The Art of Friendship
Alzheimer’s disease and other dementia change us all. Because of the associated memory loss and confusion, your mother, father, sister, brother, husband, wife, or partner may no longer know you or understand his or her relationship to you. Many friends and family members are confused, frustrated, sad, or even angry about these losses. Your mother may have always been your closest confidante and strongest supporter; now, she does not recognize you. A spouse whom you counted on for many years to balance the checkbook, pay bills, file the income taxes, or cook three meals a day is no longer able to do these things. Your longtime neighbor famous for her home baking now forgets your name and burns her cakes in the oven. As a result, your relationship with the person changes whether you like it or not.
Adopting a Best Friends approach can have a powerful impact on the person with dementia. When you rethink, or recast, your relationship to an individual with dementia and become the person’s Best Friend, the person feels you are on his or her side. This can reduce behaviors that are challenging and foster cooperation. In addition, friendship helps evoke some of the social graces or learned manners of the person with dementia. It helps the person with dementia operate at his or her best.
Adopting a Best Friends approach can help diminish the pain and loss you feel about your situation. It can restore a sense of fun, support good conversation, help you overcome the bad days, and teach you ways to encourage activity. Dementia has changed the relationship you have always had with your family member or friend; memories are lost and routines disrupted—but a Best Friends approach helps to build a new kind of relationship that can also be healing. “Mom is now my friend,” one care partner told us. “She doesn’t exactly remember who I am, but we are having more fun than ever as best girlfriends.”
Because of its pioneering use of the Best Friends approach, the Best Friends Day Center in Lexington, Kentucky (formerly named “Helping Hand”), has become one of the most admired adult day programs in the United States. Many individuals who attend this dementia-specific center have been considered difficult and challenging by their own family care partners. Yet at this day program, because the staff and volunteers are acting as friends, all persons thrive. Families can have similar success using the Best Friends approach at home.
Rather than staying in a state of despair, care partners can learn to work through the pain and focus on gaining maximum value from the present; caregiving is transformed from a terrible burden to a job that becomes meaningful and satisfying. The process changes from a series of failures to a series of successes, turning a “no” into a “yes.” Recasting this relationship to become a Best Friend does not mean taking away love or loving the person with dementia any less. It simply means approaching the relationship differently.
One son attending an Alzheimer’s conference told us that he had always had a troublesome relationship with his father—so bad, in fact, that he ran away from home at age sixteen. He now cares for his father full time and says they have never been closer. They take a daily walk together, have an evening scotch and soda, and watch the grandchildren play soccer. They have found that they now enjoy each other’s company. Because the father has forgotten much of the past and is often unsure of his relationship with his son, the son has realized that he, too, must let go of past slights and injustices. “What’s the point of me dwelling on it?” the son asks. “What’s past is past.”
Like many care partners, the son never dreamed he would be in the position of taking care of his father, a father whom he admits disliking for much of his life. However, this family’s approach to Alzheimer’s care has helped heal not only the son’s relationship with his father, but also wounds he has carried inside himself.
Being a Best Friend is not just about altruism. Care partners who recast their relationships take advantage of the principles of friendship to gain new ideas for handling day-to-day care in a more natural, positive way; prevent problems before they happen; form a new relationship with a loved one based on getting the most out of every day; and replace the stress and strain of caregiving with satisfaction. The following are the key ingredients for success:
What Is a Best Friend?
FRIENDS KNOW EACH OTHER’S PERSONALITY AND HISTORY
A Best Friend becomes the person’s memory.
A Best Friend is sensitive to the person’s traditions.
A Best Friend respects the person’s personality, moods, and problem-solving style.
FRIENDS DO THINGS TOGETHER
A Best Friend initiates activities.
A Best Friend encourages the person to enjoy the simple things in life.
A Best Friend enjoys activities with the person with dementia.
A Best Friend involves the person in chores.
A Best Friend ties activities into the person’s past skills and interests.
A Best Friend remembers to celebrate special occasions.
FRIENDS COMMUNICATE
A Best Friend listens.
