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Friday, December 25, 2009

More Christmas Poems

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia music activity

To all the readers of this blog who are eager to learn more about dementia, I want to take this opportunity to wish you and yours a very merry Christmas.

Your Christmas Poem


Mr Glisten Comes To Town

Robin

Christmas Folly

Christmas Spree

God Incarnate

Christmas Eve

I Have Not A Penny

All of God's Creatures

Christmas Wish

On Christmas Eve Morn

Dear Santa

Christmas Morning

Christmas Is

Full of Christmas Spirit

Once Upon A Christmastime

This Christmas Time

Last Christmas Day

Twelve Days 'Till Christmas

Hidden In The Closet

The Christmas Star

The Holy Family

Through Christmas

The Holy Family

The Miracles of Snow

Thoughts of You Friend

The Christmas Present

The Simplicity of Christmas

Advent Song

A Little Late

Denton Tap & Sandy Lake

The Disgruntled Elves

Oh Little Child

Christmas Star

Christmas In The Country

Thursday, December 24, 2009

Your Christmas Poem

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia music activity

To all the readers of this blog who are eager to learn more about dementia, I want to take this opportunity to wish you and yours a very merry Christmas.

Your Christmas Poem


Sandy's Christmas Poem

Christmas Is All About Love

Silver Strands

Christmas Spirit

My Christmas Tree

Family Christmas

Star of Hope

Sitting on Top Of The Christmas Tree

Christmas Senses

I Have Not A Penny

Sounds of Christmas

Christmas Season

Shopping Centre Christmas

December Remembrances

A Christmas Time of Year

Throw Away Christmas

Tinsel Truth

A Christmas Wish

I Was Just A Little Star

Christmas Used To Mean A Lot

A Christmas Angel

What's Happened To Christmas?

Christmas In The Air

The Old Man

His Regret

Jesus Is More Than Just Christmas

A Man For All Seasons

Seasons Greetings

The Not So Great War

Shhhh, Silently They Fall

Cherish His Christmas

Christmas Angel (The)

Christmas In Edinburgh

Whisper of Wings

Christmas Jamming

Monday, December 21, 2009

How to Understand Advance Directives for Healthcare

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia music activity

To all the readers of this blog who are eager to learn more about dementia, I want to take this opportunity to wish you and yours a very merry Christmas.

eHow

Understand that advance directives for healthcare permit you to furnish instructions to healthcare providers and your family about your wishes concerning medical treatments in the event you become incapacitated. Most often these directives only go into effect when you cannot make and communicate your own healthcare wishes. Up until then, you can continue to give directions to your healthcare provider even though you have an advance directive.

Healthcare providers are required under the federal Patient Self Determination Act to provide patients information about their rights to make their own healthcare choices.

There are several advanced directives. They include a Living Will, which allows you to say whether you want treatment if it only makes the dying process longer; a Health Care Power of Attorney (HCPOA) that allows you to name someone to decide about your healthcare choices if you are not able to do so;
and Advance Health Care Directives, which combine a Living Will, an HCPOA and other state specific options.

Instructions
Step 1Discuss your medical choices. Make sure the person you are considering as your agent understands what your wishes are concerning your healthcare.

Step 2Choose an agent. Understand that an agent is someone who will make medical decisions for you in case you are no longer able to do so. Make sure this person cares for you so he will carry out your wishes. You can limit his power if you so choose.

Step 3Understand that you should decide upon an alternate. This is a good idea because of situations where your first choice is unable to be your agent.

Step 4Make sure your doctor understands your advanced directives. Talk about your advance directives with your doctor before you sign it. Make any necessary changes.

Step 5Sign the.....read all of How to Understand Advance Directives for Healthcare

Saturday, December 12, 2009

Dementia Holiday Activities That Lower Stress and Raise the Joy(part 2)

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia music activity

by Paula Spencer caring.com

Have fun with food

Make cookies.Someone once famous for her Christmas cookies may miss the kitchen activity. She may no longer be able to handle Pfeffernusse or a spritz gun, but together you could mix up a simple slice-and-bake dough (or do it for her in advance) and then let her slice the log and and arrange the cookies on a baking sheet. Or set out colored sugar, sprinkles, and other decorations for decorating a tray of sugar cookies or gingerbread men you've already cut-out. (Kids love this, too.)

Crack nuts. Put the person to work with an old-fashioned nutcracker and a big bowl of walnuts, pecans, and Brazil nuts. A nice, soothing activity during family gatherings. *

Make a soothing atmosphere.

Stock up on classic holiday movies. Favorites to put in your Netflix queue or pick up cheap at the local superstore: "It's a Wonderful Life," "Miracle on 34th Street," "White Christmas," "Christmas in Connecticut," "How the Grinch Stole Christmas," (animated Seuss version), and "A Christmas Story" (that's the 1983 modern classic about the boy who dreams of a Red Ryder BB gun). Invite your relative to choose if decision-making is not yet too fraught.

Put together a photo album of holidays past. This one takes a little time, but pays off in hours of repeated reviewing. Better yet, get a child to jot down the person with dementia's descriptions of each photo -- faces, places, funny things that happened (you may be surprised what's remembered, though also be prepared for nothing to be recalled); insert the notes in the album next to each picture.

Play holiday music throughout the day. Mental grooves are deep for these tunes, which makes them especially soothing. Stick to classics you know the person is familiar with – this is probably not the year to spring Bob Dylan's or Taylor Swift's new Christmas album. (Although you never know!)

Thanks Paula

Friday, December 11, 2009

Dementia Holiday Activities That Lower Stress and Raise the Joy

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia music activity

by Paula Spencer, Caring.com senior editor

Holiday stress can soar for caregivers whose loved ones have Alzheimer's and other forms of dementia. And for good reasons: Your own already-bursting to-do load stretches longer than the lines at the post office. Safety worries intensify – the person who has dementia may want to drive to the mall to shop, wander away in a crowded store, or insist on resuming dangerous old habits or activities, like baking or woodworking. You may feel prickles of grief over things the person can no longer do (travel cross-country to visit grandchildren or set up the Christmas tree, for example). Beloved traditions -- especially lots of lights, lots of company -- may now be bothersome or frightening to your relative. And did I mention that longer-than-ever to-do list?

One solution: Help the person keep busy and engaged with repetitive seasonal activities. Repetition that seems tedious to the rest of us is often soothing to someone with cognitive impairment. These activities stoke feelings of accomplishment and pride. All good: Call it repetitive de-stress syndrome.

Some ideas:

Make decorations

Set the person to work stringing garlands. All you need is a long heavy thread and a darning needle. Try stringing cranberries, popcorn, even O-shaped cereal (Fruit Loops are cheerfully colorful).


Fashion paper chains. These require a bit more dexterity: You have to cut the strips of paper, then curl them around one another and staple. A good project to have an older grandchild supervise while the person with dementia helps in whatever way she can. Use construction paper or, for a really festive look, heavy-stock wrapping paper.

Make pomanders. Clove-studded oranges to hang or display in a bowl are not only lovely, but their scent may evoke calming, happy memories. Again, they require a little dexterity but not much. Instructions here (scroll down; it's a different blog I do just-for-fun).

Have fun with food

Make cookies.Someone once famous......more tomorrow

Thursday, December 10, 2009

More Activities for People with Alzheimer's

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia music activity

Table Ball
submitted by Natasha Pokorny of Nesconset Nursing Center


Size: 10-20

Equipment: Tables that line up together and a ball (preferably a bright color).

