Going home to visit your aging relatives can be time-consuming and anxiety-ridden. Especially if those you are visiting have memory problems, or a diagnosis of dementia. Sometimes families stop visiting altogether because conversations with persons with dementia can be fraught with frustration and anxiety. Something like:

“Hi, Grandma, it’s Ellen come to visit you.”

“Oh, hi, dear. Why didn’t you bring Ellen with you? She usually comes on Wednesdays.”

“I AM Ellen, Grandma, and it’s Thursday.”

“No, you stop lying to me, and tell me where Ellen is.”

“I AM Ellen, Grandma, don’t you remember me? I’m your granddaughter from Detroit.”

“ Detroit? Is that where we are? I told them I didn’t want to live in Detroit!”

“No, Grandma, you’re not in Detroit, you’re in Toledo.”

“Stop lying to me, and go get Ellen!!!”

Many of you have had similar conversations which go round and round in circles of dialogue. The person you’re visiting becomes more and more agitated, the visitor feels frustrated and saddened and responsible for the elder’s agitation, so the visits become fewer and fewer until relatives no longer visit at all. “It’s okay,” they’re told by a well-meaning attendant, “She doesn’t remember you anyway. She won’t know that you haven’t visited.” Indeed, I know many family members who visit daily and their loved one still complains that they never visit.

One solution to this dilemma is to learn the technique that was first created and written about by Naomi Feil, an advanced-degreed social worker from Cleveland, Ohio. In “The Validation Breakthrough” she describes much more humane and simple ways of communicating with persons with dementia that she calls Validation.

Simply put, Validation encourages visitors and caregivers to focus more on what the person might mean by what they are saying, and stop trying to re-orient them to reality. If Grandma thinks that it’s Wednesday, but it’s really Thursday, who cares? If she doesn’t recognize Ellen, Ellen needs to accept that and perhaps explore with Grandma who it is that Ellen reminds her of.

Dr. Feil’s theory includes the concept that behaviors do not occur in a vacuum. Even so-called “meaningless” behaviors such as pacing, repetitive motions, or emotional outbursts are theoretically triggered by a person’s past experiences in their life. It is possible that our “old-old” (Dr. Feil’s terminology) are acting out feelings related to past unresolved issues. For example, your father was a mail carrier, and in the long term care facility, he paces up and down the halls. How about giving him some of the junk mail that comes in and ask him to deliver them to the residents? Or even the monthly newsletters or activity fliers? This gives purpose to his “pacing” and makes him feel more useful. This type of solution “validates” his feelings as being real to him.

Too often family caregivers, or more so paid caregivers in facilities, brush aside the behaviors and speech patterns of the “old-old” as being nonsensical and troublesome. Some behaviors ARE troublesome, such as a resident’s constant attempt to leave the facility, or even worse, physical or verbal outbursts that endanger others’ safety or comfort. It is important that our facilities begin to implement these techniques to validate their residents’ feelings and human worth, rather than warehousing and restraining them as happens all too often. Today, physical restraints are rare due to state and federal regulations. However, chemical restraints are used regularly, and often necessarily. But sometimes, simple Validation techniques could be implemented to solve the behavior problem.

As a visiting family member, just remember a few pointers from Dr. Feil:

“Empathize with her fear of aging, dependence, loneliness, and death. Understand that her possessions are symbols of her youth. Use these Validation techniques:

• Rephrase: e.g., "Your wedding ring is gone, and you say I have stolen it?"
• Use the visual sense: e.g., "That was that beautiful white gold wedding ring with the date of your marriage engraved on the inside."
• Reminisce: e.g., "How old were you when you were married, Mom. How old was Dad. How did you meet him?"

You can't cure aging. It's too late to give her insight. She will not face her fears directly. But now she will feel less fearful and safe with you, because she trusts you because you listened and understood.” [excerpts from http://www.vfvalidation.org

Other techniques include:

• Maintaining eye contact, communicate on their physical level – if they’re sitting down,
  sit down eye-level with them.
• Use touch, as appropriate, being sure not to startle someone by coming up from behind them.
• Use singing to communicate with those who have the most difficult in conversation. Sing songs that they remember from church or from school. Singing is the universal language of memory.

I’ve had the privilege of meeting Dr. Feil and attending one of her two-day workshops. The techniques are not hard to learn, but they take some practice and understanding. I recommend her book, “The Validation Breakthrough,” and offer my services, as a Professional Care Manager, to assist you in learning these, and other, techniques to assist you in communicating with your aging loved ones.

Please don’t stop visiting them. They need your loving understanding, your empathy, and your unconditional acceptance. I believe that some part of them will always remember you. You need to reach through the fog of dementia sometimes, to see the soul of the person remaining in their frail human shell. And if you touch them, I guarantee, you will be touched by them in ways that you can only imagine. Working with, and helping seniors and their families has given my life meaning and purpose. If I can’t be with my own dad every day, I can help others be closer to their families. And that makes it all worthwhile.

Debra Sorensen, MSW, LISW, CMC, is a professional care manager and owner of, Debra J. Sorensen & Associates Inc., a private geriatric care management company in Maumee, Ohio. She can be reached at 419-367-8835 or e-mail debra@professionalcareforyou.com. For more information about care management, go to www.caremanager.org.