A Guide to Excellence in Dementia Education, Dementia ...

I Already Told You. . . 

Don’t You Remember? 

A Guide to Excellence in Dementia 

Education, Dementia Communication 

& Behavior Prevention 

Erin M. Bonitto, M.S., A.D.C. 

Founder & Lead Coach 

Gemini Consulting 

www.Gemini-Consulting.org 

© 2012. Gemini Consulting, Inc. • 1218 5 th St. South • Cold Spring, MN 56320

Understanding Dementia 

Age-Associated Memory Impairment 

(A.A.M.I.) 

Temporary lapses in memory in otherwise healthy adults. 

• Misplacing your keys 

• Forgetting your friend’s name 

• Forgetting your sister’s phone number 

• Forgetting where you just parked the car 

Dementia. A term used to describe a number of 

conditions that are characterized by the gradual loss of 

intellectual functioning. 

A ‘Text Book’ Definition 

1. Memory impairment, and 

2. One of more of the following cognitive difficulties: 

• Language difficulties (aphasia) 

• Impaired ability to conduct motor activities (apraxia) 

• Failure to recognize or identify objects (agnosia) 

• Disturbances in intellectual functioning, such as 

planning, organizing and abstract thinking. 

Source: www.ageworks.com, 

Gerontology Center of the University of Southern California 

© 2012. Gemini Consulting, Inc. • www.Gemini-Consulting.org • 612-749-1220 • Cold Spring, MN 56320 page 2

What Happens in the Alzheimer’s Brain? 

Re-Name the Brain 


Sketches Sketches 

Sketches 

Notes 

Notes 

The Memory Glue Guy 

The Control Tower 

Out-of-Character Responses 

The Translators 

Brain 

Sketches Sketches Sketches & & Notes 

Notes 


Communication Strategies for Dementia 

Tips for Making a Good First Impression 

• Treat every single interaction as if it’s your first – it may feel that way to the person! 

• Carefully monitor your facial expression, body language, and tone of voice. 

• Smile & approach with a warm, unthreatening manner. 

• Remain below eye-level. 

• Always offer a handshake, a hug, or a kiss. 

• Approach gently from the front – where the person can easily see you. 

SKILLS to PRACTICE – Types of Introductions 

• A Standard Introduction for Dementia 

1. 

2. 

3. 

4. 

• ( and. . . Making a Good LAST Impression!) 

• The Gracious Reminder 

• The Long Lost Friend Introduction 

• The Gentle Introduction 


More Communication Strategies for Dementia 

Using Words 

• Simply describe what you will be doing. 

• Use the 7 & 7rule. 

• Use concrete language – not jargon. 

• Use words the person has used in their 

lifetime. 

• Graciously ‘fill-in the gaps’ ‒ preventing 

embarrassment when language or memory 

fails. 

• Avoid ‘baby talk’ or a childish tone of voice. 

• Use positive wording – not negative. 

• Allow ample time for response. 

Using Non-Verbals 

• Always make eye contact first! 

• Remain below eye level – kneeling or 

using a stool or chair. 

• Use exaggerated facial expressions. 

• Use gestures & body language. 

• Use props. 

• Use a matching ‘energy.’ 

Anxiety, paranoia, combativeness 

• Before you respond: Take a breath and take time to focus. Then, step into the ‘person’s world.’ 

• As always, use non-threatening tone of voice, body posture, facial expression. 

• Focus on and respond to the emotional content of the message – not the literal words. 

• Understand and use Validation approaches – to step into the person’s reality. 

• Understand that validating an emotion is the best way to diffuse the emotion. 

• Use touch when it is safe to do so, including: hand-holding, arm around back, head on shoulder, 

etc. 

• Important: Reality Orientation and Behavior Modification therapies are not appropriate for 

Alzheimer’s-type & related dementias. In fact, these approaches make many situations worse. 


More Communication Strategies for Dementia 

MORE SKILLS to PRACTICE 

• Vocal Quality 

• Sparkly Face 

• Endorphin Boosts 

• Simple Statements 

Simple Statements 

for Changing Gears 

I want to show you something! 

