Creating Days that Have

Meaning and Joy

Teepa Snow, MS, OTR/L, FAOTA

Beliefs

• People with Dementia are Doing the BEST they can

• We must learn to DANCE with our partner

• We are a KEY to make life WORTH living

• What we choose to do MATTERS

• We can change the WORLD with help

• We must be willing to CHANGE ourselves

• We must be willing to STOP & BACK OFF

How Can We Become Better Care Partners?

Be willing to try something new

Be willing to learn something different

Be willing to see it through another’s eyes

Be willing to fail & try again

Ten Early Warning Signs• memory loss for recent or new

information – repeats self frequently

• difficulty doing familiar, but difficult tasks – managing money, medications, driving

• problems with word finding, mis-naming, or mis-understanding

• getting confused about time or place - getting lost while driving, missing several appointments

• worsening judgment – not thinking thing through like before

• difficulty problem solving or reasoning

• misplacing things – putting them in ‘odd places’

• changes in mood or behavior

• changes in typical personality

• loss of initiation – withdraws from normal patterns of activities and interests

The Basics for Success…

• Be a Detective NOT a Judge

• Look, Listen, Offer, Think…

• Use Your Approach as a Screening Tool

• Always use this sequence for CUES

– Visual - Show

– Verbal - Tell

– Physical – Touch

• Match your help to remaining abilities

Now for Progression… think GEMS not just loss

Sapphires

Diamonds

Emeralds

Ambers

Rubies

Pearls

Now for the GEMS…

Sapphires – True Blue – Slower BUT Fine

Diamonds – Repeats & Routines, Cutting

Emeralds – Going – Time Travel – Where?

Ambers – In the moment - Sensations

Rubies – Stop & Go – No Fine Control

Pearls – Hidden in a Shell - Immobile

What Do People with Dementia Need?• DAILY Routine!!!!

• Help to Fill Their DAY with meaning

• A Balance of:

– Productive activity – feeling valued

– Leisure activity – having fun

– Self-care activity – wellness, health, personal care

– Restorative activity – sleep, rest, and re-energizing

• A Match-Up for Preferences:

– Large Group, Small Group, 1:1, Alone

– Active versus passive

– Sensory options – visual, auditory, tactile, olfactory, gustatory

What Are We Offering People?

• List Your Current Activities

– Monday-Sunday

• For Each Listing:

– What type of activity is it? P, L, S, R

– Is it working well?

– When Do You NOT Have something happening?

– What is MISSING?

What Does It Take

To Make a

Day Have Meaning and Joy?

Know each

PERSON!

Understand

ACTIVITIES!

Make & Use a

SCHEDULE!

Build staff

SKILLS!

Manage the

ENVIRONMENT!

Resources to

succeed

Know each Person

Health Status

medical conditions,

medications,

limitations & abilities

Life History

Who the person has

been…

Personal history and

background

Cognitive Status

thinking, memory,

processing skills and

limitations

Emotional status

psychological

condition and mental

health & limitations

Routines and Habits

patterns of behavior,

daily routines, time use

& schedules

Sensory Status

sight, hearing, touch,

balance, coordination,

temperature regulation

Personal Preferences & Values

• Who have you been?

• What did you value?

• Who are you now?

• What do you value now?

• Why does it matter?

• Who gets a ‘say’?

• Who gets to set the priorities?

Personality Traits

Who are you?

• Introvert-Extrovert

• Lots of Details – Big Picture only

• Logical – Emotional

• Planning ahead – Being in the moment

Who is the person you are trying to help?

Introvert - Extrovert

Introvert

• Likes to be alone

• Likes to think it out

• Likes personal space

• Needs alone time

• Private

Extrovert

• Think out loud

• Talk it out

• Seek out people

• Share a lot

• Not good with boundaries

Life Story

• Family – past & present

• Living place(s)

• Work history

• Leisure History

• Music history

• People history

• Plant history

• Animal history

• Plant history

• Sensory Environment preferences

• Cultural history & concerns

• Food likes & dislikes

• Daily routines

• Organizations & memberships

• Roles & responsibilities

• Comforts & Irritants

Design Each Day

8 am – coffee circle

8:30 – songs of joy

9 am – time to ‘go’

