes, it does. A person living with this disease has lost his purpose, they may have lost the ability to do things, but they have not lost their heart. You just have to find it. They will respond to being loved, being safe, given empathy and affection, more than at any previous time in their lives. Just try it. It works.

Until next time remember: “We all deserve the best”

Send your comments and stories to [email protected]

© Debbie Selsavage, 2016

3 Replies to “The Skill of Redirection and it’s Importance”

  1. Thank you, Debbie <3
    I came here from a link posted on our FTD FrontalTemporal Degeneration (FTD) Info and Support Facebook site – to read your "Showtime". And Oh yeah – how that resonated!

    I find it completely stunning that most 'expert medical staff' and most care facility staff seem to know nothing (& seemingly don't care to) about the degenerative brain condition FTD, whose behavioral variant certainly poses lots of challenges for carers! All FTD's variants combined affect only about 10-15% of dementia people but that's still an awful lot of individuals! Treating them like people with Alzheimer's as normally occurs, doesn't work at all well – at least not until they are a long way through their illness and experiencing memory loss.
    My ex-husband has bvFTD & has needed care facility residence for about 4 years now. I am a Guardian for him & seem to be his only remaining friend – due to his past behaviours even two of our 3 sons have no contact now. He says and does the most awful things but I always try to treat him with respect and humanity, as I would wish to be treated if the situation was reversed.
    I believe it is truly hard for people to 'get it' – that the bad behaviours ARE the DISEASE, not the person deliberately being mean/an embarrassing nuisance. It helped me enormously to have proof of that via a functional scan – SPECT – showing 3 particular brain lobes very compromised in their function, since in his case he also has various brain functions that remain intact (so in some situations he presents fairly normally).
    I'm really quite good at redirection now, diverting attention AWAY from the critical issue at hand while giving him choices about less critical matters and thus 'getting through'. I notice the little things about people, it helps me to treat them as individuals. A person who always agitates if uneaten food is left on their plate & then repeats their loud comments over and over – much easier just to whisk the plate away out of their view & make life better for all. Why it's not obvious to others I dont know!
    Having lived a solitary life myself – 15 years without a partner and 6 years since my youngest left home – I also understand how necessary human touch is for our soul.

    1. Hello Beth,
      What you have written is very common. The professional industry does not see the person as an individual, they want everyone to be on the same schedules and that does not always work for people living with dementia. Most time people are doing different things, different stages. Professionals are use to doing the same thing and getting the same results, this does not work with dementia. They need human contact just as anyone else. I am glad that you enjoyed are article and if there is anything else I can help you with please do not hesitate to contact me. If you are local to Citrus County we present a coping with dementia conference. If you need more information let me know. Thank you for your kind words. happy New Year.

    2. Hello Beth,
      This is a very complex disease for the healthcare and medical community. One reason is that this is very different for every person, they cannot fix it, they cannot give each person the same solution for their problem and it will work, they have to spend some time to know the person, what did they do, who were they. Giving the person the respect and dignity that they deserve is one way to start building a relationship. A person living with dementia is no different then anyone else, they need attention, respect, love. This can also simply come from eye contact and a hug. Thank you for your comments. Please visit my website. Debbie Selsavage

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