Putting on Your "Thinking Hat" While Making Decisions for A Loved One with Dementia

Dorian Martin Health Guide
  • I know that at times, family members can drive you crazy. In my case, my father has a tendency to be critical at times; my brother is very analytical, always spouting off data on any subject; and I tend to be generally intuitive in my thought process. Having various family members rely solely on these specific thinking styles can quickly lead to disagreements which, if you’re not careful, can turn into outright warfare when making caregiving decisions for a loved one with Alzheimer’s disease.

    So what can you do to avoid this clash? One possibility is to take a look at the concepts addressed in “Six Thinking Hats,” a book by Dr. Edward de Bono, who was a university scholar and who has consulted for many international corporations. De Bono suggests that six different thinking styles are often used in making a decision. He describes each of these styles by using the metaphor of a hat of particular color:

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    -    White hat – This hat is neutral and objective, concerned with facts and figures.
    -    Red hat – This hat is the emotional view.
    -    Black hat – This hat represents the “devil’s advocate” and is careful and cautious.
    -    Yellow hat – This hat is sunny and positive, and involves identifying what would need to happen to put an idea into practice.
    -    Green hat – This hat focuses on creativity and new ideas.
    -    Blue hat – This hat is the organizing hat, often worn by the facilitator.

    Looking at this list, I can see that my dad’s natural tendency is to always wear the black hat when we’re having a discussion. My brother often responds in the white hat mode. I, on the other hand, usually utilize the red hat approach.  And naturally, by only “wearing” these respective hats, we end up with a clash of ideas and some hurt feelings. Instead, De Bono suggests that if everyone involved in making a decision uses the same color of hat at the same time, the group can more easily focus on the current situation, look at the data, brainstorm pros and cons, develop new ideas, and determine how to move forward.

    So here’s a scenario of how it could play out in a caregiving situation. First of all, we would need one person to continually “wear” the blue hat (the facilitator) to keep everyone from falling back into their natural thinking modes and to keep the conversation moving forward. Additionally, markers and chart paper can be helpful in capturing the information that comes up during one “hat” feedback session. Therefore, you’d have six pieces of chart paper, one per hat color.

    So let’s say the topic for discussion was about moving my mom to a different nursing home. My father, brother and I would spend time metaphorically wearing the same color of hat at the same time so we all would respond in the same thinking style. All comments would be written on a piece of chart paper so that we had a record of our conversation and could see how the thinking progressed. Here’s an abbreviated version of some of the potential salient points of the conversation:

  • -    White Hat (information) – Number of times that Mom’s oxygen tank was empty when we visited; the state rankings for the nursing homes that are under consideration; the cost of the new nursing homes; the proximity to our homes; staffing patterns at current nursing home as well as the potential ones; responsiveness by staff at the current nursing home; the impact of previous moves to Mom’s health.

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    -    Red Hat (feelings) – “I like the activity director at Mom’s current nursing home.” “The other nursing home has a ‘homier’ feel.” “Mom would feel alone at the new nursing home.”
    -    Black hat (identifying deficiencies in thinking process) – “Mom doesn’t participate in many activities since her attention span is so limited and she often needs a nap when the activities are taking place.” “Mom doesn’t remember people she meets ten minutes after meeting them so she won’t have any concept of being alone in a new place.”
    -    Yellow hat (putting the idea into practice) – Identifying what would need to happen for Mom to remain at the current nursing home. Identifying what would need to happen to move Mom to a new nursing home.
    -    Green hat (identify new ideas, options) – “Mom could come live at my home and we could hire a nursing service to help her.”
    -    Blue hat (facilitator) – “We now have three options on the table – keep Mom in the same place, move her to a different nursing home, or move her to Dorian’s home. Do we need to go back through the Thinking Hats process to look at the new option identified when we got to the Green Hat section? Or are we ready to determine which approach is the most feasible based on the information that we’ve gathered thus far?”

    If properly facilitated, this approach can provide a safe environment to help each person put ideas, emotions and concerns on the table. It also can help the group really probe the different facets of potential decisions and safely come to consensus about what is the best caregiving decision both for the loved one and for the family members. Taking care of a loved one with Alzheimer’s is hard enough by itself, so adding family strife about caregiving decisions to the mix can be especially brutal.  That’s why I think the Thinking Hat approach can help families make informed decisions while helping them maintain good relations throughout the decision-making process.

Published On: March 22, 2010