9:15 – take a hike – walk’n’roll

10 am – cool down & stretch

10:30 – watering hole

11 am - ‘use your brains’ games

11:30 - time to ‘go’ – wash up

11:45 – ‘set-‘em up’ crew

12 noon – let’s eat

12:30 – clean up crew

1 pm – music and meditation

1:30 – coupons clipping

2 pm – time to ‘go’

2:15 – let’s dance

Make a

schedule and

follow it

Be structured

BUT allow

flexibility

Create a FLOW

for the day

Build up and

then slow down

Circadian

rhythms

Offer a variety

of activities

every day

Leisure, work,

rest, self-care,

groups and 1:1,

passive and

active

Create Group

schedules

BUT

also build

individual

schedules

Not everything

is for everybody!

Build a Foundation

of Familiar and Favorite

Activities

Add a few

special events and something

different

Understand Activities

Modify and Structure the Activity for

Success

Change the materials, the complexity, the

setting, the help offered, the task demands, or

the purpose of the activity

Analyze the

Activity…

What do you

need to do

it?

What skills,

abilities,

interests?

What is the

activity all

about?

Doing

something

or

making

something?

What type of activity is it???

Self-care, leisure, work, rest…

Spiritual, social, physical, cognitive,

passive, active, solitary

Two Examples

Paying Bills

• Do it independently

• Together – use a calculator

• Together – do all of them

• Together – do one at a time

• You do most, they sign and put in envelopes

• You do all but the signature

• They put on stamps

• Both take them to the mail box

Washing dishes

• Do it independently only after meals

• Do it independently – when needed to fill time

• Together – one wash one dry

• Do parts

• Watch & guide

• Carry dishes to/from sink

Build Care Partner Skills

Environmental

Management skills

Using space &

keeping up the

place

Problem-solving

skillsFiguring out what to

do when it does not

work right

1:1 Interaction

Skills

Do you work

with your

partner(s)…

Group Leading

Skills

Getting people

together &

having fun

Customer

Relations Skills

With families,

clients,

volunteers

Documentation

Skills

Record

keeping and

reporting

Practical

Hands-on

Skills

Crafts, games,

cooking,

working…

Planning & Time

Management

Skills

What to do &

when to do it!

Peer

Relationship

Skills

Helping each

other

Observation

skills

What you see,

hear, sense…

Learn How to…

• Do something new…

• Learn a new type of exercise or activity

• Simplify a dance…

• Re-look at a old skill and make it easier

• Share a tasks

• Do something without touching things

• Get someone to do something without words

• Give POSITIVE feedback and say “thanks”

Pay attention

to the lights,

sounds, seating,

work surface,

space…

Manage the Environment

Do the ‘right stuff’ in

the ‘right place’

Match what you do

to where you are…

Use the space

well

Plan and place

for BEST effect

Create & Use

Storage

Make set-up &

clean-up part

of the activity

Change it

around – if

you need to

- to make it

work!

Keep it ADULT

Make sure supplies,

activities, and games are

meaningful

Play & laugh with folks,

not at them

Give out tools and

materials ‘just in time’

Control the activity so

clients are successful –

not overwhelmed

- not out of synch

Make it look friendly

Get me to want to come

Take a look, listen, feel…

• Lighting- Enough, non-glare, focused

• Sounds – background, distracting, volume

• Feel –

– Temperature

– Space – how crowded – intimate, personal, public

– Work surface

– Seating surface

– Walking surface

– Familiar? Friendly? Fun? Forgiving?

Enough Supplies

& Materials

The right

equipment for

clients’ needs

Good quality

lighting

Skilled

leadership for

the activity

Good work

surfaces

Seating that

works

Enough help for

each personA BACK-UP

Plan

Two Options…

DOING

• Filling socks – rice socks, bean socks, corn socks…

• Adding herbs – lavender, citrus, eucalyptus, mint

• Putting a sock inside another sock

• Heating the socks

• Rubbing the socks over muscles

• Emptying socks out

MAKING

• Fruit salad – from fresh fruit

• Fruit salad - from canned fruit

• Fruit salad – from pre-cut fruit

• Fruit salad – one fruit and yogurt

• Fruit salad – dried fruit & granola & yogurt

• Putting the fruit salad in small cups or bowls

• Serving the fruit salad

How Do We Create Meaningful Activities?

