Leadership Journal

The first time I walked into a secured dementia unit, I wanted to slither away. Each resident seemed to be babbling, staring, or trying to remove clothing. Some of them drifted toward me, strange smiles pasted across their faces.

As a young pastor, I tended to avoid the old and the cognitively impaired. When I later became a retirement home chaplain, I had to care for the people I had feared and neglected.

At my first visit, I was rescued by a sympathetic staff person. She explained that these people were glad to see anyone, especially a minister. She introduced me to each person, helping me to see the faces of individuals behind the masks of dementia. She showed me how gently and eagerly they responded to simple questions and directions.

That started my learning. Here's how I now visit in such settings.

When I entered the dementia unit that first time, I felt overwhelmed by the unfamiliar (persons with dementia often feel the same way!). Now when I enter, I aim to sense what the resident feels.

What can I learn about the person I'm visiting, even before she notices me? I notice the atmosphere, the noise, activity, and the mood of the staff and visitors. I observe how rapidly she's breathing and the emotion in her eyes. I want to enter her world as an empathetic friend.

Too often, I've walked up behind an individual with dementia, loudly called his name, and scared him out of his wits. When I did this to Paul, he asked, "What did you have to scare me like that for?"

I had entered his world too abruptly. He felt disturbed and dishonored, and rightly so.

When I approached Eleanor the same way, she jumped sideways, put on an angry expression, and withdrew her arm from my touch.

Now I try to slow down to match Eleanor's pace. I calmly approach from the front, bend or kneel just below her eye level, and catch her visual attention. As her eyes meet mine, I say, "Hello, Mrs. Miller. I'm Rev. Steve Klotz, the pastor at Country Meadows. May I visit with you a little while?"

If I sense intense but muddled emotions, I try to help the resident verbalize them. As I sat and talked with Paul, his voice was loud and abrasive and his arms were flailing. I asked, "Are you angry or sad, Paul?"

He replied, "Both. My son doesn't come to see me."

By helping him to express his feelings and identify the causes, I relieve his anxiety and build a relational connection that enables me to truly minister.

Dementia-affected persons typically live in a world where time shifts between present and past. Recent memories are clouded by neuron damage, leaving only distant recollections.

The person with dementia who stands at the locked entrance displays this time-confused state. He knocks on the door and shouts, "I want to go home! How do I get out of here?"

In the past I said, "This is your home now," or, "You'll be going soon. How about us getting something to drink first?" Both allayed my anxieties but missed how the resident was feeling.

The dementia-afflicted ...