A Best Friend fills in the blanks.
A Best Friend asks questions that are easily answered.
A Best Friend recognizes the importance of nonverbal communication.
A Best Friend gently encourages participation in conversations.
FRIENDS BUILD SELF-ESTEEM
A Best Friend gives compliments often.
A Best Friend carefully asks for advice or opinions.
A Best Friend always offers encouragement.
A Best Friend offers congratulations.
FRIENDS LAUGH TOGETHER OFTEN
A Best Friend tells jokes and funny stories.
A Best Friend takes advantage of spontaneous fun.
A Best Friend uses self-deprecating humor often.
FRIENDS ARE EQUALS
A Best Friend does not talk down to the person.
A Best Friend works to help the person “save face.”
A Best Friend does not assume a supervisor role.
A Best Friend recognizes that learning is a two-way street.
FRIENDS WORK AT THE RELATIONSHIP
A Best Friend is not overly sensitive.
A Best Friend does more than half the work.
A Best Friend builds a trusting relationship.
A Best Friend shows affection often.
From The Best Friends Approach to Alzheimer’s Care, ©2003, Health Professions Press. Used with permission.
FRIENDS KNOW EACH OTHER’S PERSONALITY AND HISTORY
Typically, people become friends because they have something in common; perhaps they graduated from the same high school or college or both enjoy Monday night football. As the friendship grows, they learn more about each other—how many brothers and sisters each has, their birthdays and birthplaces, cultural and religious traditions, hobbies, and special achievements. As much as we think we know our friends, there are often surprises. Perhaps it turns out a friend once thought to be strictly a country music fan has a passion for opera.
Friends also become good judges of each other’s moods and personalities. A friend develops a sense of timing, such as where and when not to tease someone. Friends even begin to understand each other’s problem-solving style, knowing when a word of advice is welcome and when it may be resented.
A Best Friend Becomes the Person’s Memory
A Best Friend should bring up as much as possible about the person in order to offer cues and reminders of his or her previous achievements. If the person has early-stage Alzheimer’s, work with him or her to develop a Life Story (see page 101). Even if you think you know all about a parent or sibling, you will be surprised to see from his or her perspective which experiences stand out.
When friends or family members spend time with Mary Edith Engle, they know that they can always bring a smile to her face when they remind her of her extraordinary life and accomplishments, notably as one of the elite female pilots during World War II, when she was a member of the Women’s Air Force Service Pilots (WASP). “You’re very petite to have flown those big B-29 bombers. Are you just kidding us? Did you really fly those planes?” a friend may ask. “Sure did,” Mary Edith replies.
Mary Edith has been inducted into the Kentucky Aviation Hall of Fame. When young women volunteers talk with her at the day center, they often gain new respect for her as a trailblazing woman for her times.
Mary Edith Engle in her WASP uniform, 1944.
A Best Friend Is Sensitive to the Person’s Traditions
Even late in the illness, the person often retains his or her values and traditions. Religious traditions and faith, for example, are deep-seated, and knowing a person’s beliefs can be important in providing quality care. Knowing this also helps a Best Friend understand why individuals sometimes do the things they do.
Leota Kilkenny always had a good appetite and enjoyed lunch at the day center she attended at a local church. One day, she refused to eat her lunch, saying, “I cannot. I must not now.” She became agitated after several attempts had been made to encourage her to eat, so the staff let her skip the meal. When her daughter, Ann, picked her up that day she solved the mystery by saying that while they were driving to the day center she had told her mother they were going to the program “at the Church.” Ann told the staff, “Mother is Catholic and must have thought she was going to her church and would be taking communion. In her tradition, you do not eat within an hour before receiving communion.”
This is an example of one way that a deeply felt tradition, even one that cannot be expressed in words, can affect daily care.
A Best Friend Respects the Person’s Personality, Moods, and Problem-Solving Style
Personalities and problem-solving styles do sometimes change with the onset of dementia, but the underlying attitudes and styles usually remain. For example, a person who always coped well with adversity may bring some of this resiliency to living with dementia. A person who has always been a “take-charge” individual or in a position of authority generally does not like being told what to do.
