Conflict in the Family – Will Mediation Help You?

This month’s dementia care article is guest-authored by our colleague Karen Dworski, LCSW. Thank you Karen for sharing your insights, and by supporting our shared communities. 

Mediation for Families Facing Dementia

by Karen Dworski, L.C.S.W., ElderPath Consultant and Mediator

Few people are prepared to hear that their mother, father, brother, or sister has been diagnosed with a dementia (now called a Neurocognitive Disorder). Just like the grief process described by Dr. Elizabeth Kubler-Ross in her work on the five stages of grief, family members of a loved one with a Neurocognitive Disorder go through a similar grieving process: denial, anger, guilt,sadness and acceptance.* Often families struggle with the denial stage, such as when a family member, say a daughter in California, is in contact with her Connecticut sister who is managing care for their mother who has been diagnosed with Alzheimer’s disease. So often I hear that the California daughter says, “Mom’s fine! I talk with her every week and she makes sense, she knows who I am.”  Or a son who is not a caregiver may struggle with his mother’s decision to place his dad in a memory care assisted living, struggling with his own guilt about not being available to give enough support to keep his dad home.

These are two of many scenarios that occur when family mediation can be very helpful in assisting families with the emotions and decisions related to caring for a loved one with a Neurocognitive Disorder (dementia). Often families benefit from sitting down with a dementia care specialist who can facilitate a discussion about care, covering such issues as:

  • what is each family member’s goal for care for that loved one with a Neurocognitive Disorder?

  • What is a realistic assessment of the loved one’s level of dementia and stage of the disease?

  • How to help a family understand the level of functioning and explore the options, develop different plans of care that meet the needs of the loved ones in a way that basically satisfies the family- finding the right path for elder care.

  • How to have this discussion and bring family to the same page, preserving family connections and relationships

As a social worker and therapist specializing in geriatrics and Neurocognitive Disorders, I meet with families in their homes or my office to mediate these issues.Often families are surprised to find out about the many good options for care that are available, from in- home care that ranges from a few hours to 24/7 care, supplemented by adult day recreation programs, to excellent memory care assisted living communities and nursing homes. An important part of the mediation is to address the grief, loss, and sometimes denial that family members experience, bringing them to an accordance around a plan of care. Of course, the discussion also includes reviewing funding for care, and referrals to funding sources where possible.

I recently met with a daughter, Jessica, from Massachusetts and her father’s partner of over 20 years, Doreen. Doreen had been providing care for Jessica’s father for the last 3 years and his father’s Neurocognitive Disorder was advancing rapidly, leaving him currently with the developmental abilities of a 5 year old child, needing help with many functions of daily life: medication management, dressing, bathing, meal preparation, and recently toileting assistance. Doreen was burned out from working full time and providing all the care except for a 2 hour a day caregiver 5 days a week. Jessica’s father was home alone except for 2 hours a day with a caregiver, so he was often bored and began to feel more depressed. We identified Jessica’s wish that Doreen could continue to care for her father, yet she understood Doreen’s exhaustion and the need to stop caregiving and return to being a companion/partner. We talked about the way Doreen’s role over the last 3 years slipped into one that was primarily caregiving instead of a life partner, and how stressful and lonely that was for Doreen. During the 2 hour mediation session, Jessica and Doreen agreed on a plan for in-home 24/7 care with Doreen moving  out over several weeks, but continuing to visit a few nights a week after work in the role of companion/partner. They were aware of the option of moving Jessica’s father to a memory care community and ultimately to a nursing home with a dementia care specialty, but that wasn’t the first choice.

With the aid of mediation, both Jessica and Doreen were able to develop a plan where everyone’s basic needs were met: Jessica’s needed to know that Doreen would continue to be a part of her father’s life and that her father would have the care and support he needed.  Doreen sorely needed a respite from caregiving and to be able to return to her role as companion/partner. Jessica’s father would have high quality paid caregivers who would provide the stimulation and activity needed to keep him from becoming depressed and would keep his functioning as high as possible over time. Both Doreen and Jessica agreed on the steps needed to put in home care and remove Doreen from direct caregiving. Ultimately, they agreed on a good plan for Jessica’s father and, importantly,  their relationship with each other was preserved, one of the goals of good mediation. As you can see, family mediation can provide the right help at the right time.

*See Grief and Loss as Alzheimer’s Progresses:

Karen Dworski, L.C.S.W. is a Consultant and Mediator for ElderPath LLC; www.elderpath.net860-652-8809;

Thank you Karen for submitting this. And thank you all for reading our blog. For more information about stages of dementia, services which may help you or how to schedule a dementia consultation, call Hebrew HealthCare at 860-920-1810. ~Pam

#1 Way to Avoid Conflicts with Confused People

One of the greatest challenges families and care professionals face in caring for people with dementia  is responding to agitation. When I train caregivers, a strategy we stress is to avoid the things which cause agitation, instead of having to respond to it. And there is ONE technique that is most important to avoid conflicts when someone is confused or disoriented.