How to spend the time…

Key Activities to Consider

• Productive -Work

• Enjoyment - Leisure

• Wellness – Personal Care

• Restorative - Rest

Productive Activities

• Helping another resident

• Helping staff members

• Completing community tasks

• Making something

• Sorting things

• Fixing things

• Building things

• Creating something

• Caring for things

• Counting things

• Folding things

• Marking things

• Cleaning things

• Taking things apart

• Moving things

• Cooking/baking

• Setting up/breaking down

• Other ideas….

Please Help Us Clean Up…

Active Passive

• Socials

• Sports

• Games

• Dancing

• Singing

• Visiting

• Hobbies

• Doing, Talking, Looking

• Entertainers

• Sport Program/event

• Presenters

• Lobby sitting

• TV programs – watched

• Activity watchers

• Being done to

Leisure Activities

Playmate

Hey, hey, hey playmate

Come out and play with me

And bring your dollies three

Climb up my apple tree

Call down my rain barrel

Slide down my cellar door

And we’ll be jolly friends forever more.

Cognitive Physical

• Table top tasks– Matching, sorting, organizing,

playing

• Table top games– Cards, board games, puzzles…

• Group games– Categories, crosswords, word

play, old memories

• Exercise

• Walking

• Strengthening tasks

• Coordination tasks

• Balance tasks

• Flexibility tasks

• Aerobic tasks

• Personal care tasks

Self-Care & Wellness Activities

BREATHE!!!

• Take a deep breath in• BLOW it all the way out• Take another breath in• BLOW it out• Take one final breath in AND• SING IT OUT….

• Feel what happened to you… • Look at what happened to the people around you…• Think about how and when you might do this…

Rest & Restorative Activities

• Sleep – Naps

• Listen to quiet music with lights dimmed

• Look at the newspaper

• Look at a calm video on TV screen

• Rock in a chair

• Swing in a porch swing

• Walk outside

• Listen to reading from a book of faith

• Listen to poetry or stories

• Listen to or attend a worship service

• Stroke a pet or animal

• Stroke fabric

• Get a hand or shoulder massage

• Get a foot soak & rub

• Listen to wind chimes

• Aroma therapy

Offer a Shoulder Rub & a Hand Massage

GOOD Activities ones that involve…

• Plants

• Animals

• People

• Music

• Objects

How Does Skill Change Over Time With Dementia?

• Interests

• Helper cues that help

• Environmental cues that help

• Ability to focus & change focus

• Sensory awareness & processing

• Motor skills – gross and fine

• Decision making & reasoning

Let Go:

• How it “used to be”

• How it “should be”

• How you “should be”

Identify

• What you’re good at…and what you’re not

• Who can help…and how they can help

• What really matters

Care Partners…

• Be a partner, not a boss

• Be an advocate, build a team

• Do with me, not for me or to me…

• Learn the ‘SO WHAT?’ philosophy…

• Learn to let go not give up

• Learn what you are good at, & what not…

• These ideas are for you TOO!

Final Note…

• Evaluate…

• How is it going…?

– What’s working?

– What’s not working?

• Is it time to change?

– Dementia is progressive

– Activities will need to change

• Its about letting go NOT giving up…

I Will Change!

(to the tune of This Little Light of Mine)

By Teepa Snow

I am gonna meet and greetBefore I start to treatI am gonna meet and greetBefore I check your feetI am gonna meet and greetBefore I help you eat

How I start sets us up to succeed!

No more just “Getting’ it Done”I’m gonna DO with youNo more just “Getting’ it Done”I’m gonna help you thruNo more just “Getting’ it Done”We’re gonna work, we two

Cause if I do it ALL, we BOTH LOSE!

I’m gonna laugh and dance with you Not just watch and frownI’m gonna laugh and dance with youNot just stand aroundI’m gonna laugh and dance with youWe’ll really go to town

For the POWER of JOY I have found!

Contact INFO• DVD sets for $38.75

• www.pinesofsarasota.org

Web site – www.teepasnow.com

Home Instead Website: www.homeinstead.com