nursing home in the south of France, for
example, the residents prepare appetizers
for a Sunday afternoon get-together
each week. Everyone in the village is
invited, as well as the residents’ family
members and other people they know.
So each weekend the residents have to
go to the market to shop, come back
and prepare the food and then serve and
entertain their guests when they come
by. Everyone loves these little parties and
has a wonderful time.
So, again, this method is a wholly
different approach. It’s about being
connected with life. And that’s the sort
of model we teach — we want everyone
to live the Montessori values of respect,
dignity and equality.
What are some of the challenges
of adapting the Montessori
Method for adults with dementia?
The biggest challenge is that the older
models of care are very embedded in the
system. You have to work to get past all
the assumptions of how dementia care
should be done.
These older models include the
hospital model where the assumption is
that the person with dementia is diseased,
so your priority is to treat the symptoms
because dementia can’t be cured. The
emphasis is to deliver medications, keep
people safe and not allow them to leave
without a doctor’s orders. These people
are often called “patients” and they are
treated like they’re sick.
Another popular model is that of
a hotel, where people are guests for
life and everything is done for them.
They don’t have to worry about doing
anything. But that model doesn’t work
so well either. Because you do not live
in a hotel, you stay in a hotel. And who
wants to stay in a hotel indefinitely?
People want to live in their homes.
As Maria Montessori once said,
“Everything you do for me, you take
away from me.” So that’s a central
assumption in our model. We want
them to do for themselves. And that’s
a key assumption that changes the
nature of jobs. It changes the nature
of the relationship between the person
with dementia and the individuals that
provide care. Instead of doing for them,
they are helping people with dementia
to do for themselves, whether it’s getting
dressed, serving meals or some other
A nursing home in Neuchâtel,
Switzerland, that has adopted our
approach has totally new guidelines for
staff. It’s not the hospital or the hotel
model of old. It’s a new model that
assumes the staff are guests at these
people’s homes. And the staff need to
act that way. It’s a very different way of
thinking with a fundamentally different
set of assumptions of the roles, the
responsibilities and what constitutes
success for treatment and care.
The Montessori approach is
very well respected, yet it has
not been adopted by the public
school system in the United
States. Is adopting it for dementia
care the same?
It’s exactly the same problem. And it all
boils down to a single issue: Giving up
control. What we do in our training is
teach people how to create a residence
that is driven by the people who live
there. And we always talk about giving
up control to the residents. That’s very
hard for many people because they want
to be in control.
It’s the same in a school system. The
first Montessori school was called the
Children’s House — and it was their
house. The idea was that a teacher’s job
was to enable the children to do things
for themselves and just step back and let
them. That’s what constituted success.
And that’s a very foreign concept to
people who like regimentation in these
kind of institutions.
You’ve said you wanted to
change expectations about what
people with dementia are capable
of. How can you do that?
We haven’t tested the upper boundary of
what a person with dementia is capable
of doing. We certainly know the lower
boundary. We need to create a very
different environment for dementia
care — an environment that any one
of us would want to live in. And people
who have started down our path have
seen persons with dementia create
photography clubs, do improvisational
theater, train puppies from rescue
shelters, learn how to use chopsticks, put
on musicals and really engage with life
and the community around them.
The boundaries that are put on
persons with dementia are those of
our imagination. They are based on
untested assumptions so it’s simply a
question of starting from a different set
of assumptions. We know that a person
with dementia can learn new procedures.
Procedural learning and memory
remains intact. So the first question
should be, “What procedures would you
like persons with dementia to learn?”
The second question should be, “What
procedures do they want to learn?”
Your work dovetails nicely with
new studies that link successful
aging to independence,
engagement and activity in life.
So why, in your opinion, aren’t
more long-term care facilities
taking a different approach to