In 1950, Erikson talked about the basic concepts of trust vs mistrust in the development of an infant. This led to the concepts of patients having trust in their nurse, that also implies, someone they can rely on. The person caring for them that they have confidence in for continuous care, the person that they trust, and who gives them hope.

When there is a trusting relationship:

  • the patient is more likely to share information with the caregiver.
  • the patient is going to be more willing to cooperate with treatment.
  • the patient demonstrates that she knows the caregiver has her best interest at heart.
  • the patient who trusts will have decreased negative physical concerns.
  • the patient who trusts will experience fewer behavioral problems.
  • the patient will experience less stress.

This is not a social relationship due to the fact that the focus is always on the patient not the caregiver. The caregiver doesn’t share their personal problems with the patient. But, rather focuses their attention on the patient and the patient’s needs.

Listen, show and tell, to develop trust. Show your concern and respect for the patient. Show concern by being very sensitive to pain, discomfort, hunger and thirst. Show respect by being very sensitive using the patients preferred name, awareness of the patient’s age and to privacy issues. Listen to the patient, and let her know that you are taking her thoughts and ideas seriously. And, tell the patient often that you will be there, reassure that you will take care of her, tell her that you want her to be comfortable and happy. Tell her, that it means a lot to you to be able to take care of her.

When the relationship is well established it can certainly become social as the patient and caregiver bond through activities, shared laughs and experiences. But the first work of the caregiver is to build trust. The caregiver who is either unwilling or unable to put another person first, and develop that trust, will never be that best caregiver.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


There they were cruising the Caribbean as she said they had done so many times before. They were Ben and Dahlia from Texas. They looked like so many of the other aging couples on that cruise ship. But after the brief introductions at the large dining room table, Dahlia found the need to tell the table that Ben has dementia.

What was so much more obvious than Ben’s confusion was Dahlia’s need to talk about it. Even to a table full of strangers, for one short meal on a seven day cruise, she felt the need to tell.

This information wasn’t needed for their table companions. Ben was impeccably dressed, even to the white sweater tied by it’s sleeves over his shoulders and sun glasses perched on top of his head. It wasn’t because of Ben’s table manners, although slow, Ben needed no assistance cutting his food or eating. Yes, Ben was very quite, but so are many older men who just sit back and let their wives do the talking.

No, Dahlia needed to tell for herself. She told of their 28 year marriage, the trips they had taken, how life had been before dementia robbed her of the life she once knew. You could see how she needed to tell, as she frequently repeated the same phrase “You should have seen him, he was something.” The listener could tell she has repeated this so many times over these last nine years since his diagnosis. Just saying it gave her a moment to remember, as she was still picturing him as he had been.

When they parted, you could see that people were trying to say something understanding, supportive, and comforting to Dahlia. So just as you do when you see that young mother who is struggling with a baby and toddlers in tow. You smile and say “wow, you have your hands full, and your children look so great and happy,” and you see that smile break out on her weary face. Someone has recognized, how hard her life is, and she is doing it well.

So now you tell Dahlia what an amazing job she is doing. Ben looks so content, and well taken care of, she is surly doing the hardest job there is, that of a caregiver. Dahlia gives you that same smile that you receive from the recognized mom. As you walk away you take one last look back, at this stranger with the big problem and the quiet husband.


Adult coloring books are everywhere, from the internet to your neighborhood craft or book store. The choices are suddenly endless from floral, to animals and even the chance to color the masters of the art world. In this fast paced, goal driven, digital age, opening a fresh new coloring book and colors is soothing in itself. Taking any individual to a place of quiet and relaxation, but especially so for the senior with dementia..

For the person with Alzheimer’s disease, or another related disease causing dementia, coloring brings many benefits.  Coloring is among other things, an activity of reminiscing. Everyone remembers the wonderful feeling of opening a new box of crayons. And if you were the fortunate child who had the set of 64 with the built in sharpener, the feeling was quite amazing.

Coloring, gives the senior with dementia an opportunity to be successful. When you color it gives you chances to make decisions about which picture to color, where to start and which color to use. For a person with dementia who makes many mistakes all day long, due to memory loss, coloring is very safe. Art is in the eye of the beholder and there is no way to be wrong.