Objective: The objective Table Ball is: improved hand eye coordination, socialization, attention span, following of simple directions.

Description: This activity is recommended for residents with Alzheimer's. Place tables end to end (enough to fit about 10 or more people all the way around). Place the ball (we use a bright red one) in front of one of the residents and tell him/her to roll it to someone else at the table. Encourage each resident to keep the ball moving on the table. It should be natural for them. Alzheimer residents in my facility can play this game for an hour before getting tired. It definitely lessens agitation.


NOTE: not all Alzheimer residents can play this game depending on what stage of Dementia they have. Place those more capable next to someone who might have difficulty and encourage them to help each other. This increases the socialization. Call out names often to refocus.


Shopping Scavenger Hunt
submitted by Debra Ekstrom of Geriactives on June 1, 1999


Group Size: 1-20

Equipment: scissors, sale ads from Sunday newspapers,plastic trays

Objective: I work with participants that have Alzheimer's/dementia. The objective was to create a fun yet learning experience. Most have no idea what things cost these days.

Description: Collect sales ads from several Sunday papers. Pass ads and scissors out to everyone. Also give them a list of items to search for: example-
1. tent
2. baby diapers
3. blue dress


I typed out over 50 items to search for. I had volunteers assisting them if they needed help. If they were unable to cut out the items, a volunteer would do this. The participant would cross off the items on their list as they found them. Items found on the hunt were placed on a plastic tray. A count was taken at the end of the activity and the person with the most items was the winner. They would share their ads with others and ask if anyone had ones they needed.
The interaction was fantastic. Even my low functioning people could participate. It was a fun activity....

Note: I need to add that the higher functioning people can search for the highest or lowest priced items. Also, the cut out ads can be saved for a collage as a later activity.

Wednesday, December 9, 2009

Activities for People with Alzheimer's

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia music activity

Leaf Hunt
submitted by Chris

Size: Unlimited

Equipment: Baskets

Objective: To prevent alienation and encourage creativity, exercise, helping others and overall stimulation.

Description: I work in an Alz. Specific facility and the residents are typically lethargic and do not want to stray far from the comfort zone. I decided that they needed a few things...first fresh air, I am a true believer in it. Second, Mild exercise. Finally, sensory stimulation.

I took a group outside armed with baskets and a mission...my wheelchairs were the "spotters" they would find the prettiest colors and shapes. My walkers wouldpick them up and shape the decorations for the residents who could not participate. ( self esteem ) Since we have mild weather here in atlanta this was great. I have found that if you have a "mission" for the residents, they feel special and needed. THis was a very productive activity. Just makke sure that there is no poisonous stuff in there and let them run wild!

Monday, December 7, 2009

Alzheimer's Therapeutic Activities

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia music activity

Alzorginfo.com

Activities for People with Alzheimer's
•There are many different stages that a person with Alzheimer's and dementia will go through, therefore activities for individuals in the early or middle stage of the disease will differ from the end stages of Alzheimer's.
•When planning activities for the person with Alzheimer's disease, creating routine and structure is extremely important.
•In order to improve quality of life at each stage of the disease it is important to focus on the patients strengths and abilities. It is important to look at what the patient can do, instead of what they cannot do. Planning activities is a process of trial and error involving continual exploration, experimentation and adjustment.
•Activities can be passive or active. Some patients may participate in an activity, while others may only observe or watch.

Communicating with An Alzheimer's Patient
•As Alzheimer's disease affects each area of the brain, certain functions or abilities can be lost. It is important for caregivers to remember that changes in a persons behavior and ability to communicate may be related to the disease process.
•Alzheimer's disease has a profound effect on language. The disease affects speech and the use of words, as well as the understanding of words. As the disease progresses, language as a means of communicating becomes less effective. Caregivers need to use different ways of communicating their message and staying in touch.
•When speaking to an Alzheimer's patient make sure there are few distractions. It is easier to communicate if other things are not happening at the same time. Television or Radio should be turned off.
•The tone of your voice is very important in speech. Speak slowly and articulate to help the person hear and process the words. Sit facing or stand in front of the person and make eye contact.

Facts About Alzheimer's Disease
•Alzheimer's disease is the most common form of dementia affecting 4.5 to 4.7 million Americans.
•1 in 10 Americans over the age of 65 and nearly 1 in 2 Americans over age 85 currently have Alzheimer's disease.
•Alzheimer's disease is a progressive disease which advances in stages from mild forgetfulness and cognitive impairment to wide spread loss of mental abilities and total dependence on a caregiver. The time from the onset of symptoms until death ranges from 3 to 20 years with the average duration lasting about 8 years.
•The progressive loss of cognitive function is accompanied by pathologic (disease associated) changes in the brain.


The Importance of Pre-Planning: Alzheimer's Disease and Health Care Proxies
•Alzheimer's disease is one of the most emotionally draining and traumatic diseases for patients and families alike. The progressive, degenerative nature of Alzheimer's disease presents unique challenges for health care proxies.
•During the end stages of Alzheimer's disease the patient typically loses the ability to communicate effectively with their loved ones; adding an additional burden to the health care proxy.
•It is essential for families to openly discuss the kind of end-of-life care early, while the person with Alzheimer's still has the ability to communicate their wishes.
•Families can often benefit from a mediator (an independent third party, usually a social worker) to facilitate the discussion of end-of-life care.

Saturday, December 5, 2009

Patient-Centered Care for People With Dementia

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia music activity

eHow

For people with dementia, establishing an environment that focuses on the individual's strengths, interests, preferences and particular needs will provide the best patient care. Patients with dementia can live at home, in an assisted-living facility or at a nursing home. Wherever they reside, you must concentrate on the individuality of each person who has dementia.

Dementia

Dementia is not a specific disease, but rather a group of symptoms that occur because the dementia person's brain no longer works properly. This person's memory, ability to think clearly, communication skills and behavior are affected by dementia. Because each individual with dementia has particular strengths, interests, and conduct, patient-centered care is essential.

Patient-Centered care

Tom Kitwood and the Bradford Dementia Group in England designed Person-Centered Care in the late 1980s. Patient-Centered Care puts the person first regardless of his level of mental functioning. This type of care takes into account each person's experience of well-being, through the eyes of the person receiving the care. The person living with dementia can experience physical and mental well-being as well as social and even spiritual well-being from this type of care. Many places provide....
read all about Patient-Centered Care for People With Dementia

Wednesday, December 2, 2009

Introduction to Creative and Sensory Therapies for Alzheimer's Disease (part 2)

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia music activity

by Christine Kennard

Reminiscence Reminiscence refers to recollections of memories from the past. Reminiscence is about exchanging memories with the old and young, friends and relatives, with caregivers and professionals, passing on information, wisdom and skills. Reminiscence is about giving the person with Alzheimer’s a sense of value, importance, belonging, power and peace.

Lesley, an acquaintance of mine, sent me this great article about how this activity helped her. Lesley's Tip- Reminiscence Manuals

Painting, pottery, sculpting can be done as an individual or group activity. You can try out the different mediums.

Drama is usually used as a therapy in long-term care or day centers as a means of communication and therapy. A drama therapist's skill is needed to make the experience meaningful. Not only can drama therapy meet many of the aims of creative therapy and treatment previously mentioned, it can also help with diagnosis and evaluation, too. An example might be someone enacting how the medication they take makes them feel, or the therapist seeing what effect a new medication has on the way a person behaves. This information can feed into patient evaluation.
Drama therapy usually involves people of mixed skills and abilities and can use other mediums, such as art, to assist in creative expression.

