clinical focus
the walker is there in front of them and they
get their insulin, they put a check mark next
to the time and date when it occurred. So,
a check mark for Monday morning and one
for Monday afternoon.
What happens is they learn to go to this
location to see whether they’ve had their
insulin for that day. With repetition, they
learn that when their anxiety rises – “Have
I had my insulin?” – they can go there and
see whether they’ve had it.
That’s an example of how we can use
that location learning to enable a person to
reduce their own anxiety. Another example
happens in a place in Arizona, where guys
with dementia go on a regular basis to a
used furniture store. They bring back the
furniture, they sand it down, they refinish
it. They still have those skills. They then
resell the furniture to raise money for the
Alzheimer’s Walk, and in that particular
place they were able to raise US$10,000
($14,000) for the walk by using the abilities
that they still have, and that are meaningful
for them.
In Cleveland, Ohio, a group of residents
formed their own company and began to
make homemade, all-natural dishwasher
soap. They sold it to raise money to buy
their own therapeutic pets.
So, we’re looking at using the capacities
people still have and using these learning
systems to engage people in meaningful
activity, to give them purpose and to allow
them to be part of a community with shared
visions and goals. It gives persons with
dementia the kind of life that anyone wants
as a human. And when people are engaged
in meaningful activity, we don’t see a lot of
the challenging or responsive behaviours
often associated with dementia.
In terms of outcomes, we see reductions
in the use of psychotropic medication, sleep
aids and hypnotics, because when people
are active during the day, they sleep at night.
We also see a reduction in antidepressants,
staff turnover and accidents. So you get this
cascade of really good effects when your
treatment for dementia is trying to provide a
better quality of life, and using the capacities
that people have rather than focusing on
their disabilities.
Have you and your colleagues written
papers on this? Or have you seen
quantifiable results when using these
principles in dementia care?
Both, actually. There’s a very solid research-
based document, as well as many instances
where the application of Montessori
approaches to dementia has resulted in
these kind of effects, in aged care settings
across Australia, as well as the work we do in
Europe and North America. These are results
that are replicating across different settings
and across continents.
Is it easy to roll out these ideas? Is there
much training for staff or high costs?
Well, Dementia Australia has been a partner
with us for many years, and they provide
training in this particular approach for
aged care settings. We always try to find
organisations within a country, within a
culture, that we then partner with, and that
can be a dissemination channel for these
ideas within a country, within the culture.
Dementia Australia has provided a
very good resource for family members,
for example, called Relate, Motivate and
Appreciate. It was done in collaboration with
my centre. They’ve also been advocating
to push the aged care royal commission to
try to get universal training for working with
dementia – for everyone who works in aged
care – because currently it’s like going into
a cardiac unit with a heart attack and just
hoping the people there have been trained
in cardiac medicine.
In aged care, at least 50 per cent of
residents have a diagnosis of dementia,
and many more have dementia without the
diagnosis. I know Maree McCabe, who is
the CEO of Dementia Australia, was giving a
witness statement to the royal commission
on this very issue. That’s a long way of
saying that Dementia Australia is a very
good resource if someone’s interested in
learning more about this and being able to
get training in it.
In the US, are people who work in aged
care facilities given dementia-specific
training as well?
They’re supposed to, but the kind of training
they get is often haphazard. It’s one thing
to tick off a box, it’s another for a person to
know how to deal with a resident who keeps
asking the same question, or who’s going
into another resident’s room.
Our approach in the US is to work closely
with organisations and to try to convince
them that it’s in their best interest and an
exceptionally good business model to
provide this kind of training to their staff.
You get all of these good results, and you
get the deduction of so many bad results
– and it’s also what people want. If you were
touring a place where you were thinking
about having a spouse or a parent come
to live, and you came to a place that was
using this approach, it would be a different
experience. You would have a resident who
would help guide the tour with a person
who was on the staff.
You would be introduced to an individual
welcoming committee of residents who
would be welcoming new people coming
in. You would be able to hear about the fact
that residents choose where they would
like to go on outings, that they have input
on the menu and their entertainment.
There’s a number of places where residents
interview potential hires for staff, where
residents have much more control over
their lives because it’s their community. Staff
encourage enablement, independence and
engagement throughout the day as their
job expectation, as their way of determining
if they’ve done a good job. That is just
different. And it is what people want.
Could the Montessori method be
applicable to other areas of aged care, or
even to stave off dementia in residents
who don’t have it?
It’s certainly an approach that can be used
in a variety of circumstances. We’re applying
this to working with family members who
are living in their home taking care of a
person there. We’re looking at enabling
persons in independent living, for example,
to be volunteers who can work with persons
with dementia in memory care.
I never talk about being able to prevent
dementia, but it is about having a good
quality of life. It’s about living well with
dementia, just as we try to live well with
diabetes or cancer.
It’s also about a way of living, period. We
have, for example, a Montessori pledge, and
it goes like this:
I will try to create the place where I
would want to live. I will remember
I’m a guest in the home of residents.
I will remember I must earn their trust;
they must learn to trust me. I will treat
everyone with respect, and dignity,
and equality, and I will treat people
the way I wish to be treated.
It is a way of living that applies to persons
with dementia, but also in settings where
you don’t have dementia, because it’s how
everyone wants to live.
People want to be part of a community.
They want to know one another, be in
relationships with one another. They want
to be treated with dignity and respect.
They want to have purpose in life. It’s a
very humanising way of living, and what
happens is, if we start this in memory care,
people who don’t live in memory care will
say, “Well, why can’t we have this as well?” ■
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