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FEATURE|VERA FRAMEWORK|CARING FOR PEOPLE WITH DEMENTIA
VERA Framework
Caring for people with demen a
with insight from Rebecca Bristow RGN, Winterbrook Nursing Home
It is only when someone close to us is diagnosed with demen a that we gain an insight into what ‘living with demen a’ really means to the person, their family, caregiver, or health and social care provider. Finding out that a rela ve or friend has been diagnosed with demen a can be heart­ breaking. It’s a  me when you need to remain posi ve and focus on how they were with you before the demen a; this will help you and will help your ‘loved one’ too.
Nothing prepares you for those moments, when you visit your ‘loved one,’ at home or in a care se ng, only to find that they are unable to recognise you, or chat to you like they did before. For all involved, it can be a bewildering and disconcer ng experience.
For the health professional, trying to find answers to the myriad of ques ons you have posed to them, may also be overwhelming for them. They are doing their best to assess the person in their care; they may not have all the answers straightaway, but will work towards finding the best outcome for your ‘loved one’.
What was usual before is now very different. You can see that your ‘loved one,’ is physically with you, you can hug them, kiss them and talk to them, but they’re not as they were. You crave a sign from them, but none comes, then a glimmer, a flee ng moment of lucidity and an acknowledgement, tears come when they look at you, then nothing, back to walking, or moving invisible things around in the air. You are le  bere , lost in thought about past  mes with them and wondering what do next. Pa ence, love and respect for their dignity is what is needed now. Learning to communicate differently with your ‘loved one’ is the way forward.
There are tools and  ps, which family members and care providers can use to help them become more effec ve communicators. The most important being observa on and ac ve listening (see pages 26­29).
As a family member, try using these techniques it is important they are used in an open non­ threatening environment. How you behave when you are listening can enhance and encourage communica on, or shut down it altogether.
If you are looking a er a person with demen a, you may find that, as the illness progresses, you'll have to start discussions to get the person to make conversa on. This is common, as their ability to process informa on gets progressively weaker and their responses can become delayed.
It's important that you encourage the person to communicate what they want in whatever way they can. Remember, we all find it frustra ng when we can't communicate effec vely, or are misunderstood.
When someone has difficulty speaking or understanding, try to:
• Be pa ent and remain calm, which can help the
person communicate more easily.
• Keep your tone of voice posi ve, warm and
friendly.
• Talk to them at a respec ul distance to avoid
in mida ng them – being at the same level or lower than they are (for example, if they are si ng) can also help.
• Pat or hold the person's hand while talking to them to help reassure them and make you feel closer – watch their body language and listen to what they say to see whether they're comfortable with you doing this
Try using non­verbal communica on:
• Although it may seem that most communica on happens verbally, research has shown that non­verbal communica on has more of an impact.
• Non­verbal communica on occurs through an individual’s body language.
• Observa on can play a part too, align your body language with theirs, this may help them to feel comfortable in their environment.
Just as family and friends learn how to communicate when living with someone with demen a, so too does the health or social care professional. Fortunately, there is much evidence­based research and training available for health and social care professionals to assist them in their professional prac ce. One such tool is the VERA framework.
Rebecca Bristow, RGN ­ Winterbrook Care Home writes: “By learning about the VERA framework, I have gained a be er insight into how to communicate with ‘people living with demen a’. I feel more confident in my prac ce and support residents with demen a, to feel safe and reassured in their environment”. I also think that the VERA framework may benefit caregivers and families too.
What is the VERA framework?
The VERA Framework was specifically developed for health professionals working with people who have demen a. This useful tool describes a stage­ by­stage process of communica on, that helps professionals to respond in a sensi ve and compassionate manner. The VERA (Valida on, Emo on, Response, Ac on) validates that all communica on by the pa ent is meaningful, and that every interac on can be validated whether it is verbal or non verbal.
Valida on, emo on, reassurance and ac vity are the core concepts of the framework. By u lising each concept together, professionals are able to acknowledge what the person living with demen a is saying, then respond to the underlying emo on and offer an ac vity to underpin the reassurance.
VERA is a cycle of interven ons that can be broken into four stages:
V ­ Valida on
E ­ Emo on
R ­ Reassurance A ­ Ac vity
Valida on: explana ons for acts of behaviour or communica on that value a person and avoid nega ve and unhelpful assump ons that create barriers to engaging with them.
Emo on: understanding and engaging with the emo onal content of communica on even when the words used make less sense.
Reassurance: an act that intends to communicate that a person is safe.
Ac vity: doing something with the communica on between oneself and the person, such as working further to engage with and join meaningfully with the person, or learning from the interac on about what is helpful and
what is not.
 VERA in prac ce
Valida on, Emo on, Reassure and Ac vity Jean is walking about and asking for
her mum (who died many years ago)
VERA Stage
Relevance
Response
Valida on
Gives value
to a person’s behaviour, rather than just blaming ‘the demen a’
“You are looking for your mum Jean?”
Emo on
Pays a en on
to the underlying emo on being communicated
“You sound worried”
Reassure
Using words or ac ons to
give renewed confidence that the person is safe
“You are safe here Jean”
Ac vity
Engaging the person in a more structured ac vity to offer
a degree of occupa on and maintaining their sense of iden ty
“Come and help me take these cups to the tea trolley”
VERA devised by Blackhall et al (2011)
       At the core of the VERA framework are crea ve personal interac ons making a connec on with the person ‘living with demen a’ that are compassionate and kind. Let us make those last two words our watchwords as we journey together with someone ‘living with demen a’.
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