Buddy bingo and more

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Here is a dementia music activity

Buddy Bingo
submitted by Tracy Groene of Enid's Senior Care

Residents that need help playing bingo sit with residents that need no assistance --- they are buddy bingo players. Its great fun for all that play. Both recieve prizes when one of them bingo's.



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Bingo and the Bazaar
submitted by Sue Neitzelt of Rosewood Manor

The residents play bingo and win play money. They then have a bazaar every two weeks and buy things with the money they won at bingo. For prizes, find cheap items at local discount stores. The residents at times donate things they no longer want to the bazaar.


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Card Bingo
submitted by Jan Huegerich of Exira Care Center

Residents are each given 7 cards face up laid out on a table. The leader will then have a new deck and read out the cards as they are dealt. Everyone with that card turns it over and when all of each residents cards are turned over they holler "bingo". Prizes are then given. We have played this with 1 to many residents. You also can alter the number of cards that are dealt out, it really makes no differance. We use it for our seperate activity for our ladies and our men.


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Intercom Bingo

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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.

Bingo Plus (Bingo Lottery)

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recreationtherapy.com

People who join together in an activity have a common bond that unites them, resulting in better communication, closer friendships, and increased self-confidence." (Hastings, Complete Handbook of Activities and Recreational Programs for Nursing Homes, 1981).
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Bingo, despite what many say, is a great game! Hundreds and thousands of people play bingo each day around the country. But sometimes its over utilized in the nursing home setting. Program coordinators must provide residents opportunities for activities "Beyond Bingo." But, since bingo is so popular, I listed some alternative ways to run your bingo games just to make it interesting. Send in your favorite bingo alternatives.


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Bingo Lottery
submitted by Alice Greene of Grace Ridge Retirement Community

Size of Group: any size

Equipment: Bingo cards and a print sheets of all of the bingo numbers

Objective: to enhance communication, to enhance eye-hand coordination, to initiate communication, to make a decision, to make friends,

Description: At the beginning of the month explain to all residents that will be playing how to play Bingo Lottery. The bingo lottery game is a cover ALL.

Each day two numbers are posted on the activity board at lunch time and dinner time. It will take about the whole month to play

Each day the residents mark their cards and whoever completes a cover all first wins the game. The prize is lunch out anywhere with the Activity Staff. This game has been so fun that the residents enjoys coming out of their rooms just to check the numbers. It gives them something to look forward to each day.

What's My Thanksgiving Line?

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Associated Content

A Game About Thanksgiving Food for Dementia Sufferers, Long-Term Care Residents

Thanksgiving is right around the corner and will be here before you know it.

This game is ideal for folks with Alzheimer's disease, related dementias, other long-term care residents, those attending adult daycare and people with these diseases living at home.

The group leader can be an activity staff member, other long-term care staff member, a volunteer or family member.

This game is easy to do, a lot of fun, can be adapted and modified for other occasions, and can be used with a wide variety of audiences.

The game is loosely based on the classic television show called, What's My Line. This program originally aired in the 1950s and 60s.

Instead of guessing the guests profession, the guest is pretending to be a Thanksgiving dish.

Before starting the activity, set the stage for the group or individual playing. Tell them that each person is going to pretend to be a food served at a Thanksgiving dinner.

It is probably best to discuss foods eaten on Thanksgiving first. If possible, give each participant a list of food eaten during Thanksgiving. The list can be given before the discussion or after depending on the group's cognitive level. Alternately, you could have a whiteboard or a blackboard and write down the foods as they are mentioned.

As the foods are talked about, it is probably a good idea to discuss the characteristics of the food to remind the group members about the foods. You could include this information on your list.

You will also want to have pictures of popular Thanksgiving foods. You could also write a food name on an index card to hand to the participant who is having trouble thinking of a food on his own. Have a number of cards, each with a food written on it. Also have some blank cards for those who have thought of a food on their own. Handing them the card with the food name on it is a good reminder of the food's name should they forget what they chose.

Remember, folks with Alzheimer's disease and related dementias have poor short term memory.

After the discussion, it is time to play the game. Tell the group or individual again that each person is going to have a turn "being" a Thanksgiving food

read all of What's My Thanksgiving Line?

How to Improve the Care in Facilities for Alzheimer's

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

Brain Exercises for Dementia

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eHow

Dementia, a condition affecting the brain, causes loss in memory and thinking skills. Dementia gets worse over time. The key is slowing down progression of this condition. One way to do this is to engage those with dementia in mentally stimulating brain exercises. Exercising your brain throughout your life is beneficial if you succumb to dementia. After your loved one has dementia, the trick is finding the right activities so your loved one keeps functioning at the highest possible level.

