Photo credit Pixabay/Pexels
by Bonnie (Zhi) Dong
I’m grateful to my placement supervisors and field education coordinator for encouraging my reflection on this experience—not just for my professional development, but also in the hope that it may offer insight and encouragement to student colleagues navigating dementia care.
Starting Off with Uncertainty
When I began my first field placement at the Veterans Centre in January 2025, I felt both excited and nervous. I had trained with the Alzheimer’s Society of Toronto, but this was my first direct experience with clients living with dementia. I was unsure what to expect or how I would connect with the residents.
My supervisors suggested it would be a valuable learning opportunity to start with weekly supportive visits (30-60 minutes each) to my first client, over the next five months. He is a Navy veteran in a cognitive support unit and is experiencing cognitive decline. He displays responsive behaviors such as confusion, restlessness, and exit-seeking, meaning that more focused care and psychosocial support are required. This experience would also help me learn to build rapport and develop a therapeutic relationship with him in a long-term care setting.
During my first visit, I noticed a photo of him on his door. A few items stood out in the image—his cap and his glasses. I gently commented, “Nice cap—you look sharp!” He smiled. It wasn’t a big moment, but it gave me something to start with.
However, his behavior was alarming to me. I struggled when he kicked at doors, tried to leave the unit, or wandered into other residents' rooms. I joined him on walks, but often felt uncertain about how to respond. One afternoon, he sat restlessly with a coloring sheet. I suggested using blue. When he reached for that color, his expression softened slightly. That moment stayed with me.
From Discovery to Ocean-Themed Therapy
In the following weeks, I continued to seek ways to foster meaningful engagement. My supervisor mentioned that the resident had loved fishing as a child. As a nature lover myself, I took in magazines featuring birds, animals, and peaceful outdoor scenes. He engaged with them a little. It wasn’t dramatic, but it was enough to encourage me to keep trying.
One day, I received a magazine with a warship on the cover. Recalling his Navy background, I brought it up during my next visit. The cover immediately caught his attention. I had a feeling—this could be his “window,” a chance for me to connect with him and explore more together! I began flipping through the pages, showing images of people’s stories about serving on the ships. He remained engaged for quite a while, even pointing to a ship and exclaiming, “We are there!” and “We had that!” It struck me that perhaps he saw people who reminded him of himself. I had met him where he was, although it was a point from the past.
During another visit, he appeared restless. I gently invited him into the activity room and brought out an ocean drum. At first, he didn’t know where to sit and wandered around uncertainly. I tilted the drum slightly, which created a soft, wave-like sound. His attention shifted. I said, “Do you hear that? It’s the ocean.” He paused, listened, then took the drum and rocked it gently himself, making the wave sound over and over. His body softened. He looked calmer. In that moment, I met him where he is—in the present.
That moment became the heart of what would grow into my creative, ocean-themed engagement approach. I began weaving in nautical colors that comforted the eyes, sea imagery that stirred memories, rhythms that soothed the ears, and stories that resonated deeply within him. This multi-sensory connection helped him feel grounded in something familiar, even when words didn’t come easily.
I was learning to let him guide our interactions—whether stepping into the world he once lived in, or simply being present with him in how he was at that moment. I could feel his strengths and emotions, both in his memories and in the present. Connection with clients can take shape in the most unexpected ways.
Moments That Mattered
As the visits continued, I began to realize the importance of small personal routines. One day in April, I found him without his cap and glasses, and he seemed more withdrawn than usual. I gently guided him back to his room and encouraged him to put them on. “We’re a cap-and-glasses team,” I commented with a smile. He chuckled, and once those familiar items were back in place, he appeared more at ease.
Another time, I noticed a coloring page that said, “Smile More.” At first, he didn’t remember it, but when I pointed out the colors and read the phrase, he smiled. I asked, “We’re gonna smile more, okay?” He laughed—one of those warm, simple moments.
Of course, there were still challenges. Once, he hurt his toe by kicking a door. I didn’t know how to respond at first, but the next time it happened, I lightly touched his arm and asked, “Are you feeling pain in your toe?” He chuckled and replied, “I know.” After that, the kicking seemed to happen less.
