Habilitation Therapy for Alzheimer's Patients

Massachusetts Alzheimer's Association Technique Increases Positive Emotional Experiences and Reduces Stress

The weeping elderly woman is pleading.

“I want to go home! Please find out why my ride isn’t here!” Exasperated, her daughter snaps at her, “You are already home, mom! I keep telling you, why can’t you remember? You moved in with us in Boston last year!”

More weeping, snapping, pleading and exasperation follow. Around and around this goes, several times a day. Both women end up beside themselves with frustration, sadness, anger, and fatigue.

While looking at books at their local library, a man suddenly jumps to his feet, announcing loudly to his wife, “I have to go to the bathroom, now!” Five seconds later, he wets his clothing, urine puddling around his feet.

“I asked you to go before we left home and you refused! Why can’t you control yourself? I can’t take you anywhere like this,” she says to him in despair and exhaustion. They are both embarrassed and ashamed, a wedge stands between them and tension hangs thick in the air.

Alzheimer’s Disease and Related Dementias (ADRD) and the difficult, troubling behaviors that arise from these illnesses cause grief for families. Over their course, there can be many changes in their loved ones, and much work to attend to their many needs. Despite everyone trying their very best, all too often by the time the day is done, it’s been a really difficult one.

But what if there were enough periods of pleasure, connection, peace and satisfaction — and far fewer difficult behaviors — that the person with dementia and their family could call more days good than bad? This is both the promise and reality of Habilitation Therapy (HT): increasing positive emotional experiences while providing a set of effective tools to reduce difficult behaviors.

HT was developed at the Massachusetts Chapter of the Alzheimer’s Association over the past 20 years. It is considered to be the best standard of care for all types of dementia. Sadly, it is not in as widespread use as it should be.

This approach focuses not on what the person has lost through their illness, but on their remaining abilities, aiming to create and maintain a positive emotional state through the course of each day. Their capabilities, independence and morale are thoughtfully engaged to produce greater psychological wellbeing. In this way, difficult symptoms can be reduced or eliminated, despite the disease’s progress.

This method emphasizes validating the client’s emotions, maintaining dignity, creating moments for success, and utilizing all of the patient’s remaining skills. Habilitation therapy helps caregivers have positive and successful interactions with their loved ones by optimizing and maximizing the care recipient’s strongest skills. The goal is not to rehabilitate the client to an earlier state of functioning, but to “meet them where they are” with the remaining skills they possess.

Every interaction with the person with dementia, every task performed for or with the client, and every aspect of the environment around the client can be thoughtfully selected or adjusted with habilitation in mind. Habilitation therapy can be applied in the home or institutional setting, and can be learned by family, friends and professionals alike.

It’s best that every person who cares for a person with ADRD should be a part of applying Habilitation Therapy. This includes family, friends, and all types of caregivers.

HT is not rocket science. It requires learning some basic concepts and approaches, getting some practice, applying some creativity, and having a willingness to see ADRD though a — sometimes very — different perspective.

In 2011, as part of their public health efforts to relieve the problems faced by Alzheimer’s sufferers and their families, the commonwealth of Massachusetts and the Alzheimer’s Association developed a curriculum and trained some clinical staff in homecare agencies staff to coach family and train caregivers in the use of Habilitation Therapy, reducing the care challenges they face. In a surprisingly few hours the basics can be taught. The application of HT can start immediately.

Habilitation therapy enables caregivers to enjoy time together and to share a relationship, activities, and feelings with a person with dementia. The satisfaction we get from forming warm bonds with our dementia homecare clients, and to help them have satisfying, peaceful days is what keeps us excited about this work. Applying Habilitation Therapy helps family members to also join this warm circle.