Teepa Snow’s 10 Steps to De-Escalating a Dementia Care Crisis
Strategies for Calming a Person in Acute Distress
By Valerie Feurich, Positive Approach to Care Team Member
Have you ever encountered a situation where a person living with Alzheimers or another form of dementia was in acute distress and terrified of one or more people?
Did you want to help calm the situation, but weren’t sure how?
It can be heart-wrenching to watch, and leave you feeling helpless.
In a popular video clip, filmed and shared with the generous permission of the Alzheimer’s Support Network of Naples, FL, Teepa Snow tells the story of Milly, an older lady living with dementia who became extremely upset when a group of Emergency Medical Technicians (EMTs) were trying to take her with them to the hospital.
While responding to a situation like Teepa is able to requires a skill-level that is on the goal-list for many of us, there are some general tips and techniques she uses that may be helpful the next time you encounter a high-stress situation similar to this.
Depending on your unique learning style, you may like to watch the video first and then read the blog, or vice versa. Therefore, I have added the video here for you, but also encourage you to read the blog below.
It’ll likely help you remember the steps if you review the content several times and in different formats. With that said, here are the 10 steps Teepa used to de-escalate a crisis:
(Video above not working? View the video at https://youtu.be/9IsyitaUtwE)
1. Remove the threat
If you encounter a situation where a highly distressed person is surrounded by one or more people, similar to the situation Teepa describes in the video, ask the other people to step back. That way you’re removing the perceived threat to the person.
If you are the one being perceived as a threat, you’ll want to back off. Trying to push through your agenda when the person living with dementia is in a highly agitated state could result in harm to you, them, or the relationship that you both share.
2. Create space
If there are people standing around watching, tell them to back off and go away. This will create visual space for the person in distress and make the situation appear less threatening.
3. Take her/his side
When in a scary or stressful situation, most of us would likely appreciate having a friend nearby; someone that is by your side to help and support you. The same applies to a person living with dementia in acute distress.
To become that person of support, Teepa matches Milly’s level of distress through body language and volume. In a louder and distressed voice Teepa says “Milly! All of these people — everyone is coming at you!” Simultaneously, Teepa turns her body so she is standing next to Milly, facing the same direction as her. Teepa then gestures and shouts “All you people — leave her alone!”
By speaking against the other party in this way, Teepa is doing what Milly was trying to do. She thereby validates Milly’s distress, making her feel like she’s no longer alone in this situation. And by physically positioning herself next to Milly, facing the same direction, Teepa reinforces through body language that she is by her side for support.
4. Crouch down to get at or below the person’s eye level
Next, Teepa says “Oh Milly, I can’t believe they did this,” continuously reinforcing to Milly that she is on her side. In addition, Teepa crouches down beside her so she is below Milly’s eye level.
Why do you think Teepa positioned herself on Milly’s side, at or below her eye level? To answer this, try to imagine two different scenarios:
In the first, you’re sitting in a chair, and another person is standing right in front of you. They lean down a little towards you, hovering near your face, and say “I can’t believe they did this to you.”
Now, in the second scenario, that same person is crouching down next to you on your preferred (dominant) side instead, a little bit below your eye level, and says “I can’t believe they did this to you.”
Which one of these would feel more comfortable to you? Chances are, you’d prefer the second setup.
By positioning yourself on the person’s side, at or below eye level, you give the person much more visual space. This in turn is perceived as non-threatening, as it gives the seated person a perceived way out.
Try to remember that standing and directly hovering over someone can be perceived as threatening. This can trigger a fight or flight response, which, considering that you’re physically blocking the flight option, may lead the person to lash out physically.
Instead, position yourself beside them so they can feel supported and not threatened.
5. Use Hand-under-Hand®
While continuously expressing empathy with Milly over the situation, Teepa reaches out and offers her hand. Milly responds by taking her hand, and Teepa transitions into Hand-under-Hand® (HuH).
What is HuH, you may wonder?
Hand-under-Hand® (HuH) is an evidence-based, research-proven, care technique that was developed by Teepa Snow. It utilizes the remaining muscle memory of a person living with dementia to offer comfort, initiate activity, and assist them with activities of daily living, such as eating, drinking, or personal care. (Teepa Snow demonstrates HuH in this YouTube clip, between 0:14–2:28.)
In the situation we’re describing here, connecting with the distressed person using HuH will help calm them down. By offering your hand and gently positioning your hands into HuH, you’re automatically applying gentle pressure to the person’s palm, which has a calming effect on a person’s sensory system.
6. Take a deep, audible breath to start breathing in sync
After connecting with HuH, reassuring Milly verbally, and maintaining eye content with her, Teepa takes several deep, audible breaths while visually reinforcing her action by moving her body in sync.
As humans, when we observe another person take deep, audible breaths, we tend to match them. So, by taking several deep breaths yourself, the person you’re connected with may do the same. This in turn has been shown to slow a person’s heartbeat, lower stress, and lower or stabilize blood pressure.
Tip: If the person isn’t looking at you, apply a very gentle pump to their hand that you’re holding. This will likely get them to turn and look at you.
7. Calm your voice
In the video, Teepa then continues to reaffirm Milly with words like “You’re okay. I’ll deal with them,” while slowly transitioning into a calmer tone of voice.
By turning down the volume and tone that you’re using, you can help the other person slowly calm down as well.
8. Relax your body
If you have closely watched Teepa in the video, you may have also picked up that at this point, Teepa has relaxed her body and is no longer in a tense position.
Humans often unconsciously mirror one another’s behavior, so by visibly transitioning into a calmer posture, Teepa is helping Milly to calm down as well.
9. Communicate openly and tend to the person’s needs
Once Milly calmed down, Teepa walked over to the EMT’s gurney with her. Milly laid down, and Teepa was able to secure her with the straps. Since Teepa had established herself as a person that is by her side and can be trusted, Milly no longer objected.
If you listened closely, you might have also caught that every time before Teepa did anything, such as fastening the straps, she let Milly know in advance and explained why she was doing it. That way Teepa’s actions didn’t come across as a surprise or a threat, and gave Milly a chance to follow what was going on.
Since Milly was freezing, Teepa also covered her with a blanket to ensure she was comfortable.
So if you find yourself in this position, letting the person know what you are about to do, and why, may help decrease resistance and tension. Try to see if the person may have any unmet physical needs, such as being cold or being thirsty, and see if you can offer comfort by meeting that need (offering a blanket, a glass of water, etc.).
10. Be willing to go where she/he is at that moment
Milly felt terrified and trapped, and the people around her didn’t realize that they were making it worse in their effort to help.
Teepa on the other hand was willing to be with Milly where she was at that moment in time, and demonstrated to Milly that she was not a threat, but a friend.
Try to signal to the person in acute distress that this is as upsetting to you as it is to them. Try and help them understand that you are on their side to help calm them and the situation overall.
Conclusion
De-escalating a crisis situation is not easy. It can be challenging to know how to help. Teepa is an expert in reading and solving situations similar to this. But even without being an expert, there may be things you can do to help.
By removing the perceived threat and signaling to the person that you are just as upset as they are, you may help the person no longer feel alone. By helping them calm down and building their trust, you may be able to help de-escalate the situation. By following some of these steps, you may be able to build or protect the relationships that are so critical and precious in dementia care.
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Positive Approach to Care
Positive Approach to Care (PAC), founded by dementia care educator Teepa Snow, offers caregiver education through effective hands-on care skills and techniques.
Interested in learning more? Visit www.teepasnow.com/blog.