Agitation is usually a result of a communication conflict. Caregivers tend to focus on correcting the person with dementia about facts they’ve misstated or forgotten. At a recent support group meeting we discussed this. With her permission, I share the response from one of our members:

They do not need to live by facts anymore as that is not the world they are living in.  I’ve been thinking a lot about it and am really understanding that their feelings of their story is a comfort to them.  They don’t have the ability to process feelings the way we can, so supporting those stories helps them feel supported – like they matter.  I think that is critical in their lives.  They may feel that they can’t contribute anymore therefore they are not important/they don’t matter. 
There is a great benefit when caregivers focus on feelings; quickly caregivers see results. She continued:
If we add excitement and enthusiasm or at least agreement to their story, they perhaps feel validated and a bit more significant.  I’ve already been applying this since I returned home.  Thank you again for imparting such wisdom.
Thank you to Brenda M and all of the participants in our support groups. Your courage and emotional generosity inspires US each month.
Let us know what techniques you have found successful to prevent agitation.

Cultivate Your Creativity Now to Cope with Stress Later

Pamela Atwood, MA, CDP, CLL, Director of Dementia Care Service, Hebrew HealthCare

An article in the January 11 Hartford Courant inspired this blog post. “Can the Arts Heal” by Fredrick Kunkle of the Washington Post reviews research on arts and wellness. There are many challenges: poorly designed studies without controls, sample sizes too small to prove relevance, and limited funding for something that is not quantifiable. Regardless, there’s a strong body of research that the arts help people cope. What’s missing is the big question – will the arts help YOU cope when YOU need it? The answer may be “no,” unless you cultivate creativity now.

Chances are good that YOU will end up with some sort of disability in late-life. We’re good at keeping people alive longer, but they live with chronic conditions such as severe arthritis limiting mobility, impaired vision from glaucoma or macular degeneration, Alzheimer’s disease or other cognitive impairments, diabetes, or movement disorders such as Parkinson’s or MS. The key to SUCCESSFUL AGING is adaptation. The arts help you adapt and maintain a quality life.

As I look at my friends and those younger than me (I’m a Gen-Xer, kid of the 80s), I see more reliance on little boxes of technology. The technology might be helpful as we age, but let’s face it: aging services are often the LAST to get new technology. The arts are timeless and readily available. Music, dance/movement, art, cinema/drama, poetry require little outlay of cash. But if we don’t cultivate our ability to use the arts to help us NOW, then it will just be “an activity” later in life.

Here’s what I mean. The article had a picture of a gentleman with paranoid schizophrenia who paints murals. The ability to paint reduces his need for medication – maybe eliminates it. He said, “The paintbrush and the art give me an outlook and a feeling of serenity and peace, love and joy. The paintbrush is the treatment for all else that has failed.” But if he didn’t LOVE painting, it would just be busy-work and he would still need lots of medications to treat his symptoms.

I once saw a resident who looked bored, and I asked her if she wanted to draw (I’d seen her drawing in the past). Her response was “Drawing is what they have us do when they don’t know what to do with us.” Ouch. I don’t think that was true, but at the very least, that was HER perception (and perception is reality, especially to those with dementia).

So what will YOUR future look like? Will you see the arts as “just an activity” in your boredom-filled days, something offered between the primary activities of meals and personal care? Or will you look forward to free time, trying to figure out if you have enough time to finish crocheting the afghan for the new grandbaby, or eagerly waiting for the paint to dry on your ceramics, or allowing the songs you sing to bring memories of what you can no longer see? CULTIVATE YOUR LOVE OF THE ARTS and it could free you from the confines of your age-related conditions. Make time for them every day now, and they will help you cope with the changes of aging. Adaptation is the key to successful aging, and the arts will help you adapt and live a life worth living. If you don’t know where to start, begin by reading our other blog articles on Zen Tangles, Timeslips creative writing, Poetry and Life Enrichment. Also, check out for more information on the arts and creativity throughout life.

Zentangles For Wellness

Zen is a Buddhist-based philosophy of meditation and intuition. Commonly, it is thought of as profound state of calm and enlightenment. By definition, it is a noun. In recent popular culture, it has been used as an adjective to describe an enlightened or peaceful quality.

Zentangle is a structured form of doodles. They are based in intuition and, when practiced, create a meditative state. “Zentangles” is a registered trademark and certified instructors (CZT) are in several communities. For disclosure, I am not a CZT. I am self taught with several different books available on the subject.