And there was the day he wandered toward another resident’s room. This time, I gently guided him back, pointing to the photo on his door: “This is your room. You see yourself smiling?” He looked at the picture, repeating, “I’m smiling.” That brief moment of recognition felt like something we had slowly built together.
Theory in Practice
Looking back, I recognize how several theories were shaping my approach during our interactions:
- Person-centered dementia care taught me to view the resident’s responsive behavior not as something to fix, but as ways of expressing needs—especially his need for movement, freedom, and autonomy.
- Ecological systems theory reminded me to see how the environment influenced his behavior. The unit’s locked doors and structured routines were important for safety, but they also seemed to increase his restlessness at times.
- Trauma-informed care guided me to be gentle, consistent, and mindful of how my tone and presence impacted him, always working on creating a sense of emotional safety.
- Gentle Persuasive Approach (GPA) equipped me with practical tools that I used regularly—a soft voice, calm body language, visual cues, and respectful redirection.
Rather than applying these theories as a checklist, I found that they offered me a deeper understanding of my clients and my methods, helping me feel grounded even in unpredictable situations. I also realized that using them eclectically, as appropriate to his presentation in the moment, was the most effective application of the theory into practice, rather than working solely from one theoretical base.
Advice for Student Colleagues
Start small, and stay curious.
You don’t need to begin with a perfect plan. What helped me most was paying attention to small cues that indicated the client was responding well—a moment of eye contact, a shift in posture, or a smile at a specific color or image. These little signals can serve as powerful entry points, especially when working with clients who may struggle with communication or emotional regulation.
Let creativity guide you.
Whether a client is living with dementia, cognitive impairment, or mental health challenges, creative approaches often open doors when traditional methods fall short. The ocean-themed engagement I developed wasn’t planned—it grew from observing what sparked joy or calm, and continuously building on that. Tailoring our approach to the client’s strengths and needs isn’t just helpful—it’s essential.
Don’t take disengagement personally.
What works one day might not work the next, and that’s okay. One day, I had fishing videos, and he barely reacted. Instead of pushing him, I invited him to sit with me in the solarium to enjoy the sunshine. He didn’t say much, but he seemed content. That experience reminded me that flexibility and patience go a long way. As well, remember the importance of the social worker meeting the client where they are, without imposing a focus on the client.
Be present.
Some of the most powerful moments occurred when I stopped trying to act or fix things, but rather focused on “being there.” He didn’t always remember my name, but I believe he remembered how I made him feel, and that is the essence of what matters.
Closing Thoughts
I didn’t begin this placement with a polished toolkit. I started with curiosity, nerves, and a willingness to learn, to grow, and to risk. Over several months, with support and reflection, I found ways to connect with clients who are fairly challenging to engage with—not through grand interventions, but through creativity on my part, through rhythm, repetition, and genuine presence.
The ocean-themed approach wasn’t a planned method. It naturally emerged between us. It reminded me that even in the face of memory loss, connection is possible—especially when we invite our clients to guide us.
For me, that is the heart of social work—listening closely, paying special attention to client cues and presentation, being flexible in approach and adapting gently, and allowing space for connection to take shape.
Resources
Alzheimer Society Toronto – Dementia Care Training Recommendations: https://alz.to/health-care-professionals/ast-courses-programs-for-healthcare-professionals/
Alzheimer Society Toronto – GPA® in Dementia Care: https://alz.to/health-care-professionals/ast-courses-programs-for-healthcare-professionals/gentle-persuasive-approaches-paid/
Alzheimer’s Association – Dementia Care Practice Recommendations: https://www.alz.org/professionals/professional-providers/dementia_care_practice_recommendations
Bonnie (Zhi) Dong is a Master of Social Work student at the University of Toronto in Ontario, Canada. She completed her field placement at the Veterans Centre, Sunnybrook Health Sciences Centre, in May 2025, where she worked with older adults in long-term and complex hospital care.