Teaching people to talk to elders

KAREN McNALLY BENSING

Originally appeared in column Coming of Age: Beyond Midlife, Cleveland, The Plain Dealer, 11/7/93

Most people are lucky to have four grandparents. Naomi Feil had dozens of grandparents while she was growing up at the Montefiore Home for the Aged in Cleveland Heights. Her father, Julius Weil, a psychologist, was president of the home for almost 30 years. Helen, her mother. established and directed the department of social services at Montefiore.

Together the Weils set up physical and occupational therapy programs at Montefiore, counseled older residents, and devised a sheltered workshop where residents could earn pocket money. In 1968, they left Montefiore to found Schnurmann House, an independent-living facility for older people in Shaker Heights.

As a child at Montefiore in the 1940s. Feil made friends with some of the oldest residents, many of whom were confused and may have been suffering from Alzheimer's disease or similar illnesses. She and the other residents shared good times and sad memories.

"The very old disoriented people taught me," Feil says. "I learned that they have an intuitive wisdom. a basic humanity that we all share."

Inspired by those early experiences, Feil left Cleveland to study psychology and social work at Columbia University, and work with older people in New York City's community centers.

In 1963, Feil came back to Cleveland and completed her education at Case Western Reserve University's School of Applied Social Science. She also returned to the Montefiore Home and began working with disoriented residents there.

Feil's special childhood relationships with the oldest residents at Montefiore helped her develop a new technique for understanding and communicating with very old people. She calls her method Validation, and created the Cleveland-based Validation Training Institute to educate professional and family caregivers about what it's like to have a dementing illness.

To understand the behavior of anyone, you must know his or her physical strengths and social and psychological needs, says Feil. Validation offers a way of classifying the behaviors of older, disoriented people, and provides practical techniques for reducing anxiety, increasing physical and social functioning, and maintaining self-esteem.

The principles and practice of Validation have been presented in workshops to more than 70,000 people, Feil says. Seven thousand nursing homes in the United States and abroad apply Validation methods.

Feil's workshops teach professionals about the joy of working with people who have Alzheimer's disease. In order to do this, "We need to be aware of our own aging," she recently told an audience of nursing assistants at a Validation training session. "We have to know ourselves and how we deal with losses."

In front of an audience, Feil can quickly change from an attractively-dressed 61-year-old instructor, to a tearful old lady, screaming at her caregiver; a result of her New York theatrical training (Feil performed in several off-Broadway productions).

"I grew up in a home, so I know how mean old people can be," Feil tells the nursing assistants. "The old lady is not really yelling at you; you remind her of someone from long ago. She's trying to resolve some unfinished business from the past at this final stage in her life," Feil explains.

Feil offers suggestions for communicating with disoriented older people. "The techniques don't take long." she says, "but they take energy.

• Release your own anger and emotions so that you can listen empathetically to the other person. "Put your feelings on the top shelf, to be taken down later and acknowledged."
• Use non-threatening, factual words. Confused people are not interested in understanding why they behave the way they do. Ask who, what, when, where and how, instead of why.
• Repeat what the confused person says to you, using the same words and tone of voice. He or she may find comfort in hearing his or her own words spoken by someone else. "I hear myself in your voice," Feil explains. Reminisce. Helping a confused person remember how he or she coped with problems in the past may help him or her handle problems in the present. Feil says it's too late for a very old person with dementia to learn new coping skills.
• Maintain close eye contact. Looking into the eyes of the older person will make him or her feel loved and secure.
• Use a clear, low, loving tone of voice. High, soft tones are hard for someone with a hearing impairment to understand. Arguing with someone who is confused is rarely productive.
• Use touch to establish a relationship. Gentle stroking of a hand or cheek can remind an older person of pleasant times from the past. But remember that some people don't enjoy physical contact. The personal space of all people, disoriented or not, must be respected."
• Use music to communicate. Tunes and songs from the past may be recalled even when an older person is no longer able to talk.

Feil has written several articles and books on Validation Therapy. Her latest — "The Validation Breakthrough: Simple Techniques for Communicating With People With Alzheimer's-Type Dementia" (Health Professional Press) — was published earlier this year. Feil and her husband, Edward, a filmmaker, have also produced nine instructional and documentary videos on Validation techniques.

For additional information, contact Edward Feil Productions, 4614 Prospect Avenue, Cleveland, Ohio 41003. Phone: (216) 881-0040 Fax: (216) 751-6434.

Feil's 10 principles of validation

Here are Naomi Feil's "Ten Principles of Validation":

1. All people are unique and should be treated as individuals.
2. All people are valuable, no matter how disoriented they are.
3. There is a reason behind the behavior of disoriented old people.
4. Behavior in old age is not only a function of changes in the brain's anatomy, but reflects physical, social and psychological changes that take place during the lifespan.
5. Behaviors of older people can be changed only if the person wants to change them.
6. Old people should be accepted non-judgmentally.
7. Each stage of life has particular life tasks to be completed. Failure to complete these tasks may lead to psychological problems.
8. When recent memory fails, older adults restore balance to their lives by retrieving memories from the past.
9. Painful feelings that are expressed, acknowledged and validated by a trusted listener will diminish. Painful feelings that are ignored will gain strength.
10. Empathy builds trust, reduces anxiety and restores dignity.

 
Coming of Age is produced under the auspices of The Benjamin Rose Institute, a Cleveland-area nonprofit agency that delivers social, health and residential services to the elderly and their families. Karen McNally Bensing is librarian at the Institute.