Dancing and movement can be an activity offered in day and inpatient centers and it doubles as an enjoyable exercise. But just having a good dance to music that the person with Alzheimer's can remember, or is part of their era, is reason enough. Make sure you give yourselves a bit of space!

Cooking is a great means of expression, especially for women. It clues into their previous activities and skills and new ways for them to give back to their caregivers

I hope I have given you some useful ideas. Try them out. I would love to hear how you cope. We would all like to. Why not submit an article passing on all your tips and ideas.

Atricle Sources Include:
Cantley, Caroline (ed). A Handbook of Dementia Care. 2001. Philadelphia: Open University Press, 2001.

Bornat, Joanna (ed). Reminiscience Reviewed. 1995. Bristol P A: Open University Press, 1995.

Kitwood, Tom. Dementia Reconsidered-the person comes first. 1997. New York: Open University Press, 2004.

Tuesday, December 1, 2009

Introduction to Creative and Sensory Therapies for Alzheimer's Disease

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia music activity

by Christine Kennard

Enhancing the Lives of People With Dementia
All societies value creativity and creative expression. When someone has brain damage as the result of a disease like Alzheimer's, many of their skills change and decline. As Alzheimer's disease progresses, caregivers have to explore new ways to engage with people who have the disease. In this article, I have put together a list of activities that can enhance a person's creativity and other abililties, and if you have a helpful activity you would like to share, please do so (see below.)

Aims of Creative and Sensory Activities for People with Alzheimer's:
•to promote wellbeing
•to help maintain skills
•to use other senses to aid communication by using sensory rather than cognitive pathways.
•to maintain and enhance relationships
•for relaxation
•to utilize past skills
•to express emotion
•to facilitate decision making
•As a means of cooperating with others

Let's Look at Some Activities With Links to More Information
There are many activities that use our creative skills. One of the interesting things about using creative skills is that often people who had skills in an area, such as painting or sculpting, often seem unable or unwilling to explore them further when they have a chronic illness such as dementia. New creative and imaginative activities have to be explored.

Sensory activities are well established for people with Alzheimer's. Aromatherapy and massage is a good example.

Reminiscence Reminiscence refers to....read more tomorrow

Saturday, November 28, 2009

Intercom Bingo

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia music activity

recreationtherapy.com

Intercom Bingo
submitted by Penkay

Intercom Bingo cards are sold for $1.00 each through the activity department. Residents, Staff & Family Members may purchase as many as they desire. (The activity staff may not purchase any)

Each bingo sheet has a number on it. When someone purchases a bingo sheet/card write that number and the name of person who is buying the card on a sheet of paper. This paper is kept in the activity office. (This will help in case reference is needed for any reason, lost, misplaced cards & it helps keep track of the number of cards sold).

Intercom Bingo is played Monday through Friday. Bingo numbers are called one a day. Mon - Fri. Example: Monday I announce B10 Tuesday it maybe O63, Wed I19 etc.. The game can on for 2 or 3 weeks sometimes only a 1 week & a day or 2.

At the end of your morning announcements (which includes the day, date & year) announce the intercom bingo number. You get the intercom bingo number by using one of the large print calling cards. The number is then posted on a bulletin board. These numbers stay up on the board until the end of the game.

When you have a winner, verfiy the card against the numbers on the bulletin board, then announce over the PA System that you we have a intercom bingo winner. Write the winners name on the winning card & post it on the bulletin board. I do not give the winner the money until 2 days later. The reason for the 2 day wait is in case there is a second winner, who may be off, works a later shift or for whatever reason is out of the facilty for a couple of days.

The money you collected for the cards is divided between the winner & the Resident Council funds. (The Resident Council fund is money being raised for a large priced item they have voted on to purchase for the facility/activties like a Snow Cone Machine) Example of how the money is split: Total number of cards sold will be the dollar amount collected $40.00 the winner gets $20 & the resident council funds get $20. In the case of 2 winners the pot is split by 3.

I have found residents & staff listen to the morning annoucements much closer by doing this activity. You will see residents that normally don't interact with others or leave their room will come to the bulletin board to check the numbers called against their cards & will often stay out for a while.

Wednesday, November 25, 2009

How to Improve the Care in Facilities for Alzheimer's

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia Thanksgiving activity

read all of....How to Improve the Care in Facilities for Alzheimer's

Monday, November 23, 2009

The National Association of Activity Professionals

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia Thanksgiving activity

The National Association of Activity Professionals (NAAP) was founded in 1982, and is the only national organization that exclusively represents Activity Professionals working primarily in geriatric settings. NAAP provides opportunities for professional development and personal growth through national and regional conferences that offer a variety of topics and numerous hours of education. NAAP has established partnerships with allied organizations, governing bodies, consumer groups, regulatory agencies, and provider groups. They continuously work toward uniform Standards of Practice for all Activity Professionals working with elders. For more information, contact the NAAP Office at (865) 429-0717, e-mail thenaap@aol.com, or visit www.thenaap.com.

Sunday, November 22, 2009

Is your activity program ready for survey? (part 2)

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia Thanksgiving activity

Diane Mackbee

* Whether there is observation or documentation of specialized programs for bed- or room-bound residents. You must provide for all residents at your facility and not just those who can actually make it to the activity room. Surveyors are focusing more and more on room-bound residents and what you are doing for them. Are you providing sensory enhancement and stimulation? Music and relaxation? Mentally stimulating activities, such as word puzzles, cards, books on tape, videos? How about independent crafts? Pet therapy? Chaplain visits?

* Whether facility staff invites and helps residents to the activities. All staff should constantly encourage, invite, and escort residents who are interested to the activities (and, thanks to the new Interpretive Guidelines, it is the facility's responsibility to escort people to activities and not just activity staff). Those who can come on their own are becoming fewer in number, and those who need encouragement and assistance are on the rise. Of course, people have the right to refuse, but be sure that they are truly refusing.

* Whether staffing levels are sufficient to meet resident needs and interests. The activity department must be staffed appropriately and with enough manpower to provide the types of programs residents need and deserve. You should also develop a volunteer program to supplement the activity staff.

* Whether activity staff are the only ones involved in activities. It is up to every staff member and not just the activity department to help see that residents are getting the assistance they need to become involved in the activity program. An encouraging word from a housekeeper, CNA, or administrator is sometimes all they need to become involved

What are you doing to make sure that your activity program is the best it can be? Are you an advocate for your residents and does your administrator back what you do? If not, you need to sit down and re-evaluate your program and become a stronger voice for each person in your facility. The Activity Professional should be treated as a true professional with the expertise to manage an activity department that meets every resident's needs.

Diane Mockbee, BS, ADC, is certified by the National Certification Council of Activity Professionals and is President of the National Association of Activity Professionals (NAAP), with 1,400 members, as well as a member of the Arizona Association of Activity Professionals. She is employed by Palm Valley Rehabilitation and Care Center in Goodyear, Arizona and is the Activity Consultant at Ridgecrest Healthcare Center in Phoenix. For more information, phone (623) 536-9911, ext. 212. To send your comments to the author and editors, e-mail mockbee0108@nursinghomesmagazine.com.

Saturday, November 21, 2009

.Is your activity program ready for survey?