Marydean Evans always told her friends and family that she was not a morning person and could be in a bad mood until midmorning. When she attended a day center, the sensitive staff and volunteers empathized and greeted her each morning with a remark such as, “Marydean, I know you’re not a morning person. Would some coffee help? How about five cups?”
Knowing Marydean’s quirks, a Best Friend would never press her to be involved in day center activities too early in the morning, respecting her desire to wake up slowly over some hot coffee. The teasing remark about “five cups” tickled Marydean’s sense of humor.
FRIENDS DO THINGS TOGETHER
Friendships often form based upon mutual activities; you may meet someone on a hike or at a coffee shop, hit it off, and become great friends. Friendships are sustained when you continue to “do things together.” When you stop doing things together, friendships flounder and relationships suffer.
A Best Friend Initiates Activities
Because the person often loses the ability to initiate activities or to fully understand a request, it generally is a mistake to ask the person if he or she wants to do something. The answer will often be “no.” Instead, a Best Friend could say, for example, “I would like to take a walk. Come on, join me! It’s great to exercise with you.”
“Come on, Pops! Let’s go for a drive,” said Riki, the son of Mas Matsumura, who sensed just the right time to initiate one of his father’s favorite activities. “Pops loved riding shotgun in the car. He keeps time to ’50s music from a CD and enjoys seeing and commenting on cars and people along the way.”
Riki spent many hours with his father every day. He knew that when he initiated activities that his dad enjoyed, such as taking a walk, being with children, watching old movies, or going for a drive, the day went better for both of them.
A Best Friend Encourages the Person to Enjoy the Simple Things in Life
Simple things are often the best things in Alzheimer’s care. For example, it can be pleasurable for both of you to browse in a bookstore. Perhaps you’ll discuss seeing a teenager with green hair, have fun looking through art books, or find a cozy corner with two comfortable chairs. This activity might not work for every situation; a person might become agitated by a large crowd. If you are unsure, take a trial run—keep the visit short, and go when the store is less crowded. You know your loved one best. If he or she is getting restless, it is time to go home.
Serge Gajardo and his wife found pleasure in a simple activity: they often stopped by garage sales. Serge had collected wood carvings and art from all over the world, and he still enjoyed browsing for treasures and irresistible bargains.
Silence is also part of any friendship. Sometimes it is nice simply to sit in a comfortable chair and watch the world go by together or to watch friends or family play a game or watch television. The person can still feel a sense of involvement and security by being in the presence of others.
A Best Friend Enjoys Activities with the Person with Dementia
It is difficult to imagine life without things to do. Most of us like to stay engaged with family and friends in a great variety of ways. Persons with dementia are no different. They long to be in the flow of life and continue the things that have given them meaning.
Tom Meyers is a volunteer at the Best Friends Day Center and Bob Steele is a program participant. They are always very engaged. They both served in the military, one in the Navy and the other in the Army. They banter back and forth about which branch of service is most important. They both have traveled extensively because of their service experience as well as for pleasure. They enjoy looking at maps to locate their favorite spots and to dream of their next trip. Tom and Bob are both members of the Civil War Roundtable, a study group in the community. They enjoy poring over the notes from the Roundtable meetings and discussing them afterward.
Tom enjoys being with Bob as much as Bob enjoys being with Tom. Activities build better relationships and add fun and variety to our daily lives.
A Best Friend Involves the Person in Chores
Even with limited skills, the person can often help with daily chores, such as drying the dishes or stacking the newspapers to recycle. The key to all of these activities is to get the person involved, to encourage him or her to be a part of life. This also connects the person with his or her care partner—it is satisfying to do a project together.
The Gajardos were together at home for ten years after Sergio (“Serge”), an executive for a large company, was diagnosed with Alzheimer’s disease. Little by little many things they once enjoyed were no longer possible. Yet his wife, Gertrude, found that Serge could still enjoy many daily chores, such as chopping up vegetables for a stir-fry dinner they could then enjoy.
