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Dr. Tashima Ricks: Good day everyone and welcome to the National Institute of Corrections Webinar entitled Evidence-Based Practices in Action: Communication Techniques in Aging Populations Experiencing Dementia. I am Dr. Tashima Ricks and I serve as a national program advisor with the National Institute of Corrections.

And I'll be the host for your webinar today. Before we get started, I just want to cover a few important housekeeping items. While I'm certain that you all will find the information shared today very useful, please note that the information shared during this event is not a direct representation of the National Institute of Corrections, the Federal Bureau of Prisons.

For the US Department of Justice. Also this is a listen-only event, so your microphones are gonna be muted. However, we strongly encourage you to engage with us through the Webex chat function, which you can use to share your thoughts and ask any questions, which we will address as fully as we can.

During the Q and A portion at the end of the webinar. So to practice the chat function, everyone, I want you to type the answer to the following question into the chat. What is one word that comes to mind when you think about dementia?

So while everyone gets a little practice typing their one word into the chat, we'll get started on our programming. So this webinar is going to explore some specialized evidence-based approaches for communicating with incarcerated adults with dementia.

So if you're interested in learning about or getting research about different evidence-based practices and services and how you can implement them in your system, whether it's for classification, assessment tools or any new promising practices and recruitment.

As it pertains to corrections, the National Institute of Corrections has an Information Center staffed by librarians who are able to assist you with your search free of charge. We're located, our library is located in Aurora Colorado. These are the hours, and you can always go to the NIC

website at NICIC.gov and request support from the librarians as you need it. So now we'll move on to our feature presentation. I'm going to hand it over to

our colleagues at the Larimer County Sheriff's Office and Dementia Together. They're gonna share some of their work that they're doing, collaborating and how they work together to develop a strategy to engage with aging adults with dementia who are incarcerated and how their approach led to improvements in the quality of life for adults in their care and the staff with whom they

interact. So with that said, I present to you deputy Chris Smith, the ADA coordinator with the Larimer County Sheriff's Office, and Cyndy Hunt Luzinski, the founder and Executive Director of Dementia Together, both of Fort Collins, Colorado. So I'll pass the floor over to

Dr. Tashima Ricks: You, Deputy Smith and Cyndy Luzinski.
Cyndy Hunt Luzinski: Thank you.

Dr. Tashima Ricks: Chris I'll share screen.

Deputy Chris Smith: So while you're pulling that up, I can just do quick introductions. So I'm deputy Chris Smith at the Larimer County Sheriff's Office. If you don't know where Larimer County is it's about an hour north of Denver. I've worked for the agency for over 15 years, spent a good chunk of the, that first part of my career eight and a half years in our jail cells.

I'm working directly with the inmates. We're a direct supervision facility, so we're on the floor in the housing areas with the inmates, and about six and a half years ago became the ADA coordinator for the agency. So I do both the entire agency, so all our administrative functions as well as our patrol and jail coordinating the effort to the agency to comply with the ADA which includes individuals with dementia. You can introduce yourself first, Cyndy?

Cyndy Hunt Luzinski: Oh, before I move on, okay. I'll move back a slide. I'm Cyndy Luzinski. I'm the executive director and founder of Dementia Together. We're a nonprofit organization in northern Colorado.

And I'll tell you a little bit about our mission and vision shortly and and how our working together with Larimer County Sheriff's Office has been a benefit to our entire community. Now I'll go with our agreement Chris.

Deputy Chris Smith: Right. So one of the things I do a lot of training all over the country when it comes to individuals with disabilities and interacting with law enforcement, and a lot of people want to spend a lot of time rehashing past incidents.

It's that's really hard for me because I wasn't there. But we spend a lot of time going over these old incidents, not that they're not important, not that they didn't happen, not that there's not something to learn there, but we really want to spend our time focusing on the future and what we can do better, how we can train our folks to properly interact with people going forward.

So we do the right thing going forward. So while the past is important, we definitely want to focus on the future. So that's the idea behind today.

Cyndy Hunt Luzinski: So when we get to work with anybody in law enforcement in northern Colorado, we share a little bit about who we are and then we give a, a really practical counterintuitive, simple approach for interacting with.

People who are experiencing cognitive impairment. And so just I'll share the same background with you that we share with them that our mission is that no one has to walk the dementia journey alone. And that does include people who are incarcerated. Our vision is that living well with dementia is the expectation and not the.

And this Chris might be where you talk about when people are incarcerated, we don't want to make it worse just because of dementia. I I don't I won't get your quote right unless you say that.

Deputy Chris Smith: Sure well so and I noticed on on the chat when people were asked to put in that one word that they think about when they think about dementia, several people said sad, and that's one of the things with that vision with Dementia Together is that living well with dementia is the expectation, not the exception. And we'll have a lot of things that we'll talk about later, that you can apply to that.

But the, the quote that Cyndy's talking about, I I'm a full blown believer in that jail sucks. Jail should suck or you know any sort of correctional type facility, that's the idea, right? And as long as I have anything to say about it, it will suck. But the thing about is it shouldn't suck any worse because of disability, whether, I mean, it's a physical or any other type of disability or dementia, yeah, jail's going to suck. That's the idea. But it definitely shouldn't suck any worse because of that disability. Right.

Cyndy Hunt Luzinski: So you might wonder why we even care about talking about this topic unless you are day to day, which it sounds like many of you are working in the jail or prison system. And so you you may have noticed that there's been a huge increase in the number of older adults in, in the prison system, an increase of 280 %.

between 1999 and 2016 23 % of incarcerated individuals in 2020 were seniors. In one Texas study it found that 9.1 % of incarcerated older adults met the threshold for dementia.

