What is Dementia? What is Alzheimer�s Disease? What is NORMAL Aging? by 3gL5jKbP


									 Promoting Wellness and
   Well Being After the
Creating Days that Have Meaning
            and Joy

     Teepa Snow, MS, OTR/L, FAOTA
• People with Dementia are Doing the BEST they
• 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

      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    • worsening judgment – not
  information – repeats self         thinking thing through like
  frequently                         before
• difficulty doing familiar, but   • difficulty problem solving or
  difficult tasks – managing         reasoning
  money, medications, driving
                                   • misplacing things – putting
• problems with word finding,
  mis-naming, or mis-                them in ‘odd places’
  understanding                    • changes in mood or behavior
• getting confused about time or   • changes in typical personality
  place - getting lost while       • loss of initiation – withdraws
  driving, missing several           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
      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?

                           Resources to

              Manage the                  Build staff
            ENVIRONMENT!                   SKILLS!

Know each              Understand                       Make & Use a
 PERSON!               ACTIVITIES!                      SCHEDULE!
                        Know each Person

      Life History                       Health Status
   Who the person has                  medical conditions,
         been…                             medications,
   Personal history and               limitations & abilities

 Emotional status                                     Cognitive Status
   psychological                                      thinking, memory,
condition and mental                                 processing skills and
 health & limitations                                     limitations

              Sensory Status             Routines and Habits
         sight, hearing, touch,        patterns of behavior,
         balance, coordination,        daily routines, time use
         temperature regulation        & schedules
     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                 Extrovert
• Likes to be alone       • Think out loud
• Likes to think it out   • Talk it out
• Likes personal space    • Seek out people
• Needs alone time        • Share a lot
• Private                 • Not good with
                     Life Story
•   Family – past & present   • Sensory Environment
•   Living place(s)             preferences
•   Work history              • Cultural history & concerns
•   Leisure History           • Food likes & dislikes
•   Music history             • Daily routines
•   People history            • Organizations &
•   Plant history               memberships
•   Animal history            • Roles & responsibilities
•   Plant history             • Comforts & Irritants
                    Design Each Day

                                                                                   Offer a variety
 Make a                                                                            of activities
 schedule and                                                                      every day
 follow it
                                                                                    Leisure, work,
  Be structured                                                                     rest, self-care,
   BUT allow                                                                       groups and 1:1,
    flexibility                                                                      passive and
                    8 am – coffee circle
                    8:30 – songs of joy
                    9 am – time to ‘go’                                            Create a FLOW
Create Group        9:15 – take a hike – walk’n’roll                               for the day
schedules           10 am – cool down & stretch
                    10:30 – watering hole
                                                                                      Build up and
      BUT           11 am - ‘use your brains’ games
                    11:30 - time to ‘go’ – wash up                                  then slow down
   also build
   individual       11:45 – ‘set-‘em up’ crew
                    12 noon – let’s eat                                                Circadian
                    12:30 – clean up crew                                              rhythms
                    1 pm – music and meditation
 Not everything     1:30 – coupons clipping
is for everybody!   2 pm – time to ‘go’
                    2:15 – let’s dance

                                                           Build a Foundation
                                                        of Familiar and Favorite

                                                                 Add a few
                                                       special events and something
                       Understand Activities

                    What type of activity is it???
                    Self-care, leisure, work, rest…
                  Spiritual, social, physical, cognitive,
                         passive, active, solitary

                                                                 What is the
Analyze the
                                                                 activity all
What do you
need to do                                                          Doing
What skills,

                   Modify and Structure the Activity for
                 Change the materials, the complexity, the
               setting, the help offered, the task demands, or
                          the purpose of the activity
                   Two Examples
Paying Bills                     Washing dishes
• Do it independently            • Do it independently only
• Together – use a calculator      after meals
• Together – do all of them      • Do it independently – when
• Together – do one at a time      needed to fill time
• You do most, they sign and     • Together – one wash one
  put in envelopes                 dry
• You do all but the signature   • Do parts
• They put on stamps             • Watch & guide
• Both take them to the mail     • Carry dishes to/from sink
                    Build Care Partner Skills

          Group Leading                                          Customer
               Skills                                          Relations Skills
                                  Crafts, games,
          Getting people                                       With families,
           together &                                             clients,
           having fun                                           volunteers

1:1 Interaction                                   Peer
                      Planning & Time                                    Documentation
     Skills                                    Relationship
                        Management                                           Skills
Do you work                                       Skills
                           Skills                                           Record
  with your                                   Helping each
                        What to do &                                      keeping and
 partner(s)…                                      other
                       when to do it!                                      reporting

