Naomi Feil, Who Transformed Dementia Care, Dies at 91

Caregivers, struggling to help people with dementia, often see their role as offering scraps of reality—reminding them what year it is, for instance, or who is in the White House.

Naomi Feil had a different strategy. As a social worker in nursing homes, she resisted the impulse to yank disoriented people back to her reality. Instead, she sought to enter their realities and affirm their emotions. Rather than offering a cup of tea or chirping that everything would be fine, she helped her charges express their anger and sorrow—and found they often were more at ease afterward.

Feil died Dec. 24 at her home in Jasper, Ore. She was 91.

In the 1960s and 1970s, Feil devised what she called the validation method for dementia care. She wrote books, led workshops and established 24 validation-training centers in 14 countries.

Feil’s ideas have become fundamental to what is now called person-centered dementia care, which focuses on discovering individual needs and preserving dignity rather than following standard routines, said Sam Fazio, a senior director of the Alzheimer’s Association. In such care, he said, “You’re meeting them in their reality versus expecting them to meet us in our reality when they are no longer able to do that.”

Fleeing the Nazis

Much of Feil’s insight reflected her own history. When she was 4 years old, her Jewish family fled Nazi Germany. They eventually settled in Cleveland, where her father was the administrator of a nursing home, which doubled as living quarters for her family. Some of her earliest friends were very old people. Late in the evening, she sometimes sneaked out with an elderly lady for ice-cream sodas at a nearby drugstore. Eventually, they were caught, and the escapades ended.

As a social worker in the 1960s and 1970s, she developed her methods through trial and error. While working at the home managed by her father, she met a retired lawyer who was always angry and claimed that Feil’s father tortured him in the home’s attic. Feil took the man up to the attic to show him it was no torture chamber. This reality check failed to calm the lawyer’s rage. Later, she learned from a family member that, as a boy, he had been locked in an attic by his own father as a punishment.

One day she joined him in cursing the shortcomings of fathers. It helped that she resented her own father’s authoritarian ways. After venting, they both felt better.

Another resident was always telling people to shut up. Feil decided to give him the role he seemed to crave. At the end of group therapy meetings, he was assigned to close the proceedings by ordering everyone to shut up. She called him the shutter upper.

A female resident was withdrawn and uncommunicative. Feil knew she was religious and sensed she wanted human connection. She gently touched the women with her fingertips. Then Feil began singing “Jesus Loves Me.” The woman chimed in. “Her eyes opened, and we had a communion with each other,” Feil recalled in a January 2023 podcast.

Odd or disruptive behavior, she found, often reflected repressed and unresolved anger or other emotions. “I grew up in a home, so I know how mean old people can be,” Feil said during a 1993 workshop described by the Cleveland Plain Dealer. “The old lady isn’t really yelling at you; you remind her of someone from long ago. She’s trying to resolve some unfinished business from the past at this final stage in her life.”

No lies

She opposed the idea of telling comforting lies. Lies could be detected, even by those who seemed most deluded, and that would destroy trust. When an old woman said she needed to see her mother right away, Feil wouldn’t point out that her mother was dead. Nor would she promise that the mother would visit soon. Instead, she would make it a conversation: “You really need to see your mother! What would you like to tell her?”

“You don’t argue, you don’t lie,” she said in a TEDx talk. “You listen with empathy and you rephrase.”

When old people were weepy, it was a bad idea to tell them things weren’t so bad, she found. It was better to let the tears flow and talk about what made them sad.

She disliked the word dementia, implying that people were out of their minds. “To say they have lost their minds is really looking down on people,” she said.

Gisela Noemi Weil, later known as Naomi, was born on July 22, 1932, in Munich. Her father, Julius Weil, who had a Ph.D. in abnormal psychology and rehabilitation, directed a home for troubled Jewish boys in Munich. Her mother, Helen Weil, helped run that home.

Her father left Germany first. When she, her sister and her mother were preparing to join him in the U.S., she recalled, Roman Catholic nuns helped by letting them hide in a basement until they could arrange to escape on a night train. After several years in the Bronx, the Weils moved to Cleveland, where her father headed the Montefiore Home for the Aged.

She wasn’t shielded from harsh realities: Young Naomi saw residents die and once noticed that an elderly man was paying a nurse for sexual favors.

After high school, she studied briefly at Oberlin College, traveled in Europe and moved to New York, where she earned a master’s degree in social work at Columbia University. An early marriage, which ended in divorce, produced two daughters. Feil took acting classes, performed in off-Broadway productions and aspired to a career in the theater. She gave that up in 1962 to move back to Cleveland, where she worked in the nursing home run by her father.

Focused on troublemakers

Her work was with the troublemakers other staff members avoided. “These were the blamers, the martyrs, the moaners, the wanderers, the yellers, the pacers, the pounders whom nobody wanted,” she wrote in one of her books, “The Validation Breakthrough.”

Sometimes nursing assistants tied people to their chairs so they wouldn’t wander off and make trouble. When she tried to engage with these misfits, a nursing assistant scolded her: “You’re getting them all worked up…. You can’t help them. I’ve been working here for five years, and I ought to know.”

Feil persisted and gradually learned from her encounters. “I learned not to contradict, patronize, argue, or try to use logic or give insight,” she wrote. Instead, she made clear she was listening. If an old person imagined the nurses were stealing her jewelry, Feil might say, “You loved that necklace, didn’t you. Who gave it to you?” She could share the emotion and then explore deeper.

In 1963, she married Edward Feil, a maker of documentary films. They had two sons. Naomi Feil appeared in many of her husband’s films, including “The Inner World of Aphasia.” He died in 2021. Her survivors include four children, six grandchildren and one great-granddaughter. One of her daughters, Vicki de Klerk-Rubin, is executive director of the Validation Training Institute, a nonprofit that trains caregivers.

Her first book, “Validation, the Feil Method,” was published in 1982. It was followed by “The Validation Breakthrough” a decade later. Over five decades, Feil led about 2,000 workshops in the U.S. and abroad.

Near the end of her life, Feil had short-term memory loss, was aware of that and didn’t consider it abnormal or shameful, de Klerk-Rubin said. “She was fighting against the medicalization of aging,” de Klerk-Rubin added. “She fought like the dickens against the medical community and the pharmaceutical companies who were trying to create this new disease called old age.”

In her own old age, she still regretted her missed opportunity for a theatrical career. One consolation was that her early experience in theater had taught her to feel and express other people’s emotions, and so enriched her training workshops and work with the elderly.

James R. Hagerty is a writer in Pittsburgh. He can be reached at [email protected].