And 35 % met the threshold for mild cognitive impairment. The difference between the two will get to when I talk about definitions shortly. And then among older adults, it's interesting that cognitive difficulty is nearly twice as like twice as common in the prison setting. So in the general community, 7.1 % versus 15.2 % of older adults in prisons are experiencing some kind of cognitive changes.

So when we talk about dementia's symptoms, we are talking about a multitude of symptoms. Primarily the memory changes are what most of us already know about, but sometimes when people actually have dementia going on, their language abilities may change or maybe they can't say what they want to.

Say very clearly or when they're hearing language, when they're hearing people talk to them, they might not be processing the instructions or the statements or the questions. And so they might not they may be nodding, but it might not at all indicate that they understand what you're saying.

Judgment can change for people with dementia where they might become more risk-taking financially or relationally, and then sometimes that's what ends them up in jail, because if you don't know what you just did, you don't know what comes next, so you're not able to figure out cause and effect.

And so, judgment is something that we might notice as a prominent symptom of somebody who's got dementia. Spatial abilities can change for people with dementia where maybe patterns on the floor get misinterpreted. You might see somebody walk from a carpeted area to a.

a linoleum area and take a really big step because they're not able to judge that there's not that much difference in the flooring. Shadows on the wall might get misinterpreted as well. Sometimes black rugs in front of a doorway.

Look like a hole and somebody might want to step over that hole or go around it to get out the door. Other visual abilities that change with dementia include peripheral vision. So if you were in a class with us live, I would make you make binoculars with your hands and mimic for yourself.

how limited the peripheral vision is for somebody who's about mid stage Alzheimer's disease. The peripheral vision shrinks dramatically and it doesn't have anything to do with the eyes necessarily, it has to do with the way that the brain can process all that information coming in. So their world gets smaller as does their peripheral vision. So that is why if somebody approaches in.

Anybody with dementia from the side, they very well might get swung at, but it's not because of what people get labeled as having dementia related behaviors or aggressive behaviors. It's because they're trying to communicate that need that, well, you scared me. You got in my space. I didn't feel safe. So making that effort, when we know somebody has dementia.

To approach from the front catch eye contact in public space, you know, like 6 ft away before even getting into personal space, that can decrease a lot of that agitation and distress when somebody approaches from behind or from the side. Other signs or clues that you all might see.

I laughed when I looked at this slide this morning and I thought dressed inappropriately. Well, my guess is there's not much choice in jails or prison what they're wearing, so that doesn't come. But all these other signs and clues might give you an idea that they probably have some dementia going on, some cognitive.

Impairment. So the difference between cognitive impairment and dementia, the terms. Cognitive impairment is not severe enough to interfere with everyday life, but processing is slower. Memory has changed, whereas dementia is an umbrella term to describe a condition or group of symptoms. So dementia is not a full diagnosis, whereas dementia related to.

Probable Alzheimer's is a full diagnosis or probable Lewy body dementia. So dementia is a condition and it's caused 60 to 70 % of the time by Alzheimer's disease, which means 30 to 40 % of the time it's not Alzheimer's disease, and maybe it's something else. So it could be Lewy body dementia, which is what Robin will.

Williams had. It could be frontotemporal dementia, which is what Bruce Willis has. It could be head injury related dementia or trauma related dementia, which we're hearing more and more about because of NFL football players and hockey NHL hockey players, you know, that are experiencing some of that dementia related to.

Injury. Sometimes dementias could be vascular dementias related to maybe high blood pressure diabetes, maybe they've had a stroke. So if you looked online, you would see hundreds of brain disorders, hundreds of causes for dementia the condition. And we don't spend a lot of time on that.

Because when you are interacting with people on a day to day basis, I don't think it probably matters in how you, how you treat them if you understand all the disease processes. So at Dementia Together, our teaching is very much more focused on, okay, if we treat dementia as a simple disability that can be positively managed.

That's really all we need. We don't need the medical terminology, we don't need to understand brain pathophysiology. We don't even really need to understand which disease is causing the dementia symptoms. We take it at a different level and treat dementia as a simple disability and the disability we define it as is the increasing inability to store the facts of what has just occurred while still storing feelings the same way as usual. And we use.

There's an analogy to explain this and this is will become abundantly clear to you in just a few minutes what I mean by this whole ability to store feelings but not having an ability to store facts. We use the analogy of what's called the SPECAL, it's not a typo. Specal photograph album, and I learned about this 15 or so years ago when my dad had dementia and.

I wanted him to live well and finish well and I went over to London and met the lady who developed the SPECAL approach. And when I first learned it I wondered why I didn't learn it in nursing school and.

I was hopeful that I was gonna be able to help my dad finish well and then also I wondered why doesn't everybody in the United States know this? So for the last 15 years, it's sort of become my mission to share this approach with anybody, and it's a simple analogy that helps us see that our memory system is like a photograph album, and I.

I don't know if you can see me or not Yes. No. Okay. Depending on your view, you might be able to see me, but I'm gonna just show it on the slides anyway, but imagine a photograph album representing your memory system in every single memory you have, every experience you have is stored as a photograph in your album, a split second after it occurs.

And every photograph contains the facts of what just happened and the associated feelings. So the taking and storing of the photographs in our album is an automatic unconscious process. It's going on in the background of our lives. Each of us, again, has our own album and all of our own experiences are stored as photographs. So, as time goes by page after page.

