“Strategies That Work!”The Common Sense Approachto One-to-One Programming

CAT SELMAN, BSTHE HEALTHCARE COMMUNICATORS, INC.WWW.THEHEALTHCARECOMMUNICATORS.COMWWW.CATSELMAN.COM

Dementia Care Principles

Person–Centered Care. CMS requiresnursing homes to provide a supportiveenvironment that promotes comfort andrecognizes individual needs andpreferences.

Dementia Care PrinciplesQuality and Quantity of Staff.

The community (facility) must providestaff, both in terms of quantity (directcare as well as supervisory staff) andquality to meet the needs of theresidents asdetermined byresident assessmentsand individual plansof care.

Definitions Related to Recognition andManagement of Dementia

Person-Centered orPerson-AppropriateCare is care that isindividualized bybeing tailored to allrelevantconsiderations forthat indivi-dual,including physical,functional, and

Barriers to Person-CenteredActivity Programs

• Failure to really change how people are listenedto and responded to resulting in superficialchanges

• Focus on staff training to the exclusion offamilies and self-advocates

• Failure to pay attention to the implementationof plans

• Disconnection between seeing what isimportant to people in the process and howresources are allocated and used

Barriers to Person-Centered ActivityPrograms• Focus on technical training and failure to pay

attention to follow-up support, managementaction, and embedding person-centered valuesin organizational cultures

• Implementation of person- centered carewithout good connections toother plans and strategies

• Failure to get person centeredplans developed for the maintarget groups

• Failure of departments towork effectively together

Definition

One-to-OneProgramming

▶Programming provided to residents whowill not, or cannot, effectively plan theirown activity pursuits, or residents needingspecialized or extended programs toenhance their overall daily routine andactivity pursuit needs.

One-to-one Programming

▶ One-to-one programming should be provided forall residents who have been assessed as needingsuch intervention, especially those residentsneeding added sensory stimulation, socialization,or specific activity adaptations.

▶ The length, duration, and content of one-to-oneprogramming is determined by the specific needsof the individual resident. A one-to-one activitymay be as short as 3 minutes if someone hasextremely low tolerance, or if there arebehavioral issues.

Residents who may need 1-to1…• Those who have symptoms of depression

• Those who do not socialize with others

• Those who prefer involvement in the privacy of theirroom

• Those who are bedfast

• Those who have cognitivedeficits

• Those who have a type ofdementia

• Those who are disruptiveor abusive when in groups

Matching the Individual to the Activity Initial assessment/interview

Identification of individual strengths, abilities,interests and former life-style (customary routine)

Mental status scores, depression scales, and anyother assessment tools

Individual goals and objectives

Activity analysis

Staff’s skills and abilities

Interests versus skills (adaptations/modifications)

Evaluation

Program Types1. Aromatherapy – “…healing with

essential oils through the senseof smell by inhalation…”

2. Art Therapy – the use of art to express consciousand unconscious feelings. Technique usesmethodology that asks a resident to express, indrawings or images, what they may have troubleexpressing in words.

3. Bibliotherapy – the method of assisting othersthrough examples in reading materials such asbooks, plays, and pamphlets can be useful indemonstrating that others may share similarproblems.

Program Types4. Dance Therapy – “the psychotherapeutic use of movement

as a process which furthers the emotional, cognitive andphysical integration of the individual” – American DanceTherapy Association.

5. Drama Therapy – “…the intentional use of creative dramatoward the psychotherapeutic goals of symptom relief…andpersonal growth…” Stimulation of a person’s creativity is aprimary goal.

6. Horticultural Therapy – “…a processutilizing plants and horticultural activitiesto improve the social, educational,psychological, and physical adjustment ofpersons thus improving their body, mindand spirit.

Program Types7. Milieu Therapy – therapeutic interventions designed to

assist in making the institutional environment healthierfor residents by altering the patterns and theenvironment in which the residents live. Purpose is tohelp elders avoid social withdrawal, decreased physicalactivity, and other negative impacts.

8. Music Therapy – “…the use of music in theaccomplishment of therapeutic aims: the restoration,maintenance, and improvement of mental and physicalhealth.” - NAMT

Program Types9. Pet Therapy – the use of animals to provide

therapeutic effects and to illicit positive emotions.

10. Phototherapy – uses snapshots and family photoalbums as a stimulation and bridge to therapeuticcommunication.

11. Poetry Therapy – uses poem “…as a catalyst for exploring deeperthoughts and feelings.”

12. Reality Orientation – “…continual, stimulating,repetitive orientation and by encouraging theresident…back into his environment.”

Program Types13. Remotivation – finding new ways to “…provide an

environment and opportunity to activate theuntouched areas of a person’s personality.”

14. Validation Therapy – “…a therapyfor communicating with old-old(over 75 years of age) people whoare diagnosed as havingAlzheimer’s disease and relateddementias.”

