Dementia Friendly Surroundings

Your offices should have a protocol to ensure it is ‘dementia friendly’ as well as age friendly.  The following protocol and communications strategies chart were developed from the publication Making Your Workplace Dementia Friendly – Information for Legal Professionals produced by the Alzheimer Society of BC and the Notary Foundation.

Making Your Workplace Dementia Friendly

There are three publications by the Alzheimer Society of British Columbia. Each publication is tailored to a different professional audience, and they have been developed with the help of expert committees. Here is what the Alzheimer Society has to say about its work:

“Think about your typical day in the office: would you know if a client or customer had Alzheimer’s disease or another dementia? If you recognized the signs would you know what you could do to make their experience as positive as possible?

“More than 70,000 people in British Columbia are living with dementia. Many people with dementia will continue to be active and independent for a long time after they start experiencing signs of dementia. As a result, many British Columbians will work with people who have dementia on a regular basis. In an effort to create communities that are as inclusive and supportive as possible the Alzheimer Society of B.C. is working with professional groups through our Dementia-Friendly Communities initiative.”

Here are the links to the publications:

Information for Legal Professionals

Information for Financial Professionals

Information for Housing Professionals


Below we set out a suggested law firm policy, based on the Alzheimer booklet for legal professionals:

Dementia Friendly Law Firm Policy

 At Dewey, Helpum & Howe LLP, we are committed to providing a dementia-friendly law firm.  These are actions we can implement in our physical office space, in our day-to-day activities and within our overall organization to assist our clients, and their friends and family, suffering from dementia.  Note that it is not always immediately evident that a person has dementia. Everyone‘s dementia journey is unique, with different strengths, abilities and challenges along the disease trajectory. See the attached table for signs of dementia and communication strategies.  Our practices include the following:

Physical Space

  • Designate a quiet space away from background noise where it is easier to have a conversation.
  • Avoid cluttered spaces; it can be challenging to concentrate with too much visual stimulation.
  • Ensure lighting is adequate. Poor lighting can make the environment confusing or even scary.
  • Avoid verbal directions.   We have ensured our signage for washrooms and other important areas is large and clear. Verbal directions may be forgotten quickly and people with dementia may accidentally leave a building or area if there are not clear signs to help them find their way.

Day to Day Activities

  • For older adults with diminished capacity, send out a courtesy reminder with a checklist of what to bring to an appointment. [Note that changing motor skills, language challenges or changes in short term memory may make writing difficult, so it may be tricky to do this over the phone. If possible, follow up by phone the day before or the day of the appointment.
  • Tactfully ask if the person has travel arrangements to get them to and from the appointment.
  • If possible, send any documents for signature to the client in advance of the appointment. Include an opportunity to review what was discussed at the last appointment.
  • Encourage the person to take notes if they are able to do so without getting frustrated.
  • If the person has a support network and where it is ethical and appropriate, include family members or close friends. They may be able to verify information or help with transport to and from appointments. However, if friends or family members are included in meetings we need to discuss waiver of confidentiality and attorney-client privilege, unless the person is necessary to the representation.  Use the ABA’s pamphlet – Why Am I Left In the Waiting Room – the 4 C’s of Elder Law Ethics to discuss these issues with the client and third parties.
  • It is important to be attuned to any indication that a person may be being unduly influenced. You can read more about undue influence by reading the “Recommended Practices for Wills Practitioners Relating to Potential Undue Influence” guide published by the British Columbia Law Institute.  Keep the practices and red flags checklists handy.
  • Think about whether certain times of day are better when scheduling appointments. For example, some people with dementia experience “sundowning,” a phenomenon which results in greater disorientation or confusion later in the day. In these cases, late afternoon or early evening appointments should be avoided.
  • Develop ongoing relationship with capacity assessment specialists
  • Be familiar with legal tests of capacity for common legal transactions
  • Understand incapacity provisions of the Rules of Professional Conduct
  • Review American Bar Associations Handbook for Lawyers – Assessment of Older Adult With Diminish Capacity and the capacity assessment worksheet; use as framework

Other Communication Tips

  • Remember to make eye contact. If you are making notes, take a break and make sure to look at the person.
  • A person’s ability to understand body language is often maintained for a long time along the dementia journey. Take note of your body language and tone of voice. Watch your gestures, facial expressions and posture, and keep positive.
  • If possible, sit beside the person rather than behind a desk to make her feel more comfortable.
  • It may be necessary to remind someone to put on their glasses or turn on their hearing aid, but do not assume that every person with dementia has a visual or hearing impairment.
  • Always speak to the person with dignity and respect.
  • Avoid using “elder-speak” or baby talk (for example, “sweetie” or “dear”).
  • Never speak about the person as if they are not there.

 Firm Wide Practices

  • Everyone in our firm has a role to play in contributing to a dementia-friendly environment.  We want to ensure that all staff know how to recognize dementia and communicate appropriately.  This is key to creating a workplace that is supportive and inclusive of people with dementia.

  • One person at our firm will be designated the “go-to” person about dementia. They will review the American Bar Associations Handbook for Lawyers – Assessment of Older Adult With Diminish Capacityand the ABA’s best practices. They will check with the local branch of the Alzheimer’s Society for any educational materials or opportunities such as the Canadian publication Making Your Workplace Dementia Friendly – Information for Legal Professionals from which this policy was adapted. They will mentor others and help other staff to identify that someone is having challenges.

For a copy of this policy to edit for your own use, click here: Dementia Friendly Law Firm Policy


Signs Of Dementia And Communication Strategies

The Alzheimer Society’s publication also includes some useful pointers regarding supportive communication strategies when dealing with older adults  showing signs of experiencing the symptoms of  dementia:

Signs

Communication Strategies

Problems with memory.

As the condition progresses, a client may forget things more often, especially more recent experiences.

 

She may forget the details of an event or an appointment entirely.

 

Or she may forget to pay for an item at the store, for example.

  • Do not argue. If our client does not remember a discussion from a previous appointment it may be because she is no longer able to properly store that memory due to changes in her brain.
  • Unless her safety or security is at risk, try to adjust to our client’s reality because she may no longer be able to adjust to yours. Try responding to her feelings, not necessarily the stories she is sharing. For example, if she feels that you forgot to send a document it is better to apologize to her and acknowledge that she feels frustrated (her reality) than to try to convince her that you sent the document (your reality).

Difficulty with familiar tasks.

Challenges in abstract or sequential thinking may cause our client to have trouble with tasks that have previously been familiar to her. Completing paperwork or following directions may now be difficult.

  • If you are providing instructions, speak slowly in simple language and provide one message at a time. This gives more time to digest the information and complete a task.
  • Try demonstrating rather than providing directions verbally.
  • Be patient and supportive.

Inability to follow a conversation or find the right words.

Everyone has trouble finding the right word sometimes, but our client may frequently forget simple words or substitute a less appropriate word for the one she really wants.

 

This can make her sentences or accounts of events difficult to understand.

  • When possible and appropriate use closed-ended or “yes” or “no” questions. When this is not possible use questions that have parameters: for example, “Tell me about going to the bank yesterday afternoon” rather than “What did you do yesterday?”
  • Ask our client’s permission to help her find the right word.
  • Repeat the question a different way, or try again later.
  • Bring her to a quieter place.
  • Don’t rush – this may mean booking a longer appointment or meeting.

Disorientation of time or place.

It’s normal to briefly forget the day of the week or your destination.

But our client may become lost in a familiar place and not know how she got there or how to get home. New spaces like an unfamiliar courthouse or office may make her anxious.

  • If you have concerns about our client’s ability to get home safely, ask her how she is planning to travel. With her permission, it might be necessary to wait with her until her transportation arrives.
  • If possible, suggest meeting at a place where our client feels most comfortable, perhaps her home or a familiar coffee shop.

Poor judgment.

Our client may experience decreased judgment. For example, she may dress inappropriately for the weather, she may experience less social inhibition or her behaviour may put her at risk of becoming a victim of a crime, abuse or personal injury.

  • Make suggestions tactfully. For example, instead of saying, “Why are you dressed in a t-shirt in November? You must be freezing!” say something like, “It looks like it has gotten cool all of a sudden. Would you like to borrow a sweater?”
  • Changes to certain parts of the brain can result in behaviour that is socially inappropriate such as swearing or inappropriate comments. Avoid drawing attention to the behaviour or criticizing it.

Problems with abstract thinking.

Our client may have challenges with tasks that require abstract thinking. This may make answering open-ended questions difficult. It may also be challenging to make sense of symbols or images.

  • Try to use straightforward language. Avoid metaphors such as: “A bird in the hand is worth two in the bush,” or “Level the playing field.”
  • Stay positive, but avoid jokes or sarcasm, as these require abstract thinking skills.

Changes in mood or behaviour.

Everyone experiences changes in mood. But a person with dementia can sometimes become suspicious, withdrawn or even more outgoing than before. Over time our client may become angry, more apathetic, fearful or even paranoid.

  • Adapt to the changes the person is experiencing. Like all of us, people with dementia will have good days and bad days. If your client is having a bad day it may be helpful to reschedule an appointment.
  • If you feel that your client may be angry or upset it can be helpful to acknowledge her feelings.

Again this document can be accessed in Word here: Signs Of Dementia And Communication Strategies