The person-centered approach to dementia care prioritizes independence and choice.
A music therapist by training, Leslie Sedille started her career as an activities director at a senior living community. There she found her calling serving seniors and their families. But when she became director of memory care at another company, she struggled to witness how their policies affected older adults with dementia. The facility wasn’t staffed correctly, Leslie recalls, to allow aides and residents enough time to engage at each resident’s own pace. Residents who felt rushed to shower, for example, would refuse to do so because they felt scared.
“This is just not the way it’s supposed to be,” she remembers thinking. When Leslie found the Certified Montessori Dementia Care Professional® certification, “I was like–that’s me and what my principles are.”
In addition to being a CSA, Leslie is now a CMDCP®.
A CMDCP certification represents an additional level of training for health care professionals, educators, elder care attorneys, care managers, and other professionals who serve people with dementia. The National Council of Certified Dementia Practitioners (NCCDP) offers the certification program as an online or in-person course and exam.
Montessori care, like Montessori education, is person-centered. “You’re meeting the person where they’re at and adapting what you want to be done to where their skills are,” says Leslie, who is also a member of the Senior Spirit editorial board. “It’s a common sense approach, if you know dementia.”
The Montessori Method: Not Just for Kids
In early twentieth-century Italy, Maria Montessori developed and started to popularize her now-famous educational method. Today, Montessori schools operate around the world in many variations. All are known for their holistic, child-centered teaching philosophy, wherein the teacher functions as a gentle guide encouraging children’s natural explorations.
Starting in the mid-1990s, dementia care practitioners and researchers began to see and study the potential of the Montessori method for dementia care. Now, various organizations promote the Montessori philosophy and specific techniques as applied to the care of people with dementia. The Association Montessori Internationale (AMI) promotes Montessori for Dementia, Disability, and Ageing (MDDA). The four key principles of the MDDA method are:
- Self-esteem,
- Independence,
- Choice, and
- Meaningful engagement.
“Always remember that there is a person behind the dementia,” AMI shares on their website. “We need to look for the person and focus on abilities rather than disabilities. To start, we can learn about their history, culture, lifestyle diversity, strengths, interests, needs, and more.” AMI offers another certification, the Montessori for Dementia, Disability and Ageing Certified Practitioner (MDDACP).
Montessori dementia care practitioners choose activities based on the individual’s interests. Activities use guided repetition and pattern recognition, which rely not on conscious recall, but rather on procedural and implicit memory. These kinds of memory tend to remain intact longer for people with dementia. For a person who was an interior designer, an activity might be to match different samples of wallpaper with borders.
To promote independence and meaningful engagement, Montessori dementia care also empowers people to do the daily tasks they can still do, given adequate scaffolding and time. For example, providing a visual template for a table setting allows a resident to set their own place by using the image as a guide. In a study, residents with advanced dementia showed more constructive engagement and pleasure after participating in Montessori-based activities as compared to regular programming.
Montessori care requires an active staff trained on the philosophy at some level, says Leslie. “You have to buy into it. You have to be patient.” Supporting people with dementia to complete daily activities at their own pace, not rushing them along, takes great time and patience. But the results, according to researchers and proponents of the Montessori method, are that the people being served will be happier, safer, and more able to live with dignity.
Both a CMDCP and CSA
Leslie is now a Family Liaison and Care Manager at Paradise Home Health Care in Boca Raton, Florida. In her current role, she uses the skills she learned as a CMDCP while getting to know families. “I’m asking questions that really get to the heart of who their family member is so we can communicate that to the aide.” That familiarity is key because, with Montessori dementia care, the person providing care needs to understand the individual’s preferences and personality. Leslie asks questions like, “What time does your mom get up?” and “How much can she do on her own?” to prepare her aides to know what the client really needs help with, and what they prefer to continue to do for themselves. In home health care, the goal is that the client still runs their own home, with the help they need.
Both the CMDCP and the CSA certifications are focused on the well-being of seniors, Leslie says. For her, having both certifications opens up access to different resources, people, and networks. The approaches complement each other. “Being a CSA, it’s not just sales and marketing. When potentials call, I’m talking to them and building a rapport, but it’s the way I talk with them.” She’s listening, providing resources, and speaking to the humanity of the family and their loved one. “Even if they don’t go with us, six months later I’ll get a call.” As a CSA and a CMDCP, Leslie’s approach is wholly centered on the best interest and well-being of her clients.
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