Serge felt competent and successful when he helped to prepare the evening meal. One reason why this activity was successful is that it had a clear purpose and outcome (preparing dinner and enjoying it). As a Best Friend, Gertrude could praise Serge for the delicious dinner and thank him for his hard work.
A Best Friend Ties Activities into the Person’s Past Skills and Interests
Past skills and special interests often remain intact well into the advent of Alzheimer’s disease. This is why it’s important to know a person’s special interests; perhaps he or she can still pursue these interests, particularly with some help and assistance.
Tap Steven has always loved writing and poetry. Despite the onset of Alzheimer’s disease, Tap still writes, attends classes, and occasionally teaches. He and his wife, Frankie, are proud that a number of his poems have been published in Alzheimer’s newsletters and journals.
Because people like Tap have led such full, rich lives, the possibilities for activities linked to past skills are unlimited.
A Best Friend Remembers to Celebrate Special Occasions
The ritual of a birthday party, anniversary celebration, Veterans’ Day parade, or other long-held traditions can bring back many positive memories for the person. Special occasions can be celebrated throughout the year, making a big day out of a birthday or other family event.
Phil and Karen Zwicke renewed their marriage vows after many years of marriage. Surrounded by friends and family, the couple enjoyed the afternoon, including champagne and wedding cake. Phil, then fifty-two, had been open with others about his diagnosis of Alzheimer’s disease; both of them were determined to keep him active and enjoying life as long as possible.
Phil enjoyed these simple life celebrations, just as he enjoyed being at one with nature in his beautiful home of Santa Barbara.
FRIENDS COMMUNICATE
The best friendships often involve a lot of talking. Whether it is on the telephone or over the office water cooler, friends generally love to swap stories, gossip, share ideas, send e-mails and instant messages to each other, and confide in one another. Friends are also there to listen to each other, in good and bad times.
A Best Friend Listens
In dementia care, it is important to try to be there for the person when he or she wants to talk about important feelings. Individuals with Alzheimer’s disease should be given time to offer their feelings or ideas. Sometimes patience is rewarded with an insight.
Maria Scorsone has spoken three languages in her lifetime: Italian as a child, Spanish when she lived in Argentina, and English after she moved to the United States. She now often mixes the three languages. Her in-home aides became her Best Friends by listening to Maria’s words very carefully. When the aides cannot follow the exact words, they can usually still understand her by listening to the tone of her voice and watching her facial expression and other body language.
Maria’s gift with languages allowed her to be a teacher to the staff who enjoyed learning words and phrases from languages they didn’t speak.
A Best Friend Fills in the Blanks
People with dementia begin to lose the structure of their sentences and language. When you can provide clues and cues, communication can vastly improve. Sometimes even filling in the blanks by supplying one or two words keeps the dialogue going.
Edna Edwards loves to converse but has major difficulty finding the right words. When Edna says “Those little ones, I miss them . . . at the school . . .” her Best Friend says “Picadome School?” Edna can continue, “Picadome, that’s my school!”
Conversation can continue about early childhood days, her teaching, and her schoolchildren, all because her Best Friend brought up some familiar names of people, places, and things in Edna’s life.
A Best Friend Asks Questions That Are Easily Answered
The person may become easily frustrated if asked questions to which he or she does not know the answer.
When Evelyn Talbott, a retired librarian, returned from a vacation, she would have been frustrated if someone had asked her to recall, “Where did you go on vacation?” or “What was the name of the beach?” Instead, a friend asked skillfully, “Did you and your husband, Bob, have a good time watching those big waves on the ocean?”
When her Best Friend provided some details within the question, it triggered memories and allowed Evelyn to share her joy from her vacation and participate in the conversation.
