Best Friends Approach to Dementia Care, Second Edition

Second Edition

By Virginia Bell, M.S.W., and David Troxel, M.P.H.

ISBN 978-1-932529-96-8
264 pages
6 x 9 paper
© 2017


Training available!

Successfully implement this relationship-centered approach to dementia care that builds on the essential elements of friendship—respect, empathy, support, trust, and humor.

For decades the acclaimed Best Friends™ approach has been widely recognized for helping people with Alzheimer’s and other dementias experience meaningful engagement and dignity in all aspects of their lives. In this completely revised and expanded second edition, care partners learn how to apply the core principles of the approach through practical tips and instructive examples of Best Friends in action. An all-new section also provides a roadmap for creating and sustaining a Best Friends program.

Become familiar with:

  • The building blocks of the approach, including the Dementia Bill of Rights and the concept of relationship-centered care
  • The core tenets of Best Friends: the Life Story, skilled communication, and caregiving Knack
  • New approaches to minimizing challenging behaviors and to creating activities that produce true engagement
  • How to use Best Friends in a variety of care settings
  • Effective ways to involve families and volunteers
  • An approach that’s embraced around the world!

Make each day reassuring, enjoyable, and secure for the people in your care with this simple, compassionate approach to dementia care.

Format: E-book
e-ISBN 978-1-938870-63-7

E-book available through:

Also available through: Baker and Taylor, OverDrive, Gardners, and Follett

About the Authors
Preface: Our Best Friends Journey

PART 1. The Best Friends™ Approach

  1. Starting with the Person: The Life Story and Human Rights
    • Life Story of Rebecca Matheny Riley
    • The Best Friends Dementia Bill of Rights
  1. Introducing the Best Friends Approach
    • Building Blocks of the Best Friends Approach
    • How Friendship Works in the Context of Dementia Care

PART 2. Best Friends in Your Care Setting

  1. The Life Story
    • Preparing the Life Story
    • Ingredients of the Life Story
    • How to Use the Life Story
    • Best Practices for Enhancing Preparation of the Life Story in Your Dementia Program
  1. The Best Friends Approach to Communication
    • How Best Friends Communicate
    • Communicating Skillfully
  1. The Knack
    • Elements of Knack
    • Knack in Dementia Care
  1. The Calendar Is Just the Beginning: Celebrating Activities with Engagement
    • The Purpose of Activities
    • Activities versus Engagement
    • Activities Done the Best Friends Way
    • Getting Started Putting Your Knack to Work
  1. Best Friends and Behavior That Is Challenging for Staff
    • Empathy Is the Key
    • Creative Problem Solving to Address Behaviors in Dementia
    • Intimacy and Sexuality in Dementia
    • Protecting Yourself from Aggression
    • Avoiding Judgmental Language
    • Bring It All Together: Patricia Estill

PART 3: Creating and Sustaining a Best Friends Program

  1. Being a Best Friend to Family Care Partners
    • Family Caregiving and Dementia
    • Supporting Families
    • Encouraging Early Use of Services
    • Best Friends Approach to Family Interactions
  1. Growing a Volunteer Program
    • Effective Volunteerism
    • Steps to Starting a Successful Volunteer Program
    • Involving Student Volunteers and Interns
  1. Creating and Sustaining Your Best Friends Program
    • Steps for Creating a Best Friends Culture
    • Sustaining Your Best Friends Program
    • Bringing It All Together: Americare
  1. Conclusion
    • Informed Love
    • Looking Ahead
    • Thank You For Sharing Our Journey

Suggested Resources

The Best Friends Approach t… by on Scribd

Virginia BellVirginia Bell, M.S.W., was one of the most influential thought leaders in the field of dementia care over the last four decades, who continued right up to the time of her passing in 2023 to improve the lives of people with dementia and their caregivers. Her Best Friends™ model of dementia care transforms attitudes in care institutions and among families about a debilitating disease. An author, speaker, and advocate, her work has profoundly influenced the lives of untold individuals, and her Best Friends approach to dementia care continues to be adopted world-wide by care programs.

She lectured widely on Alzheimer’s disease at national and international conferences, speaking at the National Education Conferences of the Alzheimer’s Association and lecturing at the conferences of Alzheimer’s Disease International. She has published journal articles and book chapters, notably in Dementia Care: Patient, Family and Community (John Hopkins, 1989). Many of her articles have been reprinted numerous times: “The Alzheimer’s Disease Bill of Rights” (1994), “The Other Face of Alzheimer’s Disease” (1999) and “Spirituality and the Person with Dementia” (2001), co-authored with David Troxel and published in the American Journal of Alzheimer’s Disease and in Alzheimer’s Care Quarterly. She has also co-authored six books with David Troxel, beginning with The Best Friends Approach to Alzheimer’s Care. She received her M.S.W. from the University of Kentucky in 1982.

