Best Friends Staff

Building a Culture of Care in Alzheimer’s Programs

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

ISBN 978-1-878812-63-6
296 pages
7 x 10 paperback
© 2001


The Best Friends™ approach to Alzheimer’s care has taken the field by storm and is changing the lives of people around the world. It improves the quality of life not only for clients with Alzheimer’s disease but also for the staff providing care.

Virginia Bell and David Troxel are recognized internationally for their innovative work helping people with Alzheimer’s disease. Now, they’ve applied their years of experience to a training approach geared to help your staff achieve better outcomes and more rewarding experiences—and help you retain an effective, satisfied staff.

Read stories and ideas from real staff in facilities worldwide who are already implementing the Best Friends approach with their residents. Get the inspiration and working tools to transform your care culture:

  • hundreds of case studies illustrating successful programs
  • creative ideas you can use to implement change
  • a training toolkit in each chapter that features learning exercises, activities, games, and resources
  • proven advice on staff training and retention

Help your staff make every day consistently reassuring, enjoyable, and secure for people with Alzheimer’s disease, and more rewarding for themselves.

Training Tool Kits (Contents)

The Best Friends Model

  • Staff with Knack: Being Well Informed
  • Having Empathy
  • Respecting the Basic Rights of the Person
  • Maintaining Caregiver Integrity
  • Employing Finesse
  • Knowing It Is Easier to Get Forgiveness than to Get Permission
  • Using Common Sense
  • Communicating Skillfully
  • Maintaining Optimism
  • Setting Realistic Expectations
  • Using Humor
  • Employing Spontaneity
  • Practicing Patience
  • Developing Flexibility
  • Staying Focused
  • Remaining Nonjudgmental
  • Valuing the Moment
  • Maintaining Self-Confidence
  • Using Cues that Are Tied to the Life Story
  • Taking Care of Oneself
  • Conclusion

Staff Recruiting, Training, & Development

  • A Day in the Life of a Skilled Nursing Facility Administrator
  • Recruitment and Hiring: Potential Employees
  • When Staff Fail
  • Training and Retention: Training Programs that Do Not Work—The Old Idea Care Center
  • Training Programs that Work—The New Idea Care Center
  • Ideas for Training Programs that Work
  • Conclusion
  • Training Tool Kit

Medical & Scientific Basics

  • What Does the Word Dementia Mean? Is It the Same as Senility?
  • What Is Alzheimer’s Disease?
  • What Is the Difference Between Alzheimer’s Disease and Normal Age-Associated Memory Loss?
  • What Are the Related Irreversible Dementias?
  • What Are the Most Common Irreversible Dementias in Older Adults?
  • What Are the Related Reversible Dementias?
  • Should Everyone Who Has Symptoms Get a Thorough Diagnosis?
  • Are All Persons with Alzheimer’s Disease Alike?
  • Can Alzheimer’s Disease Be Inherited?
  • Can Alzheimer’s Disease Be Prevented?
  • How Can Excess Disabilities be Prevented?
  • Do Sudden Changes Suggest Problems Other then Alzheimer’s Disease?
  • What Is the Role of Psychotropics and Other Drugs?
  • Resources for the Best Friends Staff
  • Conclusion
  • Training Tool Kit

The Experience of Alzheimer’s Disease

  • When Staff Don’t Get It
  • The Best Friends Way
  • To Know Someone, You Must Walk a Mile in His or Her Shoes
  • Person-Centered Care Is Central
  • Losses Caused by Dementia Can Evoke a Wide Range of Distressing Feelings and Emotions
  • Persons With Dementia Can Experience Joy, Love, and Happiness
  • The Feelings of Persons with Dementia Are as Real as Yours and Mine
  • Behaviors that Seem Out of Place Are Not
  • Feelings and Behaviors Can Be Changed by Meeting the Needs of the Person
  • Conclusion
  • Training Tool Kit

Assessment & Expectations

  • Why Assessments Often Fail
  • The Best Friends Assessment: Review Physical and Mental Health
  • Review Cognitive Health
  • Assess Who the Person Is
  • Assess the Care Environment
  • Emphasize Remaining Strengths
  • Do Not Overemphasize Stages
  • Individualize Care Plans
  • Assess Frequently as a Caregiving Team—Persons Vary from Day to Day
  • Assess Combative Behavior Carefully
  • Set Realistic Expectations
  • Share Information with Families and Other Visitors
  • Conclusion
  • Training Tool Kit


  • Friends Know Each Other’s History and Personality
  • Friends Do Things Together
  • Friends Communicate
  • Friends Build Self-Esteem
  • Friends Laugh Together Often
  • Friends Are Equals
  • Friends Work at the Relationship
  • Friends Show Love and Affection
  • Friends Can Overcome Social Barriers
  • Conclusions
  • Training Tool Kit