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia Thanksgiving activity

Diane Mockbee

Surveyors are looking more closely at activity programs to ensure that they are adequately serving the needs of the nursing facility residents. Since the new guidelines for F-tags 248 and 249 were implemented on June 1, 2006, many facilities and activity departments are being hit hard because of nonqualified directors running programs and poor staffing ratios to handle the ever-changing needs of today's residents.

We are all facing many challenges and changes, including tougher and more punitive state and federal surveys. The residents we serve are making greater demands due to the huge array of needs each one has, compared to 10 years ago. The baby boomers are arriving and they want more, need more, and expect more. Families, too, are more informed when they are looking for placement for their family members

The nursing facilities that will continue to flourish are the ones that strive to meet all of their residents' needs. This means reaching beyond the basics. It's more than feeding, dispensing medications, and providing good activities of daily living (ADL) care. It means tackling the problems of socialization, spiritual life, and friendships, and that we continue to provide for each resident emotionally, mentally, spiritually, and physically.

During new employee orientation at my facility, Palm Valley Rehabilitation and Care Center in Goodyear, Arizona, I always share the importance of each department working together. I also discuss the fact that OBRA has ensured us recognition as a true profession and that we are vital to the ongoing existence of each resident because of the quality of life we bring them. Quality of care and quality of life should be looked upon as equals. If quality of care were to outweigh quality of life, you would have well-cared for residents, but depression, isolation, and behaviors would run rampant because they would feel that they have no real reason to live. Balancing the scale results in happy, well-adjusted people who receive good care and want to live life to its fullest.

Let's look at your program and the survey process. If you are just turning on the television, showing videos, and having bingo one night a week, your program will not meet your residents' needs, nor will the surveyors brush lightly past your programs. Why? If that is all you do or if you only offer two activities per day, the program does not constitute a satisfactory activity program.

Surveyors are looking at the activity program more and more, and they have certain "red flags." If they see happy, satisfied, and busy residents with lots going on, chances are they will leave you alone. If, however, there are long stretches of nothing going on and you and your staff are "out of sight," the surveyors will probably begin to dig and delve into your program, your space, your charting, and your paperwork. Some key areas of evaluation include:

* Whether the activity area is too small or too noisy. You need to make sure your areas are adequate in size to meet the needs and requirements of your population and that your activities are not constantly interrupted by out-side noise, incidents, or staff activity (running vacuums, shift change, etc.)

* Whether long periods of time go by with no activities scheduled. No one expects you to do activities 2 4/7, but each day's calendar should include a variety of activities that residents can choose from--and some should be available during the morning, afternoon, and evening time periods, seven days a week.

* Whether supplies are sufficient to meet residents' needs. Facilities should make sure that there is enough money in the activity budget to give the staff the tools they need to develop a creative and exciting program.

* Whether residents appear bored, sleep through activities, or do not attend. Activities should be designed to meet residents' interests and abilities. Often, facilities or staff blame low attendance on residents "not being interested," but this can't be used as an excuse anymore. If the residents are not interested, then the facility is not providing a program that meets their needs. If they are sleeping through the program, they are probably not stimulated adequately and are in the wrong activity.

* Whether activities actually insult the dignity or intelligence of residents. Activities should be designed to meet residents' interests and abilities. Often, residents can be found sitting around a television watching children's programming or kiddie videos--or worse, violent talk shows. Providers should be offering classic movies, the news, or other programming the residents would enjoy. However, watch what is shown on a dementia unit. Real news can be very disturbing to people with dementia, and videos and music are more likely to appeal to them.

* Whether the facility routinely cancels activities or does not follow its schedule. Not only must you create an exciting, interesting calendar, you must actually stick to it. While some circumstances are unavoidable, you should strive to follow the calendar. Just because you don't feel like doing something (e.g., bowling) doesn't mean your residents don't want to.

Friday, November 20, 2009

MEDPEDIA PROJECT EXPANDS PLATFORM TO INCLUDE Q&A, NEWS & ANALYSIS AND ALERTS (PART 2)

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia Thanksgiving activity

About The Medpedia Project
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Thursday, November 19, 2009

MEDPEDIA PROJECT EXPANDS PLATFORM TO INCLUDE Q&A, NEWS & ANALYSIS AND ALERTS

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia Thanksgiving activity

New Tools for Sharing and Advancing Medical Knowledge

SAN FRANCISCO, CA (November 10, 2009) – The Medpedia Project today announced the addition of three new services on the beta version of the technology platform for the worldwide health community: Medpedia Answers for asking and answering medical and health questions; Medpedia Alerts for displaying real-time medical and health news alerts; and Medpedia News & Analysis for sharing medical news and analysis. These free resources are available today at www.medpedia.com.

Medpedia Answers collects questions and answers about health, medicine and the body. Each question is tagged with both MeSH and plain-English headings for better discovery. Each question is also pushed into relevant areas throughout the Medpedia Project such as patient communities and article pages. Questions and answers are for general information purposes only, not as a substitute for in-person evaluation or specific professional advice. Anyone with a profile on Medpedia can participate. The Medpedia Answers Top Contributors list gives recognition to the most active contributors.

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These three new interrelated tools are part of the Medpedia platform which provides medical professionals and organizations a central place to record their knowledge and receive national and international recognition and visibility for their expertise. Medpedia, which launched in February 2009, also includes a collaborative knowledge base, a Professional Network and Directory for health professionals and organizations, and Communities of Interest in which medical professionals and non-professionals can share information about conditions, treatments, lifestyle choices, etc. Since the announcement of The Medpedia Project in February 2009, thousands of people have become a part of the community and thousands of physicians, researchers, organizations and experts have begun contributing to the knowledge base.

While only physicians and Ph.D.s in a biomedical/health field can edit the Medpedia knowledge base directly, consumers have an important role to play. They can suggest changes to the Article pages, and they can participate in Communities, and they can ask and answer questions.

About The Medpedia Project.....next time

Sunday, November 15, 2009

Beyond Bingo: Meaningful Activities for Persons with Dementia in Nursing Homes (part 9)

Activities directors, caregivers, and healthcare professionals,here is some great information
Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia Thanksgiving activity

Annals of Long Term Care

Marianne Smith, PhD, ARNP, BC, Ann Kolanowski, PhD, RN, FAAN, Linda L. Buettner,
PhD, LRT, CTRS, and Kathleen C. Buckwalter, PhD, RN, FAAN

Summary

The 2006 activity revision provides important opportunities to advance the value of culture change in LTC settings. Developing and maintaining successful, person-appropriate activity programs for individuals with dementia relies on the cooperation and assistance of all team members, a basic working knowledge of dementia processes, and a sound knowledge of innovative, evidence-based activities that are matched to the interests and abilities of individual residents. Ongoing training and education of LTC staff, including but not limited to programs like the NEST and the CD-based Dementia Training programs, is a necessary first step in building facility-based, interdisciplinary teams that share responsibility for ensuring ongoing involvement in person-appropriate, meaningful activities for residents with dementia.

Acknowledgment

Content in this article was first presented by the authors as a workshop at the American Association for Geriatric Psychiatry Annual Conference, March 14, 2008, and is based on a CD-based training program funded by the Retirement Research Foundation, Chicago, IL.

Dr. Buckwalter received grant support from Retirement Research Foundation (RRF), Dr. Smith received grant support from RRF and Wellmark Foundation, Dr. Buettner received grant support from RRF, the Alzheimer’s Association, and Florida Elder Affairs, and Dr. Kolanowski received grant support from the NINR: R01 NR 008910.

The authors report no relevant financial relationships.

