Implementation of a person-centered approach.

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Implementation of a person-centered approach.

Karlskoga, Sweden
Project Stage:
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

The aim in Karlskoga Municipality: The dementia care will be based on VF / Validation ® by Naomi Feil, to create a person-centered care.

About Project

Problem: What problem is this project trying to address?

The person with dementia disease has as a result of the disease, severe difficulties in using as well as understanding verbal forms of communications. Living with dementia may mean that the person is in a life that can be rather fragmentary, where it’s difficult to experience wholeness and meaning. The cognitive impairment in dementia effect the person's ability to communicate with its environment, social activity and functional abilities in daily life. The chaos that occurs can lead to lower self-esteem, becomes frightened, anxious or feel threatened. Dementia is a complex illness that requires that the staff have a lot of knowledge. There is a risk that a mainly task-oriented and routinized nursing care, will lock in even more securely the individuality of each person in that emotional and psychosocial functions will be in disclosed. By supporting the person’s experience of wholeness and meaning through elaboration of the environmental conditions, the interactions and the caring activities the care could improve.

Solution: What is the proposed solution? Please be specific!

The word validation means confirmation and a validating caregiver confirms that the feeling the person with dementia experience is true. The method involves an attitude and certain principles based on theoretical assumptions within the field of humanistic psychology. In addition, methods for categorizing behaviors and thus divide the people with dementia in four phases. The method also includes advice on appropriate techniques for communicating at various stages and situations. The validating caregiver use both verbal and non-verbal communication. Even reminiscence, music, touch, and activity (so called sensory- and memory stimulation) is included and is used to facilitate communication with the person and to catch up on clues and thus help him / her to channel and express their feelings. To achieve the goal, equal basis of values requires the training and supervision of staff in all occupational categories in the method. In Karlskoga there are approximately 30 certified Validation workers of staff in all occupational categories. A Validation worker has always carried this attitude to their work and they also serve as an inspiration to colleagues. The idea is that there should be certified validation worker in all dementia care units within the municipality. In the current situation, we have four people who have moved on to Validation Group Practitioner. We have also an ongoing course in Validation Group Practitioner right now.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

The underlying causes of the behavior of a person with dementia may be deficiencies in one or more of basic human needs. If the Validation Worker understand the need behind the behavior, it is easier to show more empathy for the person who validated. It's evening and Arne is angry and threatening to staff. He has penetrated the staff in a corner of the kitchen, blocking the road and their fists and shouting "I'll kill you you bastards." Validationsarbetaren Stina hears this and approaching. She takes care of Arne's arm with one hand and say. "What you're angry, Arne! What has happened? "First, he does not care about Stina, but directs his anger towards her. When Stina repeats his question, "You're so angry Arne! Want to tell us what made you so angry? Then he calms quickly and says "It's not you I'm mad at." Stina asks "John, can you tell me what made you so angry?" Arne says, "Do you know where Elizabeth is?" Stina confirms the feeling by asking "Do you miss Elizabeth?" John said, "Yes, she's my wife" . "Yes, I know it," answers Stina. "You want to tell me about her? "When Stina helps Arne to express his regret for his wife and confirm his feeling he will become calm.

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

In the current situation, all municipalities’ performance based grants when introducing a computerized record investigates the Behavioral and Psychological Symptoms of Dementia. Staff must attend a course in the registry. It will provide advice on some activities that can reduce these symptoms. The staff should also make a plan for interactions with the person. This will be monitored continuously. The problem I see with this is that the work with the registry does not give knowledge about interaction with people with dementia. They only focus on the symptoms of a possible bad interaction. What I know is the Validation Worker Course the only training available in person-centered care in Sweden.
About You
About You
First Name


Last Name


Implementer(s) and cooperation partners

Karlskoga Municipality, Sweden


Public body

Country where main implementer is located

, OR, Karlskoga

How long has the main implementer been operating?

More than 5 years

Please provide a short description of the main implementer.

Maria Hedman (Degree of Master( with a major in Nursing Science) is the projektleader and has been that since year 2000.
We have a steering committee for the development of Validation in our municipality. The group includes Maria Hedman as project leader, a Manager of one nursing home (Carl-Henrik Lindén) and one elderly care manager in our Municipality(Lisa Kihl). The steering committee will decide on the further development of the method in the municipality.
There is also a working group which includes Maria Hedman and three other certified Validation Workers.

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Cooperation partner

Rita Schwarz


Private company

How does this cooperation partner support the initiative? What competencies and resources does this partner bring to the initiative?

The teatcher we use and she is also our discussion partner in our in our efforts to develop VF / Validation ® by Naomi Feil

Cooperation partner

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How does this cooperation partner support the initiative? Which competencies and resources does this partner bring to the initiative?
Cooperation partner

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How does this cooperation partner support the initiative? Which competencies and resources does this partner bring to the initiative?
Cooperation partner

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How does this cooperation partner support the initiative? Which competencies and resources does this partner bring to the initiative?
Problem and solution
Which of these fields of Active and Healthy Ageing are addressed by your initiative?

Assisted daily living.

If none of the above, answer here:

improve daily life, improve preparedness to handle demanding situations and not least in order to provide a quality care for peo

Please describe if and how your stakeholders (cooperation partners, funders, users, etc.) have been participating in defining the problem and developing the solution.

