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.

"The Vicarage Philosophy" Video Transcript

So at The Vicarage we care for the whole person living with dementia, understanding it from a medical perspective, looking at what the illness is, the disease process, diagnosis, and ways to potentially slow the process.

Thomas Kitwood, a psychologist out of the United Kingdom, was the founder of the Bradford Dementia Group. He coined this term “person-centered care” and it really refers to understanding the whole person that’s living with dementia, outside of just the diagnosis. So, who they are, their history, their personal life experience, and then their present interests, their desires for engagement in current life, what makes their day successful, and what their wishes are for their future.

And at the Vicarage, one way that we think about caring for someone in a person-centered manner is to what we refer to as normalize aspects of their dementing illness. So, an example that I use frequently is to talk about this medicalized concept of wandering when people are feeling the need to move and go, maybe anxious about something and need to get out for a walk. Rather than engaging with them in a way that’s perhaps more institutional by locking doors, our doors are unlocked. It’s a secure facility but we do allow them to walk and move and we walk with them, or we wander with them. This is a powerful way to normalize this behavior and also has tremendous benefits to the individual as well as for that matter to their care provider. Getting outside offers all the healing aspects of the natural world, it gives people exercise, it’s time spent between the person that is walking as well as their care provider, having some one-on-one conversation and getting some sunshine and fresh air. It’s a really great experience for all those involved.

Another example of the way that we might normalize some behaviors that are viewed as more challenging from a medical perspective is what we refer to as ‘living in their reality’. And this refers to when someone is engaged in a thought process, a memory, and needing to ask questions or have it validated. As opposed to approaching it as a problem and trying to control it, we simply go where they are in their reality and we do what Naomi File has coined the term, her phrase that she uses in much of her work, and this is work that’s been around since the 1970’s really, it’s referred to as Validation Therapy. And it is essentially validating what someone is saying, hearing them, recognizing what they’re saying, validating it, and then working to try and meet that need that they’re expressing. So, by living in somebody’s reality and validating that it’s appreciated, it’s understood, it’s heard, we’re normalizing that experience that from a medical perspective might be viewed as problematic and challenging and something that needs to be altered.

All of these aspects of normalization that we engage in at The Vicarage help to create what I refer to as the culture of dementia at The Vicarage, which is a culture that again is working hard to validate, to recognize, and to respond appropriately to the needs of the individuals who are living with these illnesses.

The culture looks different but it ends up being a more, again, in Thomas Kitwood’s words, a more person-centered culture. It steers a little further away from a medicalized perspective towards a more social, psychological, and emotional care model.