Which after page of photographs build up in our album and our album falls open naturally on today's page, which is where these latest photographs are flying in. And it's this latest information that we must have if we're gonna be able to make sense of who are we with, what are we doing? Where are we? You know, why are we even here? The reason why it makes sense to you that you're sitting and looking at a computer and you're listening to me talk is because you have facts from earlier in the day that show, oh, I got up, I got.

Test I had breakfast, I came to work, we had this in-service, all of that has stored for you, so this all makes sense. So we are referencing our album all the time just to get through the day in what seems like a seamless fashion. We can reference what happened a long time ago. We would do this if.

We're in a conversation about something that happened a long time ago. We have memory cafes in northern Colorado, which are social gatherings for people with dementia and their care partners, and they're around a theme every month. So if the theme was back to school.

And we're talking about favorite elementary school memories or teachers. I would check my album. I would say let me think to myself. So anytime we're let me thinking, we're checking our album for facts we need.

To be able to share in a conversation. So I might look back at older pages and be able to tell you about my third grade teacher who was my favorite teacher and I could tell you all sorts of stories about that. But then I would quickly be referencing back on today's page where these latest.

Photographs are flying in, but we are using our album all the time in normal conversation and in normally just getting through the day. So with dementia, a different kind of photograph is taken and stored in our album, and you can see how it looks different. With the dementia related photograph, the experiences still store, but they store without the facts. So we call these dementia related.

Photographs blanks, but we don't mean that the experience isn't storing. It's just not storing with the facts. So the feelings are taken up all the space where the facts would normally have stored. So blanks are just blank in terms of facts.

And so, after the arrival of the first blank, for anybody with a progressive form of dementia, more blanks will follow randomly, intermittently, and with increasing frequency. And eventually people end up with ribbons of blanks.

And that's probably about the time somebody's getting a dementia related diagnosis because other people are noticing that facts are not storing. There's chunks of time missing. And as dementia continues to progress more and more feelings only blanks will store on today's page and recent pages.

And really until the end of the progression of dementia, there still will be some normal photographs with facts and feelings that store, but they're random, not predictable, and they exist in a sea of feelings only blanks.

So what happens when somebody with dementia is trying to figure out, well, what do I need to do? They're gonna check their album just like we do. So anytime we have a question to ourselves or we're wondering, you know, what do I need to do next? We check our album to get the factual information we need. Well, somebody with dementia.

Isn't finding the factual information they need. So very reasonably, they'll match back to older pages in their album from the time before dementia, and they'll find photographs that match what they're feeling right now and they'll use those facts to help them cope with what's happening on today's page. And we have to listen and learn to, well, what are they matching to? Because that's telling us are they okay or not okay?

So, there's ways to interact with somebody who's got a blanking album so that we don't disturb what makes sense to them cause it's not to our advantage to disturb what makes sense to them.

And so three simple strategies that we teach no matter who we're or who we have in our classes. It could be family care partners, it could be healthcare or senior care professionals, it could be people out in the community, but specifically with folks in law enforcement, these three strategies are helpful as well. So the first one.

And I'll go into each one, is don't ask direct questions, especially about recent facts because the recent facts haven't stored. second one is listen to the expert, so the person living with dementia is an expert, and they're an expert at knowing how to cope with a blanking album. A lot of times families will tell us, well, my loved one's not an expert at anything anymore, and that's not true.

They're definitely an expert at knowing how to cope with a blanking album. And then the third golden rule is don't contradict, don't argue with the facts that experts choose to use so that they can make sense of what's happening today. So let me just go into this first, strategy or we call, we call them golden rules as well. But this first strategy of don't.

Ask direct questions. I want to just share why we don't ask direct questions. And it has I'm not gonna even use a jail or prison example. I'm just gonna use a very simple example of what happens anytime a question is asked. So imagine somebody asked me a very simple question, would you like a cup of coffee? And my album looks like the one on.

The left. I've got all the facts and feelings stored coherently. This is the process that happens and the album helps us see and slow motion what's happening when somebody says asks us any kind of question. So would I like a cup of coffee, my answer is, well, it all depends. Let me think, let me look in my album.

And I need to get some factual information before I can answer. So I might ask myself, well, it all depends. I'm asking myself, do have I just had coffee? Or is it free? I didn't bring any money or would I be the only one drinking coffee? So I have to find out some factual information before I can.

Even give an answer to that question, so we don't just know things. We only know what is stored in our album and we get that factual information before we can answer a question. And I'll do it in lightning speed. But again, the album helps to see we don't just know the answer to every question that's asked of us. Every single question drives us to our album first.

And then we can give an answer. But now imagine my album looks like the one on the right. I've got some dementia and somebody asked me that question, would you like a cup of coffee? So I'm gonna check my album and ask myself the same question, you know, I don't know if I want a cup of coffee. Let me think.

Let me look. And when I ask myself, have I just had a cup of coffee and I'm confronted with one of those blanks? What else I'm confronted with is the feeling like well why don't I know this? I feel like I should know if I've just had a cup of coffee wh what happened? And I'm gonna start to ask myself more questions like what where am i? How do you.

I get here, where's my car parked? I'm gonna start asking myself a lot of questions if I'm confronted with the blanks. And if the person who offered me the coffee, asked me if I wanted coffee, is seeing me kind of have this internal.

