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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
For the slides from this presentation, visit:
www.teepasnow.com/presentations
Slides will be available for 2 weeks
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Handouts are intended for personal use only. Any copyrighted materials
or DVD content from Positive Approach, LLC (Teepa Snow) may be used
for personal educational purposes only. This material may not be copied,
sold or commercially exploited, and shall be used solely by the requesting
individual.
Copyright 2017, All Rights Reserved
Teepa Snow and Positive Approach® to Care
Any redistribution or duplication, in whole or in part, is strictly prohibited,
without the expressed written consent of Teepa Snow and
Positive Approach, LLC
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Developing Activities
That Have Meaning
Those Living with
Dementia
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
How Does Skill Change Over
Time With Dementia?
- Interests
- Helper cues that help
- Environmental cues that help
- Ability to focus and change focus
- Sensory awareness and processing
- Motor skills: gross and fine
- Decision making and reasoning
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Progression of
Dementia: The GEMS®
Sapphires
Diamonds
Emeralds
Ambers
Rubies
Pearls
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Sapphires:
- Us on a good day
- Clear and true to ourselves
- May feel ‘blue’ over changes
- Can typically choose our behavior
- May have other health issues that affect
behaviors
- Recognize life experiences, achievements
and values
- Can follow written info and hold onto it
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Diamonds:-Sharp, hard, rigid, inflexible, can cut
-Many facets, still often clear, can really shine
-Are usually either Joiners or Loners
-Can complete personal care in familiar place
-Usually can follow simple prompted schedules
-Misplace things and can’t find them
-Resent takeover or bossiness
-Notice other people’s misbehavior and mistakes
-Vary in lack of self-awareness
-Use old routines and habits
-Control important roles and territories, use refusals
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Diamond Interests:
- What they feel competent at
- What they enjoy
- Who they like
- What makes them feel valued
- Where they feel comfortable but stimulated
- What is familiar but intriguing
- What is logical and consistent with historic
values and beliefs
- Whoever is in charge
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Emeralds:
-Changing color
-Not as clear or sharp, more vague
-On the go, need to ‘do’
-Flaws may be hidden
-Time traveling is common
-Are usually Doers or Supervisors
-Do what is seen, but miss what is not seen
-Must be in control, but not able to do it
correctly
-Do tasks over and over, or not at all
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Emerald Interests:
- Doing familiar tasks
- Doing visible tasks
- Historic tasks and people and places
- Engaging with or helping others
- Finding important people or things
- Having a ‘job’ or ‘purpose’
- Being an ‘adult’
- Getting finished and doing something else
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Ambers:-Amber Alert- Caution!
-Caught in a moment
-All about sensation and sensory tolerance, easily
over or under stimulated
-May be private and quiet or public and noisy
-No safety awareness
-Ego-centric
-Lots of touching, handling, tasting, mouthing,
manipulating
-Explorers, get into things, invade others’ space
-Do what they like and avoid what they do not
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Amber Interests:
- Things to mess with (may be people!)
- Places to explore
- Stuff to take, eat, handle, move
- Visually interesting things
- People who look or sound interesting, or
places that are quiet and private
- Textures, shapes, movement, colors,
numbers, stacking, folding, sorting
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Rubies:-Hidden depths
-Major loss of fine motor finger and mouth skills, but
can do gross motor skills like walking, rolling,
rocking
-Comprehension and speech halted
-Wake-sleep patterns very disturbed
-Balance, coordination, and movement losses
-Eating and drinking patterns may change
-Tends toward movement unless asleep
-Follows gross demonstration and big gestures
-Limited visual awareness
-Major sensory changes
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Ruby Interests:
- Walking a routine path
- Going forward
- Watching others
- Being close or having space
- Things to pick up, hold, carry, push, wipe,
rub, grip, squeeze, pinch, slap
- Things to chew on, suck on, grind
- Rhythmic movements and actions
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Pearls:-Hidden in a shell: still, quiet, easily lost
-Beautiful and layered
-Spends much time asleep or unaware
-Unable to move, bed or chair bound, frequently fall
forward or to side
-May cry out or mumble often, increases vocalizations
with distress
-Can be difficult to calm, hard to connect
-Knows familiar from unfamiliar
-Primitive reflexes
-The end of the journey is near, multiple systems are
failing
-Connections between the physical and sensory world
are less strong but we are often the bridge
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Pearl Interests:
- Internal cues
- Pleasant and familiar sounds and voices
- Warmth and comfort
- Soft textures
- Pleasant smells
- ‘Good’ tastes
- Smooth and slow movement
- Just right touch and feel
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What Do People with
Dementia Need?- Daily Routine!!!!