Although there is structure, there is no right or wrong way to do Zentangles. This fact makes it a natural failure-free activity to do with persons with dementia.zentangle heart

Creativity has many positive benefits. Research (including Ebersole & Hess, 1998) done over the past several decades has verified that creative expression helps:

  • Create balance and order
  • Give a sense of control over the external world
  • Make something positive out of a loss, bad experience or depression
  • Maintain your sense of integrity
  • Help resolve conflicts
  • Make thought and feeling clear
  • A greater sense of well-being and personal growth
  • Improve relationships

The design above was posted by

Request your free copy of “A Guide to ZenTangles for Dementia Care” today at


Words, Image and Ideas: Pathways through Dementia

Pamela Atwood, MA, CDP, DCCP, CLL, Director of Dementia Care, Hebrew Health Care

CAN PEOPLE WITH ADVANCED DEMENTIA READ? Ask clients about their previous interests and older adults answer “Well, I used to like to read.” Has this favorite hobby been lost along with their memory of what they had for breakfast? Hebrew Health Care loves evidence-based practical activities for people with dementia and their families – we HAD to share this resource with you, so we’ve invited Susan Ostrowski to guest-author an article for you. Email us your feedback at

Memory-challenged adults may not speak well or comprehend language easily; maybe they can’t manage their hygiene independently. It is easy to assume that their ability to read has atrophied as well.

If we put a large print single word in front of a memory-challenged adult, and she can see it, there’s an excellent chance that she can read it, i.e., sound out the word and comprehend it. If we put a phrase or a sentence or even a small paragraph, printed in big, black letters, on a bright white piece of paper – would she read it? Most likely, yes.

For most memory-challenged adults with functional vision and functional language, reading is an intact, preserved skill. Then why are conventional newspapers, magazines and books so difficult for adults with dementia to process?

The answer lies in the format of typical published reading material.

Typical published material consists of condensed small print, low visual contrast and extraneous visual stimuli. These are major impediments to reading for seniors with dementia. However, if we present written language with large, bold font on white paper with wide margins and extra space between the sentences, they can usually read it.

To increase the readability of a text for this group of seniors, the following elements must be present:
-minimal visual distractions (which compensates for attention deficits),
-sharp visual contrast (decreases eye strain),
-spacious lines of print (compensates for visual tracking difficulties),
-short, direct syntax (lessens the burden on working memory),
-contextual photographs (prompts and maintains interest).

And here’s the exciting part: these lifelong readers generally do not require diluted vocabulary or juvenile subject matter. When presented with child-like material, they show little motivation to read. They can process sophisticated words and subject matter that are reflective of their spoken language. Generally it is only the presentation of the reading material that has to be modified.

Caregiver Corner: Surviving the Holidays

Originally posted on Geriatrics: Our Mission Is Our Passion:

Pamela Atwood, MA, CDP, Director of Dementia Care Services

Holidays represent opportunities for togetherness, love, laughter and sharing with family and friends. In reality, they can be stressful times for everyone. They can be completely overwhelming to caregivers, and often represent loss, sadness and disappointment. Keeping these survival tips in mind will help caregivers make the most of this holiday season.

Be realistic
Know your limits, and the limits of your loved one. Adjusting expectations will help caregivers, family and friends. Activities often need to be simplified and minimized to reduce stress levels. If you usually serve 20 people, serve only 5 this year. Or instead of making all the food, have guests bring the holiday dishes that mean the most to them. Caregivers can expect the normal tensions of the season, plus the stress of caregiving responsibilities. Let others know what they can do for you – and then…

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Cyber Monday Gift Ideas for Seniors

by Pamela Atwood, MA, CDP, CLL

Happy Thanksgiving. In case you haven’t noticed ~ the holidays have started. Negative political ads have been replaced by holiday “needs” in a nearly-constant bombardment of commercials, while Facebook-ers debated whether or not to shop on Thanksgiving. I think shopping for me would be much more pleasurable if I had a good sense of what each person on my list really wanted. As I was thinking last Friday of the “deals” I was surely missing as work trumped Black Friday, it struck me that you might like a list of ideas for those on your list who are elderly or living in Assisted Living or Nursing Homes. For a complete list of ideas and resources, visit and scroll down to “Your Personal Consultant.”

Hobby & Leisure – there are great resources available for everything from adapted puzzles to games and reading. The puzzles should always be age-appropriate (not childlike), and suitable for the current ability – from 4 or 6 pieces to 50 pieces. Magnetic puzzles with stands are great for those with neck problems. For reading, my newest resource is based in solid research from a physician and speech/language pathologist: This product has adapted graphics and photos, plus reading content tailored to various abilities — people with advanced dementia may still be able to read! Games which spark memories, use contrast and easy to manipulate materials are available at, and

Cognitive Fitness – books, activity cards, games and software are available in all shapes and sizes. offers the Whole Brain Workout series. Resources throughout the web offer products such as “Connect: Memory Enhancing Game” which can be used in a number of ways to improve neuronal flexibility for all abilities.

Physical Fitness – being confined to a wheel chair does not mean you should quit being active. Some of the best exercise videos are now available at very little cost. Enjoying yoga, aerobics and stretching and strengthening is now possible in your own living room or day room. Check out, and the award winning PBS special

Quality of Life – No one should have to watch garbage television, wonder where the family is or be isolated because of changes in communication. A communication book, talking photo album or alternative TV program would improve quality of life for all., and can provide ideas for any gift giving budget.

If you order through Amazon, sign up for AmazonSmile and add Hebrew Health Care as your charity: a % of your total will be donated so your gift is twice as nice.  Thank you, and Happy Holidays!