Dialogue and they're waiting for an answer. They might prompt me with, well, would you? Which is another question. And I'm gonna have to check my album again, potentially be confronted with yet another blank in my album.

And even more panic of what I what? So we are not meaning to put people on the spot. We're not trying to be mean when we ask a question, kind people ask questions. However, we really underestimate the harm that we can do when we're asking people.

Who are not storing recent facts to answer questions. So I'll just give you an example of my friend Jenny who was living with dementia at home with her husband Rodney, and the night before he was ready to put the alarms on the front door so she wouldn't go out. She got out while he was still sleeping and.

And walked all around one of the northern Colorado towns. And, and so when law enforcement came upon her 4 h later, the natural instinct is to ask her, how did you get here? How long have you been here? Are you hungry? Are you thirsty? I mean all the questions that we ask people.

That she couldn't answer because her whole last 4 h had stored with very few facts and a whole lot of feelings. And so those types of questions don't help her. Instead they can cause actually more anxiety. So rather than asking direct questions, we actually provide more choice.

And we're able to find out what we need by using a different strategy and nothing we teach at Dementia Together is rocket science, so this is the answer. Instead of asking direct questions, just use statements because it doesn't put people on the spot. You're not demanding.

Finding that they have to check their album and look for facts that aren't there and have that feeling like they should know but they can't. So when you just say things like, oh, I wonder if you live around here, it, well it looks like you've been walking a while. It seems hot. Let's go sit in the shade. Or here, here's some water. Let's drink water together. Something like that, where you're just making statements, you're encouraging a response without demanding an answer. And that makes all the difference in the world.

Same with in in the jail setting I think anybody in jails and prisons have less trouble with using statements compared to questions than anybody else in the world because you're kind of used to giving direction and and commands, but anybody else might say, do you want to get cleaned up if they're in a senior care?

Community for instance, Whereas it's better so it's probably good that you all are trained in this to say, you know, it's time to get cleaned up or it's time to read to read your tablet, whatever it might be. Using a statement like that, really can change the whole dynamic and decrease anxiety for somebody with dementia.

So what, just some examples that have come up when we've done classes live, so instead of asking like who can we call for you? Just saying, oh, I wonder if there's somebody we can call. You're gonna find out that same information, but you're just not putting them on the spot. You're not giving them that feeling of interrogation.

Instead of saying, did you fall if somebody's sitting on the floor, it might be, oh, it seems like you might have fallen. And they can say, no I haven't, I'm just sitting here or they can say, Yeah, I've fallen. Is your hip hurting? It might just say, hey, it looks like your hip is hurting. Because in that moment, if they're sitting there and their hip's not hurting, they're gonna say no, my hip's not hurting, and then they move and wince. So.

You have to have memory in order to have the pain, to know that it has been hurting. Questions like what happened, you could just reword to, oh, tell me tell me what's going on here. Tell me what happened. Instead of, do you want, do you want to get that checked out? It might be, you know, it might be good to get that checked out or let's get this checked out together.

What medications are you taking? It could just be again more chit chatty with. We're trying to figure out what medications you're on. I wonder if you can help. So just creating that feeling can decrease anxiety for anybody who's not storing recent facts. And when you're wondering, because you're gonna come on a scene, you're gonna be in a situation and you're naturally gonna be asking questions. That's what we do. I'm a nurse. That's what I do.

And you would do the same thing. But when you start to hear, I don't know is your response or they start to look at somebody to rescue them with the answer. That is your cue to back off, take a deep breath and realize, oh, I'm asking too many questions. I need to start wondering and supposing and using statements like that.

That don't put them on the spot to have to check their album for facts that aren't there. So that's one just real simple strategy, change your questions into statements. second strategy listening to the expert, so the person with dementia is the expert. And so what we want to do is really listen to their questions.

And answer the feeling behind the ask. So I said that every time we have a question, our album is our first go to place to check. So that includes the questions we might ask a person with dementia or.

It includes any questions that we are asked, but it also includes questions we ask ourselves. So when somebody with dementia is asking themselves, you know, I wonder what's next? What do I need to do next? They're gonna check their album and they're gonna look for facts that tell them what they've just been doing so they know what to do next.

If they've got dementia they don't know that. And so if they're if it's important enough to them to want to know what's next, they're gonna verbalize that to you. But know that there's been a lot of album activity that they've had before they ever even verbalize it. And so your response is you don't tell them what's next all day long. It's like next we are.

Walking over here. Next, we are having breakfast. So it's really just giving the absolute next thing that is happening almost right now and not trying to expect that this whole litany of what we're doing today is gonna store because words are facts, facts don't store.

We really just need to be paying attention to the feeling underneath why somebody would ask that. Same thing with when do I get to go home? You sometimes don't even have to answer that with factual information. You can just say to them, oh, you wanna go home, of course you do.

I'm glad we're working on it. You it's okay to be vague. It's hard to track time anyway when you don't have facts storing. But saying their exact words back can be helpful so that they feel heard. So with that, listening to the expert.

Just keep in mind recent facts are not storing using fewer words, more gestures can be more meaningful. Gestures are stored on that feeling level, avoiding answers disturb what's making sense to that person.

So what we wanna do is really answer the feeling, the anxiety underneath, why somebody would ask when can I go home? Cause obviously when they're asking, they're not feeling at home and and we describe home as a feeling where everything makes sense. So when they're asking that typically, no matter where they are, even.

