March 23, 2011
Betty was filling the watercolor paper with multi-colored dots. Dots of blue and green and yellow and pink were raining down everywhere on the paper. Suddenly, Betty stopped and looked questioningly at the aide sitting next to her.
“Is this alright? I am doing this right?” Betty asked about her painting project.
The aide smiled and shook her head.
“Don’t worry, Betty. There is no right or wrong way to do a painting. Anyway, you are a regular Mozart!”
The resident aide had just completed a training session with us, and had received loudly and clearly our message that there is no right or wrong way to create a work of art. This aide was a little confused about the role that Mozart had played in history, but the warmth of her smile and the encouragement in her voice gave Betty the incentive to continue working on her painting. We did not correct the aide and tell her that Mozart was a famous composer, not an artist; that would have been going against one of our own core beliefs: Take a moment and think before you jump into a situation! It was very clear that day that the resident aide meant to encourage Betty, not give her a lesson in Western culture.
It is so easy to jump in and correct anyone, someone living with Alzheimer’s, or someone trying to help them. Before we get busy inserting ourselves into situations, we try to stop and ask ourselves if interfering at this point is necessary or kind. We give ourselves that small moment to think and reflect before interjecting ourselves. Taking the time to reflect, to run through a brief mental review before we leap into action is helpful in caregiving, and it is also often the right decision for our larger lives.
Taking that brief moment before we act is very important when we are trying to help a person who is dealing with the phenomenon understood as failure to initiate. Failure to initiate is often caused by a person feeling confused about what steps must be taken to begin an activity. The inability to remember how to begin a task can be something as simple as remembering which clothes to put on first, or remembering what to do first when making coffee. Most people living with Alzheimer’s experience failure to initiate. If it is hard to remember how to perform an activity in its entirety, it is often even more difficult to remember those first few steps necessary to begin a task.
Have you ever thought about the steps necessary to make a peanut butter and jelly sandwich? Seems simple, right? Well, it isn’t simple! In our training sessions, we ask the people attending what the beginning steps are to making a PB&J sandwich. It is amazing the number and variety of ways that people would begin to make a PB& J. Some say they would pick up the bread first, some say they would pick up the knife first, some say the jar of peanut butter has to be first. We have had people almost come to blows over what comes first in the seemingly simple task of making a sandwich!
So, the point here is that everyone has their own way of doing things, their own unique way of approaching the task at hand. When we lose that ability to remember how to begin a task, we tend to feel frustrated, angry, or frightened. The first signs of Alzheimer’s are usually seen in this difficulty in remembering how to begin.
We have learned to help people through this problem of failure to initiate by doing the work with them. Please note, we do the work with them, not for them. To help people remember how to begin a task, we can demonstrate to them how we would begin. Or we can write out the steps for them, numbering in order each short descriptive phrase. Sometimes, if we join the person with Alzheimer’s in beginning a task, they feel more confident to try themselves.
It does not matter how large or small the task is, that feeling of success is a warm glow felt by everyone, people who are living with Alzheimer’s and those who care for them.
As caregivers, it is important to delineate between those things that people simply cannot do anymore, and those things that we do for them because it is easier and faster for us to do it ourselves. Of course, we don’t want to frustrate or upset the people we care for, but we do want to give them every opportunity to be as independent and successful as they can be, for as long as they can be. Sometimes, we need just a little help from our friends.