Welcome to Memory Care Support’s 
October 2019 Newsletter!

What If We Changed Our Perspective?

When I first met Carmen in the locked memory care unit at a nearby SNF, she was quick to let me know that she didn’t want me approaching her. She was petite but had a big presence. She almost growled as I bent to introduce myself and whisked her arm away from my touch. She turned and walked with a dignified manner down the hallway.

In the brief moment I interacted with her, I could see that her curved dirty fingernails were very long, to the point that they would probably interfere with her ability to successfully complete grooming and other daily tasks. Carmen didn’t wear shoes, only socks and walked with a slow shuffling gait. I also wondered about the state of her toenails.

Supporting people living with a diagnosis of dementia with their grooming can frequently be a challenge. Staff said they had approached Carmen many times about the condition of her nails and she had refused any care. She had also refused attempts to get her to a podiatrist.

What to do? Is it best to let Carmen walk on bent nails and limit her ability to complete her ADL’s independently due to her long, curved fingernails?

If Carmen could share her personal preferences, would she say, “Please let me have long distorted toenails and fingernails?”

Probably not! But what seemed clear is that Carmen was expressing her displeasure in the process of caring for her nails.

Had she experienced pain from previous attempts to cut her nails? Had she been scared or forced to submit to uncomfortable procedures? We had no knowledge of such previous experiences but how could we meet this current challenge to provide Carmen with dignified care?

When I talk to care teams about supporting people living with dementia, it is often something as seemingly routine as nail care or bathing that leads to frustration and labeling the person as “difficult”, “non-compliant”, and even “aggressive”.

So what could we do? How could we approach this current challenge with Carmen? She didn’t want to be touched, and I didn’t want her to continue with the long distorted and dirty nails.

Let’s look at 3 steps to meet this challenge:

1. Team meeting – very important that all stakeholders are present if possible – the CNA, nurse, significant family members, laundry person and activity director, culinary director, etc. Everyone who has contact with Carmen is able to share their viewpoint of why she is refusing nail care and suggestions of how to successfully approach her.  Items to discuss include:

· Has Carmen always refused nail care or is this a change?
· Does Carmen refuse all personal assistance or only nail care?
· Does it appear that there is infection or inflammation around her nails, causing her pain?
· Are there types of events and activities that Carmen seems to enjoy?
· Has anyone had any previous success in assisting Carmen to have her nails trimmed?
· Is there a specific person who has a trusted relationship with her?

2. Make a plan of how to approach her:

· Is there a person whom she trusts that can accompany her for the nail trimming?
· Is there a time of day when Carmen may be most receptive?
· Is there a specific location that would be pleasant for her?
· Go slow and don’t impose our schedule on her.
· Could the nail trimming be combined with an event that she enjoys?

3. Review the plan and revise as necessary:

· Was it successful or partially successful?
· What did we learn about how to approach Carmen?
· How can we proceed in the future to meet Carmen’s needs?

The story of Carmen’s nails had a happy ending…I spent time with Carmen and showed her my fingernails ( always in need of trimming and cleaning because I’m an avid gardener). Carmen agreed that my nails could use some attention. After a couple days of continuing to show her my neglected nails, I asked if she would sit with me while I trimmed them.

I spread out 2 towels and bowls of warm perfumed soapy water and some simple nail instruments on a table. She held my hand and walked over to the table with me, while I talked to her about how much I hated getting my nails cut. As I put my hands into a bowl, I signaled for her to do the same. We sat there as 2 girlfriends getting a manicure while we shared the experience of soaking our nails. I gave her a file and let her begin to file my nails and then she permitted me to hold her hand and trim away her long curved nails. She closed her eyes and relaxed into her chair as I gently massaged each hand, then she wanted to show me she could return the favor as she massaged my hands! The red nail polish she chose at the end was icing on the cake!

Could this experience have gone differently? Absolutely! But by not making it about the task of cutting her nails, she seemed to be comfortable and interested in accompanying me as I got my nails trimmed. And my perspective changed from “this is a task that must be completed,” to “what can we enjoy together as friends”?

I describe it as, Pause and be with!

Have a great day!

If you work in Assisted Living or Nursing Homes and want to make your dementia care program even better, email or call me for a free consultation.

Anne Ellett, N.P., M.S.N.
AANC Certified Gerontological Nurse
Founder, Executive Director - Memory Care Support
www.MemoryCareSupport.com
AEllett@MemoryCareSupport.com
Ph. 949 933-6201