A Best Friend Recognizes the Importance of Nonverbal Communication
Because verbal skills are diminished, body language becomes very important in dementia care. A Best Friend should greet the person warmly, smile broadly, and hold out a hand. The handshake still holds special meaning with older people who remember a time when everyone in polite company would shake hands. Almost always, the person will respond with a handshake. A mutual handshake is the beginning of a bond, a deep-rooted symbol that one is a friend, not a foe. Talking with your hands can also be effective. Gestures such as tapping the seat on a chair can help the person get the message to sit down.
Because of Mary Burmaster’s hearing loss, body language was especially effective for a day center volunteer relating to her. After making eye contact, the volunteer would smile and say, “Mary, lunch is ready.” The volunteer would then touch her gently on the shoulder, pat her hand, and guide her to the table.
A Best Friend’s gentle touch spoke volumes.
A Best Friend Gently Encourages Participation in Conversations
It is important to include the person in conversations as much as possible. Broad, open-ended questions (“Tell me about . . .”; “What do you think about . . .”) that touch on the person’s life experience can be particularly effective.
There is so much in Jim Holloway’s life to talk about: fishing with his uncle, raising German shepherd dogs, collecting yo-yos, studying great artists and their works, enjoying classical music, teaching theology, visiting Pompeii, attending Yale University, working on old cars, being a medic on a troop ship during WWII, and much more.
All of this stays tucked away until a Best Friend gently encourages conversation by saying, “Tell me about . . .”
The Art of Friendship Comes Naturally
At a skilled nursing home we spoke to a diverse group of staff—many of whom spoke English as a second language—about the Best Friends approach. Instead of giving the staff lists of things to do (and not do), we talked about friendship and Alzheimer’s care and did an exercise that can be very helpful to you as you support the person in your life with dementia. We first asked participants to name a close friend and say why they are friends. Here are some of the answers:
Maria: She is a good listener
My mother: She’s always there for me
Mike: Laughter
Tony: Nonjudgmental
My sister: She knows me so well; we know what each other is thinking
Jackson: Loving
Mia: Honest feedback
Joe: Supportive
We then asked the staff to think about the residents with dementia and whether they thought those persons would respond to some of these characteristics embodied by good friendship. “Yes,” the staff answered.
We then asked the staff how a friend could help a resident with dementia in the following scenarios. Here are some of their answers:
The resident seems upset, agitated:
Give her a hug. Ask her what’s wrong. Spend some time with her. Check to see if she is physically okay. Sing a song together. Offer a compliment about her pretty pink sweater.
The person is pacing:
Walk with her. Ask her if she needs some help. Tell a funny joke.
The person won’t cometo an activity he or she usually enjoys:
Tell her we need her. Remind her about it, but gently. Don’t bug her and let her decide.
The person is angry:
Tell her you’ll look into the problem. Back off for a while. No big deal; I get angry now and then too.
By understanding these concepts—that persons with dementia are just like our own friends with similar needs and feelings—the staff could now stop, look, and listen when problems were brewing and ask themselves, “What would a friend do?” or “How can I be a Best Friend?” This helped them be more successful at work. Being a friend comes naturally, and the elements are simple to put into practice.
Try the above exercise at home. Ask yourself how you can be a Best Friend to Mom if she is upset or angry, frustrated, or not wanting to go out. The Best Friends approach can lead you to new ideas for success.
FRIENDS BUILD SELF-ESTEEM
A good friendship brings out the best in each person. It involves a mutual support system, with each giving the other constructive criticism and feedback as well as unconditional support. Friends also look at strengths more than weaknesses. Self-esteem is built when friends give a compliment, remain loyal, stay in touch, and tell us how important we are to them.
A Best Friend Gives Compliments Often
Telling a person “You look nice today” or “You really did a good job gardening” builds self-esteem. A compliment also can “disarm” the person who is having a bad day or bad moment. The compliment distracts the person, moving him or her away from the problem or concern.
Ruby Mae Morris loved pretty clothes. Compliments for Ruby Mae such as “You are pretty as a picture,” “You are all dolled up today, ready for a party,” or “That pretty blue dress matches your pretty blue eyes” made her beam. The good feeling she got from the compliments seemed to linger throughout her day.
