In this case study, originally documented in our DCS Training Center in 2012, Terra Osbourne, DCCCP at The Summit at Park Hills, talks about something that we’ve all seen happen: an elderly person begins to pull inward, and their loved ones assume that deterioration is irreversible. The missing ingredient? Engagement—when family members and attentive staff identified ways that she could still participate in the joys of daily life, they came together to facilitate that possibility. And one step at a time, she came out of her shell and found the courage to live again.

SITUATION: She was lost in the shuffle. 
At our community, we have an assisted living side as well as a memory care side. It is part of my job to help assisted living staff observe and recognize when a resident starts having early signs of dementia. The last thing we want is for someone to “get lost in the shuffle” on our assisted living side when we have a memory care side that can enhance the quality of life of those living with dementia as well as preserve their dignity. 

“J” was one of those residents. She came to our community from her home with signs of early stage dementia. As so often happens, her family was unaware that at this early stage affected individuals often try to mask their dementia symptoms. This also made it tough to figure out which side of our community she best fit into. Her family wasn’t ready to accept that she needed memory care—and neither was she.

It became clear that assisted living wasn’t the best fit for J. She stayed in her room without any TV or radio, didn’t open her blinds, and didn’t turn on the lights. She didn’t get out of bed because she wasn’t aware of time, didn’t know how to follow a calendar, and couldn’t follow along with the assisted living activities if she did attempt to participate in them. She argued with staff about going to meals and showed up for them randomly throughout the day. J was also resistant to care; she wouldn’t do her activities of daily living (ADLs) such as bathing or changing clothes.

But these weren’t new challenges—she’d masked many of these behaviors prior to coming into care, and her family was in denial. They often stated, “She has always been private.” But as somebody with extensive dementia training this was clearly more than being private. This was a resident showing signs of early stage dementia, while being able to mask it with the family until she moved into assisted living. My rehab director and I had many discussions about how she would flourish on the memory care side—the sooner we could transition her to that level of care, the better.

SOLUTION: Plant the seeds of potential within residents and their loved ones.
We don’t want a resident to simply exist. We want them to feel a sense of purpose. We want to set them up for success in all areas of their life. This can still happen even with a dementia diagnosis! One day, my rehab director and I finally had a chance to plant a seed of this possibility with J’s daughter—we told her our vision of ways that her mother could still engage in a fulfilling and positive life with the enhancements of our Dementia Capable Care training. It went well. Before you knew it, we had gathered with the whole family to discuss the potential for J to flourish in memory care. They put their trust in our hands as best they could, and decided to transition her from assisted living to memory care.

RESULTS: A passive presence has turned into an active participation in life. 
It didn’t happen overnight, but it did happen. J has adjusted well in her environment, with her roommate, her new peers, and the staff. She’s developed her own routine that suits her and works with the collective community.

Sometimes she struggles—for example, due to a separate health condition, sometimes she still wants to sleep in. But knowing her life story and her diagnoses, we are sensitive, and can support the variances in her routine that make sense for her well-being. This is critical in the life of those living with dementia. 

J smiles at you if she knows you, talks to you if she wants to, joins in when approached correctly, and does most of her ADLs with supervision and setup. She likes to help with chores and engages in activities of her choice, and she even goes out to lunch with the “lunch bunch” most Wednesdays. 

J is “living the life” as she knows it now. She’s come a long way from sitting in a darkened room.