And literally for our families when they're in their home that they've lived in for ten years or 50 years, and they're saying when can I go home? What they're saying is things aren't making sense to me. When are they gonna make sense? And that's where you want to go home, of course you do. I'm sorry this isn't making sense, let's see what we can do to help. The other thing we talk about other than just tracking phrase questions is noticing phrases. You might have some inmates who have a certain phrase they say, you know.

Who's the Pope? Catholic? or, oh, it's another day in Paradise or you can't win them all. When you use those phrases back to them, their exact words, you can establish quick rapport and comfort with them. So I'd encourage you to pay attention to that and if you notice it pass it on to the next shift to make their shift a little bit easier too.

And then our third strategy is just don't contradict, don't correct or criticize or argue with what facts they're using to help make sense of what's happening now. So we have a moral imperative knowing that we are storing all the facts.

And the person we're interacting with doesn't. So we're the ones that need to accommodate for their disability by not disturbing what makes sense to them based on whatever they're matching to.

So instead, we just find it interesting and realize whatever they're saying, that they're sharing what they're feeling. And then we just show with our nonverbal expression, we don't have to say anything a lot of times, we could just give them a look like, oh, that's interesting without even saying that or you could say something pretty.

In benign like oh that's interesting or there's a thought or I hadn't thought about that way or good idea, you know, just stuff like that that doesn't decrease their confidence to even try to speak, so they're not running into contradiction all the time. People who run into contradiction with whatever they say eventually will stop talking.

And essentially it's like they're gonna close their photograph album all together because it's easier to shut myself off to the world than risk that every time I open my mouth I'm gonna be contradicted. And so part of that is unlike in mental health where you don't buy into the delusion, with dementia, you just don't.

disturb what's making sense to them. And so kind of whatever they throw at you, it is like improv comedy. Whatever they throw at you, your answer is never no. It's actually yes and so even things like I I wanna go look out the window at the birds.

You might be no, you can't do that now or it could be yes, and let's do that when it's light out so that you can see them. Or yes, let's do it after breakfast when everybody can get out and look at that. Whatever it might be, but it really is that mindset of yes and instead of no but and in the.

Prison system that is way harder I'm sure than for us lay people out in the community. But I I would say take that piece of it and figure out what can you still say yes to or what can you just almost say nothing to?

That implies a no, but it doesn't put them on the defensive when they hear no can't or don't. So that's finding it interesting is really a nonverbal tool more than anything else.

So kindness realizes that feelings are more important than facts, our philosophy as we choose to be kind instead of right. And with that, we know that feelings are more important than facts, so I would say if you sear any image into your mind right now, this would be it. Like this is what the album looks like for the person that I'm interacting with.

With who's experiencing dementia, and our photographs look more like this, but their photographs don't have the facts. And so when we talk about feelings for everybody, I'm just gonna jump into talking about feelings kind of in color so we can talk about trauma for just a minute. So when we teach the photograph album analogy in color.

We show that feelings are either okay acceptable, and they're colored green or they're wholly unacceptable, deeply traumatic, and we color those types of photographs red. So we make the assumption for most of us, most of the time, our albums look like this, like our lives are okish. There's no shades of green, but this could be top-of-the-mountain-experience green or this could be not great, but it's okay ish. But for all of us.

In our lives, we have had some trauma, some terrible thing that has happened, and any time trauma happens to us. So if this, for an example, if this is a trauma of a beloved dog running out in front of the house and getting hit by a truck, there's the trauma.

And, and when that happens, a person is automatically driven to take action in response to that trauma. So when we have trauma, it's red. We've got to take that action to bring ourselves back into green. And so maybe the action is, oh, I gotta very.

My dog, how am I gonna tell the kids? I gotta call my partner, any of that like and it's not great, but it's taking action in response to that initial trauma of the dog getting hit and then life goes on on green. And it could very well be that when you're matching back to tell a story of, you know, your favorite third grade teacher, like I could do, I might run across that room.

Red, but I'm not gonna focus on it because I'm on a green search for green information in a conversation. I go around the red, and again, life goes on on green. So we don't deny that the trauma is there, but in general, how we cope with old trauma is.

Unless we're dealing with it at the moment, we're just going around that trauma. So with dementia, there's a different cause for trauma, and it's caused by common sense communication. And when somebody is using common sense communication.

That trauma for somebody with dementia may store with the facts and they can take action and they kind of know what to do, but it also may store without the facts, and that truly can be catastrophic. And so some triggers to.

Trauma for anybody who's got dementia is when we give information to the person with dementia that we know something that's happened in their life and they don't know it because they they didn't store it with the facts.

And that can be so traumatic when that does happen. And when, when that trauma happens without the facts red will beget red and you get somebody with an album that looks like this, and you know when somebody's in red, because you come near them and they're gonna say, get away from me.

And so we all, we all know when people are in red, and I would say for you all, you know, riding on a scene or you're called to a difficult situation, my guess is those people are in red, and often you will see that they will match back to old trauma, and you might get the person that is yelling.

To, you know, get him out of here and I'll I'll give you an example. It's not from jail or prison. Chris will have some of those in just a little bit, but I I can give you an example from one of our memory cafe participants who fell and broke his ankle and EMS came and picked him up, brought him to the hospital.

And well meaning nurses and other staff members were pummeling him with questions. What happened? How did you get here? How much pain are you in? All those questions and not waiting for an answer. He couldn't answer them fast enough, and he was getting more and more escalated.