In the late 1990s, one nursing home in Karlskoga developed a set of values for the quality of life of the nursing home. They took part of nursing research, talked with families and the local dementia association. Then the staff estimated their own ability to achieve the various objectives. It turned out to be some areas that needed to be strengthened. One such area was to improve the interaction with people with dementia.
This was the beginning of the first 6 people certified in the method in the municipality in 2003. Because the nursing home got a reputation for being able to interact with people with dementia in a good way. This led to more people wanted to become Validation worker. Karlskoga municipality sought government stimulus funds to continue development of the method, starting in 2005.
When the “National Guidelines for care in dementia” came in 2010, we made a survey of the development needs in dementia care. Based on the survey, plans for implementation of the guidelines were made and then begin implementation. The survey showed that all groups felt it was important to continue to develop the person centered care in the municipality.

Has your solution been tested in trials, experimentations, or pilot projects? If yes, please describe the process and outcome.

From 1 June 2006 - 31 March 2007 there was a pilot study, "VF / Validation ® as a communication method of care for people with dementia" at one nursing home. Projectleader was Kirsti Skovdahl, Örebro University and Gunilla Fahlström who was then the R & D leaders at the Regional Council of Örebro. Issues with the pilot study:
Is validation an effective method of communication in the care of people with dementia?

There is not enough space to describe the process

Six people moved in to the unit and took part in the pilot study during the investigation. It was difficult to complete the study as planned. One result was that they could reduce the psychotropic drugs that the people with dementia had when they move in to the nursing home.

How long has your solution been in operation?

for more than 5 years

Please select the relationship between your solution and related solutions currently established in our society. Is your solution…

substitutive (your solutions is substituting existing solutions because they do not meet needs or solve the problem appropriately)

What barriers might hinder the success of your initiative? How do you plan to overcome them?

It always takes time to change already-established practices and there are always people who are less enthusiastic about the changes. What we have tried to this date is that there should be some Validation Workers on each nursing home for people with dementia in the municipality. It has been shown that if there is only one or two trained on a nursing home, then the distribution to the other staff becomes a little more difficult.
For that reason, we want to try to make one unit to Validation Unit where 75 % of the staff is Validation Worker. This unit will open in early 2014.
We would also like to start a dementia care team, where there is only certified Validation Workers. In the current situation, there is no economy to start this.

Organization and funding
Regularly paid employees

six persons





External advisers and experts


Others (please specify)


What are the specific professional backgrounds and competencies your team brings to the initiative?

We in the working group are one registered nurse, one occupational therapist and two nurses who are trained 2 years in VF / Validation and available in the organization. We are a multidisciplinary team that supports the implementation of person-centered care at the nursing homes in the municipality

Please describe your management or coordination structure in the initiative.

As project leader since 2000 in the development of VF / Validation ®, I am the one who has been in charge of organizing various activities based on our action plan, which among other things has been: 5 Validation Worker courses, 2 Validation Group Worker course, supervision of certified validation Workers 2 times per year, introductions to staff, spread knowledge of the method to other municipalities, participating in two conferences, arranging Workshop with Naomi Feil (2006 and this year), support for the various units in their implementation of the method.

Please provide the total yearly budget in Euro that your initiative spends on implementing the solution.

Do not know this in the current situation.

National public funding


European Union public funding


Economic return from own products/services


Foundations and philanthropy capital


Single donations from private individuals


Donations from private companies


Crowdfunding platforms


Participation fees


Other (please specify)


Target group, scale and impact
Which target group(s) do you want to reach with your solution?

Primarily, it is a development locally in Karlskoga Municipality. We also want staff in dementia care in other municipalities should have the knowledge of the method. In the end, it is the person with dementia who shall meet competent staff, when they need more care in their daily living.

Please estimate the number of persons within your target group (users, clients, etc.) that you currently reach directly with your solution.

All staff in dementia care in Karlskoga Municipality, approximately 400 staff.

In which local/regional/national area(s) is the solution currently implemented?

Besides us in Karlskoga, there are approximately 150 Validation Workers spread across Sweden. even in europe and U.S

What is the impact on your target group (users, clients) you want to generate?

According to Naomi Feil and our experience you can see that VF / Validation ® help people with dementia. Changes in behavior are slow and fluctuating from day to day, but permanent changes occur. These are some of the effects that can occur:
• They sit more upright
• Increased social control
• Less screaming, walking, thumping (repetitive behaviors)
• Less aggressive
• Reduced need for chemical and physical restrains
• Increased verbal and nonverbal communication
• Less withdrawal
• Increased self-esteem
• Increased awareness of reality
• revitalized sense of humor

What is the wider impact on society you want to generate?

Better dementia care. According to “the national guidelines” which came in 2010, the person-centered care in dementia care is important. No one has developed such a comprehensive person-centered concept that Naomi Feil.

What are the impacts on your target group you already achieved?

This is a process that is constantly evolving. Where we have certified Validation Workers we have seen changes as listed above. Since we started with Validation, the awareness of daily activities based on individual preferences and abilities increased a lot. Even certified Validation Workers feel safer in difficult encounters with persons with dementia and job satisfaction is higher.

How has the impact of your initiative been assessed?

Experience-based self-assessment (you assessed the impacts based on your experiences with the target group), Feedback-based self-assessment (you assessed the impacts based on feedback from the target group without using specific methods).

Public information and strategy
What information on your initiative is publicly available?

Mission and strategy, Organisational structure, Working method and 'theory of change'.

Please indicate webpage or contact for obtaining the respective information.
What are your milestones for further developing, implementing, and establishing your initiative in the next three years? Please describe 1-3 milestones.

In 2013, filmmaker Bjorn Mathlein will complete a film about VF / Validation, designed for SVT and recorded in Karlskoga. The film follows municipal validation Workers in meetings with persons with dementia.
In addition to continuing the work already begun, we will also:
Develop a validation Unit - In early 2014 - 75 % of staff on one unit will be certified Validation Workers
Arranging a Validation Teacher course during 2014
Develop a dementia care team with personnel who are or will train to become a Certified Validation Workers