How Occupational Therapists Can Work With Caregivers on ADL Routines for Patients With Dementia

By Julie Brown, OTR/L, BCG, LSVT certified, CDCS
Occupational Therapist

A vital aspect of staff and caregiver success with patients with dementia is their carryover of ADL programs. Sometimes, this can be one of the more difficult parts of our job as clinicians—but working together is key to everyone’s success.

At times, staff and caregivers can be fearful of working with patients with dementia due to a lack of experience or uncertainty in how to approach and communicate with these patients. They may be looking for strategies and guidance in these areas. Occupational therapists are just the people to help with this.

How Occupational Therapists Should Interact With Patients With Dementia

One of the most important things to remember when working with patients with dementia is that they are people, too. Their diagnosis does not define them. They are not dementia patients, but rather patients with dementia, along with many other diagnoses. They need to be treated with respect and privacy. Staff and caregivers may need education in this area as well. For optimal success in working with patients with dementia, you should remember a few key things.

1. Have the patient’s attention before giving directions or engaging them in an activity. Approach them from the front; say their name and speak in a normal volume.
2. When speaking to patients with dementia, you do not need to baby them or belittle them.
3. You may need to speak slowly and clearly and in short, concise phrases.
4. Tell them what you want them to do or what you are going to do before each step or activity.

Communicating With Staff and Caregivers

To begin developing an ADL routine for your patient with dementia, you need to build a relationship with the staff or caregiver to establish an open line of communication and trust. Talk with caregivers and staff to get to know your patient’s likes and dislikes as they probably know the patient better than you do. Find out your patient’s ADL routine history. Were they a morning bather or did they shower and wash up in the evening? Does she typically wear a bra? What are their clothing texture preferences? You want to try to stick with a routine that is familiar to the patient.

You will need to assess the patient’s physical abilities and limitations—strength, balance, UE ROM as well as problem solving, awareness, and sequencing to begin to develop a plan. It is important to remember and educate caregivers that although the patient with dementia may be able to walk and have physical abilities to wash and dress, they may not be able to initiate a task or sequence activities of daily living. Many times these types of patients are mislabeled as independent and do not receive the assistance that they need.

Work with the patient completing ADLS to determine their abilities and level of assistance. Determine what specific cues and routines work best. Once you have determined what you think is the best routine, work directly with staff or caregivers performing ADL tasks together for hands-on training and listen to any suggestions they may have. Demonstrate specific, concrete cues as well as any other techniques or strategies that help with participation and success. Once you have determined the best strategy, write it down—document, document, document. I write up the program and give a copy to the caregiver and also document it in the chart or electronic health record so it can be put in their plan of care, etc. Sometimes using an ADL routine picture chart works for patients and staff to follow. I often print out color clipart pictures of each activity, since color pictures allow for more visual discrimination and seem more real than black and white. This could include teeth brushing, face washing, donning t-shirt, underwear, shirt, pants, sock, and shoes—whatever routine you have set up. If permitted, hanging this in the patient’s bathroom to see each day helps with success and consistency.

Work side by side with caregivers performing ADLS over several sessions. This gives you time for continued training and the reinforcement of specific cues and strategies, and to make sure the caregiver is allowing the patient to independently perform as much of the task as possible. Remember, staff and caregivers can be very busy and have a lot of demands placed on them and may think it is easier to just go in and do the tasks for the patient. But this quick approach often causes increased behaviors and resistance from the patient and increased effort by staff. It is our job to show them how a specific consistent sequenced program guiding the patient through their routine with visual and tactile cues can decrease their effort, decrease patient resistance, and thus increase patient success. Once the staff member or caregiver sees this for themselves, they are usually more willing to follow the program.

Once you have set up a program and provided thorough training and education to the caregiver, you should make yourself available for questions, concerns, issues and then work with the caregiver to address these. Allow time to check in with staff from time to time to make sure they are following through with the program and things are going well.

To achieve the best caregiver follow through and carryover of ADL routines with patients with dementia, you need to work closely together with a sense of mutual respect and provide adequate education and training, not just on the ADL routine, but on dementia as well.