promoting wellness and well being after the diagnosis: creating days that have meaning and joy teepa...
TRANSCRIPT
Promoting Wellness and Well Being After
the Diagnosis: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 newBe willing to learn something different
Be willing to see it through another’s eyesBe 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
SapphiresDiamondsEmeraldsAmbersRubiesPearls
Now for the GEMS…
Sapphires – True Blue – Slower BUT FineDiamonds – Repeats & Routines, Cutting
Emeralds – Going – Time Travel – Where?Ambers – In the moment - SensationsRubies – Stop & Go – No Fine ControlPearls – 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 TakeTo 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 HistoryWho the person has
been…Personal history and
background
Cognitive Statusthinking, memory,
processing skills and limitations
Emotional statuspsychological
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 joy9 am – time to ‘go’9:15 – take a hike – walk’n’roll10 am – cool down & stretch10:30 – watering hole 11 am - ‘use your brains’ games11:30 - time to ‘go’ – wash up11:45 – ‘set-‘em up’ crew12 noon – let’s eat12:30 – clean up crew1 pm – music and meditation1:30 – coupons clipping2 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 fewspecial 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 skills
Figuring 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 SkillsWith families,
clients, volunteers
Documentation Skills
Record keeping and
reporting
Practical Hands-on
SkillsCrafts, games,
cooking, working…
Planning & Time Management
SkillsWhat to do & when to do it!
Peer Relationship
SkillsHelping 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
meaningfulPlay & 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 friendlyGet 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 person
A 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 person• Helping family members or
caregivers• 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• Living room or Lobby sitting• TV programs – watched• Activity watchers• Being done to
Leisure Activities
Playmate
Hey, hey, hey playmateCome out and play with meAnd bring your dollies threeClimb up my apple treeCall down my rain barrelSlide down my cellar doorAnd 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!
