The End-of-Life Namaste Care Program for People with Dementia By Joyce Simard, M.S.W.

Excerpted from Chapter 2 of The End-of-Life Namaste Care Program for People with Dementia by Joyce Simard, M.S.W.

Copyright © 2007 by Health Professions Press, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

What is Namaste Care?

The word namaste, pronounced "nah-ma-sta," is a Hindu greeting often used in the United States by yoga instructors as a farewell to students at the end of class. Two hands are pressed together and held near the heart with the head gently bowed as the person says, "Namaste. Go in peace." The word namaste expresses a wish to "honor the spirit within" and was selected as the name to describe a special way of caring for nursing facility residents with advanced dementia. As the Namaste program evolved, "Care" was added to the name to describe the many ways that Namaste team members provide services and programming to residents and their families. Thus, the name of the program has officially become Namaste Care.

Namaste Care is designed to honor the spirit of nursing facility residents who have reached the stage of their disease in which they are no longer able to speak, walk, think, and reason. Namaste Care philosophy supports the belief that the spirit of residents with advanced dementia continues to live. We see the spirit in residents' eyes, their smiles, and their response to a loving touch. This is the spirit that is undaunted by disease, the spirit beyond the disease. It is the essence of a person.

Namaste

I honor the place in you

in which the entire Universe dwells,

I honor the place in you

which is of Love, of Truth, of Light and of Peace.

When you are in that place in you,

and I am in that place in me,

we are One.

Namaste Care supports the belief that each resident is unique, like a finely woven tapestry. During each stage of the disease, more threads of the tapestry are unraveled, and the fabric of each individual's life fades. When residents with advanced dementia reach a state in which they can no longer relate their life history, their personhood is compromised.

Namaste carers take pride in knowing each resident in their care and individualizing their care to each person. Namaste carers review the resident's social history; they speak to the resident's family members and friends to learn the resident's likes and dislikes. Namaste carers also share information with each other about the residents. Thus, Namaste Care team members feel a strong bond with residents in their care. Residents are respected as individuals. Care approaches are tailored to make interaction between Namaste carers and residents personal.

The staff members who provide care are given a unique title, Namaste carer, which recognizes and respects their unique knowledge and training. With the expectation that what we learn from Namaste Care will be reflected in the care received by all people with Alzheimer's disease (AD), the term care partner is used in place of nursing assistant for the remainder of this book. It equalizes the relationship between two parties and reminds all staff members, Namaste carers included, that they should always treat residents as individuals who, whenever possible, deserve to be offered choices and to be involved in their own care.

Namaste Care began as a day program of sensory activities. Residents were transported to the Namaste Care room for the entire day or part of the day. While in the room, residents were offered a variety of sensory activities by Namaste carers. Later, the program was expanded to include food and beverages; residents with advanced dementia are at risk of weight loss and dehydration and seem to enjoy taking nourishment in the Namaste Care room. Families began to enjoy visiting in the Namaste Care room as team members would give ideas on how to make their visit more enjoyable. At this stage of their disease, many residents do not recognize their loved ones. Family members say that their visits are more enjoyable when they can do something for their loved one, so they are offered ideas on how to make their visits special. For example, some family members like to feed their loved ones ice cream, others are given lotion to massage into their loved ones' hands.

Eventually, the original Namaste Care program expanded to an entire wing with a private room for the actively dying resident and his or her family. After-death care became a part of the services offered, and Namaste Care kept "blossoming."

When hospice members saw Namaste Care in action, they expressed a desire to bring their patients to the Namaste Care room and learn ways to provide meaningful activities for residents with advanced dementia. Pleas from other units in the nursing facility to include their residents in Namaste Care gave the impetus to put together a movable Namaste Care cart, which became fondly known as Namaste a la Carte.

It became apparent that Namaste Care could be provided in many settings, including assisted living communities, hospice houses, and family homes. Namaste Care can be provided by anyone who understands its philosophy and the comfort care approaches used. Most Namaste carers who have worked with the program find that activity ideas just flow when they focus on using sensory-based techniques. Anyone who can express love, offer a gentle touch, and be present for people who are embarking on the final stage of life can be a Namaste carer. 

This book focuses on implementing Namaste Care in nursing facilities because this is the final home for many people with advanced dementia. As AD progresses, it becomes more and more difficult for family members to provide care in the home; likewise, assisted living communities are often not able to provide the level of care needed.