15. Restorative – working with other members of theinterdisciplinary teams who primarily are focusedon rehabilitative and restorative issues.

Program Types16. Eden Alternative – an environmental, “human

habitat” concept; utilizes plants, pets, and children

17. Snoezelen Environment – arecreational program for childrenand adults, offers a “…blend ofsights, sounds, aromas, movementand sensory stimulation in apositive environment.”Environment is created that includes visual,auditory, tactile, and olfactory stimulation.

18. Reminiscence – “…the act or process of recalling thepast…”

Program Types19. Life Review – “…occurrence in older people of an

inner experience or mental process of reviewingone’s life.”

20. Sensory Stimulation – a method of activating one ormore of the five senses to cause a positiveresponse.

21. Humor – “…a coping strategy based on anindividual’s cognitive appraisal of a stimulus whichresults in behaviors such as smiling or laughter.”

22. Touch and Therapeutic Touch – atactile method for communicating

One-to-One Programming

▶ Sensory stimulation orcognitive therapy; i.e.,touch/visual/auditorystimulation, reminiscence,or validation therapy.

▶ Social engagement; i.e., directedconversation, initiating a resident toresident conversation, pleasure walk orcoffee visit.

One-to-One Programming▶ Spiritual support, nurturing;

i.e., daily devotion, Biblereading, or prayer with or forresident per religiousrequests/desires.

▶ Creative, task oriented; i.e., music therapy,pet therapy, letter writing, word puzzles.

▶ Support of self-directed activity; i.e.,delivering of library books, craft material torooms, setting up talking book service.

Group Work1. Take each of the above categories (descriptions)

of one-to-one programming and make a list ofpractices currently being implemented withinyour building that would “qualify” under thesedefinitions.

2. When identifying these practices, indicate whichstaff or “discipline” is actually implementing theprogram.

Sensory StimulationNumerous experiments have shown that whennormal, healthy adults are deprived of sensorystimulation they exhibit negative effects such as:

•Decreased motivation

•Poor concentration

•Impaired motor coordination

•Difficulty with abstract reasoning

•Increase in disorientation and somatic complaints

Sensory Stimulation

These effects were increased by:

• Perceptual deprivation (being in a meaninglessenvironment) and

• Immobilization (increased the effects even further)

Sensory StimulationDefinition:

• Sensory stimulation is an individual or group activityfor the cognitively impaired who have difficulty inrelating and responding to their surroundings.

• Meaningful and familiar smells,movements, feels, sights,sounds, and tastes from theirsurroundings are presentedsystematically and in a formatthat can be understood.

Benefits of Sensory StimulationCognitive Function

• Sensory activities can help elders with degenerativecognitive functioning retain memory skills throughsensory stimulation.

• One sensory stimulation activity involves use of a boxthat contains familiar items that have a certain quality.

• This quality could be a familiar color scheme, shape,sound or even smell or taste.

• Because the senses are powerful memory enhancers,an object that reminds elderly people of a particularplace or event can also help them recall and imaginethat environment.

Benefits of Sensory StimulationCommunication

• Sensory activities for elders canbe used as exercises incommunication.

• Family members and residentialcare professionals can spend timewith elderly people talking aboutsensory stimulation objects and thememories associated with them.

• Talking for extended periods of time about the objectshelps elders recall and employ figures of speech andidioms necessary for complex conversation. Elderlypeople can use the objects not only as a subject ofconversation, but also to initiate reminiscence.

Benefits of Sensory Stimulation

Relaxation

• Sensory activities use familiar sights, sounds,textures, smells and tastes to help elders recallmemories and think more clearly about othertimes and places.

• Because sensory activities for elders focus onmemory recall, many find sensory stimulation arelaxing and comforting activity even while theychallenge and exercise their cognitive function.

Benefits of Sensory StimulationQuality of Life

• The specific objects selected fora sensory stimulation kit can alsoenhance an elder's quality of life.

• Use items of personal importanceto the individual that also evokesensory stimulation, like photographs of family,favorite souvenirs or knick-knacks, voice recordingsof loved ones or family home videos.

• Elders whose families are involved in a sensorystimulation program also have the satisfaction offeeling that their family members continue to beinvolved in their everyday lives.

Benefits of Sensory StimulationInclusion

• Including elders in any activities, even those that maybe more of a challenge for them if they have sensoryimpairments, makes them feel like a vital part of afamily or friend group.

• When including elders in social groups that consist ofmany younger people as well, be sensitive aboutadapting activities so thatthey are safe andenjoyable for peoplewith impaired vision orhearing.

Sensory StimulationWhat’s in it for the caregiver? Individuals who aremore able to relate to and participate in theirsurroundings…..

