Speaking Dementia: Communication Tips from Teepa Snow 

Teepa Snow is a world-renowned expert in communicating with people with dementia, in part, because she’s been doing it for a long time – more than 50 years, in fact. She started as a teen, caring for her own grandfather.

When her grandfather’s dementia progressed to the point where her family needed to move him into a care facility, Snow was in high school. The facility offered her a job as a nursing assistant — the staff was shorthanded, and her grandfather would feel more comfortable if she was around. By week two, her grandfather was exhibiting the kind of dementia-related behavior that often challenge and frustrate caregivers.

“One day, I heard a resident down one of hallways calling out, ‘There’s a man in my bed!’” Snow recalled. “It turned out my grandfather had gotten in bed with another resident.”

Even at that young age, Snow intuited what was happening. Her grandfather had served as caregiver for his wife, who had rheumatoid arthritis.

“In the middle of the night, she would be asleep, but he would go and lay in the bed with her until she woke up, so he could carry her to the bathroom,” she said.

In her grandfather’s mind, he was still caring for his wife, even though she had passed away.

Dedicated to Dementia Care

Since then, Snow has dedicated her career to working with people with dementia. An occupational therapist by training, her experience includes stints at universities, long-term care, home care and hospice care, and serving as a care manager and a teacher of medical and nursing students.

In teaching people about communication, she starts with word choices to describe the condition. Instead of saying, “so-and-so has dementia,” she prefers to say “people living with dementia” – in the same way someone might live with a beard, or a sore tooth, she says.

Call it Brain Change

She also often employs the phrase “brain change” as a non-judgmental way of describing what causes some of the behavioral challenges that can arise with people living with dementia.

“What’s happening with dementia is that people’s brains are changing,” she said. “The chemistry in their brain is changing. The structures of their brains are changing. The wiring’s not right. The structures are not connecting anymore. It’s important to realize that it’s not just brain failure.”

While people living with dementia may be losing formal language skills, they may be picking up new language – “including language that you wish they didn’t have,” Snow said. “Maybe they don’t have depth of content when they speak, but the person may still like to chitchat.” To be effective, a caregiver must learn how to hold a conversation with that person, who still wants connection despite their language limitations.

The Wrong Word

As dementia progresses, one of the first language skills to falter is the ability to recall nouns – names of people or words for everyday objects. A person living with dementia may ask for a cookie when they really want coffee.

A key skill for communicating with a person living with dementia: Meet them where they are. If the person is confused, don’t try to correct them. Say the person insists on going home – even though they’re already at home. Rather than saying, “This IS your home. You have lived here for years. What are you talking about?” — try to speak to person where they are at.

“Say, ‘So, you’re looking for your home,’” Snow said. Simply acknowledge what the person is saying. Allow them to feel heard.

The Therapeutic Fib

Another challenging behavior: people living with dementia may repeatedly ask the same question, over and over, even after the caregiver answers the question.

For example, it’s very common for a person living with dementia to ask repeatedly for a spouse who is no longer alive. In that situation, the caregiver might ask, ‘So, you’re making me wonder, were you needing your wife for something, or are you just missing her?” That gives the person a sense of choice, and points to the meaning behind the repeated question.

Snow says that sometimes a caregiver might need to employ a “therapeutic fib” to meet the person where they’re at. Instead of pointing out that the spouse isn’t there, or no longer living, the caregiver might say, “You two always like keep up with each other, huh? You’re missing her a little bit. Boy, wives are wonderful when you have them, right?” Offer empathy instead of correction or criticism.

“I try to figure out the meaning behind the question,” Snow said. “Because if they keep asking me the same question, there’s something I’m not giving them that they’re looking for.”

Hear more of Teepa Snow’s helpful insights into communicating effectively with a person living with dementia in an interview with Brian Levy in Episode 38 of the Manchester Living podcast. Listen to the episode here. https://share.transistor.fm/s/1e9cdd18