Predementia
According to a study published in the August 4, 2009, issue of Neurology, people who devote effort to activities that exercise the brain, such as reading, writing, and playing card games, may delay the rapid memory decline that occurs if they later develop dementia. The study found that for every activity a person participated in, the onset of rapid memory loss in dementia was delayed by 0.18 years.

"The point of accelerated decline was delayed by 1.29 years for the person who participated in 11 activities per week compared to the person who participated in only four activities per week," said study author Charles B. Hall, PhD, of Albert Einstein College of Medicine in Bronx, N.Y. This means start engaging in activities that exercise your brain.
Best Exercises
It is best to involve yourself with....read all of Brain Exercises for Dementia

The National Association of Activity Professionals

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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.

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

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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.

.Is your activity program ready for survey?

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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.

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

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About The Medpedia Project
The Medpedia Project is a long-term, worldwide project to evolve a new model for sharing and advancing knowledge about health, medicine and the body among medical professionals and the general public. This model is founded on providing a free online technology platform that is: easy to understand, collaborative, interdisciplinary, transparent, and that elevates the best medical information on the Web. The result of this effort will be to transform how both medical professionals and the general public acquire information about health and connect with each other.

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The content on or accessible through Medpedia.com is for informational purposes only. Medpedia is not a substitute for professional advice or expert medical services from a qualified health care professional. Organizations associated with Medpedia are not responsible for the content that appears in the editable pages of Medpedia, which can contain content submitted by other health professionals or other persons, including those who may not be affiliated with these organizations.

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

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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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Medpedia News & Analysis allows high-quality health and medical content sources to self organize by category and keywords on Medpedia, and then inter-link with Article pages and other parts of Medpedia. Sources reflect a wide range of professional, academic and scientific topics, and over 150 sources have added themselves and been accepted by the Medpedia community onto the News & Analysis platform. Content in the Medpedia News & Analysis section is not part of the (CC-BY-SA) license of Medpedia and copyright is held soley by the author(s). Organizations and individuals who regularly publish medical and health content online are encouraged to submit their source to the News & Analysis section of Medpedia at http://www.medpedia.com/news_analysis.

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

How to Motivate A Nursing Home Resident

Kathleen Milazzo

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Motivating A Nursing Home Resident
Step 1Introduce yourself as a staff member or volunteer and ask if they mind you visiting with them awhile.

Step 2Strike up a conversation and don't be afraid to ask them what brought them to live in the home. As they begin to talk about their situations you will start learning more about their pasts and what things they might be interested in. You can mention for instance if they used to go to play bingo, that bingo games are held in the home and ask if they would be interested in going. Offer to come and pick them up and escort them to the game.

Step 3When residents say they don't want to join in activities ask if they would at least come out of the room for awhile and watch the game. Assure them you will come and get them and bring them back to their rooms afterward.

Step 4If they don't want to go at all ask if they would mind daily visits from you. During these visits you can offer to bring some activity they like for just the two of you to participate in. You can also gently drop hints while your visiting about joining in the group activities.

Step 5If they refuse even visits saying they want to be left alone, insist that you have to come even if it's just to pop your head in and say hello. Once in awhile a resident will tell you that they are just too sick or in too much pain to be bothered. If that's the case, respect their wishes and offer to leave something of interest in their room in case they change their mind. Use gentle prodding and don't give up. Talk to the nursing department about enlisting their help in motivating the resident, and let them know how the resident is feeling.

How to Deal With a Difficult Nursing Home Resident

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Jae Ireland

Step 1Check with the resident's doctor to rule out any medical reason as to why he would be acting out, such as Alzheimer's disease. It may be a medical condition that can be remedied with therapy or medication. Once a medical cause is rule out, you can focus on other ways to cope.

Step 2Take the time to get to know the resident. What are her likes and dislikes? What things can calm her easily? What type of past does she have? Taking the time to get to know the resident may create a special bond for you, resulting in a calmer and happier resident.

Step 3Engage the resident in activities that he enjoys. Take special care that he is invited to nursing home events and outings, as well as individual activities such as reading or working in the arts. Taking the resident's mind off of his surroundings and circumstances may result in a less difficult resident.

Step 4Make sure that the resident has plenty of visitors. Residents can sometimes become difficult when they are bored or feel like they are forgotten. If there isn't family around to visit the resident, try asking for volunteers in your community to come for a visit two or three times a week.

Step 5Discourage bad behavior by not rewarding it. Make sure to not respond with a reaction or anger. Instead be patient with the resident, and try and see things from her point of view

The activities challenge - forecasts for nursing home activities professionals

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Kathy Hughes

Residents - and all of long-term care - are changing. And so will the activities profession

Twenty years ago nursing home residents could remember a time when there wasn't electricity, when the horse and buggy was the mode of transportation and a man on the moon was still the "man in the moon." Now our residents fall more into the group just preceding the "baby boomers"; they're accustomed to and comfortable with the new technologies. Their memories and leisure skills are different from those of people who entered old age 20 years ago.