David TroxelBased in northern California, David Troxel, M.P.H., is nationally and internationally known for his expertise in the fields of dementia & long-term care. He has co-authored (with Virginia Bell) six influential books, including his newest book, and written numerous articles relating to dementia care and staff development and training. He is a writer, trainer, and long-term care consultant who has spoken at over 500 conferences including keynote presentations at various U.S., Canadian, and international conferences. He served for a decade as the Executive Director of the Santa Barbara (California) Alzheimer’s Association (1994-2004). He also helped support his mother, Dorothy, in her 10-year journey living with Alzheimer’s disease. David’s areas of expertise include best care practices for persons with dementia, caregiver support, staff training, and long-term care program development. More information about David’s work can be found on his website at or on Facebook at 

16 reviews for Best Friends Approach to Dementia Care, Second Edition

  1. Administrator

    The Best Friends Approach, Second Edition, is a joy to read. It touched my heart. At the same time, it was practical, offering clear ways to implement all aspects of this extraordinary program. Being a Best Friend is so uncomplicated when you understand that this simply means you know the person’s Life Story and the importance of the process for providing care, not just how to complete the task. This book should be ‘must reading’ for care partners, both professional and family. So often, friends are not prepared to continue a relationship with someone with progressive memory loss, and sharing this book with them will help ‘old friends’ continue to be Best Friends. Living with memory loss can be a very frightening journey, but when surrounded by Best Friends who help you continue to engage in life and continue to remind you that you are a very special person, the journey is not quite so frightening, and can still have many moments of joy.”
    —Joyce Simard, M.S.W.
    Author, The End-of-Life Namaste Care™ Program for People with Dementia, Second Edition
    Geriatric Consultant and professional speaker
    Associate Professor, Western Sydney University

  2. Administrator

    “Best Friends™ is helping to establish ourselves as a center of excellence in dementia care throughout our region.”
    —Dan Lavender
    President and CEO, Moorings Park, Florida

  3. Administrator

    “Every Wednesday afternoon for the last 31 years, a person with dementia and I have been Best Friends at our amazing adult day program. Virginia and David’s approach has helped me feel blessed over and over as I’ve forged so many friendships. And the program really works, attracting volunteers and building a fantastic day of activities and engagement. Our day center participants, I hope, have felt known, loved, and valued, as have I.”
    —Linda Rector
    Volunteer, Best Friends Day Center, Lexington, KY

  4. Administrator

    The Best Friends Approach has been our guide to help understand the huge impact we can have on the lives of persons living with dementia. Being present and accepting their reality is life affirming, not only for the person but also the family and staff. Virginia and David have changed the history of dementia care in our country since Best Friends will be included in the Dementia Strategy of Hungary!”
    ―Zsuzsa Kovacsics M.S.W.
    Administrator, Máriaremete Nursing Home, Budapest, Hungary

  5. Administrator

    “Two decades ago, Bell and Troxel’s Best Friends™ approach affirmed the primary importance of relationship in supporting well-being for people living with dementia. It is great to see this thoughtful update of a classic and time-honored model for engagement and care.”
    —G. Allen Power, M.D., FACP
    Board-certified geriatrician, dementia advocate, and author of Dementia Beyond Drugs, and Dementia Beyond Disease

  6. Administrator

    “The Best Friends books have become our go-to resource for ideas and inspirations about quality dementia care. This new edition raises the bar as it challenges us to develop authentic relationships, meaningful activities, and create outstanding programs.”
    —Dina Newsom
    Expressions™ Product Manager
    Prestige Senior Living, Vancouver, WA

  7. Administrator

    “Think of the penetrating, dense isolation of the dwarf planet Pluto. It parallels the chilling isolation of dementia—engulfing feelings of loneliness, loss of self, fears that you have not a friend in the world. I know the landscape well. Virginia Bell and David Troxel, in their inspiring book, The Best Friends™ Approach to Dementia Care, have shown me the way home, and given me new confidence that I am not alone, that I don’t have to fight Alzheimer’s myself; that I just have to learn to dance with it. Bell and Troxel are partners who can lead.”
    —Greg O’Brien, author, On Pluto: Inside the Mind of Alzheimer’s

  8. Administrator

    “The Best Friends philosophy is perfect for home care settings and beautifully supports the Home Instead Senior Care® network’s To Us, It’s Personal® philosophy. Professional caregivers embracing this approach spend time with the client enjoying old family scrapbooks, gardening, walking to a neighborhood park and engaging in meaningful connection and conversation. The result is a win-win for all involved. The person with dementia benefits from this loving approach and the professional caregivers, including our network’s CAREGivers℠, can help manage the challenges of dementia with wisdom and creativity.”
    —Jeff Huber
    President & CEO, Home Instead, Inc.