The Life Story

  • Every Program Should Obtain a Person’s Life Story Before Admission
  • The Life Story Should Be Accessible to Staff and Volunteers
  • Every Dementia Care Program Should Have on File a Written Life Story on Each Member or Volunteer
  • Use the Life Story to Greet the Person and Improve Recognition
  • Use the Life Story to Introduce and Reintroduce Residents to Individuals Around Them
  • Use the Life Story to Reminisce About the Person’s Life
  • Use the Life Story to Provide One-to-One Comforting Care
  • Use the Life Story to Improve Communication Through Clues and Cues
  • Use the Life Story to Improve Activities
  • Use the Life Story to Point Out Accomplishments
  • Use the Life Story to Prevent Challenging Behaviors
  • Use the Life Story to Incorporate Past Daily Rituals
  • Use the Life Story to Broaden the Caregiving Network with Volunteers
  • Conclusion
  • Training Tool Kit


  • Check the Environment
  • Remember the Basics of Good Communication
  • Use the Person’s Preferred Name
  • Make a Good First Impression
  • Keep Language Simple
  • Ask Questions Using Discretion
  • Employ Good Timing
  • Be Conscious of Nonverbal Communication
  • Do Not Argue With or Confront the Person
  • Remember that Behaviors Communicate a Message
  • Treat the Person as an Adult
  • Use the Life Story Often
  • Maintain Caregiving Integrity
  • Respond to the Persons’s Emotional Needs
  • Screen Out Troubling Messages or News
  • Speak Using Positive Language
  • Employ Humor
  • Turn “No” into “Yes”
  • Do Most of the Work
  • Conclusion
  • Training Tool Kit

Being Together Using Best Friends Activities

  • An Activity Philosophy
  • Purpose of Activities
  • The Art of Activities Is Not in What Is Done; It Is in the Doing
  • Activities Should Be Individualized and Tap into a Person’s Past Interests and Skills
  • Activities Should Be Adult in Nature
  • Activities Should Include Pets and Other Animals
  • Activities Should Recall a Person’s Work-Related Past
  • Activities Should Stimulate the Five Senses
  • Doing Nothing Is Actually Doing Something
  • Activities Should Tap into Remaining Physical Skills
  • Activities Usually Are Initiated by Others
  • Activities Should Be Voluntary
  • Everyone Can Still Engage in Some Form of Activity
  • Intergenerational Activities Are Especially Desirable
  • Activities that We Think Will Never Work Sometimes Do
  • Activities Should Appeal to the Staff as Well as to the Person
  • Personal Care Is an Activity
  • Activities Can Be Short in Duration
  • Activities Can Happen Day or Night
  • Activities Can Fill a Spiritual Need
  • Activities Are Everywhere
  • Conclusion
  • Training Tool Kit

Caregivers as Members of the Best Friends Team

  • The No-Clue Day Center
  • The Best Friends Way
  • Understand that the Definition of “Family” Is Changing
  • Remember that Each Family’s Response to Alzheimer’s Disease Is Unique
  • Realize that Placement Does Not Always Make Things Easier, Only Different
  • Share a Defined Philosophy of Care with Families
  • Believe that Most Families Are On Your Side
  • Create a Care Plan for Families
  • Never Give Advice
  • Involve Families in Care Decisions and in the Program
  • Develop Honest, Effective Dialogue
  • Handle Conflict Appropriately
  • Encourage Use of Services
  • Help Families Recast Relationships
  • Conclusion
  • Training Tool Kit


  • Invest in Staff
  • Treat Staff with the Same Respect that Good Programs Give Their Residents or Participants
  • Recognize that Staff Have a Desire to Be Part of a Caring Community
  • Give Staff the Tools that They Need to Build Effective Job and Life Skills
  • Involve Staff in Decision Making
  • Recognize that Leadership is Vital to a Program’s Success
  • Encourage Staff to Be Involved with Residents and Participants Through Group and Individual Activities
  • Assign a Best Friend to Each Staff Member
  • The Best Friends Model as a Tool for Change

Notes and References
Appendix A: Programs Featured in The Best Friends Staff
Appendix B: Professionals Featured in The Best Friends Staff
Appendix C: Suggested Resources for Trainers

The Best Friends Staff: Bui… by on Scribd

Virginia Bell, M.S.W., has lectured widely on Alzheimer’s disease at national and international conferences, speaking at 11 National Education Conferences of the Alzheimer’s Association and lecturing at the last 16 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 four books with David Troxel, most notably The Best Friends Approach to Dementia Care.

Virginia is currently the Program Consultant for the Greater Kentucky and Southern Indiana Chapter of the Alzheimer’s Association. She received her M.S.W. from the University of Kentucky in 1982.

David Troxel, M.P.H., has become nationally and internationally known for his writing and teaching in the fields of Alzheimer’s disease and long-term care. He has co-authored four influential books (most notably, The Best Friends Approach to Dementia Care) on Alzheimer’s care as well as numerous articles relating to Alzheimer’s disease care and staff development and training.

His latest book on activities was published in 2004. David received his Master’s Degree in Public Health from UMDNJ, Robert Wood Johnson Medical School (formerly Rutgers Medical School) in 1986.

David is a past Executive Board member of the American Public Health Association and is a member of the Ethics Advisory Panel for the United States Alzheimer’s Association. He currently serves as a Program Consultant to the Alzheimer’s Association California Central Coast Chapter in Ventura, Santa Barbara and San Luis Obispo Counties.


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