            Environmental           Observation               Problem-solving
          Management skills            skills                      skills
           Using space &           What you see,              Figuring out what to
           keeping up the          hear, sense…               do when it does not
                place                                              work right
              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”
                     Manage the Environment
                            Do the ‘right stuff’ in
                              the ‘right place’
   Pay attention
                             Match what you do
    to the lights,
                             to where you are…                                 Create & Use
  sounds, seating,
   work surface,
                                                                             Make set-up &
                                                                             clean-up part
                                                                             of the activity

                                                              Change it
                                                              around – if
   Use the space                                             you need to
        well                                                 - to make it
  Plan and place                                                 work!
  for BEST effect

                                                                            Keep it ADULT
  Give out tools and
 materials ‘just in time’                                               Make sure supplies,
                                                                      activities, and games are
Control the activity so              Make it look friendly                     meaningful
clients are successful –            Get me to want to come             Play & laugh with folks,
not overwhelmed                                                               not at them
     - not out of synch
       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      The right
   & Materials     equipment for
                   clients’ needs

  Good quality     leadership for
    lighting         the activity

                     Seating that
    Good work

Enough help for
                   A BACK-UP
 each person
                    Two Options…
DOING                           MAKING
• Filling socks – rice socks,   • Fruit salad – from fresh fruit
  bean socks, corn socks…       • Fruit salad - from canned fruit
• Adding herbs – lavender,      • Fruit salad – from pre-cut fruit
  citrus, eucalyptus, mint      • Fruit salad – one fruit and
• Putting a sock inside           yogurt
  another sock                  • Fruit salad – dried fruit &
• Heating the socks               granola & yogurt
• Rubbing the socks over        • Putting the fruit salad in small
  muscles                         cups or bowls
• Emptying socks out            • Serving the fruit salad
How Do We Create Meaningful
     How to spend the time…
Key Activities to Consider

• Productive -Work

• Enjoyment - Leisure

• Wellness – Personal Care

• Restorative - Rest
             Productive Activities
• Helping another person      •   Counting things
• Helping family members or   •   Folding things
  caregivers                  •   Marking things
• Completing community        •   Cleaning things
  tasks                       •   Taking things apart
• Making something            •   Moving things
• Sorting things              •   Cooking/baking
• Fixing things               •   Setting up/breaking down
• Building things             •   Other ideas….
• Creating something
• Caring for things
Please Help Us Clean Up…
                   Leisure Activities
Active                        Passive

•   Socials                   •   Entertainers
•   Sports                    •   Sport Program/event
•   Games                     •   Presenters
•   Dancing                   •   Living room or Lobby sitting
•   Singing                   •   TV programs – watched
•   Visiting                  •   Activity watchers
•   Hobbies                   •   Being done to
•   Doing, Talking, Looking
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.
     Self-Care & Wellness Activities
Cognitive                             Physical

• Table top tasks                     •   Exercise
   – Matching, sorting, organizing,   •   Walking
                                      •   Strengthening tasks
• Table top games
                                      •   Coordination tasks
   – Cards, board games, puzzles…
                                      •   Balance tasks
• Group games
   – Categories, crosswords, word     •   Flexibility tasks
     play, old memories               •   Aerobic tasks
                                      •   Personal care tasks
•   Take a deep breath in
•   BLOW it all the way out
•   Take another breath in
•   BLOW it out
•   Take one final breath in AND

• 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 poetry or stories
• Listen to quiet music with   • Listen to or attend a
  lights dimmed                  worship service
• Look at the newspaper        • Stroke a pet or animal
• Look at a calm video on TV   • Stroke fabric
  screen                       • Get a hand or shoulder
• Rock in a chair                massage
• Swing in a porch swing       • Get a foot soak & rub
• Walk outside                 • Listen to wind chimes
• Listen to reading from a     • Aroma therapy
  book of faith
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”
• 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 greet
Before I start to treat
I am gonna meet and greet
Before I check your feet
I am gonna meet and greet
Before I help you eat

How I start sets us up to succeed!
No more just “Getting’ it Done”
I’m gonna DO with you
No more just “Getting’ it Done”
I’m gonna help you thru
No 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 frown
I’m gonna laugh and dance with you
Not just stand around
I’m gonna laugh and dance with you
We’ll really go to town

For the POWER of JOY I have found!
             Contact INFO
• DVDs
• www.pinesofsarasota.org

Web site – www.teepasnow.com

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