  9. Administrator

    “Troxel and Bell’s deeply encouraging, effective, and enduring methods have improved the quality of life for people with dementia around the globe through the universal foundation of friendship. Their respectful, affirming, and applied wisdom transforms that act of caregiving into the art of care-partnering and I heartily recommend this bright gem of a book to anyone needing a light along the dementia path.”
    —Lisa Snyder, MSW, LCSW
    University of California San Diego
    Author of Speaking Our Minds: What It’s Like to Have Alzheimer’s

  10. Administrator

    “The Best Friends philosophy has changed the face of dementia over the last two decades leading the way to honoring the person’s journey, creating a rich and worthwhile life, and supporting family and professional care partners with education and expanded services. This new edition of Best Friends will teach you everything you thought you already knew.”
    —Amelia Schafer, MS
    Vice President of Programs
    Alzheimer’s Association of Colorado

  11. Administrator

    “Congratulations on the 2nd edition of The Best Friends™ Approach to Dementia Care! It is an excellent resource for professional caregivers in a variety of care settings—long-term care, home care, day programs, assisted living, and acute care, and also for family caregivers. It is a beautifully written and well-crafted training tool that provides accurate and current information about dementia, latest research on triggers for responsive behaviors, and the power of personalized music, skillful communication, and meaningful engagement in resolving these behaviors. The pictorial representation of standard approach versus Best Friends approach and the difference in outcomes, with the stories of success in the sidebars, not only makes it easier for the reader to have a deeper understanding of the approach, but also help retain readers’ interest. The chapters on growing a volunteer program, and creating and sustaining a Best Friends program, offer a rich array of effective strategies for ‘Best Friends communities’ facing staffing issues and limited resources to build and sustain caring communities. Based on my experience as a Master Trainer of the Best Friends approach, I strongly recommend this book as an essential resource for anyone and everyone working in a care setting.”
    –Padma Genesh, BSc, MBBS, BA (Gerontology)
    Learning Specialist
    Learning and Support Services
    Alzheimer’s Society of Calgary

  12. Administrator

    “Alzheimer’s Disease International (ADI) works around the world to raise awareness of dementia and promote the importance of care and support for persons with dementia. Virginia and David’s Best Friends philosophy, rich in relationships and engagement, and respectful of human rights, provides a lasting foundation for dementia friendly communities and quality care.”
    –Marc Wortmann
    Executive Director
    Alzheimer’s Disease International

  13. Administrator

    “Virginia Bell and David Troxel are long-time advocates of using the personal history of people with dementia to build relationships and engage them in meaningful activity. Their ideas have benefited families and professionals worldwide who are working to find ways to enhance quality of life. Being a Best Friend is one of the ways to foster cooperation and success, preventing or minimizing behavioral outbursts. As dementia specialists—counselors, trainers, and authors—we have found the Best Friends approach to be extremely helpful in reducing behavioral challenges.”
    —Beth Spencer & Laurie White, co-authors, Coping with Behavior Change in Dementia: A Family Caregiver’s Guide

  14. Administrator

    “Whether your program serves six persons with dementia or six hundred, this new edition of Best Friends will become an invaluable resource. In addition to its practical tips for quality dementia care, the book offers insights into how you can obtain staff buy-in, implement your ideas, and sustain a great program over time.”
    —Tom Cullen
    CEO & Owner
    Community Care Options

  15. Administrator

    “We embrace the Best Friends philosophy in all our Life Guidance® memory care neighborhoods across the United States. This new edition of the classic Best Friends book is full of contemporary best practices and practical tips for successfully navigating the challenges of dementia care. It will be a valuable resource for our staff as we encourage relationships and meaningful activities to create a successful day.”
    —Tom Alaimo
    Vice President
    Memory Care Operations (Life Guidance®)
    Atria Senior Living

  16. Administrator

    “This book goes right to the foundation of person-centered care with practical solutions and basic knowledge for creating not just a program but a lifestyle to staff members caring for people with dementia. This book teaches staff how to help people with dementia have a quality of life, not just existence…. A great tool for healthcare staff involved in the day-to-day routine care for residents with dementia.”
    Doody’s Review Service

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“An outstanding guide for anyone involved in the care of individuals with Alzheimer’s disease. The Best Friends™ method is an innovative, sensitive and unique approach that can greatly improve the quality of life for patients with the most devastating disease known to man.”
William R. Markesbery, M.D., past director, Alzheimer’s Disease Research Center and Sanders-Brown Center on Aging, University of Kentucky

