Pause, Assess, and Repeat
by Stephanie "Teffie" Landmann, COTA/L,
PAC Support Mentor, Coach, and Trainer
As I walk through the halls of any place I work, I make a habit of scanning rooms to see if folks are okay when I walk by. One afternoon I walked by Mr. Doe’s room several times and realized that he had been in the bathroom for at least thirty minutes. I decided to check on him to make sure he was okay. Here is what happened:
Knock, knock. Mr. Doe. It’s Teffie.
I entered the room to find Mr. Doe in the bathroom. He’s sitting on the toilet with the toilet lid down, pants on, three absorbent underwear on top of his pants, and clean toilet paper in hand.
Pause and assess: Is there something not quite right with this picture? Yes, a few things. What do you notice that is right? He answered my verbal cue at the door to his room. He had all the necessary items he needed for the task.
Mr. Doe, I noticed you’ve been in here awhile. Are you feeling okay or not good?
Yeah, I’m fine, just finishing up.
Pause and assess: Where is Mr. Doe in his task sequence? We aren’t sure yet. Where does he think he is at in his task sequence? The end or near finishing.
Tell, you what. Let’s throw the toilet paper away (showing him the waste basket). He throws it out and starts to reach for more toilet paper from the roll on the wall.
Oh Mr. Doe. Let’s take the extra undergarments off. As he looks at his pants, I put a towel over the toilet paper roll and move the carton of clean new undergarments out of visual range. As he starts to pull one off, I pull the other two off, matching his movements. He pulls them down from his waist as far as he can get while seated. Then turns around and flushes the toilet.
Pause and assess: What cues are his brain using to take in data? Yes, mostly visual and a little bit of verbal. Is he able to do the task? Yes, with visual cues and step by step support. Why did he turn and flush the toilet? Could be the next step in his routine from years of toileting his way.
Good job. Now, stand up. I visually show him with my hand stand up as I stand up next to him. He stands up.
Great. Okay pull these off. I use the technique of Hand-under-Hand® (HuH) to support him and draw his eyes to the undergarments. He starts pulling them down and then steps out of them. While he is doing that connected to me with Hand-under-Hand, I check his waist line for an undergarment under his pants. There’s one in place, check.
Mr. Doe. Phew, good work. While he is looking up at me, I use my foot to slide the undergarments on the floor behind him.
Let’s go this way. Pointing while in Hand-under-Hand out the door to his room.
Has something like this ever happened to you while working with someone living with dementia? Notice that Mr. Doe was able to do a majority of the tasks himself. By using visual cues for the steps of the task and removing visual cues of a step that was already done Mr. Doe found success in finishing his toileting. What type of tasks do you find yourself doing for someone rather than with someone? What small step do you what to try differently?