THE RESCUING APPROACH
Being Rescued
Many of us in life get ourselves into difficult situations in which we need help to get out of a
corner we have got ourselves into. It may be being awkward over something or being
stubborn, it may be denying our true feelings or arguing with someone over something that
is not really worth persisting with. We often continue being like this because we have got
ourselves stuck.
Usually we have the ability to eventually retreat from our initial feelings. We eventually
realize nothing is to be gained in life by sticking out too long over things that could easily be
resolved. We learn to apologise, to back track or to retreat from a cornered position.
Sometimes it takes the love, support or assistance from someone else to help us move
forward from being in a cornered position. Sometimes we are just not big enough or our
feelings have become too set and we need someone to rescue us from an entrenched
position. Usually when we are rescued we are relieved that someone cared enough to save
us from ourselves.
Balancing Being Person Centred With Our Duty Of Care.
This approach to rescuing someone from their own difficult feelings is very relevant in a
person centred approach towards people experiencing a dementia.
Many staff often get confused themselves about how they are to balance the principles in
both being person centred which is about:
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Respect.
Accepting as they are.
Going with a person’s reality.
Not correcting people or highlighting their mistakes with also exercising a duty of
care and not being neglectful.
If staff take this confusion too far they can misguidedly use the ideas and beliefs in a person
centred approach to justify what amounts to neglecting people by saying this was because
the person with a dementia did not want something or refused our care. Being neglectful
can never be justified by any arguments which come from being person centred. The
answer is that it is possible to both be person centred and to follow the key principles in this
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approach with also our need to exercise our duty of care. The answer is to develop skills in
applying the rescuing approach towards people with a dementia.
Rescuing People With A Dementia
Just like us many people with a dementia get themselves unwittingly into situations that
they cannot get themselves out of. The difference with us is that often we can extricate
ourselves if we really try and we don’t always need the assistance of others. However
people experiencing a dementia can find themselves into situations that they cannot
because of their brain damage rescue themselves from. Examples often where staff need
help with how to respond are:
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People with a dementia who are incontinent of urine or faeces but who deny that
this is the case even when they are in need of assistance to be clean.
People who regularly and persistently will not accept a wash or bathing due to
perceptual difficulties.
People who blame staff or families regularly for many thing that may not be
happening.
People who regularly accuse others of stealing their personal possessions.
Clearly there are many other situations where people with a dementia have a different
perception or reality about themselves i.e.:
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Wearing clothes in the wrong order.
Using hands and not utensils to eat.
Think that they are at work.
Pouring liquids i.e. orange juice over meals or mixing foods up together that would
not usually be eaten together.
The overall approach in these situations is always to:
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Respond to the persons feelings
Avoid being logical
Accept the person’s reality.
Go with things that do not really matter i.e. wearing 3 cardigans.
However when someone is at risk of health problems i.e.: sores from being unclean or from
abuse by others disturbed at seeing someone smelling etc. the difficult balance then has to
come in of how far the being person centred is compatible with leaving someone’s needs
unmet. The answer is in extreme situations people cannot be left but must be supported
quickly, sensitively and with care even against their wishes. This is when the rescuing
approach needs to be brought in by staff trained in this approach. The rescuing approach is
a last resort strategy when all other responses to behaviours we find difficult has been tried
in terms of changing the environment, removing triggers and altering our approach.
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How Does The Rescuing Approach Work?
Essentially this approach will always require two staff to work together who have been
trained in this response. The first member of staff takes on the role of the sensitive ‘Trouble
Maker’ i.e. as seen by the person with a dementia. A person with dementia who doesn’t
want personal care, bathing or help with toileting is clearly going to feel that any help given
is an invasion of their feelings, body and wishes. The staff member assigned to help the
person needs to understand that this is a reasonable response in someone who doesn’t
want or feel they need help. The person cannot accept that the ‘care’ you are offering is
needed or being done with care – obviously it is but the person with a dementia will not see
that. In these situations staff must be as kindly, gentle and as sensitive as possible whilst
trying as quickly as possible to complete the task without arguing, disagreeing or
confronting the person with dementia – i.e. they must realise that they are the ‘Trouble
Maker’ however caring they are trying to be. The staff member should communicate care
and concern but also accept the person’s reality as to how they are being seen.
The Role Of The Rescuer
The second member of staff is then ‘on the ready’ to intervene in the persons care situation
as soon as the task has been completed i.e. bathing, changing soiled clothing etc. and must
step in and ask for the first member of staff to leave immediately as if they had been doing
‘wrong’. In other words the person with a dementia cannot rescue themselves from how
they are feeling – invaded, attacked, and disrespected. They need to be believed, they need
their reality to be accepted – however distorted - and their feelings to be validated. The
role of the rescuer is to agree with the person experiencing a dementia with how they are
feeling; to validate their reactions, to show that something will be done about the other
staff member the ‘Supposed Trouble Maker’. They may say ‘how terrible this has happened
to you – something will be done about that person’ i.e. the staff member who has just
‘helped’ ‘attack’ the person. People with a dementia cannot rescue themselves from being
someone who has urinated in their own bed or past faeces into their clothing or be smelling
very strongly – they need help to be rescued from being this person – they cannot be
someone who has become like this – they need rescuing from what dementia has done to
them – they need to feel that they couldn’t be this person - they need help to get
themselves out of the corner their dementia has put them in. This is the role of the second
staff member to rescue them.
Showing the Rescuing Approach.
Obviously staff need training in this approach and to understand this is the last resort in
being person centred – hopefully other strategies will work before this is needed.
Staff will also need support – it doesn’t feel good being the worker in the first role where
you know and accept that you can’t make it right with the person and for the second worker
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to seem to be the rescuer whilst you feel like the ‘Trouble Maker’. Staff need to swop and
share being both of the roles.
It is important to remember that most people with a dementia will not retain the memory
of who was the ‘Best Friend’ or the ‘Trouble Maker’ but they will retain the feeling and
sense of being rescued. We can move on from our own feelings of carrying out these role –
people with a dementia in extreme situations need our help to be rescued from their
feelings. This is being person centred.
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