Dr. Smith is Assistant Professor and Dr. Buckwalter is Sally Mathis Hartwig Professor of Nursing, University of Iowa College of Nursing, Iowa City; Dr. Kolanowski is Elouise Ross Eberly Professor of Nursing, Penn State University, University Park; and Dr. Buettner is Professor of Therapeutic Recreation and Gerontology, University of North Carolina at Greensboro

Saturday, November 14, 2009

Beyond Bingo: Meaningful Activities for Persons with Dementia in Nursing Homes (part 8)

Activities directors, caregivers, and healthcare professionals,here is some great information
Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia Thanksgiving activity

Annals of Long Term Care

Marianne Smith, PhD, ARNP, BC, Ann Kolanowski, PhD, RN, FAAN, Linda L. Buettner,
PhD, LRT, CTRS, and Kathleen C. Buckwalter, PhD, RN, FAAN

Teamwork: Making It Work

As recommended in the NEST approach, collaboration among disciplines is essential for activity programs and therapies to be successful. The importance of collaboration is underscored by the CMS rules and investigative protocols that interview nurses, nursing assistants, and social workers, as well as activity directors and their staff. Although a wide variety of factors interact to determine outcomes of care, experience and research suggest that successful programs regularly have the full support of the facility administration to form a team, include key staff from all available disciplines to participate in the team, identify a leader who is knowledgeable about dementia and activity involvement, meet on a regular basis, and communicate well with others.

Success also relies on building on the strengths of team members. As activity methods and processes are put in place, the discipline of the team member is less important than the person’s interests and skills. For example, a nurse who is a coin collector may be the ideal person to lead the Coin Collector’s Club; a nursing assistant who plays guitar and sings might organize an evening sing-along; or a social worker who is an early-morning person may be ideally suited to escort the Early Risers Walking Club. Building on staff members’ natural interests and skills is essential to developing and sustaining programs.

Other aspects of teamwork involve helping all staff members appreciate and assist with common aspects of activity involvement, such as helping residents be appropriately dressed and outfitted for the program. For example, wearing sturdy and well-fitting shoes for walking or wearing sunglasses and sunscreen for outdoor activities may be pivotal in the overall success of the program. Staff collaboration also extends to resolving “competing demands” for residents’ time—such as adjusting medication schedules to best accommodate activities (eg, giving as-needed pain medications before or after the activity, adjusting timing to enable full participation), or making appointments to avoid conflicts with scheduled small-group activities.

Another important aspect of teamwork is helping daily staff providers gain needed skills to successfully facilitate activity programs. Although recreation and activity personnel may be available during “business hours” (eg, 9:00 AM to 5:00 PM, Monday through Friday), both scheduled and “as-needed” programs may be needed at all hours of the day, every day of the week. This issue is specifically addressed in the CMS discussion of Care Planning, which notes that activities may occur at any time and are not limited to formal programs provided by activity staff, and that all relevant departments should collaborate to develop and implement an individualized activity program for each resident.3 For example, nursing personnel may benefit from understanding the importance of and strategies for transitioning residents from one activity to another (eg, using the Price Is Right Game before meals, using a Simple Pleasures butterfly to engage a restless resident during personal care). Staff members may also need guidance and assistance to ensure that the residents, not the staff members, conduct the activity. For example, teaching staff caregivers to cue residents to start, demonstrating without “doing” the activity for the person, and providing verbal prompts without dominating conversations is important to activity success.

Coming up.....Summary

Friday, November 13, 2009

Beyond Bingo: Meaningful Activities for Persons with Dementia in Nursing Homes (part 7)

Activities directors, caregivers, and healthcare professionals,here is some great information
Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia Thanksgiving activity

Annals of Long Term Care

Marianne Smith, PhD, ARNP, BC, Ann Kolanowski, PhD, RN, FAAN, Linda L. Buettner,
PhD, LRT, CTRS, and Kathleen C. Buckwalter, PhD, RN, FAAN

Psychosocial Club–Based

A wide variety of “club-based” activities may be developed to address topics of interest: birds, bowling, cars, golfing, weather, needlecrafts, and fashion, among others.7 Club-based programs engage residents in small-group socialization, discussion, and activity engagement around the club theme, and are used to reduce depression, social isolation, passivity, sensory deprivation, restlessness, and wandering. Meetings are held once or twice per week for 30-45 minutes (depending on the club and its specific activities) and are led by a recreational therapist, nurse, or other healthcare professional. For example, Jewelry Club members are given a jewelry box filled with costume jewelry to sort through, rearrange, organize, or try on. Discussion cues are used to enhance socialization and interaction (eg, “Did you have a locket? Whose picture did you keep in it?”). As with all protocols, involvement in club-based activities is guided by residents’ individualized interests and preferences.

Nurturing

Another important group of interventions engages residents in caring or nurturing behaviors. Animal-assisted methods, including both Animal-Assisted Activities (AAAs) and Animal-Assisted Therapy (AAT), may contribute to well-being among residents but have different goals.7 Animal-Assisted Activities may be conducted by volunteers and largely involve visiting interested residents who enjoy animals (or the specific type of pet visitor). The exchange may have social, motivational, educational, or recreational benefits20 but does target a specific outcome and is not documented as a part of the person’s care.

In contrast, AAT is directed by a healthcare professional, interactions with animals have specific therapeutic goals, and outcomes of the intervention are documented in the resident’s chart. Each AAT visit involves three main components: (1) the approach, in which visual and verbal contact is made between the animal and resident, and the resident is invited to work with the animal; (2) the process, in which the animal-resident interaction is focused on meeting identified therapeutic goals; and (3) the closure, in which the resident rewards the animal, accomplishments are reviewed, the next session is planned, and goodbyes are said.7 Therapy animals are commonly provided by pet-handler teams, such as those registered by the Delta Society Pet Partners program.20 Potential benefits of AAT include increased communication, better attention to task, and improved self-esteem, confidence, and mood,20 as well as increased motivation and/or calming effects and reduced loneliness.7

Coming up....Teamwork: Making It Work

Thursday, November 12, 2009

Beyond Bingo: Meaningful Activities for Persons with Dementia in Nursing Homes (part 6)

Activities directors, caregivers, and healthcare professionals,here is some great information
Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia Thanksgiving activity

Annals of Long Term Care

Marianne Smith, PhD, ARNP, BC, Ann Kolanowski, PhD, RN, FAAN, Linda L. Buettner,
PhD, LRT, CTRS, and Kathleen C. Buckwalter, PhD, RN, FAAN

Life Roles

Therapeutic Cooking offers a familiar, family-like intervention that may simultaneously stimulate cognition skills, improve motor function (fine and gross, depending on the activity), and reduce anorexia.16,19 Cooking activities may involve different levels of engagement, such as planning menus, assembling food required by a particular recipe, using adapted equipment to prepare food (eg, using an apple peeler to prepare pie), stirring batter or placing dough on trays, preparing finger foods (eg, putting cherry tomatoes on decorative, plastic serving “trees”), and enjoying baked or prepared items in a group. Cooking may be combined with other activities, such as gardening in raised beds, setting or decorating the table, and, importantly, socialization related to past experiences and current interests.