Find a quiet place, avoid a cluttered kitchen table, instead pick a place where the supplies can be spread out and enjoyed as well. Do not have the distraction of a TV, or even a radio unless it offers soft background music, preferably without lyrics. Even if the person with dementia never cared for art or crafts before, this is an area where they can do well now. This activity doesn’t require remembering facts, people, places or use any language skills. Just the ability to hold onto a coloring pencil or crayon.

When a person does an activity mainly engaging the right side of the brain where art, music and the softer side of life resides, it becomes a little vacation for the mind. As almost a form of meditation it can bring mindfulness to the person and make them more focused. Distraction is a major problem with dementia and developing activities which bring greater focus are worth the effort.

Having many coloring books and colored pencils or crayons around is a great way for the senior to do an activity with a child. The child knows instinctively how to get to the right side of the brain where there is only color, choices to be made and those spaces to be filled in.

Not only is coloring a great activity for the senior with dementia, it is also great for his caregiver. Time can fly when you are engrossed only in choosing which page to color next or what color to use. And the companionship created while you compliment each others work of art creates a pleasant feeling of friendship for both. Feelings that can last long after the crayons are put away.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology



The traditional color for healthcare workers has been white. There are good reasons for this. Many times when I have walked into a bedroom of an elderly confused person to check on them, if the elder wakes they immediately say “nurse”. I would reassure them that everything was alright, but that white uniform said much more.

White of course reflects and stands out in a dark room making the caregiver easier to see. White is connected in everyone’s brain with good, pure, heavenly, and clean. This perception doesn’t change when a person gets old or confused.

On the other hand when an athletic team wants to intimidate their opponent they will wear black. A team dressed in all black will look larger and more dangerous. Add a little red to that athletic uniform and red adds the message stay away, danger.

Any clothing in very dark, almost black, colors might be difficult for a confused elder to see, and they may only see black. Happy colors are in the yellow family. Also light green is considered a color that improves mental functioning. Green has been shown to improve test results with students, and light blue is shown to be a stay-awake color. The combination of white with yellow, light green or light blue is the perfect combination for caregiving.

Archive pictures show Florence Nightingale in her familiar uniform of long black dress. But that dress was softened by her white lace collar and lacy cap. Even pictures in her old age showed her in the same combination with the addition of a white lace shawl. However, for many years the color of healthcare has been white.

Every time research is conducted on what profession people think is the most trustworthy, nursing rises to the top. So dress the part, especially if you provide care at night, wear white and you will hear your elder say “nurse.”

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing


I don’t know if you remember me, Virginia, but I have never forgotten the last time I spoke to you, and it has bothered me all these years.” I did remember her, as well as her husband and her mother-in-law, who had been our resident.

“I do remember you Thelma, but I honestly don’t remember the last time I spoke to you.” I responded.

Thelma then told me of the day years ago when I had called to tell her that her mother-in-law didn’t have much more time and we wanted them to know. Thelma told me she had informed me that they were in the middle of a family party and it was a bad time for me to call. She said it had bothered her every time she had thought of it, that she had been so rude to me that day.

She remembered how her mother-in-law had died that night, and they hadn’t come to be with her. I reassured her that I really hadn’t thought about it at all, or her response. That I didn’t judge her, just had wanted her to know.
“I’m sure that your mother-in-law didn’t die alone, Thelma.” It had always been our tradition to have staff members who cared for the resident to take turns sitting with them, when family couldn’t be there, when they died. “ I am very sure Betty didn’t die alone.” I said.

More than remembering Thelma, I well-remembered, Betty. From the day Betty arrived, until she no longer could communicate, she constantly cried out, “Help me, help me I’m falling.” No matter if she was sitting on a couch, lying in bed, or had placed herself on the floor, she repeated that phrase, over and over.

We had had her ears checked, reviewed her medications, sent her to numerous physicians and never found out why this very old woman had the constant sensation of falling. But call out she did, day and night, “Help me, help me I’m falling.”

Leave Betty to die alone? No, that wouldn’t have happened.

Now Thelma is old, her husband is gone as well as her mother-in-law. Now Thelma lives with us after having some health problems requiring hands on care. And every time she sees me, she tries to once again explain that day so long ago now. That day, she can’t seem to forget, the day she didn’t come.

Virginia Garberding, R.N.
Certified in Gerontology and Restorative Nursing


Gratitude – feeling thankful and appreciative.

In the life of a caregiver it might be hard to see where gratitude may come in, but gratitude is an attitude. And the caregiver with a positive attitude will greatly influence the person they are caring for.

