A strengths-based perspective on dementia care, hospice conversations, and the importance of recognizing preserved abilities.
Over years of working with people living with dementia, I began noticing a pattern that deeply impacted the way I viewed dementia care.
In many situations, conversations about hospice or end-of-life care began very quickly.
Often, the focus centered almost entirely on decline:
what the person could no longer do,
what had been lost,
and how the condition would continue to progress.
What I heard far less often was discussion about what abilities might still remain.
I want to be very clear:
Hospice absolutely has an important and valuable place in healthcare and dementia support.
This article is not anti-hospice.
But I do believe that in dementia care, conversations can sometimes move toward end-of-life thinking before retained abilities, meaningful engagement, and strength-based approaches are fully explored.
That realization became one of the driving forces behind the creation of the Preserved Abilities Method™.
What Still Remains Matters
One of the things I have learned over the years is that people living with dementia often continue to retain meaningful abilities far longer than others expect.
Sometimes those abilities are obvious.
Sometimes they are subtle.
But they are often still there.
A person may no longer communicate the way they once did…
yet still respond deeply to music.
A person may struggle with memory…
yet still thrive when routines and structure are aligned to retained strengths.
A person who appears withdrawn may suddenly become engaged when communication approaches, environments, or activities align with preserved abilities.
When care focuses entirely on decline, these opportunities are often missed.
A Conversation I Will Never Forget
Years ago, a nurse once told me she would not want me working with her clients because I would “keep them alive.”
That statement stayed with me.
Not because I viewed myself as preventing death or opposing hospice care…
but because I realized how differently we were viewing people living with dementia.
I was still seeing engagement.
Still seeing responses.
Still seeing retained strengths.
Still seeing opportunities for comfort, dignity, and quality of life that others may have overlooked.
Over time, I encountered multiple situations where families were encouraged to begin thinking about hospice because it appeared there was very little quality of life remaining.
But in some of those situations, once preserved abilities were identified and supported, things changed.
Not cured.
Not restored to who they once were.
But more engaged.
More connected.
More responsive.
More successful within daily life.
Sometimes communication improved.
Sometimes distress decreased.
Sometimes families felt they had their loved one back in meaningful ways they thought were gone forever.
One Daughter’s Experience
Ericka Clausen of Englewood, Florida shared an experience that perfectly captured this reality.
She was told by a home care agency that her mother had end-stage dementia and should be placed on hospice. Nearly every conversation focused on what her mother had lost.
But Ericka believed there was still more there.
Instead of focusing entirely on decline, she began using the Preserved Abilities Method™ to identify her mother’s retained strengths and use them to guide communication, engagement, and daily care.
According to Ericka, everything changed.
“Care became easier. She became more engaged. And she seemed happier.
Years later, she’s still here. Living with dementia… and still enjoying life.”
— Ericka Clausen, Englewood, Florida
One part of her story has always stayed with me:
“Everything they shared focused on what she had lost. Nothing about what she could still do.”
That sentence captures the heart of why the Preserved Abilities Method™ was created.
The Risk of Focusing Only on Decline
Dementia is progressive.
There is no denying that reality.
But progression and decline are not the only realities.
Quality of life matters.
Connection matters.
Comfort matters.
Meaningful engagement matters.
And many people living with dementia continue to retain abilities that can still support those things far longer than others expect.
When care focuses only on what has been lost, people are often unintentionally limited further.
But when caregivers begin identifying and supporting retained abilities, the entire direction of care can sometimes change.
Not because dementia disappears.
But because the person is finally being supported through what still remains instead of being viewed only through what has been lost.
The Smallest Ability Can Change Everything
Not every person will improve dramatically.
Not every situation will avoid hospice.
And not every outcome will change.
But I believe people living with dementia deserve every opportunity to have their retained abilities recognized and supported before they are viewed only through loss.
Sometimes the smallest preserved ability becomes the doorway to:
- meaningful engagement,
- reduced distress,
- improved communication,
- comfort,
- dignity,
- and connection.
And sometimes, recognizing what still remains changes the entire direction of care.
Learn more about the Preserved Abilities Method™ at https://preservedabilities.com/