“Bell and Troxel … argue persuasively that the proper metaphor for organizing our thinking in this area is not the distant clinical reserve of the professional but the open and engaged warmth of a best friend… [They] have written powerfully about this in their book.”
William H. Thomas, M.D., founder, The Eden Alternative

“Using the Best Friends approach … caregivers are provided with a wide range of practical tools and strategies for how to deal with the many challenges of coping with this difficult disease.”
Ken Dychtwald, Ph.D., CEO and founder of Age Wave

“The Best Friends book is my ‘go to’ resource for helping families and professionals caring for persons with dementia… [It] can turn around behaviors that are challenging, support good communication, and help care partners create a successful day.”
Elizabeth Edgerly, Ph.D., chief program officer, Northern CA & Northern NV Alzheimer’s Association

“I recommend the Best Friends approach to all my support group members. It’s so easy to understand and implement. The book is a great daily reference and a ‘caregiver bible’ that everyone should have.”
Rose Mary Jacobson, Community Outreach Coordinator, Alzheimer’s Association, Desert Southwest Chapter, Las Vegas, NV

“Our caregivers embrace the Best Friends™ philosophy every day, knowing that good care is about relationships and doing creative things together. This new book offers hundreds of life-affirming, creative ideas that family and professional caregivers can use at home. Highly recommended!”
Buck Shaw, Home Instead Senior Care, Sacramento, CA

“The authors’ approach contains a humanity and warmth that I wish could be present in every instance when a person with Alzheimer’s receives care.”
Wendy Lustbader, M.S.W., author of Counting on Kindness: The Dilemmas of Dependency

“Virginia Bell & David Troxel are leaders in the field of aging. Their words will offer caregivers new ideas and new hope as they face the challenge of Alzheimer’s disease and dementia.”
Gloria H. Cavanaugh, former President & CEO, American Society on Aging

“The Best Friends™ philosophy … has been adopted as a model throughout Maine and has become one of our most valuable caregiving resources. We’ve seen it in action and heartily recommend it!”
Eleanor Goldberg, past Executive Director, Maine Alzheimer’s Association

“Embracing the activity principles in the Best Friends model has helped us to capture the very essence of how activity programming should be for person-centered care. Our residents and staff have responded so positively to the Best Friends program that we have made Best Friends our road map to achieving excellence in dementia care.”
Jill Hess, L.M.S.W., A.C.S.W., former Vice President, Organizational Development, Heritage Community of Kalamazoo, Kalamazoo, MI

“A must read for all those who care for people with dementia. A Dignified Life is well written, packed with effective and practical advice, and full of humanity. It shows that there is much that can be done to help make the lives of both caregivers and people with dementia better and more fulfilling. I give it a 5-star rating.”
David Snowdon, Ph.D., Author of Aging with Grace and Director of the Nun Study

“Caregivers can easily become overwhelmed by the daily challenges facing them. The Best Friends approach will give you simple, easy to learn tools that can make the most daunting problems seem easier to cope with. I highly recommend this book.”
Elaine St. James, Author of the international book series, Simplify Your Life

“As a neurologist, I dream about the day that we will find a cure for Alzheimer’s disease. Until that time, the Best Friends approach is here to give families practical tools for bringing out the best in persons with Alzheimer’s disease. This is a well-written, insightful book that gives caregivers a life-affirming, practical framework for approaching this difficult disease. I recommend it to my patients and their families.”
Donna Masterman, M.D., Assistant Clinical Professor, Neurology UCLA Medical Center, Clinical Core Director of the UCLA Alzheimer’s Disease Research Center

“Thousands of families have read this book. By putting into practice what they learned, they have discovered that much can be done to improve the lives of their loved ones.”
Lilia Mendoza, Founder, Federación Mexicana de Alzheimer


“Innovative and refreshing due to the relaxed and natural ‘hands on’ approach – an empowering book that proves one can enjoy life after a diagnosis of Alzheimer’s disease.”
Aging & Society (on The Best Friends Approach to Alzheimer’s Care)

“One of the first, and still one of my favorites [positive, uplifting books on Alzheimer’s disease] … easy to grasp and always respectful of the person with the disease.”
Alzheimer’s Care Quarterly (on The Best Friends Approach to Alzheimer’s Care)

“Here at last are two compassionate, humorous, experienced authors [Bell and Troxel] who say it’s time to stop being morbid and negative about AD. …It’s the best training guide for families and professionals in print.”
Wiser Now (on The Best Friends Approach to Alzheimer’s Care)

“[Bell and Troxel] have laid out a way of relating that is immediately accessible to all involved in dementia and a policy and programme for service provision. …Here is an initiative that is easy to understand and is within the immediate capacity of each of us to deliver.”
Journal of Dementia Care (on The Best Friends Approach to Alzheimer’s Care)