Physical-Based

Engaging persons with dementia in various types of physical exercises and activities is associated with improved sleep, function, and mood, as well as reduced restlessness and wandering. For example, Exercise for Function7 is a structured physical activity that combines range of motion (eg, head rotation, shoulder shrugs, knee lifts) with strengthening (eg, water jug lifts) and endurance (eg, tethered balloon ball) activities. A 20-minute exercise routine is choreographed to familiar music, with exercises moving from head to feet under the guidance of a therapist and used three times per week as a small-group intervention (eg, 3-5 residents).7

An alternative program engages early risers who are at risk for unsafe behaviors such as wandering, falling, or agitation. The Early Risers Walking Club7 is conducted 30 minutes a day, five days a week, starting at 7:00 AM. These morning walks are individualized and graded to increase as endurance levels improve.7

Cognitive-Based

The Price Is Right Game7 may be used for several purposes: cognitive stimulation related to guessing prices; appetite stimulation related to thinking about food; socialization, as foods and prices are discussed; and as a means to engage residents who tend to wander away from the dining room before meals are served. During the small-group intervention, a therapist introduces empty food containers as though they have just come from the grocery store. Two food items are held up, and residents are asked, “Which one do you think costs more?” After each guess, residents are shown the actual price (marked on the bottom of the item) and engaged in brief discussion (eg, “Do you think that is a fair price? What do you make with [name of item]?”).

Another cognitive-based program is to play Dominoes,7 using regular or large dominoes, or picture dominoes as outlined in Simple Pleasures. Dominoes may be played according to rules with higher-functioning residents, while building structures or setting dominoes on edge in a line to be toppled may be preferred by mid-functioning residents. Lower-functioning residents benefit from color-matched dominoes or those with large wooden pictures.

Coming up....Psychosocial Club–Based

Wednesday, November 11, 2009

Beyond Bingo: Meaningful Activities for Persons with Dementia in Nursing Homes (part 5)

Activities directors, caregivers, and healthcare professionals,here is some great information
Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia Thanksgiving activity

Annals of Long Term Care

Marianne Smith, PhD, ARNP, BC, Ann Kolanowski, PhD, RN, FAAN, Linda L. Buettner,
PhD, LRT, CTRS, and Kathleen C. Buckwalter, PhD, RN, FAAN

Annals of Long-Term Care
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American Geriatrics SocietyAAGPAAPMNCGNPSORIMBeyond Bingo: Meaningful Activities for Persons with Dementia in Nursing Homes

ISSN: 1524-7929 VOLUME: 17 PUBLICATION DATE: Jul 01 2009
Sidebars_in_article:
Issue Number:
Volume 17 - Issue 7 - July 2009
Start Page: 22
End Page: 30
author:
Marianne Smith, PhD, ARNP, BC, Ann Kolanowski, PhD, RN, FAAN, Linda L. Buettner, PhD, LRT, CTRS, and Kathleen C. Buckwalter, PhD, RN, FAAN
Introduction

The importance of redesigning nursing homes to better emulate living in one’s own home has driven regulation reform for decades. The early focus of addressing residents’ rights in the Nursing Home Reform Act1 has slowly expanded to a broader vision of creating “a culture of aging that is life affirming, satisfying, humane and meaningful.”2 Commonly called “culture change,” the movement to improve quality of life among older adults in nursing facilities and other long-term care (LTC) settings has gained considerable momentum. The primary advocacy group, the Pioneer Network, emphasizes values such as knowing the person, putting the person before the task, emphasizing self-determination, promoting growth and development, and using the environment to its best potential.2

Many of these values are exemplified in the revisions of activities regulations set forth by the Centers for Medicare & Medicaid Services (CMS) in 2006. According to 483.15 (f)(1), “The facility must provide for an ongoing program of activities designed to meet, in accordance with the comprehensive assessment, the interests and the physical, mental, and psychosocial well-being of each resident.”3 This seemingly simple requirement is strengthened and expanded by definitions that characterize activities as enhancing well-being and promoting physical, cognitive, and emotional health, such as self-esteem, pleasure, comfort, creativity, success, and independence. An additional emphasis is placed on “person-appropriate” activities that are relevant to the specific needs, interests, culture, and background of individual residents, including those with dementia. “One-to-one programming” requires that caregivers provide assistance for those who cannot plan their own activity pursuits, or need special assistance, such as those with dementia. Finally, the program of activities is defined as being a combination of large- and small-group, one-to-one, and self-directed activities that occur throughout the day, every day of the week.

The investigative protocol that accompanies the rule reinforces the need for activities to be an ongoing program that is implemented throughout the day, one that is composed of activities that are compatible with the resident’s known interests, needs, abilities, and preferences, and that is implemented in an environment that promotes success.3 To determine compliance with the rule, residents, activity staff, nurses, nursing assistants, and social workers are all interviewed to determine whether the individual resident’s preferences and choices are assessed, activities are implemented in accordance with needs and goals, resident-specific outcomes are monitored and evaluated, and approaches are revised as appropriate.3

The proverbial “bottom line” in the activity revision is that the large-group programs that dominate activity calendars on a Monday-through-Friday basis are insufficient. The rule simultaneously calls for activities that are person-directed and for collaboration among team members to assure that meaningful activities are continuously available to residents. Language specific to persons with dementia emphasizes the important role that staff may need to play in identifying enjoyable activities that are consistent with the person’s level of current functioning, as well as implementing, monitoring, evaluating, and revising plans of care to ensure that needs and preferences are best met.

Training to Promote Activity Involvement

For many “pioneers” of culture change, the rule is an exciting opportunity. For others, the requirement is greeted with the same unenthusiastic response that has echoed throughout Nursing Home Reform: “More rules without any additional funding to make needed changes.” No matter which viewpoint one takes, the rule is in effect and will likely be a focus of compliance in future reviews. Just as facilities needed training to reduce physical and pharmacological restraints in the 1980s, many LTC settings currently need assistance to better understand viable activity options that promote the dual mission of quality of life for residents and regulatory compliance. In particular, training related to the needs of persons with dementia may be especially acute given disease-related deficits that interfere with communication, problem-solving, and initiation of activities.

As a result, a group of researchers collaborated to develop an innovative, self-directed CD-based training program, Dementia Training to Promote Involvement in Meaningful Activities (Table I). Information on which the training program is based was presented in a workshop entitled “Beyond Bingo and Painted Nails: Meaningful Activity for Persons with Dementia” at the American Association for Geriatric Psychiatry Annual Conference in March 2008. Underlying principles presented at the symposium and contained in the training CD are briefly reviewed in this article.

Activities in Dementia Care

An important first step in modifying activity programs for persons with dementia is to understand how dementia-related changes may influence the approaches required to meet activity needs and preferences. Important background information includes understanding cognitive losses that characterize dementia, such as expressing interests (eg, aphasia), identifying and planning activities (eg, executive function), and remembering how to do activities (eg, memory loss, agnosia). In addition, understanding the relationship between behavioral and psychological symptoms of dementia (BPSD) and unmet activity needs is equally, if not more, important for daily care providers.

Theory-Driven Activity Involvement

The Need-Driven Dementia-Compromised Behavior (NDB) model of dementia care4,5 provides an important framework for understanding how caregivers can adjust daily routines to reduce the risk of BPSD and promote comfort, function, and enjoyment in living. The NDB model suggests that BPSD are the direct result of both background factors that are fairly stable (eg, neurological factors, cognitive abilities, health status including physical functional abilities, psychosocial factors including premorbid personality) and more changeable proximal factors (eg, physiological and psychological need states, qualities of the physical and social environments). The interplay between background and proximal factors produces need-driven behavior, the most integrated response a person can make given the limitations imposed by the dementia, strengths preserved from abilities and premorbid personality, and the constraints or supports offered by the environment.