Recognition in the form of a compliment can be so easy with such big returns. The emotion provided by compliments lasts long after the words are forgotten.
A Best Friend Carefully Asks for Advice or Opinions
Another way to show a person that he or she is valued is by asking for an opinion. The question should not be about the national debt or foreign trade. Instead, you could ask, “I didn’t have a chance to look in the mirror today. Do you think my tie matches my shirt?” This could lead to a lengthy discussion about fabrics, textures, colors, changing widths of ties, and perhaps even the need for a new wardrobe.
“What do you think about Mexico, Mother? Do you think it would be a fun place to visit?” Emma Simpson likes it when her daughter Patricia asks her opinion about a future trip.
Even though Emma can no longer travel, she enjoys the fact that Patricia values her opinion. A question like this allows mother and daughter to look at travel brochures together, discuss clothing and the weather, and even talk about what kind of food tourists might eat in Mexico. Like most mothers, Emma is thrilled when her daughter comes to her for advice.
A Best Friend Offers Encouragement
People with Alzheimer’s disease need as much encouragement as possible, in many forms. Sometimes it is to encourage individuals by reminding them of their value as friends: “You add so much to my life” or “We’re just like sisters.” The person can also be encouraged to attempt a particular task, especially a task that seems possible to accomplish. A Best Friend might say, “I could use your help in putting this puzzle together. Would you sit by me and help out?”
A beautiful scarf, creatively displayed to complement her outfit, was Edna Carroll Greenwade’s hallmark. One day the director of the day center brought a collection of scarves and encouraged Edna Carroll to show everyone how to wear them. Edna beamed as she helped each participant tie her scarf and, as the fashion show of scarves passed by her for inspection, she exclaimed, “I’m so glad to be of help!”
Often, gentle encouragement is all that is needed to practice an old skill.
A Best Friend Offers Congratulations
In dementia care, the person should be congratulated often for small and big successes.
When Edna Edwards’s granddaughter was a finalist in the Miss Kentucky beauty pageant, the day center volunteers said with excitement, “Edna, congratulations on your granddaughter’s winning the Miss Kentucky beauty pageant; Mary Dudley must have gotten her good looks from you!” Edna would often respond, “You know it!”
A person can also be congratulated for a current personal or family achievement or for something in the past. Perhaps someone like Edna has been a beauty queen in her own right!
FRIENDS LAUGH TOGETHER
Humor is a powerful element in all relationships. Humor helps people enjoy shared experiences, relieves tension, and brings people together. Many researchers have also confirmed that laughter has positive physiological effects, boosting the immune system and lowering blood pressure.
A Best Friend Tells Jokes and Funny Stories
Even the corniest joke can evoke big laughs from someone with dementia. Funny stories are also popular, particularly ones involving either the care partner or the person. For example, a Best Friend might say, “I still haven’t forgiven you for eating the last piece of grandmother’s pumpkin pie that Thanksgiving.” Don’t forget that the person can sometimes remember or tell a great story or joke.
In spite of the fact that he had had a series of strokes, Jerry Ruttenberg retained his great sense of humor. When a volunteer in the day center handed him corn on the cob, he said loudly, “Oh, shucks.” Another time, in answer to the serious question, “How do sand dollars reproduce?” he quipped, “They give birth to baby dimes.”
It is a running joke in some friendships: “Not that story again, I’ve heard it before!” Yet in dementia care, a story that is repeated often can be a favorite with the person. It may be that they are simply not remembering hearing it before. More likely, they connect with the smiles, laughter, and joy associated with the story.
A Best Friend Takes Advantage of Spontaneous Fun
Things happen spontaneously that are often humorous for the person and the people around him or her. Laughter can come from watching staff at a nursing home chase a pet rabbit that has gotten free from its cage. Fun can come in many ways:
Riki took advantage of spontaneous moments while caring for his dad, Mas. “Pops loved to laugh at pratfalls and physical humor. Every chance I got I faked bumping my head against a wall or tripping over my feet. At times he caught me faking it, but other times he laughed hysterically. Pops also loved to rhyme and laugh at language used awkwardly or uniquely. He continued to be witty and clever and loved spontaneous humor in people and situations.
