Relationship Enhancement Approach to Care
Relationship Enhancement is a connection we establish with someone that requires few spoken words. A person’s feelings and values are our priority. An enhanced relationship is a true expression of identity between or among people. It provides positive experiences that help balance the ongoing challenges faced by someone as cognitive decline progresses.
Cognitive decline is used instead of “dementia” or “Alzheimer’s” to describe changes in an older person’s ability to think and reason. This term more accurately describes the medical symptoms of the condition – memory loss, confusion, disorientation – and separates them from a person’s response to the condition – feelings, values, coping skills – their unique experience of cognitive decline.
Live Better with Cognitive Decline
The Relationship Enhancement (RE) Approach to Care supports a person’s natural tendency to maintain and shape their identity through universal needs, feelings and connections with others providing balance to the challenges they face as they cope with cognitive decline.
To care and be cared for, to be valued, freedom from judgment, have control and meaning in our lives are universal needs we all share. Similarly, hope, optimism, trust, curiosity and creativity are universal feelings we can all relate to. Connecting with someone while singing, dancing, laughing or eating is also universal. All these universal experiences help maintain identity.
Support Changing Identity
But identities also change over time shaped by a person’s interpretation of the life events they experience. The identity of caregivers and the people they care for are changed when providing and receiving care. Those who can adapt, feel more in control and less stress.
Create Safe Spaces
Meeting someone’s need to freely express themselves in safe places – be curious, explore, learn, develop trust in people and their environment – helps them be creative and discover ways to adapt to their changing circumstances. What is meaningful and enjoyable also changes.
There is No Judgement
The RE approach separates our identity from our achievements or failures. If a caregiver can’t encourage the person they care for to do something, they aren’t a failure and neither is the person they care for. Similarly, if a caregiver can encourage the person they care for to do something, they and the person they care for aren’t successful. We set goals and achieve them or fail, but this doesn’t mean we are a success or failure. It means we have successes or failures. There is no judgment.
Learn, Empathize, Customize Care
The approach also doesn’t focus on how to get from A to B. We live in the moment, genuine, learning and caring for others. We learn what motivates someone when they refuse and when they agree to better understand them and empathize with their experience of cognitive decline. Offering customized care makes it easier to engage with someone because the activity or task is meaningful to them. When both of you are engaged, an enhanced relationship is possible.
Three main principles of the Relationship Enhancement approach to care are:
- Feelings remain intact despite the effects of cognitive decline on the brain
- Effective relationships offer meaningful opportunities to explore, learn and discover new ways to adapt to changing circumstances brought about by cognitive decline
- The pathway forward is unique and personal for everyone who experiences cognitive decline
Feelings are a constant in our lives. Learning to connect with someone through feelings comes naturally to some people. For others, it takes time and practice. Understanding how it feels to be someone who experiences cognitive decline is also needed to provide effective support.
Through their own initiative or with effective support from others, people who experience cognitive decline can take an active role in creating a new identity for themselves as they discover different ways to cope and do things. When barriers exist, it is possible for a person to learn new skills to help them adapt to their changing circumstances.
Knowing a person well – the interests, passions, skills and competencies an older person has developed over a lifetime – is invaluable and often information family, friends and co-workers have that can be used to ensure there is an opportunity for meaningful activities to continue or be adapted.
Social Relationships at Home
Getting to know a person, understanding their experience of cognitive decline and finding ways to connect meaningfully is an on-going process. We are always evolving.
Building rapport and developing a warm, reciprocal connection with someone who experiences cognitive decline is the cornerstone of providing effective, long-term, one-on-one care. This is not a new concept. Naomi Feil’s validation method focuses on developing positive relationships with people who experience severe dementia (cognitive decline) as she explains in her September 2016 interview with Dr. Brian Goldman on the CBC radio program
White Coat, Black Art.
Social Relationships in Community
Relationship Enhancement advocates a social model of support which looks at ways of removing barriers in society that restrict life choices for people who have a disability such as cognitive decline.
In 2001, the World Health Organization redefined the term disability. It determined that a person’s limited ability to function in society may cause limitations or impairments, but these do not have to lead to disability unless society fails to remove barriers and create access to include people regardless of their individual differences.
For someone experiencing cognitive decline, barriers include feelings of failure at being unable contribute as they once did, embarrassment of forgetting something they once knew well and fear of upsetting others. These invisible barriers often inhibit someone who experiences cognitive decline from fully participating in society. Addressing how to remove these barriers is an important consideration for all communities.
Creating authentic places and spaces where people who experience cognitive decline can genuinely express themselves, is one way to remove barriers and create access in community.
Removing barriers helps to maintain the role of someone who experiences cognitive decline as a:
- Community member
- Participant in discussions
- Decision maker
When social barriers are removed and opportunities for social participation are created, people who experience cognitive decline are able to continue to engage in meaningful activities and conversations in their communities.
This helps them maintain good physical and emotional wellbeing improving quality of life for themselves and those around them in their community.
"Disability and Inclusion", Art Beyond Sight Bringing Art & Culture to All, 2014
How Can I Help? A Week in My Life as a Psychiatrist, by David Goldbloom and Pier Bryden, Simon & Schuster, Inc., 166 King Street East, Suite 300, Toronto, Ontario, Copyright 2016
Talking to Alzheimer’s, Claudia J. Strauss, New Harbinger Publications Inc., Oakland, CA, 2001
The Explosive Child, Ross W. Greene, PhD., 2021
* From Ulysses - Lord Alfred Tennyson (1809-1892)
© Simile – Training in Supportive Care, 2023