And he started to yell. Get me out of here. Why am I in the hut? Get me out of the hut! I'm stuck in the hut. Why are you tying me down in the hut? And so what he was doing was feeling traumatized and he's having well meaning staff say, Oh John, it's okay. You fell, you broke your ankle.

Which causes it's a contradiction like any question. Contradictions force us to check our album to get the facts we need. He had no facts storing that he fell and broke his ankle, but they sure had evidence on their side, these people telling him what happened.

That they know something about his life that he didn't know. And that was the trauma for him. Again, they meant well, but he absolutely was matching back to when he back in the sixties was in the military, he'd be dropped from a helicopter into a hut, and he'd be forced to listen to.

He was being held hostage in in this claustrophobic hut that he hated and his wife knew enough about our approach to figure out what he was doing. So he absolutely was in red. And whenever, and this is the application for you all, whenever you arrive on a scene and somebody is in.

Red, how do you bring them from red back to green? And the answer is not to say with a calm voice, here's the actual factual details of what happened. It just doesn't help. Instead, what we need to do is simply join the club.

And like I said, what we teach is not rocket science. We have four steps for how do you join the club and here they are. We agree and hang on to that tone. We don't actively disagree. We agree, we apologize, we align.

We attract. So in John's case, what it sounded like was if he says, I need to get out of the hut, he needed somebody with that same tone saying back to him, you need to get out of the hut, of course you do. That's a lot of words though. So also what would also work might just be the hut.

You like, you don't even have to think if you just say a couple of the words back, it gives you a second. And then it's like, oh, apologize. I'm so sorry this happened, let's see what we can do together to make this better. Let's see what we can do together to get you untangled from all this stuff. So that, and this is where man, if you have people in.

That you can show me a little bit about these boats. Wow! Or tractors or trucks? His wife knew that this that this book for him was everything. He loved to share stories about boats and tractors and trains, and he was an expert. So when you attract to what are they an expert in? What do they love to talk about? Who were they at their finest hour?

Just knowing one little gold nugget, and if that's what you pass on at change of shift to the next person, hey, their gold nugget is he, he used to be an expert fly fisherman. Talk about fly fishing. When you can note just that little bit, it can really help bring somebody from red to green.

And just back to the healthcare example. This is our friend John for real, and he loved that we would share his story with anybody who could learn from it and how to use that agree, apologize align, attract.

Diagram. If you think about the expert living with dementia trying to navigate the rest of the world, and by the rest of the world, we mean people that are using common sense and logic. They're contradicting. They might be rushing the person, they might be interrupting them, they might be pummeling them with questions. All that is the rest of the world. That's just common sense, and it's really hard to navigate that when.

They have nobody to help them. So they need a trusted companion who knows these three strategies. They're not gonna question, they're not gonna contradict, they're gonna listen to this person as the expert and together with it's just eye contact and that facial expression. Oh, I've got somebody wo.

With me who can rescue me when I need it. I'm not wondering what to do next because I can catch eye contact with somebody who's gonna give me a clue. That's creating that "we" relationship with them and that really is the key to promoting lifelong well-being for anybody who's not storing recent facts. So I'm gonna stop sharing for a minute before we show you a video and get Chris's input here.

Deputy Chris Smith: There's so many good things to say. I mean you had done such a good job and I didn't want to interrupt.

Cyndy Hunt Luzinski: Normally you do. I know, right? I was kinda waiting, but I was talking probably pretty fast.

Deputy Chris Smith: I mean, one of the examples that I remember, the particular individual that.

Actually resulted in Cyndy and I meeting, when he was in custody and after we were starting to learn these strategies and that kind of thing, he would, he realized he was in jail, maybe not why, but he knew where he was, and he would yell at us, you know, Shannon's here to bond me out. Shannon's here to bond me out. And.

You know, initially we were trying to explain to him, you know, well, no one's here to bond you out, you know, you, you have no bond at the moment, these kinds of things and they didn't make a lot of sense to him. But we were able to figure out, you know, Shannon's here to bond me out and he's yelling at us and matching that tone, you know, I know you want to leave. I get that, I understand that and but then quickly redirecting him and bringing ourselves back down, the bonding process takes a really long time, which sucks. But you have to wait here until they're ready.

In booking, they'll call me and as soon as they call me, I'll let you know. But while we're waiting, and he was a pretty religious individual, why don't you read your Bible until they're ready? Okay, you'll let me know when they're ready. I will let you know when they're ready. And we might have to do that multiple times over a short period of time because he would get escalated again. Shannon is here to bond me out.

Now I know she's here. You know, we would never tell him something like I know Shannon's here cause that's lying to him, you know, but when booking's ready, I'll be sure to let you know if booking's ready. You'll let me know Yep, and in the meantime, let's, let's go read the Bible. And we could redirect him back to that pretty easily.

Cyndy Hunt Luzinski: And that made sense to him, so you weren't disturbing what made sense to him. And that was the kinder thing to do than to try to make him figure out all this actual factual details that would have been data overload for him.

Deputy Chris Smith: And somebody earlier, you know, just asked about individuals in them aging in the, in this process and developing dementia. For a lot of you guys, if you're in a system, in a department of corrections type system, that maybe the case for someone like me that's in a county jail, the individuals aren't coming in with dementia, they're typically not developing.

In custody. But I think a lot of times when they're here, you know, they, they're not, they may not understand why they're in jail or may not understand exactly what's going on and they have that photograph album and they're trying to figure out what's going on and they're referring back to their album and it's not making sense. And then they turn and they look at somebody who's standing there in a uniform.