There is spontaneous fun all around us free for the taking to help lighten the losses of dementia.
A Best Friend Uses Self-Deprecating Humor Often
Friends are not afraid to be the butt of their own jokes. Embarrassing moments happen to all of us, but are a particular concern of people with dementia. When a person can’t find his glasses, a helpful response from a Best Friend might be, “I looked all over for my glasses last week and then found them—right on my nose.”
The spotlight at the day center was on Marydean Evans as she demonstrated the steps to the waltz. The group was enjoying the occasion when suddenly Marydean began looking for something to show the group. She was sure that she had it when she came to the program that morning: “I’m always losing my things, and I wanted to show it to everyone.” In keeping with the celebratory mood, her Best Friend quipped, “I have the same problem sometimes. Good thing my head is securely fastened. I’d lose it too!”
Self-deprecating humor reassures the person that he or she is not the only one in the world who is forgetful. It also diffuses negative situations and helps the person stay in a positive mood. A good self-deprecating remark also allows for laughter to break the tension, for a frown to turn into a smile.
FRIENDS ARE EQUALS
No friendship will survive condescending behavior. Everyone has different strengths and weaknesses, but differences should be celebrated rather than dwelled on.
A Best Friend Does Not Talk Down to the Person
Condescending language is never appropriate in dementia care. Examples of inappropriate language include speaking in an exaggerated, slow, and measured voice; being insensitive; using childish language; being flippant; not giving the person time to respond to a question; asking inappropriate and embarrassing questions; or talking about a person as though he or she were not present.
Rubena Dean enjoyed looking at cards that contained brief biographies of famous women. One day she was trying to recall facts about Helen Keller when she lost her train of thought. A Best Friend felt her pain at not being able to finish and simply said, “I’m sorry.”
Rubena’s Best Friend did not condescend by trying to negate or dismiss her feelings. Rubena needed her friend to empathize and be supportive.
A Best Friend Works to Help the Person “Save Face”
Many people with dementia remain fiercely independent. The person may still have a lot of pride and be reluctant to accept help or “charity.”
When Margaret Brubaker’s friends or family visited, they were often concerned that she was not eating well. She was very proud and refused gifts of food, saying that she was not hungry or had “just eaten an enormous meal!” A volunteer took a different approach. During one visit he said, “Margaret, you could do me such a favor. Bananas were on sale this week, and I bought 3 pounds. My wife went to the store separately and bought 3 pounds. We just don’t know what to do with all these bananas. It would help us so much if you’d take some off our hands.”
Margaret took the bananas with delight because she was doing her friend a favor and her friend was respecting Margaret’s dignity.
A Best Friend Does Not Assume a Supervisory Role
Friends generally have a sense of equality between them. The person wants to feel independent. He or she almost always responds negatively to being bossed around.
Edith Hayes was a devoted mother to her daughter Dona and provided loving care during her childhood. When Edith moved in to her daughter’s home, Dona had to tread lightly. “Mother could smell being managed a mile away. Being Best Friends worked well for both of us. I liked to provide opportunities for meaningful things for Mother to do on her own or with family and friends. We as a family are still very active in our church, and we often have gatherings of our four generations, and Mother could still function very well in those family settings. We gave each other space by taking advantage of the local adult day center. Mother always liked being in the helping role; she liked helping others in the center.”
Dona knew her mother well and let her mother have her say as much as possible.
A Best Friend Recognizes That Learning Is a Two-Way Street
Equality means learning things from each other. Many people with dementia can still share stories from their personal histories, express compassion and concern, or demonstrate old skills and hobbies.
Dicy Jenkins was a walking encyclopedia of information about plants and herbs used for health and healing. She knew how to use juniper berries, ginseng, feverfew, bee pollen, and burdock root for medicinal purposes.
Many of these old remedies now are actually back in style. Her family and friends remained endlessly fascinated by her wealth of knowledge.
