Naomi Feil knew better than anyone that the best way to talk to elderly dementia patients was not to try to acclimate them to our reality, but to empathise by meeting them in theirs.
Relying on years of experience in nursing homes, trailblazing social worker and gerontologist Naomi Feil came up with a method called validation, which allowed patients to express their feelings rather than being lied to or told that “everything is fine.” Through empathetic listening, Feil found a way for distraught patients to find peace in the latter part of their lives.
Feil died at her home in Jasper, Oregon on December 24 at the age of 91.
Born in Munich in 1932 to Jewish parents, Feil’s family fled to the U.S. in 1937 to escape Nazi persecution. Her father left Germany before the rest of the family to find work in New York, while Feil, her younger sister and mother waited in Munich to join him. According to family legend, Feil’s mother soon discovered a note in her wash basket, presumed to be from a neighbour in the building, which read: “Get out now, the Gestapo are coming for you.”
Feil, her mother and sister left at once, and were hidden in a basement of a cloister until they could escape on a night train.
Naomi (upper right) with sister Gabi and cousins in 1942. (Photo courtesy of Vicki de Klerk-Rubin)
After several years in the Bronx, the family settled in Cleveland, Ohio, where Feil’s father became the administrator of a nursing home which doubled as living quarters for the family. Some of Feil’s earliest friends were the elderly residents of the Montefiore Home for the Aged, and she was granted a unique insight into the lives of those suffering from dementia.
Feil lived in New York for a spell to study acting and perform in off-Broadway shows. Her experience as an actor came in handy when she began teaching the validation method, using role-playing to illustrate the behaviour of dementia patients and how caretakers should respond. She earned a master’s degree in social work at Columbia University and married Warren Rubin, with whom she had two daughters. The marriage ended several years later and, in 1962, Feil moved back to Cleveland to work at the nursing home run by her father.
She learned her method of validation by making mistakes and, of course, by listening. Feil set about working with the “troublemakers” of the home, those who other staff members avoided: “the blamers, the martyrs, the moaners, the wanderers, the yellers, the pacers, the pounders whom nobody wanted,” she wrote in her book “The Validation Breakthrough.”
In the 1960s and 1970s she proposed that caregivers “step into the world" of the elderly and stop trying to lie to or distract confused patients. She developed a new way of communicating with people who suffer from dementia.
Naomi (left) working with patients in a validation group. (Photo courtesy of Vicki de Klerk-Rubin)
It became the driving force behind the "person-centred care movement”, which prioritises the specific needs of the individual rather than a one-size-fits-all approach. Feil wrote books on the method, led workshops, and set up 24 validation training centres in 14 countries around the world.
“This approach to care involves listening to the person, having empathy and meeting them in their reality versus thrusting your reality onto them,” said Dr. Sam Fazio, a senior director of Quality Care and Psychosocial Research at the Alzheimer's Association. “It’s about connecting with the person living with cognitive impairment as opposed to correcting them.”
According to Feil’s theory, there is always a reason behind an elderly person’s behaviour, which can change dramatically with dementia and prove difficult for caretakers and family members to understand. But Feil insisted that, no matter how strange, “that old human being is expressing human needs.”
Central to Feil’s method was an opposition to lying. During her 2015 TEDx talk, she shared an example of how to respond to an old woman asking to see her mother. She does not tell the woman, “Your mother is just around the corner, she’ll be here in a few minutes,” which Feil said the patient knows, deep down, is not true, and trust will be compromised; nor does she immediately remind the distressed woman that her mother is dead. Instead, Feil suggests rephrasing with questions and using empathy: “Where is your mother? Is she sick? What do you want to tell her?”
“You don’t argue, and you don’t lie,” she said. “You listen with empathy.”
Naomi on the road, 1980s. (Photo courtesy of Vicki de Klerk-Rubin)
According to Vicki de Klerk-Rubin, Feil’s eldest daughter, Feil was “dramatic”, “inspiring” and full of “nonstop energy”.
Vicki is the executive director of the Validation Training Institute and played a vital role in helping her mother build a curriculum to teach the validation method.
De Klerk-Rubin said her mother remained active until her final weeks; in addition to teaching monthly webinars and taking French and German language classes, Feil was part of an improv acting group, and participated in a session just one week before she died.
Though de Klerk-Rubin said her mother was not religious, remnants of Feil’s Jewish background reappeared during her final weeks.
“In the end she was singing Hebrew songs, religious songs, which I found very interesting because she had never done it throughout her life,” de Klerk-Rubin said.
In 1963, Feil married documentary filmmaker Edward Feil, and they had two sons. Mr. Feil passed away in 2021. The “god-mother of person-centred care” is survived by a younger sister, four children, six grandchildren, and one great-grandchild.
“Validation is not a magic bullet,” Feil said in 2017. “You can’t fix people up; you can’t change them. But you can accept them just the way they are.”