With a badge and they sitting there consulting their album. Well, when was the last time I had an interaction with somebody in the uniform and it could be good or bad. If the last time it was bad, now all of a sudden they're panicking because, okay, the last time somebody was sitting in front of me in a uniform, they told me that, you know, a loved one was in a car accident. So they've got to be here to tell me something bad.

Hold on the the flip side of that, you know, the last time they were here, my child had run away, they brought them back. a good thing, and just being able to adapt, you're listening to the expert and listening to what they're telling you and adapting how you responding to them based on those cues and and things that they're giving you.

Cyndy Hunt Luzinski: Looks like you're checking.

Deputy Chris Smith: I was. Okay somebody made a.

Dr. Tashima Ricks: Comments as well so I think we're, we're pretty much up on most of the questions so we could just keep we can keep rolling. Keep rolling.

Deputy Chris Smith: And somebody did make a comment about how do you get somebody that there's there's a lot of individuals staff individuals.

And getting them to buy into these strategies. It's a lot easier actually, I think when you have somebody in custody who actually has this, this particular individual that again led me to get to know Cyndy, he came into custody, we immediately knew and understood that he had dementia.

He is particularly aggressive with us. We'd had a lot of individuals in custody who were pretty passive, pretty easy to redirect, definitely get annoyed because they'd ask the same question, you know, a whole bunch of times in a short period of time, but we were able to manage with that. He was particularly aggressive with us. I normally wear khakis and a polo shirt to work.

And there was more than a few times I'm I'm there with deputies wrestling the guy because he decided he was leaving and there was no way we were gonna change his mind without a fight. And it wasn't pretty and it wasn't fun for anybody. We brought Cyndy in, she had a chance, she went through our building, got a chance to understand where our inmates are living, where our staff are working, and then worked with us to develop strategies and had some training for our staff, and they're like, here's some ways that you can work with this particular inmate. And it made a lot of

sense, just because now they understood using that photograph album, what's going on in his mind, why, what he's trying to do, what he's trying to process, and then employ those strategies working with them. Was it still annoying to a lot of them that they had to do the same thing multiple times during a shift? Absolutely. But they understood it, and I think that went a long way towards them being able to understand why I have to do this, you know, these things over and over and over again all day long.

Cyndy Hunt Luzinski: Accommodating for this disability, you're changing how you interact so you don't disturb their well-being. And so we call it humble deferral. You're humbly deferring to the person with the blanking album. Their album is more important than yours at the moment. That's how you raise the dignity of anybody who's experiencing dementia.

So I, I have a soapbox about that and if you want a half an hour on humble deferral, I'll give it to you. I mean it's really hard on families, but boy, when they finally understand the actual disability of dementia or we talk about, you know, if somebody lost a, a limb.

Okay. Do you want me to share the video soon, you let me know Chris.

Deputy Chris Smith: Sure, go ahead, we're gonna run out of time. What time are we done? Quarter after. So 20 min.

Cyndy Hunt Luzinski: Okay, I'll share it cause it's like 4 min, and I'll share it with sound and we'll see if you can hear it.

And if not, we'll keep talking, yeah.

Deputy Chris Smith: So if somebody asked about amnesia and whether it's a form of dementia, and I don't believe that it is okay.

Cyndy Hunt Luzinski: This scenario shows how stress of injury and illness can lead to increased confusion and even delirium, in which nothing around the person makes sense.

In order to cope with the feeling of trauma possibly without having recent facts stored to explain it, the person living with dementia very naturally matches back to old trauma to give himself a way to take action and fix the situation.

You'll be able to see that a common sense approach is not helpful. I need a shovel. I need to go home. I need a shovel. I need to bury the dog. I need a shovel. I need to go home. I need to bury the dog. I need a shovel, I need a shovel. I need to go home.

No, no, no. I need a shovel. I need to go home. I need to bury the dog. No, no, I need to bury the dog. You were supposed to call for help.

Please calm down. Who are you? Come have a seat? No, no, I need a shovel. I need to I need to bury the dog. Let's have a seat. I need to go home. This is the same scenario, which starts out with common sense, which goes nowhere. Then a staff member enters the picture. This staff member had fortunately learned just a little key information from the family advising that Joe's favorite pastime is talking about his fishing days with his dad.

This staff member enters the room with a join the club approach. She uses the Dementia Together strategy of the four A's agree, apologize, align, and attract to something better. In order to help Joe move from panic and distress to contentment and well-being.

Ultimately, she creates a "we" relationship giving Joe a way to feel like he's not alone. I need a shovel. I need to go home. I need a shovel. I need to bury the dog. Joe! I need a shovel. I need to go home. I need to bury the dog. I need a shovel.

You don't need a shovel. Don't worry, there are no dogs here. You can't go home right now. You're in rehab. You fell and hurt your hip. You can't go home because it's not safe. No, no, I need a shovel. I need to shovel. I need to. I need to go home.

You need a shovel. I need to go home. You need to go home. I need to go to bury the dog. I'm so sorry this happened. We're in this together. Let's do what we can do to make this better. Look, maybe you could show me pictures from this magazine. The pictures.

Oh! Oh! Okay I've I've been there. I've been there. You've been there? I've been there. My, my daddy and I have used to fish right there.

And that is an elk-hair caddis fly. The trout can't resist an elk-hair caddis fishing fly. Let me tell you.

Deputy Chris Smith: So there was a comment in the chat about how hard this was to watch or the initial scenario, and I agree and and being in.