FRIENDS WORK AT THE RELATIONSHIP
Every friendship has its difficult moments. Something said is misconstrued, or a friend disappoints us in some fashion. Clearly no friendship will survive a continuing series of disappointments, but Best Friends discuss disagreements and work them out. Good friendships can handle some rough-and-tumble moments, constructive teasing, and high spirits. Good friendships also require work and commitment. Friends need to stay in touch by phone or letter and initiate activities with each other.
A Best Friend Is Not Overly Sensitive
Friends must recognize that problems, when they occur, are normally part of the disease process, not part of the person. Sometimes, inhibitions are reduced by dementia. The person may say some surprising things.
Geri Greenway valued great art, music, stylish clothes, and beautiful jewelry. When a volunteer in the day center program asked Geri what she thought of some new costume jewelry she had brought to the day program to display, Geri replied, “Well, it looks like a bunch of junk to me.”
The experience of the volunteer showed. She replied to the group humorously, “Ask a question, and get an answer.”
A Best Friend Does More Than Half of the Work
In dementia care, clearly most of the work is done by the friend without dementia. Just as you would give a friend having tough times some latitude, you should do the same or more with the person with dementia.
“Frances kept us all together—me and our four children. She looked after our every need.” Her husband, Bill Tatman, praises her for always being there with clean clothes, good food, appointments made, and picnics planned. Now that she can no longer care for herself, he feels that it is their gift to her to be able to care for her every need.
In this case, Bill and the children may be closer to doing 100 percent of the work, but they recognize that it’s now their turn to provide loving support and care.
A Best Friend Builds a Trusting Relationship
Building a trusting relationship takes work, but it can be gained when care partners demonstrate confident, consistent, loving care. Obviously problems do occur, and some individuals with dementia are distrustful of the world. Piece by piece, however, a trusting relationship can be built and maintained (find out more about this in Chapter 7).
Hobert Elam’s wife took time each day to do something that he especially enjoyed. One of his pleasures was to walk hand-in-hand on the farm they owned, look at the Angus cattle, or take a drive to explore the familiar countryside where he grew up.
Just being with his wife, exploring familiar territory, and feeling comforted by the familiar helped Hobert feel more safe and secure. It also reinforced a bond of trust between Hobert and his wife. Walking together, they were husband and wife, but also Best Friends.
A Best Friend Shows Affection Often
We know of some long-term care communities and adult day centers that have a “three hugs a day” rule. Best Friends show the person with dementia affection as often as possible in various ways, including giving compliments, holding hands, giving a pat on the back, hugging, and smiling.
Frances Tatman always loved children and couldn’t wait to be a grandmother. Hugs and kisses were one thing that she could still give, and she had lots of those for her seven grandchildren. They returned her affection in double doses.
Affection can take many forms. Most people respond to hugs and touch, but not all. Sometimes affection can come from words or just spending time with the person.
CONCLUSION
Friendship is a powerful part of all our lives. You don’t need a college degree to understand it. It is multicultural. Some people have dozens of friends; others just have a few. Even a loner is capable of friendship.
Being a Best Friend restores many of the old social graces of the person with dementia. It provides support and reassurance. It gives us tools to handle everyday concerns and problems. It can reduce many challenging behaviors that people with dementia can have. It can help maintain dignity.
There are still plenty of moments of stress and tension in caring for a person with dementia, but a Best Friends approach can also create moments of contentment and joy—in you and in the person. When you rethink or recast your relationship to the person with dementia, when you become a Best Friend, you can become better prepared to cope with the challenges that arise each day or that lie ahead.
Best Friends Pointers
- The person with dementia mixes up relationships. Wife becomes “mother” or “sister.” Recasting relationships to be a Best Friend is a life-affirming, positive response and helps care partners overcome their sense of loss.
- Use the elements of good friendship, such as giving compliments and offering encouragement and support, to develop creative responses to challenges and turn a “no” into a “yes.”
- Facing so many losses and isolation, what a person with dementia needs is a good friend—a Best Friend.