Foreword by Andrew Rosenzweig MD, MPH

As a geriatric psychiatrist and guide to About.com's Alzheimer's site, I recognize the need for comprehensive and on-going dementia training for workers in eldercare facilities. Having read Cindy Keith's first book, "Love, Laughter, & Mayhem - Caregiver Survival Manual For Living With A Person With Dementia," I was impressed with her down-to-earth and practical advice to family caregivers. This second book by Cindy is equally impressive in the ways she understands the challenges faced by workers in facilities every day. Cindy tells it like it is: working with people with dementia is stressful and at times unpredictable, but being condescending to residents or back-stabbing to each other should never be acceptable. A multitude of extremely helpful tips are included for interacting with people with dementia, as well as guiding workers to take an honest look at themselves and their work ethics. It is doubtful you will find a training as easily taught, or as all-encompassing as this workbook and the Training Guide. Any facility choosing to provide this dementia training tool for their staff will see immediate, positive changes in the culture of the facility, as well as happier, and safer residents with dementia.

MODULE 5: YOUR BODY LANGUAGE SPEAKS LOUDER THAN YOUR WORDS!

Your body language will always, always, always speak louder to a person with dementia than your words do. We all constantly read the body language of every person we encounter and we're not even aware we're doing it. Dogs are masters at reading body language, babies can read body language, and people with dementia rely on their impressions of your body language because all of those words you're speaking do not make sense to them anymore. Allow me to give you an example of what I mean:

It's time for George's bath and you know from many past experiences with him that he resists getting bathed, and that it's quite possible he could become combative with you during the process. You are dreading this and when you walk up to George to take him to the shower room, you are wondering if today is the day he will hit you. Unless you are making a conscious decision to appear relaxed, calm, and happy, I can guarantee that your body language is hesitant, guarded, and anxious. At this point it won't matter much what words you use with George, because he will instantly recognize something is wrong, and he won't like what he senses. George will not want to go anywhere with you because of what he's picking up from your body language and tone of voice. Instead, you need to give yourself an attitude adjustment before you approach George. Think positively! Today could just as easily be the day when George enjoys his bath! Wouldn't that be a blessing! Put a smile on your face, a bounce in your step, and walk up to George just beaming with friendliness and joy. When you approach him with that body language and say something to him like:

"There you are George! I've been looking all over for you. I thought maybe you were hiding from me! I need some help with a little project and you're the only one I can think of who can do it for me. Could you please come with me for a minute?

Keep up the chatter with him as you walk slowly towards the shower room (which you have already prepared in advance for him). Change the subject as you walk and once you walk into the shower room, he will have likely forgotten the reason you asked him to accompany you (to help you with something). If you're chatting with him about a subject he enjoys talking about, then he may automatically go through the motions of what you want him to do. The point I want to make here is that you may not have been able to get George to get up to walk with you if you hadn't approached him in that open, friendly way. We'll talk more about the bathing issues later.

Your body language is a tool you need to use to your advantage every day when you work with people with dementia. Even if you're upset, possibly angry at one of your own family members for some reason, if you cannot mask that and act friendly, happy, and open, then your job will be ten times harder for you that day because your residents with dementia will not want to do anything with you or go anywhere with you.

Consider also, if you take offense at something a coworker has just said or done and your response is irritation or anger. You exchange a few accusations with each other in the presence of some residents. Those residents will immediately pick up on those emotions and will then mirror them. You could have half a dozen residents around you suddenly becoming irritable for no apparent reason! How do you suppose that would affect your work day? And, guess what? It would be YOUR fault if you could not get your tasks accomplished because the residents were not cooperating or if they became upset and agitated! You would be the only one in that scenario who has the ability to change your mood, your attitude, or your behaviors; your residents cannot.

The same thing would happen if a group of residents witness an argument or a physical altercation between two other residents. It will upset everyone who witnesses it, and you would need to take steps to calm each one of them down and redirect their minds to more pleasant thoughts. If you don't take a few minutes to do that, then you will likely be following around behind a few of them doing damage control while they act out their agitation. And they won't have any clue why they're agitated.

So, it's crucial to always be aware of what your body language is saying to others. If you're upset or not feeling well, then you must be especially careful to mask that from your residents with dementia or you will all have a more difficult day.

To recap, being aware of what your body language is saying to a person who has dementia benefits you in the following ways:

• When you are aware of how you're presenting yourself, you can then decide if you need to change that presentation in any way to accomplish what you want. If you're not aware of it, you cannot change it.
• When you present a calm, relaxed, and happy demeanor to a person with dementia, you greatly increase your chances of having him or her cooperate with whatever you want him or her to do with you.

Going out of your way to avoid presenting a tense, angry, or unhappy demeanor to your residents as well as your coworkers greatly reduces the emotional stress you feel in your body. When you "act as if” you're happy, your body totally believes what your brain is telling it and you will then begin to actually feel happier.

TASK: Write about an instance when you have had to consciously change your body language for a specific resident.

Has there ever been a time when you've been upset with a coworker while at work? Can you recall if your body language during that day was negative or positive and whether it affected the residents you worked with?