By Jane Verity © dementiacareinternational
Issues surrounding money are a common occurrence for people who have dementia and their carers, often resulting in frustration for everyone involved.
These challenges can be experienced in different ways;
A. A strong urge to go to the bank to take out money
B. Making purchases over and above their usual habits
C. A strong need to check transactions in their bankbooks
D. Constantly checking their wallet/purse
E. Repetitively counting their money
F. Hiding money about the house
G. Accusing others of stealing
H. Misplacing bills in unusual places
I. Bills/accounts not being paid
These scenarios of uncharacteristic behaviours can be of concern to those caring for a person with dementia. The good news is that a constructive way to address these challenges is following three simple steps.
1. Shift your Focus From What You are Experiencing to the Experience of the Person with Dementia
Once a person has been diagnosed, it can have a profound impact on their self-identity. They may lose their job or role, withdraw from regular social networks, and may have given up on coping with everyday activities such as keeping appointments or paying bills. They experience a loss of status, control and power.
2. Identify the Underlying Unmet Emotional Need Behind the Behaviour
The person with dementia may have several unmet emotional needs such as to feel worthy and valued, which will in turn boost self-esteem and identity. The person with dementia may compensate in a symbolic way by focusing on that which represents wealth, self-worth and status. These emotions can be symbolically expressed through an amplified emphasis on money, jewellery, or even bundles of keys. The more the person has lost their sense of identity and worth, the stronger these behaviours will occur.
3. Implement Solutions that Directly Meet the Particular Emotional Need/s
Repeated trips to the bank or uncharacteristic large purchases and repeatedly checking their bankbook or counting money enables the person with dementia to experience the feeling that they can pay their way and that they have status and worth. Money represents power.
One solution is to ensure the person always has cash money at hand. For the person with dementia, it may be of greater importance to have a large quantity of coins and bills rather than the monetary value of each note. Coins that are physically large may also be more valuable to a person with dementia than smaller coins
Hiding money around the house is often a symbolic action representing that the person with dementia wants to preserve what is left of their worth and their identity placing it in a safe place where no one can find it and take it away.
A powerful solution is to boost the persons self esteem by focusing on all that can be appreciated and sincerely thanking them for the things or simple tasks they do
Whilst it may seem unfair and unfounded, the primary carer is often the person on the receiving end of an accusation of stealing. To understand how this can happen, it is necessary to shift your focus from your own point of view to the experience of the person with dementia. If the person with dementia interprets that the primary carer has contributed to their experience of losing control, they may express their frustration symbolically by accusing them of stealing their money – their self-worth. Avoid arguments, as this will only escalate the situation.
Address the person’s unmet emotional needs by enabling them to feel needed and useful, to have their self-esteem boosted, and identify any roles they can still fulfill, no matter how small. You could experiment with simple solutions such as enabling the person to have input into their daily menus, ask for their opinion on purchases, request help wherever possible, or give the person receipts to check if they are still able.
Misplacing accounts or bills is often a different matter for the person with dementia who may simply want to clean up and put the bills away. However, as the ability to keep things in a logical order may have been forgotten, immediate environmental cues may trigger a desire to place it anywhere there is space. This means that if they open a kitchen drawer and there is surplus space, the bill may end up with the utensils or with the socks in the sock drawer.
A simple solution may be that you as the carer gather the accounts in a manner respectful to the person with dementia and keeps them in a logical and safe place.
Unpaid bills represent a more tangible underlying cause that the person may no longer be able to connect a due date on a bill with taking an action to pay the account.
A relatively easy solution is to organise for regular utility accounts to be paid by direct debit with the person’s financial institution. It is important to present this change of payment to the person with dementia in an extremely respectful way. You could express it this way, ‘The accounts seem to be coming in from everywhere making it hard to keep track. What if I organise for regular payments and then neither of us has to worry?’ The power of using these exact words is that the focus is moved from the person’s inability to pay bills to making the amount of bills the problem, thereby preserving the person’s self-esteem. Using the term, ‘What if,’ implies an offer of a service that leaves the person with dementia in control.
A helpful Hint
Caring for a person with dementia is a unique experience as every individual in every situation is different. What works one day may not work the next and what works for one family member may not work for another. As their carer, you are the one who knows the person with dementia the closest and trial and error is often the best tool to discover which solution will work.
About this Approach
Shifting our focus to the unmet emotional needs of the person with dementia and the symbolic significance of their behaviour is the key to identifying practical solutions that dissolve challenging behaviour. This approach is one of the core elements of the Spark of Life Concept.