When it is sometimes hard to see the positives in life, writing them down will make the person much more aware of all the good around them. And being more grateful will reap benefits for the caregiver, as well as the person they care for.

Research proves that using a Gratitude Journal will:

§  Help you get better sleep

§  Improve your immune system

§  Increase your happiness

§  Increase your mindfulness

§  Help you focus on others instead of yourself


Putting your feelings into words makes you more aware, and for the caregiver the best blessing to come from a gratitude journal may be the increase in mindfulness. Being mindful is the hallmark of great caregiving. When we multi-task we cannot be mindful. Being mindful is being in the moment, totally aware and reflective about what you see, hear, touch, all your senses. Being mindful is being non-judgmental and neutral in your observations, making you not only a great caregiver but even more aware of things to be grateful for.


When you are writing a gratitude journal throw away the rules. Spelling and grammar doesn’t matter, worrying about your spelling will just inhibit your thinking.  There are many gratitude journals available, but all you really need is a notebook. Some experts tell you to write every night, research says; it doesn’t matter what time of day you write, how many times a week you write, how many things you need to be grateful for, there are no rules to experience the benefits of just being grateful.


Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


As the person cared for changes, so the job of caregiving is ever changing. Most people only recognize the enormity of this job when it becomes necessary to bathe, dress, and feed the elder. But all stages are difficult, challenging and stress filled in their own way.

Early Stage – The first major stress – is the loss of reason.

Before the diagnosis, you find that the person who has always been so reasonable now is unable to see another point of view.  When you find yourself trying to make sense out of a nonsensical conversation, you are already a caregiver. When you are trying to understand why you can no longer have a conversation, where you; express opinions, go through all the options and decide on the best course of action, you realize one person is no longer able to reason.

Mid-Stage – Second stress – now you have the crushing truth of a diagnosis and caregiving.

While the caregiver is trying to learn everything they can about this disease process, they also have to take care of the elder. Every school child knows how tiring it is to study, and concentration before a big test.  Learning depletes the brain of its oxygen and nutrition and makes you tired. Added to the stress of learning all about Alzheimer’s disease, the grief of the knowledge that this will only get worse- not better, places a huge stress on the caregiver.

During this time the caregiver still can hardly believe what they see before their eyes. The elder now has to be monitored at all times, because they now have no safety awareness. In the early stage and many times in the mid stage of the disease, because the elder still looks so good the caregiver is also in the position of having to convince others that there is a disease process going on.

The Last Stage – The third stage of caregiver stress – now you are providing hands on care.

Now the caregiver is having to not only select the clothes to be worn, but assist putting on and taking off those clothes. The elder now needs assistance with direct hygiene care, and resists this “help,” that they didn’t ask for and don’t want.

During this Holiday season look for those caregivers in your lives and step in to try to shoulder some of stress they may be feeling.  A great gift is always listening.

Virginia Garberding R.N.

Certified in Gerontology and Restorative Nursing

Author: Please Get To Know Me – Aging with Dignity and Relevance


Why me God? Why did this happen to me? If you have ever asked this, read on.

While caring for her parent who suffers from delusions, a dear friend of mine has received so much comfort from this book that I want to share a chapter with you.

(Book excerpt)

At some point, most long-term caregivers ask the why question. It’s either “Why me, God? Or Why her?”

Isobel is typical. It took a long time before she realized her mother was suffering from a form of dementia similar to Alzheimer’s disease. Once the doctor’s named it, her question became, “Why my mother?” She cried and wept over the painful situation. Her mother had suffered so much that it just didn’t seem fair.

Eventually, it became obvious that her mother could no longer live alone. Isobel and Paul took care of her for the next four and a half years. Isobel’s mother became increasingly difficult to care for. Although she was demanding and manipulative, there was no question of not keeping her or of putting her in a nursing facility.

During this time, Isobel often asked, “Why me, God?”

Isobel isn’t alone. At some point in the midst of their pain and deep agony, most caregivers ask, “Why, God? “Why?’

As a former pastor, I realized long ago that Why? May not be the real question.

The worst response I ever heard came from a man at a funeral home. A thirty-nine-year-old mother had died. Her husband couldn’t stop weeping. I was there when he asked, “Why? Why did it have to be her? Why couldn’t it have been me?”

The husband’s friend resorted to reason and explained that life isn’t always fair, and that sometimes good people have to suffer as much or more than the wicked. He droned on and even talked about his slain buddies in the Vietnam War.