In the NDB model, background factors represent a profile of strengths, weaknesses, and usual coping style, and this information is used to individualize activities by tailoring them to these personal characteristics. Recreational activities that are individually tailored to background factors appropriately enrich the physical and social environment (proximal factors) because they meet individual needs. NDB-derived activities match the resident’s current level of cognitive and physical functioning abilities, so that they are at an appropriate level and afford the opportunity for participation. Activities also match the resident’s style of interest—his/her personality—so that they provide preferred amounts of social stimulation and novelty, thereby capturing interest. Examining the “match” of abilities and interests (background factors) to the type, duration, and timing of activities (proximal factors) provides important framework for daily care providers.

The efficacy of recreational therapies derived from the NDB model was tested in 30 nursing home residents with moderate-to-severe cognitive impairments.6 Older adults in the sample were primarily female (77%), with a mean age of 82.3 (standard deviation [SD] = 7.5) years and Mini-Mental State Examination (MMSE) score of 8.6 (SD = 7.2). Subjects were randomly assigned to 1 of 6 possible order-of-condition presentations in a crossover experimental design with repeated measures of time on task, level of participation, affect, agitation, and passivity. Three conditions tested included: (1) activities matched to skill level only; (2) activities matched to interests only; and (3) the NDB-derived condition in which activities were matched to both skill level and interests. Findings indicated that significantly more time on task, greater participation, more positive affect, and less passivity occurred under the NDB-derived condition as compared to skill-level-only treatment and baseline levels. Agitation and negative affect improved under all treatments as compared to baseline,6 suggesting that activity involvement is superior to “usual care.”

Application in Practice

The NDB model suggests that the type and frequency of activities in which the person with dementia is engaged are highly relevant to the occurrence of BPSD. In too many instances, people with dementia are left alone, often with nothing to do. The losses that are a part of dementia—such as using language to explain needs or to plan their day—interfere with their engagement in preferred and meaningful activities. Too often, they wander aimlessly out of boredom, cry out for company or comfort, or sit alone, disengaged from human and environmental interaction. Large-group activities that are often the focus of nursing home care are either too complex or stimulating for their level of function, have little in common with their current or long-standing interests, or are simply too long to be tolerated.

The NDB model refocuses caregivers, asking that they think about the person’s background factors, the things that are reasonably stable. For example, understanding the extent of their cognitive impairment and retained abilities, physical limitations that are the result of their health problems that may influence activity choices, and long-standing personality traits and activity preferences/interests are all important considerations in devising a person-appropriate activity plan. Similarly, proximal factors are equally important. For example, the person’s level of physical and psychological comfort, and things that are going on—or perhaps not going on—in the physical and social environment clearly relate to activity involvement for those with dementia.

In order to make activities person-appropriate for those with dementia, caregivers need to know the person well. As outlined in Table II, several important factors interact and need to be considered in selecting individualized activities for persons with dementia: the person’s activity interests and preferences, cognitive level, physical abilities and/or limitations, any psychiatric problems or symptoms that might influence outcomes, communication abilities, and biological rhythms that may help caregivers time activities to be maximally beneficial.

Activity Options: Many Choices

In addition to knowing the person well, many caregivers need assistance to think more creatively about activity options for persons with dementia. Of note, an increasing body of research evidence supports the use of diverse recreational therapy interventions with persons with dementia. In specific, the NEST (Needs, Environment, Stimulation, and Technique) approach described by Buettner and Fitzsimmons7 provides substantial support with over 80 therapeutic protocols that fall into 10 categories, such as feelings (eg, Memory Tea), nurturing (eg, Animal-Assisted Therapy), relaxation (eg, Guided Imagery), adventure (eg, Wheelchair Biking), physical exercise (eg, Early Risers Walking Club), cognitive (eg, The Price Is Right Game), life roles (eg, Therapeutic Cooking), psychosocial clubs (eg, Jewelry Club), and Simple Pleasures (eg, Wave Machine).

As Buettner and Fitzsimmons emphasize, these strategies were developed and tested as recreational therapy interventions aimed at reducing identified BPSD8 and are optimally used by dedicated teams in LTC settings. The NEST approach recommends developing LTC staff teams composed minimally of a nurse and recreational therapist, along with representatives from other departments, who meet daily to address the needs of persons with dementia.7 These teams collaborate to fully assess behaviors, address unmet needs, adapt the environment to promote function, complete baseline assessments (as outlined in Table II), and select activity protocols based on the individual. Activity-oriented approaches may also be incorporated into more generalized “total unit” or milieu therapy programs for persons with dementia, and used as health promotion/BPSD prevention methods that are designed to reduce the overall risk of distress and discomfort by engaging older adults in meaningful activities.9

The examples described below were developed and tested by Buettner and Fitzsimmons7 and are described in detail in their NEST manual. Research evidence to support the effectiveness of these interventions and details related to the implementation steps are described elsewhere in the literature.5,6,10-17 Key outcomes associated with the use of therapeutic recreation interventions with older adults with dementia include the following: significant improvements in calming individuals with agitation (92-100% of the time) and alerting persons with passive behaviors (79-91% of the time)16; successful engagement of persons with dementia (eg, interested in and focused on the activity, positive affect and mood, minimal or no suspiciousness, agitation or restlessness, or frustration) in preferred small-group activities17; significantly higher levels of participation, time on task, positive affect, and less passivity6; and significantly decreased depression and improved sleep, and activity and engagement.15

Simple Pleasures

A group of multilevel sensorimotor interventions called Simple Pleasures18 offers an important starting point for devising activities that may be used by nonactivity personnel throughout the day. These interventions were developed and tested for persons with dementia in LTC settings and, by design, enhance opportunities for self-initiated activities and social interaction. Simple Pleasures items may be used for several purposes, such as passive behaviors (eg, sitting without active engagement with the environment or others), boredom (eg, behavior that suggests a craving for things to touch or interact with), or agitation (eg, restlessness, wandering, physically or verbally nonaggressive behaviors). The “pleasure” derived from the item is observable in the amount of time spent on task, affective responses, and behaviors; for example, these may include alerting and engaging those who are passively sitting or, in contrast, distracting and calming those who may be escalating into more agitated behaviors. The activities are designed to be used one-to-one or in small groups of no more than five people. Length of the intervention ranges from 5-45 minutes, depending on the attention span of the person and his/her level of interest in the item. All items have been tested for safety and may be crafted by volunteers following directions that are provided free of charge online. Selected Simple Pleasures items are described in Table III.

Adventure-Based

Wheelchair Biking offers considerable opportunities for persons with dementia by combining small-group activities with rides on a Duet bike.7 Small-group discussions focus on past experiences with riding a bike. Discussion cues include, “How old were you when you first rode a bicycle? Do you remember what color it was?” and other prompts related to earlier experiences with riding bikes. The Duet bike has two parts: a wheelchair and a bike that is specially designed to fit the wheelchair, enabling the older adult to “ride” while an appropriately trained person (recreation therapist or his/her designee) peddles the bike. In the Wheelchair Biking protocol, short rides of 10-15 minutes are provided to participants. After the ride, participants tell others in the group about their ride.15 Although the investment to obtain this specialized bike is a consideration, many facilities successfully fundraise around the program and the opportunities it provides.

