Tag: personal space

Building Hands-On Caregiving Skills for Dementia Care

doctor-holding-elderly-ladys-hand-752x501As dementia progresses, it is vital to appreciate the changes in a person’s ability to be able to connect. One critical element that is often missed when trying to share information is the value of changing our delivery process. Dementia care pioneer Teepa Snow developed the hand-under-hand technique, as a guiding and assisting technique that provides family members and caregivers with an amazing connection. It promotes a physical touch connection that is friendly, comforting and attention-getting without being intrusive or overbearing.

It also provides a system of feedback and communication between the a loved one living with dementia, and a caregiver. Hand-in-hand uses the much practiced and automatic connection between the eye and hand to form a closed circuit between the person who is struggling to understand words and tasks and the care partner. It provides a comforting and calming human connection using a familiar grasp and proprioceptive (deep pressure) in the palm at the base of the thumb.

This eye-hand connection is one of the very first sensory-motor loops established in infants is used endlessly throughout our lives. By using the palmer surface of the hand, and taking the person through the desire motion or movement, we are communicating with touch and movement, without the need for words.

It’s also important and helpful to position yourself below the eye level of the person with dementia. If you do only these two simple things (get down and use Hand Under Hand), life will be much easier on everyone. Guaranteed.

Remember: the purpose is to control the situation, not the person. Dementia care partners are in the process together: always do whatever you can to respect the independence, rights and dignity of the person with dementia.

The use of hand-under-hand is multi-faceted:

  • It is used when greeting someone to sustain a physical connection, allowing the person to become more comfortable with your presence in their intimate space. It differs from a normal handshake that can be uncomfortable to sustain. By having a hand-under-hand rap, you will be able to tell if the person is enjoying your presence and wants you to allow them more space. If they keep trying to let go you, let go and move back further. They may need a break or may not you in their intimate space (within arms reach) at that moment.
  • It can be used when helping your loved one move around. It provides greater stability and support as well as a feedback loop.
  1. Since the arm is the rudder that guides the ship, by rotating the foreman outward or inward you can direct the walking path.
  2. By tipping the forearm down you can indicate physically the cue to sit down in a seat or on the bed.
  3. By tipping the forearm upward you can help the person stand upright.

When used in combination with a gesture or point, it can help provide directions and reassurance when moving through the environment in the later stages, or when in an unfamiliar setting. Because a family member or caregiver is close to the person, the awareness of balance, coordination, fear, or distress is telegraphed can be responded to in a timely manner.

  • Hand-under-hand is essential during the Amber, Ruby, and Pearl gem stages. It allows you to use their dexterity to operate the tool or utensil while your loved one is still actively participating and moving their body parts toward their body (hand to mouth, hand to chest) as they have done for their entire lives. This automatic loop allows people living with dementia a sense of both control and involvement.

Finally, it provides the caregiver or family member a way to get feedback on preferences, understanding, readiness and willingness to participate. It provides a way to do with, not to do or do for.

In the video below, Snow demonstrates how to use Hand Under Hand™ as part of the process of helping someone to bathe. But Hand Under Hand™ can be used in multiple ways: to help someone to eat, to walk, or even to calm down in a crisis.

NursePartners is committed to providing uncompromised care to those living with a diagnosis of Dementia. Our CarePartners are trained in the GEM Level Approach, and work with each family to enable safety, comfortability and happiness through home-care services.

If your loved one need home care assistance or relief, our team would love to help.

Contact us today.

Steps to a Positive Physical Approach

Building Caregiving Skills for Dementia Care

caring-matters-home-care-4It’s important to remember that people with dementia are doing the best they can; their behaviors are a result of the condition, not a choice. As family and caregivers, we are able to choose our behaviors and approach for their care. The Positive Approach to Care™ developed by Teepa Snow is a step-by-step method for developing positive and meaningful relationships with loved ones with Alzheimer’s and other forms of dementia.

Understanding the Positive Physical Approach can help families improve their ability to approach, connect and provide care with those living with dementia. By understanding the best ways to approach care, you can build a better connection that enables safety, comfortability and happiness.


Below is a step-by-step positive physical approach for someone with Dementia.

Announce and approach:

  1. Knock on a door or table to get attention and signal your approach.
  2. Pause at 6 feet: Stop moving at the boundary between public and personal space.
  3. Acknowledge a person’s ownership of personal space and get permission to enter or approach.
  4. Approach the person from the front, come in within 45 degrees of center.
  5. Move slowly – one step per second.
  6. Stand tall, don’t crouch down or lean in as you move toward the person.

Gesture and Greet:

  1. Bring a flat, open palm near your face.
  2. Look friendly by smiling and making eye contact.
  3. Wait for acknowledgment: make sure you have a connection before your start your message.
  4. Call the person by preferred name OR say “Hi!”
  5. Avoid endearments.

Shake Hands:

  1. Move your hand out from near your face to a greeting handshake position.
  2. Move toward the right side of the person and offer your hand.
  3. Give the person time to look at your hand and reach for it, if s/he is doing something else – offer, don’t force.
  4. Make sure they notice your hand out to shake, then stand tall and move forward slowly.

Offer Support:

  1. Move from the front to the side: Turn your trunk sideways to the person.
  2. Stay at arm’s length: Respect intimate space and be supportive not confrontational.
  3. Slide your hand from a ‘shake’ position to hand-under-hand position – for safety, connection and function.

Get to Eye Level and Deliver Message:

  1. Get to the person’s level to talk – sit, squat, or kneel if the person is seated and stand beside the person if s/he is standing.
  2. Give your name and greet – “I’m (name). It’s good to see you!”
  3. Deliver your message – simple, short, friendly.

Changes in the behavior of people with dementia are very common. Every person is an individual who will react to circumstances in their own way. Knowing how to approach a loved one when they are distressed can help you deliver successful care.

Here is a step-by-step guide to approaching a person distressed.

  1. Let the person move toward you, keeping your body turned to the side (supportive, not confrontational).
  2. If the person is seated and you do not get permission to enter personal space – turn sideways and kneel at six inches out.
  3. Offer greeting and shake hands again.

Look for an OK to come into their personal space. (submissive posture)

After greeting, try one of two options:

  1. “Sounds like you are (give an emotion or feeling that seems to be true)”
  2. Repeat the person’s words to you:
    • If s/he says, “Where’s my mom?” you would respond – “You’re looking for your mom?” (pause) “Tell me about your mom.”
    • “If the person said “I want to go home!” you would say -“You want to go home? (pause) “Tell me about your home.”

Caring for a loved one with Alzheimer’s disease or dementia can be a challenging journey. We understand that dementia poses many changes that requires personalized care, expertise and understanding. At NursePartners, we work with each family to enable safety, comfortability and happiness through home-care services.

If your loved one need home care assistance or relief, our team would love to help. Contact us today.