A simple bingo game that was offered for socialization just 10 years ago isn't quite enough now; many of our residents want to go to the nearest casino and play "high stakes" bingo. For them, going out to lunch, means spending the day at the movies and eating in a food court at the local mall. Shopping no longer needs to be done at the five-and-dime, but can also be done on the 24-hour Home Shopping Channel. Tatting - a highly intricate form of lacemaking - has now made room for residents who learned how to knit on a machine. Gentlemen living at the facility would rather watch "Monday Night Football" than get together, drink coffee and have the newspaper read to them.

Activities will become smaller; more emphasis will be placed on specific group programs that serve to educate rather than entertain. Individual activities, with two or three residents gathered in an area to learn a new craft or to learn all about Sony PlayStations, will be the norm. Residents will opt to e-mail their great-grandchildren from their rooms or to order holiday gifts via their televisions

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

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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

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

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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

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

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

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

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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

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

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.”

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

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

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.

Beyond Bingo: Meaningful Activities for Persons with Dementia in Nursing Homes

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

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

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.

part 2 of Meaningful Activities for Persons with Dementia in Nursing Homes, soon

DCC: Nursing Home Visits from Fido Have Lasting Benefit

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

medpageToday

By Crystal Phend, Staff Writer, MedPage Today

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco . Earn CME/CE creditfor reading medical news

GARDEN GROVE, Calif -- If dementia patients living in a nursing home are visited by a dog, they tend to laugh, smile, and respond more for weeks to come, researchers said

Group interaction with a therapy dog increased social behavior during the intervention with effects maintained over the next six weeks, Ann-Marie Wordley, a Ph.D. student at the University of Adelaide, Australia, and colleagues found.


These preliminary results from a small controlled trial suggest that the benefits of animal-assisted therapy linger longer than anticipated, the researchers reported at the Alzheimer's Association Dementia Care Conference here.


"The dog did make quite a difference," Wordley said. "One of the hardest things for residents is leaving their pet behind."


Furry visitors and even resident pets are fairly well accepted in the U.S., but studies had not looked at maintenance of the effects nor controlled for the potential benefit of interaction with animal handlers, Wordley said.


So her group prospectively studied 30 residents of a residential care facility in southern Australia. Seven were classified as "sundowners," who have particularly challenging behavior problems in the evening.


Participants were observed during a four-week run-in period followed by six weeks of animal-assisted therapy and another six weeks of observation without intervention.


The therapy consisted of a one-hour group session twice a week with the activities therapist, two visiting dog handlers, and one of three visiting dogs -- a golden retriever and two border collies. All three dogs were assessed for temperament and suitability to the nursing home environment.


Residents could pat and interact with the dog as the handler walked it around the group.


Nursing home staff completed the Revised Memory and Behavior Problems Checklist after each session and at the end of each week.


Prosocial behavior -- eye contact, smiling, verbal communication, and other responsiveness -- increased from a mean score of about 14 during the baseline period to 21 during the intervention and remained at an average of 20 during follow-up.


Memory problems among participants decreased from an average 16 at baseline to seven during the intervention and remained at a score of nine over the next six weeks.


The benefit of animal-assisted therapy on disruptive behavior did not last as long. It improved from a mean score of about six at baseline to one during the intervention, but rose again to about four points thereafter.


The group of sundowner patients also participated in a six-week study to control for the effect of the animals by having sessions with the dog handlers alone, without their dogs.


Compared with the control period among these patients, animal-assisted therapy improved prosocial behavior (mean 14 versus 7 points) and memory problems (mean 14 versus 19 points).


Although statistical analysis is not yet completed for the preliminary results, Wordley said her group expected the improvements for prosocial behavior to be significant through six weeks.

Primary source: Dementia Care Conference
Source reference:
Wordley AM, et al "Animal-Assisted Therapy for People with Dementia Living in Residential Aged Care Facilities" DCC 2008; PS-19.

Additional games and activities for Nursing Home Residents

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

by Pamela Veselinovic
Additional games and activities for Nursing Home Residents:

Bingo!
Wheelchair bowling.
Simon Says.
Sing-a-longs.
Wheelchair races.
Manicure parties.
The “list anything” game. For instance, list all the animals you can think of, or birds, or cars, or states, or?
Memory game. For instance, “Who wants to tell a special birthday story?” Or, “A wedding story.” You can choose anything they might remember.

In Closing, please make sure you do not over exert the nursing home residents. This is for circulation and fun, not for losing calories! And having fun is what you are there for!