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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