• Feel better about themselves

•Are more calm

•Are more alert

•Are more functional

•Are less demanding as a result

Environment – Person ResponseSystem

Environment

Confusing,disorganized

environmental input

Response

Confusing,disorganized

response

Environment – Person ResponseSystem

Environment

Orderly, understandable

environmental input

Response

Orderly & functional

responses

Appropriateness of Technique

• Does not focus on cognitive skills

• More suitable for individuals with lowerfunctioning

• Can be implemented by staff without anextensive background in theory andtreatment

Establishing Goals

• Improve environmental awareness

• Prompt familiar, functional behaviors

• Improve general level of alertness

• Enable appropriate social and environmentalresponses

• Provide reassuring, orienting information

• Provide pleasurable, sensory experiences

• Provide opportunities for emotional expression

Presentation of Cues

It is essential to present materials/cues in aplanned, organized manner:

•Organize the cues around a particulartheme or focus

•Direct the cues toward enabling anassociated functional response

•Present the cues in a sequential manner

Presentation of Cues

Sensory cues should be presented in thefollowing order:

•Smell

•Movement (kinesthetic)

•Touch

•Vision

•Hearing

•Taste

Let’s Look at the Senses…Visual Stimulation

• Vision is our most important sense, the one throughwhich we gain most of our information, and the onethat offers the broadest range of possibilities forstimulation

• Visual stimulation for individuals withAlzheimer's can involve light, color,shape, or motion, or a combination ofthose elements.

• Gently animated lights, kaleidoscopes, colorfulpaintings, nature movies, fiber optic Christmas trees, aglorious sunset: all examples of visual stimulation.

Let’s Look at the Senses…Auditory Stimulation

• Our ears probably provides us with our second mostvibrant source of sensory stimulation.

• Auditory stimulation for people with Alzheimer's anddementia is as effective for mood enhancement,relaxation, and cognition as it is for everyone else.

• The calming effects of musicare well known. Farmers playmusic to their cows and thecows produce more andbetter milk. Music makesplants grow larger andhealthier.

Let’s Look at the Senses…Olfactory Stimulation

• Some of our strongest memories, our most potentassociations, are triggered by odor.

• A smell that you associate with an event or momentin the past, will often transport you to that moment.

• It can do so much more than just stir a memory.

• Anything that has the power to channelreminiscences should be part of the daily life of theperson with dementia.

Let’s Look at the Senses…Tactile Stimulation

• Anything touched and anything that touches us can bestimulating.

• Every solid object has texture,temperature, shape.

• Balls in a collection can besmooth or rough, hard or soft,furry or...not.

• The sense of touch also includes the differentiationand recognition of temperature, pain, and bodyposition.

Let’s Look at the Senses…Gustatory Stimulation (Taste)

• In many ways taste is the mostpleasurable of our senses,depending on how muchemphasis one puts on food and eating.

• Taste is very closely aligned with smell, and canlead to reminiscences.

• Unfortunately our senses become less acute as weage. In many cases this is more true of taste thanthe other senses. Foods and beverages chosen fora strong flavor will be more beneficial than a morebland selection.

Let’s Look at the Senses…Kinesthetic Sense (movement of body parts throughspace)

•Usually not included in basic senses, but is crucial

•Excitement and invigoration derivedfrom strenuous exercise is obvious

•Pleasurable sensations and stimulating effect from lessstrenuous exercise, or even body movementsare not as obvious

•Because of increased dependence on staff to “assist,”the individual with Alzheimer’s and/or Dementia doesnot move as much

•So “movement” is absolutely necessary!

Helpful Hints…

• Look through their eyes

Walk around the living area with your headand gaze slightly lowered. Try to imitatetheir height, taking inventory from thisperspective. What do you see?

Helpful Hints…Encourage Rummaging

• Intentionally leave safe, enticing items in plain sight, within easyreach.

• Set out purses filled with “treasures” to actively encourageexploration.

• Display treasure chests, baskets filled withobjects, or even open chests of drawers.

• Hang “dress-up” hats and colorful scarves wherethey can be reached

Helpful Hints…Entice through “In-Progress” Tasks

• Arrange simple, familiar tasks

• Set out a basket of clothes (laundry)

• Placing a little water in a watering can next to areal (non-toxic) plant

• Lay out “un-matched” socks

Sensory Stimulation Formula• Each sense requires at least 3 different

cues/prompts

• Once you use a cue/prompt for one sense, youmay not use it again for another sense

• The idea is to “bombard” the senses!

• This formula, developed correctly, will result in theprovision of at least 18 different cues/promptsrelated to a specific topic or subject matter

• Goals can be individualized for each specificparticipant

Sensory Stimulation Formula

• Smell

• Kinesthetic Sense

• Touch

• Vision

• Auditory Sense

• Taste

• Functional Response

Contact Information:Cat Selman, BSThe Healthcare Communicators, Inc.www.thehealthcarecommunicators.com601.497.9837healthcarecomm@aol.com

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