I want to introduce you to someone. 

There’s an old friend waiting for you! 

Right this way, Madame! 

Come with me, Sir! 

Let’s take a walk! 

I could use a friend. 

Let’s get out of here! 

© 2012. www.Gemini-Consulting.org 


for Personal Needs 

Let’s wash-up. 

Let’s clean-up. 

Let’s use the ladies room. 

I’ll help you find the Men’s Room. 

Let’s freshen-up. 

I’m getting hungry! 

Let’s eat! 

Let’s get something to drink. 

I could use a nap. 

It would feel good to lie down. 

© 2012. www.Gemini-Consulting.org 


Environmental Triggers 


Understanding Dementia Strengths 

Procedural Memories. 

Also known as ‘hand memories’ – folding, sorting, sanding, painting, etc. 

Deeply-Stored Long-Term Memory 

Often from childhood or young adult years. 

Automatic Responses 

Songs, hymns, prayers, poems, old sayings & proverbs – things repeated 

many, many times over the years. 

Social Rituals 

Handshakes & hugs; passing food at the dinner table; etc. 

Desire for Genuine Human Contact 

Hugs, kisses, being close to someone. Having someone to ‘love and take 

care of.’ May also be expressed by caring for a pet; or caring for a life-like 

infant doll. 

Understanding Other People’s Moods 

Will understand tone of voice, facial expressions, and body language – and 

will often perfectly reflect-back the mood of the other person. 

Desire for Purpose 

A strong need to be “good for something.” Daily tasks, broken into very 

simple steps, often work well. 

Individual Strengths 

Examples: Sense of Humor; a Nurturing Spirit; Playing the Piano; Singing; 

Artistic Abilities; etc. 

Key Point: What Remains is __________________ 


Sorting-Manipulative 

for Procedural Memories 

Jewelry 

Crocheted Granny Squares 

Artificial Flowers 

Buttons 

Nuts & Bolts 

Ribbon 

Examples 

of 

Strength- 

Based 

Activities 

Greeting Cards 

Bright Socks 

Colorful Fabric Squares 

Baby Clothes 

Silverware 

Colorful Wooden spools 

Yarn Balls 

Photos or Postcards 

Hand towels & washcloths 

Playing Cards 

Poker Chips 

Sea Shells 

Cookie Cutters 

Embroidered Hankies 

Bright Women’s Scarves 

Office-Desk Supplies 

Service Projects 

for Purpose 

Sanding & painting blocks for children 

Birdhouses for spring decorations 

Creating scrapbooks for reminiscing 

Making bird-seed bags for weddings 

Making the “tie fringe” for fuzzy blankets for pediatrics 

Cutting coupons for staff members 

Folding church bulletins 

Stuffing & stamping envelopes 

Making simple note cards for sale 

Stamping gift bags or gift paper 

Roll silverware-napkin bundles for soup kitchens or for 

special events 

Tear newspaper for kennel bedding 

Make bookmarks for library 

Make favors & decorations for seasonal events 

Decorate invitations for seasonal events 

Bundle pencils for missions 

Pull apart squares cut from sweaters – use to stuff 

animals for children’s hospital 

Fold or flatten Campbell’s Soup labels 

Life Skills 

Rocking Life-Like Infants 

Looking at Recipe Cards & Cookbooks 

Washing & Drying Dishes 

Wiping & Clearing Tables 

Sweeping 

Cleaning Leaves of Plants 

Polishing Shoes 

Organizing Foot-Locker 

Food Prep: Peeling potatoes, snapping 

beans, removing husks from corn, etc. 

Cleaning Eye Glasses 

“Polishing” Silverware 


A Strength-Based World 

Key Concepts 

• Understanding ‘looping’ 

• Avoiding triggers 

• Opportunities for strengths 

• The ‘pre-agitation window’ 

Real-World Examples 

• Nursery: Falls 

• Factory: Combative Outbursts 

• Lounge Approach: Falls, Psychotropics, Agitated Pacing, Exit- 

Seeking 

Skilled Cuing & 

Communication 

Strengths-Based 

Opportunities 

Dementia- 

Appropriate 

Environment 


Let’s Chat More about… 

• What is the ‘philosophy’ of Alzheimer’s-Dementia care? 

