Validation: a new method to ease caregiving's pain.

Validation, now used in over 7,000 institutions in Europe, Australia and North America, is a method for communicating with very old Alzheimer-type Populations. The goals of validation are: to promote dignity and well-being, stimulate dormant speech, improve gait, lessen anxiety, lessen the need for chemical or physical restraints, help the person resolve unfinished emotions and therefore to die in peace, and reduce the frustration and burn-out of the caregiver.

A worker trained in this method first assesses the patient's stage of disorientation, ranging from: (1) malorientation, (2) time confusion, (3) repetitive motion, to (4) vegetation. Each stage is identified by specific physical and emotional characteristics. There are 14 helping techniques.

While space does not permit full explanation of all this, here is an example of Validation in action:

Eighty-three-year-old Elsie Barker cried day and night. Big sloshy tears that splashed down her long, bony nose, nestling in the deep crevices that framed her full mouth. When she stopped crying, she pounded. Her bony fist hit any flat surface with a hard wack. "HELP! HELP!" she shrieked. Residents cried: "SHUT UP!" Nursing staff tried to reassure her: "Elsie, don't cry. Everything is fine. What can we do to help you?"

Elsie ignored everyone. Although her hearing was fine, she selectively shut out the outside world. Observing her physical and emotional characteristics, the caregiver using the Validation approach can assess that Elsie Barker is in Stage 3, repetitive motion.

A person in repetitive motion has lost speech, logical thinking, social controls, and self-awareness. They are no longer motivated to conform to society's rules. They will not listen to others. Elsie was expressing her feelings and needed someone to listen to her; to care how she felt; to share her feelings of loss. Communication with Elsie Barker would have to be on an emotional level, not on a verbal level.

The validating caregiver has to step into Elsie's world, because people in repetitive motion can no longer step into our present day reality. The Validation goal is to keep communication open, to ease anxiety, to help Mrs. Barker express her feelings in order to relieve them, to lessen the need for chemical or physical restraints, and most important, to prevent her from withdrawing inward to Stage Four, vegetation.

Elsie Barker stops moaning when the caregiver gently touches her cheek with the fingertips in a circular motion. This touch triggers a mother-memory. Mrs. Barker looks at the caregiver. The validating caregiver matches the old woman's emotions. The caregiver's voice-tone mirrors the old woman's feelings of loss. The worker's voice is gentle, full of sorrow: "You miss your mother. Do you feel all alone and scared?" Elsie Barker nods. Together, they sing a familiar lullaby.

Elsie Barker smiles. She does not remember the name of the song, but she can sing the song and knows the melody. (Early memories are stored and never forgotten, although recent memory is gone.) With the help of the caregiver, Elsie Barker gets out of her wheelchair, and they move together to the rhythm of the music.

Mrs. Barker will not remember the worker's name (even if the worker is a family member), but she will remember the worker's voicetone, her touch, and her caring.

Hopefully, if a Validation team in the nursing home works with Elsie Barker for two minutes, six times a day, the crying and pounding will stop altogether in a matter of weeks. What turned out to have been Elsie Barker's need to restore her mother was met and eased by the nurturing caregivers.

The Validation Training Institute is working to encourage use of these techniques in nursing homes throughout the United States and several other countries.

Naomi Feil, MSW, ACSW, is Director of The Validation Training Institute, a caregiving consultation firm based in Cleveland OH.