Coming up........Life Roles

Tuesday, November 10, 2009

Beyond Bingo: Meaningful Activities for Persons with Dementia in Nursing Homes (part 4)

Activities directors, caregivers, and healthcare professionals,here is some great information
Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia Thanksgiving activity

Annals of Long Term Care

Marianne Smith, PhD, ARNP, BC, Ann Kolanowski, PhD, RN, FAAN, Linda L. Buettner,
PhD, LRT, CTRS, and Kathleen C. Buckwalter, PhD, RN, FAAN

Application in Practice

The NDB model suggests that the type and frequency of activities in which the person with dementia is engaged are highly relevant to the occurrence of BPSD. In too many instances, people with dementia are left alone, often with nothing to do. The losses that are a part of dementia—such as using language to explain needs or to plan their day—interfere with their engagement in preferred and meaningful activities. Too often, they wander aimlessly out of boredom, cry out for company or comfort, or sit alone, disengaged from human and environmental interaction. Large-group activities that are often the focus of nursing home care are either too complex or stimulating for their level of function, have little in common with their current or long-standing interests, or are simply too long to be tolerated.

The NDB model refocuses caregivers, asking that they think about the person’s background factors, the things that are reasonably stable. For example, understanding the extent of their cognitive impairment and retained abilities, physical limitations that are the result of their health problems that may influence activity choices, and long-standing personality traits and activity preferences/interests are all important considerations in devising a person-appropriate activity plan. Similarly, proximal factors are equally important. For example, the person’s level of physical and psychological comfort, and things that are going on—or perhaps not going on—in the physical and social environment clearly relate to activity involvement for those with dementia.

In order to make activities person-appropriate for those with dementia, caregivers need to know the person well. As outlined in Table II, several important factors interact and need to be considered in selecting individualized activities for persons with dementia: the person’s activity interests and preferences, cognitive level, physical abilities and/or limitations, any psychiatric problems or symptoms that might influence outcomes, communication abilities, and biological rhythms that may help caregivers time activities to be maximally beneficial.

Activity Options: Many Choices

In addition to knowing the person well, many caregivers need assistance to think more creatively about activity options for persons with dementia. Of note, an increasing body of research evidence supports the use of diverse recreational therapy interventions with persons with dementia. In specific, the NEST (Needs, Environment, Stimulation, and Technique) approach described by Buettner and Fitzsimmons7 provides substantial support with over 80 therapeutic protocols that fall into 10 categories, such as feelings (eg, Memory Tea), nurturing (eg, Animal-Assisted Therapy), relaxation (eg, Guided Imagery), adventure (eg, Wheelchair Biking), physical exercise (eg, Early Risers Walking Club), cognitive (eg, The Price Is Right Game), life roles (eg, Therapeutic Cooking), psychosocial clubs (eg, Jewelry Club), and Simple Pleasures (eg, Wave Machine).

As Buettner and Fitzsimmons emphasize, these strategies were developed and tested as recreational therapy interventions aimed at reducing identified BPSD8 and are optimally used by dedicated teams in LTC settings. The NEST approach recommends developing LTC staff teams composed minimally of a nurse and recreational therapist, along with representatives from other departments, who meet daily to address the needs of persons with dementia.7 These teams collaborate to fully assess behaviors, address unmet needs, adapt the environment to promote function, complete baseline assessments (as outlined in Table II), and select activity protocols based on the individual. Activity-oriented approaches may also be incorporated into more generalized “total unit” or milieu therapy programs for persons with dementia, and used as health promotion/BPSD prevention methods that are designed to reduce the overall risk of distress and discomfort by engaging older adults in meaningful activities.9

The examples described below were developed and tested by Buettner and Fitzsimmons7 and are described in detail in their NEST manual. Research evidence to support the effectiveness of these interventions and details related to the implementation steps are described elsewhere in the literature.5,6,10-17 Key outcomes associated with the use of therapeutic recreation interventions with older adults with dementia include the following: significant improvements in calming individuals with agitation (92-100% of the time) and alerting persons with passive behaviors (79-91% of the time)16; successful engagement of persons with dementia (eg, interested in and focused on the activity, positive affect and mood, minimal or no suspiciousness, agitation or restlessness, or frustration) in preferred small-group activities17; significantly higher levels of participation, time on task, positive affect, and less passivity6; and significantly decreased depression and improved sleep, and activity and engagement.15

Coming up.....Simple Pleasures

Monday, November 9, 2009

Beyond Bingo: Meaningful Activities for Persons with Dementia in Nursing Homes (part 3)

Activities directors, caregivers, and healthcare professionals,here is some great information
Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Here is a dementia Thanksgiving activity

Annals of Long Term Care

Marianne Smith, PhD, ARNP, BC, Ann Kolanowski, PhD, RN, FAAN, Linda L. Buettner,
PhD, LRT, CTRS, and Kathleen C. Buckwalter, PhD, RN, FAAN

Activities in Dementia Care

An important first step in modifying activity programs for persons with dementia is to understand how dementia-related changes may influence the approaches required to meet activity needs and preferences. Important background information includes understanding cognitive losses that characterize dementia, such as expressing interests (eg, aphasia), identifying and planning activities (eg, executive function), and remembering how to do activities (eg, memory loss, agnosia). In addition, understanding the relationship between behavioral and psychological symptoms of dementia (BPSD) and unmet activity needs is equally, if not more, important for daily care providers.

Theory-Driven Activity Involvement

The Need-Driven Dementia-Compromised Behavior (NDB) model of dementia care4,5 provides an important framework for understanding how caregivers can adjust daily routines to reduce the risk of BPSD and promote comfort, function, and enjoyment in living. The NDB model suggests that BPSD are the direct result of both background factors that are fairly stable (eg, neurological factors, cognitive abilities, health status including physical functional abilities, psychosocial factors including premorbid personality) and more changeable proximal factors (eg, physiological and psychological need states, qualities of the physical and social environments). The interplay between background and proximal factors produces need-driven behavior, the most integrated response a person can make given the limitations imposed by the dementia, strengths preserved from abilities and premorbid personality, and the constraints or supports offered by the environment.

In the NDB model, background factors represent a profile of strengths, weaknesses, and usual coping style, and this information is used to individualize activities by tailoring them to these personal characteristics. Recreational activities that are individually tailored to background factors appropriately enrich the physical and social environment (proximal factors) because they meet individual needs. NDB-derived activities match the resident’s current level of cognitive and physical functioning abilities, so that they are at an appropriate level and afford the opportunity for participation. Activities also match the resident’s style of interest—his/her personality—so that they provide preferred amounts of social stimulation and novelty, thereby capturing interest. Examining the “match” of abilities and interests (background factors) to the type, duration, and timing of activities (proximal factors) provides important framework for daily care providers.

The efficacy of recreational therapies derived from the NDB model was tested in 30 nursing home residents with moderate-to-severe cognitive impairments.6 Older adults in the sample were primarily female (77%), with a mean age of 82.3 (standard deviation [SD] = 7.5) years and Mini-Mental State Examination (MMSE) score of 8.6 (SD = 7.2). Subjects were randomly assigned to 1 of 6 possible order-of-condition presentations in a crossover experimental design with repeated measures of time on task, level of participation, affect, agitation, and passivity. Three conditions tested included: (1) activities matched to skill level only; (2) activities matched to interests only; and (3) the NDB-derived condition in which activities were matched to both skill level and interests. Findings indicated that significantly more time on task, greater participation, more positive affect, and less passivity occurred under the NDB-derived condition as compared to skill-level-only treatment and baseline levels. Agitation and negative affect improved under all treatments as compared to baseline,6 suggesting that activity involvement is superior to “usual care.”