• Being a Dementia Detective (ex: Wandering) 

• Which lens are we using? ‘Problem vs. Strength’ 

• Stepping into this person’s reality 

• Simply slowing down 


Alzheimer’s Lounge: An overview 

Some Key Concepts: 

• Pre-agitation window 

• Dementia-appropriate environment 

• Strength-based stations 

• Specially-trained, interdisciplinary staff facilitator (a.k.a. “Butterfly”) 

• A genuine social experience 

• Butterfly as Bridge 

“Life Enrichment Systems for Dementia”, 

“The Alzheimer’s-Dementia Lounge Program” , 

all related written materials and photos are copy-right protected. 

Please contact Gemini Consulting, Inc. for more information. 


Alzheimer’s Lounge Overview 

Lounge Programs are often provided for residents 

with dementia or other cognitive impairments. It is 

known to reduce wandering & falls, agitation, 

combativeness, sun-downing behaviors, and other 

symptoms of Alzheimer’s-type dementia. In addition 

to serving residents who experience anxiety, 

restlessness, and combativeness – the Lounge 

Program may also serve those residents who aren’t 

prone to agitation – but rather those residents with 

dementia who seem to just sit and sit – those 

residents who experience boredom and disinterest – 

more than agitation. 

In the Lounge Program, “strength-based stations” are 

offered at small tables – allowing residents to 

participate individually or in very small groups – 

pursuing the activity that is most appropriate for their 

current functional level and most appropriate for their 

interests. These “strength-based stations” feature a 

large variety of authentic props and activity supplies 

known to be engaging for residents with dementia. 

Some residents may actively “work” on projects – 

while others enjoy more relaxing, less-taxing pursuits. 

Often, residents may be very social – chatting and 

laughing with other residents at their station. Some 

residents may quietly pursue solitary interests at 

their own station. Others may simply sit peacefully 

resting – a much-needed respite from their continual 

wandering. There is not a set “start & stop time” for 

each residents’ experience. Instead, residents will 

come and go at whatever time is comfortable for 

them. Some will move from station-to-station – 

finding new friendships at each stop. A key element 

of every lounge session is this: Providing 

opportunities for friendship and meaningful 

connections with others. The “stuff” on the tables is 

not the primary focus. The “stuff” is the ‘trick’ for 

bringing people together. 

Residents in the Lounge Program are never left 

unsupervised or unsupported. In the Lounge 

Program, residents with dementia are 

encouraged, cued, and assisted to the stations 

and friendship pairings that are most appropriate 

for them by an interdisciplinary staff facilitator. 

The staff facilitator does not “lead” the activities 

at each station. Rather, to facilitate the many 

stations effectively, the interdisciplinary staff 

facilitator continually relies on four basic steps. 

Known as a “butterfly,” the facilitator is often 

moving about the room – quietly & gently – 

staying with each resident just a few seconds – 

and speaking very little. The primary role of the 

Butterfly is to help maintain the friendship 

connections at each station. 

Mastering these special facilitation steps 

techniques typically takes several in-depth 

sessions with active, hands-on coaching from 

specially-trained peers. These coaches help staff 

facilitators master this largely non-verbal 

facilitation style. 

More than a “little program” to be fit into the 

existing schedule – the Lounge is most 

successful when organizations use it as a 

“launching point” or a “laboratory” – for a 

whole different way of providing care. For 

some organizations, it serves as a starting point 

for overall Culture Change. The Lounge 

requires extraordinary commitment and 

continued attention from Leadership and all 

layers of the organization – to truly be 

beneficial. 

“Life Enrichment Systems for Dementia” ,“The Alzheimer’s-Dementia Lounge Program” , 

and all related written materials and photos are copy-right protected. 

Please contact Gemini Consulting, Inc. for more information. 