The bereaved man stopped crying, but I don’t think it was because of any of his friend’s answers. The lecture-and it really was one-made him feel stupid and selfish for wanting his wife.

Why? May need to be asked-and even encouraged-but it doesn’t have to be answered. Even if we had an answer, would it make a difference? Even if God whispered the reason behind the illness, would it change anything? Probably not.

The long-term caregiver still has the burden. The parent is still ill, and the child is still caring.

If Why? isn’t the real question we need answered, what are we really seeking? For each person, the pain behind the question may be quite different.

For one, the inner voice may be pleading, “God, assure me that you’re with me. Help me know you care.” To another, the question may be prompted by fears of inadequacy to cope.

Some find the question difficult to ask, as if they are demanding God to become accountable. Others are ashamed for being weak enough to ask.

I’ve learned one thing from this question. It’s wonderfully freeing to ask. Those who have wept and asked repeatedly have told me that they often found relief-perhaps not peace, but some rest from the turmoil-by simply asking the question aloud and allowing their hearts to speak the anguish they feel.

Book excerpt from: my parents, my children – Spiritual Help for Caregivers by Cecil Murphey

Published: Westminster John Knox Press, Louisville, Kentucky

The day after my friend started reading this book. She came to me with a smile on her face and told me how much this book was helping her. It was just the help she need at the time she needed it.


Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance



No one could remember what they ordered and the waitress was getting impatient

They were five for lunch, four elderly ladies with significant memory loss and their caregiver. The caregiver read the menu and ordering went just fine. Chicken salad, BLT sandwich with fries a cheeseburger, all the usual lunch at the diner orders. The problem came when the waitress returned with the order and said “Who ordered the BLT with fries,” and no one remembered.

At first there was an awkward moment while the group was feeling some pressure from the waitress to claim their meals. Then the caregiver started to giggle and pretty soon all the ladies were giggling and then laughing out loud. A moment that could have been difficult, hurtful and embarrassing was not only averted, but turned into a comfortable bonding moment for the group. Even the ladies who did not realize what the “joke” was, could join in the laughter of the group at the table.

The significant person in this scenario was the thoughtful and aware caregiver. The giggle was the cue to the ladies that, we aren’t going to take this too seriously. The giggle said to the ladies “No harm done, if this is the worst thing that happens today, what a great day.” And all the ladies were looking to the caregiver for many cues that day in the diner. Cues can come in the form of smiling while you engage in pleasant table conversation. Cues can be related to dining and the right utensils to use and where to put your napkin. But the cue the elder with memory loss needs the most, is how to react when something goes wrong.

Laughter is said to be a great “self-care tool” for caregivers

The role of caregiver is so difficult that a caregiver with a great sense of humor will be less stressed by the little things. Laughter can fight off the effects of stress and create a more positive attitude towards life.  As an unknown author once said:

“To understand a man you should walk a mile in his shoes. If what he says still bothers you that’s ok because you’ll be a mile away from him and you’ll have his shoes.”

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance



Taking a break, respite for a few hours, a few days or a few weeks.

Other words for respite are reprieve or pause, what caregiver doesn’t need a reprieve? A change, a break for both the caregiver as well as the elder with Alzheimer’s disease. The most beneficial respite care is probably a combination of a plan for taking breaks during the day as well as for a longer planned vacation,


Benefits of respite for the elder.

When the elder goes to a day-care community, it provides them with an opportunity for socialization. A chance to get out of the house and see different people, but in a safe environment. An opportunity, to participate in activities and exercise with other elders with like abilities.

It also is an opportunity for the elder to be observed by health care professionals, who may note changes that need to be communicated to the physician. If the elder likes to walk or wander it may be an opportunity for a larger area to wander in. While helping the elder get rid of pent up energy by walking it off.


Respite in the home may be provided by family, friends as well as health care professionals. Having a health care professional come in the home and provide personal hygiene while the caregiver gets a break helps the elder feel less of a burden.


Benefits for the caregiver.

The benefits are many as long as the caregiver knows that the confused elder is safe and well taken care of during the respite.

It might just mean having someone in the home for short periods so the caregiver can do chores around the house. Go out and do errands, have lunch with friends, get a hair cut or see a movie.


Everyone needs and deserves a break. Many times the problem is just having the caregiver give themselves the permission to take some R & R.


Virginia Garberding RN

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance