Dedicated to helping Activity Professionals with the daily operation of their department.
by Debbie Hommel, BA, CRA, ACC, CRTS, Executive Director of DH Special Services.
Let Debbie answer your
Activity Questions
About Debbie

Debbie Hommel, BA, CRA, ACC,
CRTS, is the Executive Director
of DH Special Services. She is a
Certified Activity Consultant on
State and National level, with
over twenty-seven years of
experience in providing direct
care and consultation to long
term care, medical day care,
assisted living, and ICF/MR
facilities throughout New Jersey,
New York, Maryland, and
Pennsylvania. She is an
experienced trainer and
workshop presenter, conducting
a variety of seminars throughout
the Tri-State area for the Activity
Professional, Administrator, and
allied healthcare professional.
Debbie Hommel is an active
member of Activity Professional
Associations on State and
National levels. She is ACC
certified through the NCCAP.
She is a founding member of
the New Jersey Activity
Professionals' Association,
serving terms as Vice President
and President. She received the
Weidner Lifetime Achievement
Award in 1994 and the
Monmouth & Ocean County
Activity Professionals Life
Achievement Award in 1999.
Providing Internet Resources
for Activity Professionals
in Long Term Care Settings

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What Can I Do? Behavioral Caregiver Strategies for the Team
By Debbie Hommel, ACC, CTRS

Let’s replay this scenario again.   “My coffee is cold” says the elderly woman in coffee social.  
“Let me warm it up for you,” says the group leader as she pours a little bit of coffee into her
cup.  “Nothing like a hot cup of coffee on a cold winter day”, says the group leader as she
smiles at the resident.  The resident says “thank you” and sips at her coffee.

Many negative resident behaviors are generated by caregiver approach or lack of approach.  
Our words, our tone of voice, our rate of speech, and body language can contribute to a
positive or negative exchange.   Caregivers often don’t realize the impact of these verbal and
non-verbal approaches and are quick to blame the resident for “having a bad day” or being

All caregivers, meaning anyone who comes in contact with residents in a care facility, needs to
have a clear understanding of caregiver strategies which may prevent,  minimize or diffuse
negative behavioral situations.    The following is a discussion of known caregiver
communication strategies which are effective with elders with memory loss and dementing

Reality Orientation: This approach is the grand-daddy of all approaches, having been
introduced in the 1960’s as a way to improve orientation of patients with memory loss due to
stroke and other cognitive diagnoses.  Dr. James Folstein and Lucille Taulbee are credited
with creating the technique in Topeka, Kansas.  Originally, patients were placed into a
classroom setting and reality information (date, time, location, and season) was introduced and
repeated until the patient was “re-oriented”.  Although this approach may be helpful to those
with mild memory loss or memory loss due to placement stress, caregivers quickly learned that
this approach was not effective with residents with advanced dementia.  Residents with
extensive memory loss cannot retain the “reality” and are often upset by the information.  The
caregiver of today can still use reality techniques but through the activity program, life in the
home and environment.  Seasonal displays in the sitting areas, seasonal décor around the
calendar, seasonal and holiday activities, and seasonal music and events are all reality cues.  
Such cues keep the resident anchored in the day.  We have found it is not that important if
they know the exact day of the month but it is helpful for them to have a sense of
connectedness with the immediate surroundings.

Validation Therapy: While conducting reality groups in the 1960’s, Naomi Feil, ACSW, found
that trying to re-orient the severely disoriented was unrealistic.  Ms. Feil came up with a new
approach called Validation Therapy.  The basic premise of Validation Therapy, which was
revolutionary when first introduced, is to accept the elderly person where they are.  The
caregiver needs to validate the person as an individual and to assist the person to regain
his/her sense of dignity and self worth and also resolve feelings of conflict or unresolved
issues.  Ms. Feil has done extensive work identifying four stages of disorientation: 1)
Malorientation, 2) Time-Confusion; 3) Repetitive Motion; and 4) Vegetation.  Ms. Feil has
developed specific therapeutic techniques which are focused on developing a trusting
relationship and understanding non-verbal means of communicating.
For more information visit the Validation web site at  

Memory Bridge – This idea is the work of the Foundation for Alzheimer’s and Cultural Memory
which is built upon Validation Therapy’s focus on the person and accepting the individual as
they are.  This organization emphasizes the importance of maintaining emotionally meaningful
relationships with elders with Alzheimer’s disease.  Memory Bridge believes that individuals with
Alzheimer’s are still reachable and able to give love and receive love.  Memory Bridge focuses
on means to connect emotionally with elders with Alzheimer’s and truly listen to what they have
to say.  For more information, visit

Moments of Joy: This communication technique was created by Jolene Brakey who has worked
extensively with dementia residents throughout the country.  This approach also focuses on
accepting the resident in the here and now and to make the most of each moment.  Ms. Brakey
has developed techniques which are called Join their Journey and Live their Truth.  For more
information, visit

It is the responsibility of the caregiver to have a working understanding of all communication
strategies in order to be able to use the appropriate approach in the right situation.  
Experience and training provide the caregiver with tools to ensure the needs of the resident
exhibiting behavioral symptoms are met.  Whatever approach is introduced, the caregiver must
always practice with compassion and empathy.  

“I've learned that people will forget what you said, people will forget what you did,
but people will never forget how you made them feel.”   
Maya Angelou
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