You know, in the corrections type environment, when you're in booking or housing or any of those other type of places when something like this is happening is hard to watch, but that's where these strategies can come in to help, help you move along in this situation. Even though that was a, a care facility and he's not able to leave, obviously if you're in.

In jail or corrections are not typically able to leave either. But then somebody else made the comment that there's so many other barriers and corrections and I absolutely agree with you, but that doesn't mean that these strategies don't work and that they can't be used. A lot of times.

Figured this out and is good with working with it. That might be the right person. I just I remember I think about myself, even before I had any of the understanding that I do now of dementia, like with my mother, my my wife's grandmother had dementia pretty bad.

She progressed pretty far through it before, she eventually passed away. It sounded bad. But anyway, I used to like to go pick her up from the, from the care home, and bring her to family events, holidays, things like that. my mother-in-law was always confused about why I wanted to go pick her up.

It's because I thought it was fun because I was employing these strategies without even realizing it to go pick her up, have her come with me who she never remembered me, but I would tell her my wife's name, hey, do you want to go see Emily and.

She'd be like, Well, yeah, I want to go see her. Sweet, let's go. Even though I was asking a question, but it was the question that made sense to her, but it just using those type of strategies in any type of situation, can work.

Cyndy Hunt Luzinski: To the right answer. Or again, just keeping our mouth shut sometimes and not directly contradicting. Well, you can't go home for two years. You're gonna be here. Like that's not a helpful answer. So really just kind of keeping our mouths shut sometimes and just giving that feeling to them that you're interested in what they're saying.

That's better. And really the ultimate goal is that people who are experiencing dementia are in green. And then I kept this other page on on the left is how do you keep your own album green? Because you all have albums too and you do hard work and I am not.

In corrections at all, and I can't even tell you how much respect I have for what you all do. And so I would encourage you to every single day on your way home every after every shift, if you can think of one thing that went better because you were there, one thing that you did right that made somebody's life better, that might at least decrease the risk for compassion fatigue and give you reason to come back the next day because this really is.

About not just making inmates lives better, but how can we help your jobs be easier and your jobs more fulfilling? So we're all about keeping people's albums green, and I hope that some of these tactics and strategies work for you to do that.

Deputy Chris Smith: Whether you have a.

Cyndy Hunt Luzinski: Go ahead Chris. I was gonna say that's part of staying green is having the tools.

Deputy Chris Smith: So when you're interacting with somebody and things go good, you can have that, that green moment.

You know, either just right then or even throughout your shift, and somebody else made the comment about being able to train new staff members in the academy is important if more more staff have that tool to use better overall results. And I hundred percent agree with that. In my experience a lot of the times when people are brand new to this profession and haven't really been doing it, a lot of.

Those tools we give them, and when they're first starting, they're an information overload, they're drinking from the fire hose, all the stuff we're trying to teach them, getting those opportunities later down the road and in-service seems to be the opportune time, at least in my mind. My agency, we do ADAs.

To set them up for success. And then when they walk in the room, it's, it's really easy for them to, to deploy those strategies, to use them, to be successful in this scenario. Of course the training is the best place to fail, cause.

Dr. Tashima Ricks: Absolutely.

Cyndy Hunt Luzinski: We also do have at dementiatogether.org, our online or website, we do have an online platform where families can access this approach. They can access a 1 h class.

At no charge, we don't charge families ever for any of our services, so don't ever hesitate if if you have a family member, you know, don't hesitate to contact us at dementiatogether.org or get on our educational platform. We have modules there. We have some specifically for first responders that.

That, you can contact our office and our development director Claire will get back to you. But that's where all of when we say no one has to walk the dementia journey alone, we mean the people that are in the trenches doing the hard work too. If we can come along and support you in any way, we're happy to do that.

Deputy Chris Smith: There's some good ones being put in there. They definitely shifted in tone compared to where it was when we first started. So if somebody did put partnerships in there, one thing that I worked really hard on, in my role, not just with dementia but across the board.

Trying to find those relationships in my community as early as I could. So whether it's working with the arc, for people with intellectual developmental disabilities, whether it's working with the brain injury alliance, for people who have TBIs, and all these type of things so that when I need a resource.

I'm not calling somebody fresh. If I have a dementia, you know, case that I'm having trouble with, I know I can reach out to Cyndy. I know I can reach out to my contact at, you know, these other organizations, but having those built ahead of time, is great. It also establishes an opportunity to build great rapport with them so that they understand.

Yeah, there's a lot of misunderstanding about jail, a lot of misunderstanding about law enforcement, that kind of stuff. We've built those relationships, we've built that trust, so when I bring them in to do training for me, they already understand my agency and it goes a long ways towards breaking down a lot of those barriers.

Oh, hey. Somebody recognizes you first. Somebody recognizes.

Cyndy Hunt Luzinski: Yeah, this is.

Dr. Tashima Ricks: Then beyond amazing deputy Smith and Cyndy, I thank you so, so much for your time and your commitment in improving the lives of correctional staff and people in custody who experience dementia. I know for me this information has definitely been helpful and I'm confident that every single person in here has learned something new.

To be able to implement in their personal or professional lives to improve their interactions with people who have any sort of age-related cognitive impairment. So we thank everyone for attending, and again, we encourage you to complete the NIC evaluation. We had posted it in the chat to tell us how we did.

As well as what other programming you would like to see from the Institute in the future. With that said, be well, everyone, and we'll see you next time.

Cyndy Hunt Luzinski: Thank you.