Logo of "the vicarage by the sea" celebrating its 25th anniversary, featuring an illustration of two people standing at an open door looking out to the sea, symbolizing support for individuals living with dementia.

Person-Centered Approach to Dementia Care

Julia Mehlman, Bowdoin College psychology major, shares her reflections on a Person-Centered Approach to Dementia Care

Julia Mehlman will graduate in May 2016 with a Bachelor of Psychology from Bowdoin College. For the past eight months, she has been volunteering at our dementia care home, The Vicarage by the Sea. She recently shared her reflections on our philosophy of a person centered approach to dementia care.

How does The Vicarage by the Sea fit into your studies at Bowdoin?

In the fall of 2014, I went abroad to the University of St. Andrews in Scotland and I looked for psychology classes that were not offered at Bowdoin.  I took a class titled, “The Psychology of Dementia” which focused on person-centered care for people living with dementia.  This class fascinated me, and it surprised me how person-centered care is such a simple concept (value and treat people living with dementia as people) yet it is not widely implemented in care facilities.

When I came back to Bowdoin, I knew I wanted to continue to study person-centered care, however, nothing like this is offered at Bowdoin.  I contacted the psychology department about conducting an independent study on person-centered dementia care and the professors loved the idea, but no one had much experience with dementia.  We were unsure if the developmental psychologist, the social psychologist, or the abnormal psychologist should advise me.  It is interesting because dementia and person-centered care could fit into all of these categories.  Ultimately, Hannah Reese, the abnormal psychology professor, became my advisor. 

How did you first learn of The Vicarage by the Sea?

After meeting with Professor Reese and explaining my interest in person-centered dementia care to her, we decided that a good way to approach the topic would be to conduct a literature review, as well as to volunteer in a facility that practices person-centered care.  I typed “person-centered care dementia Brunswick” into google, feeling very pessimistic about finding a facility in the mid-coast Maine area that would actually practice person-centered care.  To my surprise, the Vicarage popped up in my google search and I was blown away by the website.  I immediately contacted Johanna to see if I could volunteer.

Have you been to any other facilities in the area like The Vicarage?

No, I have not.  I do not think there are any other facilities in the Midcoast Maine area that practice person-centered dementia care.  However, I would love to visit other assisted living or dementia care facilities to compare their care to the care I see at the Vicarage.

What did you do while volunteering at The Vicarage?

Most of the time I simply socialize with residents.  That includes just chatting with residents, doing puzzles with them, helping them with meals, going on walks with them, taking photographs with them, etc.  Sometimes I help the staff with small chores.

What did you learn at The Vicarage by the Sea?

This is a hard question to answer without too many words!

First of all, common misconceptions are that people living with dementia completely lose their independence, as well as their ability to make meaningful contributions to their own lives, and the lives of those around them; this is untrue.  People with dementia are still valuable human beings and must be treated in a way that appreciates each individual’s personhood.  While dementia may change an individual, that individual is still a person with knowledge, experience, and perspective.

From the literature, I learned that the elements that make up person-centered dementia care are:

  1. Value both the people living with dementia and their caregivers
  2. Treat the people living with dementia as individuals
  3. Take on the perspective of the person living with dementia
  4. Provide the person with dementia with a social environment that is positive and enables him/her to feel socially confident (Brooker, 2004).

I saw all of these elements of person-centered dementia care at the Vicarage.  Here are brief descriptions of them:

  1. In order to show residents that they are valued and appreciated, the staff attempted to provide the residents with various activities. Many of these activities were chores around the house, which allowed the residents to feel helpful and productive.However, some residents were at late enough stages in their dementia that they were not able to perform activities around the house.  This did not hinder the staff’s ability to value these residents.  The staff constantly engaged with the residents through verbal and nonverbal communication.  Through conversations about various things residents wanted to discuss, or physical contact, such as hugs and kisses, the staff made residents feel warm and accepted.
  2. At the Vicarage, dementia does not define a person. The staff at the Vicarage catered to the behaviors that they saw, rather than what they inferred from hearing a particular diagnosis.  The staff took things as they came, rather than anticipate certain behaviors because they might be common to a certain sub-type of dementia. The unlocked door system also enabled residents to feel like autonomous individuals.
  3. Taking on the perspective of the person living with dementia is probably the most challenging element of person-centered care. However, it is truly rewarding.  As a caregiver, it may be difficult to detach yourself from your reality and put yourself in the subjective reality of your residents, but the benefits are incredible.  This allows one to connect on a deeper level with the resident and form a closer relationship with him/her.  This only increases the well-being of the person with dementia.
  4. Attending the biweekly hour-long staff meetings allowed me to understand how the caregivers provided the residents with a positive social environment during instances that I was not around. Johanna would lead these meetings in a style that encouraged the staff to work together to propose solutions to current issues.  The staff always helped to create an environment where the residents felt that the staff were truly looking out for them.

How would you describe the overall culture of The Vicarage by the Sea?

Genuinely loving….  The staff are at the Vicarage because they genuinely want to be there and have deep connections with residents.  They truly care about the well-beings of the residents and do as much as they can, every single day, to keep residents safe and happy.  The Vicarage is a wacky place, but it is so warm and loving.