Keeping Things Positive for Patients and Caregivers | by
Teepa Snow was raised in West Virginia and rural southeastern Pennsylvania, and says those roots strongly influenced her work ethic and caretaking nature. “I grew up in blue collar areas where you don’t walk away, you pull your own weight, and if there’s somebody in need you figure out what you can do to help. Not only did I grow up in that culture, but I then also worked in Girl Scouts for years. And in Girl Scout troops sometimes you eat noodles without sauce because somebody forgot to bring the sauce. ‘Make do or do without’ is a life motto. You learn how to roll with the punches and be a problem-solver.”
An occupational therapist with forty years of clinical practice, Snow serves as a trainer and consultant helping to promote better care for those living with dementia. As the owner and CEO of Positive Approach, LLC, she works with agencies, communities, and even individual families to guide them as they navigate this journey of identifying the best ways to provide those with dementia with the support and resources they need.
Given the name of her business, it should come as no surprise that Snow emphasizes an approach centered around positive outcomes and optimistic thinking. “Living with dementia or caring for someone who does is challenging and often tough. My strategy is, let’s figure out how we’re going to have more of those positives and fewer moments of frustration and embarrassment. Those are huge elements of success in living with the condition. The person needs to feel like they have a purpose. Whether you’re the support person, or the person living with the condition, do you have a purpose? Do you feel that you have value? Can you find joy in at least part of what our interaction is?”
It’s the little things that can make a big difference, Snow says. “It could be something so simple as asking their opinion. ‘I’m trying to decide between these two things I’m thinking of putting up, and I would really love to get your opinion on which you think would look better here. Thanks for helping me with this.’ Now you’ve got an opportunity that could lead into an interaction. Like, ‘What do you think of this flower? That reminds me of when I was little and you had those flowers, you painted on my dress. Do you remember that? I think I have a picture.’ Then it’s not only a value, there’s a memory. Whether you remember or not, I remember. That makes it different between the two of us.”
“If I have the skills and knowledge, there is much less of a challenge in the care.”
Snow has a system that boils down to a very simple tactic. “I say, ‘Tell me two things that went okay today, and one that you wish was different.’ What starts happening is, without that support from someone else, you tend to focus in on what didn’t work. ‘So, tell me what went okay.’ Explore how much of that is you making choices, and how much is the person having a sense of control. It’s never an easy condition and having a sense of control is challenging, but there’s ways to feel better about yourself and what you’re doing when you get the right support. External support helps when you can’t see ‘it’ anymore. You’re just so consumed and in the middle of ‘it all‘,” says Snow.
Having been in this role for decades, Snow has seen some positive changes in how people with dementia are treated. “Some of the biggest shifts have been seeing people living with dementia as people first, and having dementia second; not letting a diagnosis becomes a defining feature,” says Snow.
Communication and Perception
A key skill is an ability to translate what someone says to figure out what they really mean, says Snow. “When they say, ‘I want to go home,’ but there is no home because they live here, you might struggle if you don’t have the knowledge to understand what they are saying as, ‘I’m uncomfortable here.’ Or ‘I’m afraid here’, and ‘I think there’s a place where I’d find a sense of safety, and I call it home’. Once you get that, then you can go, ‘Okay, so you want to go home. Did you need to do something there, or did you just want to be there?’ And maybe they’ll say they need to fix supper, and then you can ask them details about that. Now I’m engaging you as a human and I start to understand what it is you’re telling me,” says Snow.
Communication challenges are often at the heart of the common sense of frustration, Snow says. “If I have the skills and knowledge, there is much less of a challenge in the care. It’s when I don’t know what to do and you can’t tell me what you need in clear, accurate terms, or you keep telling me what you need but I don’t know how to supply that because you can’t live on your own and that’s what you want. I don’t know what to do to help and you get frustrated because you feel like I’m not listening. Frustrations and repeated behaviors are simply expressions of unmet needs,” says Snow
Those around the person with dementia often don’t realize certain actions are caused by the condition, especially during the initial phase. “There’s a period of time where people think the person is deliberately doing things. They will say, ‘She knows what she’s doing. She does this on purpose. She was fine this morning.’ What they don’t realize is she used everything up to get through the morning. By afternoon and early evening, there’s nothing left. What we should do is look at what we’re demanding of her in the morning and look at smoothing some of those curves out so that we’re not emptying all of her reserves early in the day.
Supporting those with dementia and the people who care for them is important work, and Snow loves it, but relishes the opportunity to take a breather with something not quite so serious during her time off. “I like hiking and outdoors stuff. I also enjoy renovations and house stuff. Baking, cooking, and crafts. I watch the cooking and home renovation shows. That’s my go-to when I need to fall asleep in a hotel. I never see who wins anything and I never get to see the final reveal. It’s kind of fun but I’m not invested in it so I don’t worry about the outcome.”
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