Severe Short Term 

Memory Impairment 

Difficulty 

Sequencing 

Connect the Dots for Dining 

Tremendous difficulty 

with communication 

Remembering what was ordered 

Remembering what meal this is 

Remembering why we are in this room 

Remembering when the meal will be coming 

Initiating eating 

Switching between eating & drinking 

Tasks: Cutting, spreading, spooning, pouring, stirring 

Adding Things: Sugar, Cream, Butter 

Making preferences known 

Understanding complex menu choices 

Understanding what is going to happen in this room 

Ability to socialize 

Other Changes Related to Alzheimer’s-Type Dementia 

• Fearfulness – Anxiety – Limbic System 

• Difficulty Focusing – Inability to Tolerate Distractions – Frontal Lobe 

• Restlessness – Inability to Sit Still for Long 

• Changes in Appetite – Hypothalamus 

• Difficulty Swallowing – Brain Stem 


Practicing Simple, Specific Skills for Dining 

Guiding to the Dining Room 

• The Easy Approach 

• Sparkly Face (Exaggerated facial expressions, gestures, and body language) 


• Clear Gestures (Exaggerated facial expressions, gestures, and body language) 

Cuing Friendship – to set the tone for a pleasant & social meal 

(Include everyone – using resident-to-resident introductions) 

Simplifying Menu Ordering – to minimize embarrassment & increase satisfaction 

• Do get below eye level 

• Familiar words & language 

• Offer simple, concrete choices 

• Fill-in the gaps to prevent embarrassment, when necessary 

Presenting the Meal – to increase acceptance & pleasure 

• Do get below eye level 

• Establish eye contact first! 

• Sparkly Face (Exaggerated facial expressions, gestures, and body language) 


• Familiar words & language 

• Remember to speak low & slow – no up-talking! 

Simple Statements for Meal Time Cuing 

Descriptive Statements 

• Roast turkey and mashed potatoes! 

• It’s a grilled cheese sandwich today. 

Appetizing Statements 

• Ken made this pasta especially for you! 

• This looks scrumptious! 

• Meat loaf just like mom’s. 

• A nice big slice of homemade pie 

Graciously Handling ‘I didn’t order this!’ 

• A profuse apology 

• One gentle encourager 

• Making it right 

Discrete Cuing – to minimize embarrassment & increase consumption 

• Tune in! 

• Engage with skill – using a non-verbal cue 

• A gracious statement for everyone 

Ensuring a Gracious Dining Experience – be a social butterfly 


Be sure to introduceyourself to the person –every time! 

Understand dementia –especially language difficulties 

Do get below eye level 

Describe what is going to happen 

Include everyone –using resident-to-resident introductions 

Endorphin Boosts 


Familiar words & language 

Offer simple, concrete choices 

Remember to speak slow & low –no up-talking! 

Exaggerated facial expressions, gestures, and body language 

Verify the persons mood & energy 

Engage with Skill –using non-verbal techniques 

Remember to offer a handshake, hug, or kiss –every time! 

Gemini Consulting 

Changing minds. Changing lives 

www.Gemini-Consulting.org 


Additional Notes 

Erin Bonitto, M.S., A.D.C. Founder & Lead Coach – Gemini Consulting 

A presenter at over 350 conferences, Erin Bonitto is a sought-after keynote speaker, educator, 

consultant, and coach. Erin has had a rich career in healthcare beginning in high school, as a 

Dietary Aide. Inspired to life-long service, she later earned a B.A. in Psychology, an M.S. in 

Gerontology; and an Activity Director Certification. Erin is best-known as the innovator of ‘Life 

Enrichment Systems for Dementia’. Recently, Erin was invited to share her interdisciplinary 

program: ‘The Alzheimer’s-Dementia Lounge’ at the International Association of Homes & 

Services for the Aging 2009 Conference, in London, England. Since founding Gemini Consulting in 

1998, Erin has spent most days each week providing hands-on coaching in nursing homes, 

assisted living centers, and senior care communities across the nation. Care providers in 47 

states have lauded Erin’s down-to-earth style and real-world wisdom.

A Guide to Excellence in Dementia Education, Dementia ...

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