Revisiting the Well-Being Approach to Dementia Supports

Alzheimer’s disease and other forms of dementia affect a large percentage of people who live in long-term care settings, and supporting these residents to live full, meaningful lives can be more impactful when each person’s individual well-being is considered.

Two sets of hands, one younger and one older, are gently clasped together. The team at The Village of Aspen Lake has seen some recent successes following refreshed education on a proactive, “well-being” approach to support. They shared the story of their success at the 2023 Schlegel Villages-RIA Innovation Summit this fall.

They told the story of Mary*.

When Mary moved into The Village of Aspen Lake in the summer of 2023, she was often distressed and expressed herself with outbursts of frustration, not uncommon among people living with changed abilities and perceptions as a result of dementia.

It was hard for Mary to distinguish between past and present and she often talked about a person named Paul. Her emotions fluctuated between devotion or longing for him and hatred or resentment. She was sometimes paranoid and fearful, and something as simple as car headlights outside the window caused her to feel like she was in danger.

For team members in long-term care, Mary’s expressions aren’t necessarily unique, but her individual experience is. Psychotropic medication is often the medical response for people in her situation, unfortunately, but not long after her arrival the Aspen Lake team welcomed Dr. Allen Power into the Village to offer some education on a well-being response to personal expressions. As a geriatrician, author and RIA Research Chair specializing in dementia, Al has been a long-time friend and mentor within Schlegel Villages.

In the weeks that followed, the team saw a remarkable transformation in Mary after looking at her experience through the lens of the Seven Domains of Well-Being, (first introduced by the Eden Alternative). Al encouraged the team to consider how important it is for every person, regardless of age, background or diagnosis, to experience comfort through the seven domains of well-being:  Identity, Growth, Autonomy, Connectedness, Meaning, Joy, or Security.   

Team members on all three shifts in Mary’s neighbourhood were invited to think about each domain as a cup of water, that contributes to each resident’s experience of well-being.  What were the levels like in each of Mary’s cups?  Did the team know her story or her identity?  Did the team support her to feel independent and autonomous? 

“Her security was not at the fullest,” says Joy Lombardo, a registered practical nurse at Aspen Lake who is also the Personal Expression Resource Team lead at the Village. “She just didn't trust anybody.”

In regular huddle talks with each shift, the team would brainstorm different ideas to build trust with Mary, charting them for each shift to see, and patterns began to emerge. Different times of day might present different challenges or concerns, but the more the team zeroed in on what Mary valued, the more progress they made.

As Joy’s fellow team members presented Mary’s story at the Innovation Summit, they underscored the importance of having a “Me Form” for each resident – a snapshot of their life story highlighting their experience, values and preferences.  Knowing each resident well helps the team see them as people first, not just as a diagnosis.  It helps build relationships with them and offers important clues to understanding their distress, and the “Me Form” is the foundation of this knowledge with each resident.

This isn’t to say everything is perfect today with Mary, as distress still happens from time to time; the difference is that the team has a better understanding of how to support her when this happens. Overall, Joy says Mary seems much more comfortable and her trust in the team has grown.

“She's amazing,” Joy says. “She's got the greatest sense of humor that never came out before, but now she feels so much more secure, and she feels so much happier.”

*The name has been changed for this story.