Third Party Advantage

Third Party Advantage

One would presume that the person (spouse or adult child typically) closest to the person with dementia would have the best success at getting her/him to do something that is normal and should be done, such as eating.  But that is not what normally happens.  A caregiver barely known to Beverly is more likely than I to succeed with nearly any instruction or effort to get something done.  Examples include eating, visiting the bathroom, going to an event (such as music), and changing clothes.  This is called the “Third Party Advantage,” meaning that a person other than me or her (the Third Party) is more effective at helping or getting compliance. Beverly does not want me to tell her what to do, help her with eating, and the like.  On the surface, it is peculiar, but it is not as strange as it seems.

            We have all seen something like this with children; sometimes the parent is less effective than a grandparent, an aunt, or even a family friend.  Children get tired of their parents ordering them around and start to resist.  With dementia, the problem is confounded because the person who is being told or directed fails to think as clearly as a young child does.  Most of us, if we were having trouble eating, would be happy to have our spouse be helpful, if needed; and that would not bother our ego.

            She never liked to be told what to do and always preferred to do things herself.  So this is not extraordinary for her.  She is the perfect target for the Third Party effect.  What is striking is how widespread it is. 

            For most of the time that she has been in this facility, she has resisted my helping her with food.  In particular, she does not want me to put food on a utensil and put it in her mouth.  Any staff caregiver or visitor can do that for her without a negative reaction.  And this presents an extra complication when going out to eat; in a restaurant the process of eating results in various “messes.”  There is food on her clothing, scattered on the table and floor, and on her fingers and face. It would certainly be easier if I could just feed her.  But frequently that cannot happen.

Eating ice cream with fingers is a funny example, one which has happened many times.  It does seem strange that she would rather eat ice cream with her hand than have me help her by using a spoon to scoop up and deliver ice cream to her mouth.  

For a chuckle, imagine yourself in this situation; your loved does not manage the process of using a spoon for ice cream, so she/he starts using fingers to scoop up some ice cream, leaving messes on fingers, clothing, table, and floor.  You make every effort to get her/him to eat it with a spoon you have and will use, but this is not accepted.  At first, you are embarrassed, as I was.  But then it seems kind of fun and even funny to watch “eating ice cream with fingers.”

Staff can generally help with eating for a meal in the dining room, but this is all complicated by the reality that each staff caregiver has a number of people to manage for a meal and can’t feed everything to each of them.  Thus eating all of a meal may sometimes not happen.

            And, no surprise, telling her what to do is among the difficult aspects as well.  Many spouses have long dealt with that issue.  Even with a normal spouse:  How do you tell him/her what you want them to do?  Being too direct may be taken as impolite, even controlling:  “Close the door.”  Of course, there are variations in this regard.  But, with dementia, even “Let’s go to lunch” may be treated as something NOT to do.  A staff member (or other Third Party) can almost always succeed.  Similarly taking Beverly’s hand and heading off to lunch can be difficult, perhaps seen by her as controlling.

            Of course, for me or for staff, it is critical to avoid doing too much for Beverly and others with dementia.  Being helpful when they can do it themselves can be a mistake;  we should try to maximize their functioning.  And their capabilities change over time, slowly deteriorating.  Staff caregivers generally try to understand the right level of help for each person and avoid intervening too much.  And, when the issue is eating, staff are not embarrassed by the mess that sometimes happen with eating.

Happily in more recent times, as she has moved into advanced Alzheimer’s, the issue of my helping her with eating has lessened, perhaps reflecting her increasing loss of awareness of who I am.  Recently (before covid) she has been more willing to have me help her with eating, especially when we are at a restaurant.  

When she needs to go to the bathroom, I would have to find someone in the facility who can find the caregiver assigned to her (I likely do not know who is assigned at the moment) and free that person to take her.  It would seem easier to just take her myself.  Admittedly, bathroom visits are more personal and spouses don’t ordinarily do that.  Yet things are not ordinary here.  Similarly changing clothes and putting on pajamas is also best managed by getting someone else to do it.  Of course, as someone said, “That’s what we are paying the big bucks for.”  Yet I did not mind doing any of that when I was there.  But the “Third Party” is typically more successful.

Knowing about “Third Party Advantage” is not a major or complex bit of knowledge, but it is something one would not automatically know.