- Help to fill their day with meaning
- A Balance of:
-Productive activity: feeling valued
-Leisure activity: having fun
-Self-care activity: wellness, health, personal care
-Restorative activity: sleep, rest, and re-energizing
- A Match-Up for Preferences:
-Large Group, Small Group, 1:1, Alone
-Active versus passive
-Sensory options: visual, auditory, tactile, olfactory,
gustatory
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Know each
PERSON!
Understand
ACTIVITIES!
Make & Use a
SCHEDULE!
Build staff
SKILLS!
Manage the
ENVIRONMENT!
Resources to
succeed
What Does it Take to Have a
Day with Meaning and Joy?
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Know each Person
Health Status
medical conditions,
medications,
limitations & abilities
Life History
Who the person has
been…
Personal history and
background
Cognitive Status
thinking, memory,
processing skills
and limitations
Emotional status
psychological
condition and mental
health & limitations
Routines and Habits
patterns of behavior,
daily routines, time use
& schedules
Sensory Status
sight, hearing, touch,
balance, coordination,
temperature regulation
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Personal Preferences and
Values:
- Who have you been?
- What did you value?
- Who are you now?
- What do you value now?
- Why does it matter?
- Who gets a ‘say’?
- Who gets to set the priorities?
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Personality Traits:
- Introvert - Extrovert
- Lots of Details - Big Picture Only
- Logical - Emotional
- Planning Ahead - Being in the Moment
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Life Story:
Family: past and
present
Living place(s)
Work history
Leisure History
Music history
People history
Plant history
Animal history
Plant history
Sensory environment preferences
Cultural history and concerns
Food likes and dislikes
Daily routines
Organizations and memberships
Roles and responsibilities
Comforts and Irritants
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Design Each Day
8 am – coffee circle
8:30 – songs of joy
9 am – time to ‘go’9:15 – take a hike – walk’n’roll
10 am – cool down & stretch
10:30 – watering hole
11 am - ‘use your brains’games
11:30 - time to ‘go’ – wash up
11:45 – ‘set-‘em up’ crew
12 noon – let’s eat
12:30 – clean up crew
1 pm – music and meditation
1:30 – coupons clipping
2 pm – time to ‘go’2:15 – let’s dance
Make a
schedule and
follow it
Be structured
BUT allow
flexibility
Create a
FLOW for the
day
Build up and
then slow down
Circadian
rhythms
Offer a variety
of activities
every day
Leisure, work,
rest, self-care,
groups and 1:1,
passive and
active
Create Group
schedules
BUT
also build
individual
schedules
Not everything
is for
everybody!
Build a Foundation
of Familiar and Favorite
Activities
Add a few
special events and
something different© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
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Two Examples:
Paying Bills:
Do it independently
Together – use a calculator
Together – do all of them
Together – do one at a time
You do most, they sign and
put in envelopes
You do all but the signature
They put on stamps
Both take them to the mail
box
Washing Dishes:
Do it independently only
after meals
Do it independently – when
needed to fill time
Together – one wash, one
dry
Do parts
Watch and guide
Carry dishes to/from sink
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Learn How To:
- Do something new
- Learn a new type of exercise or activity
- Simplify a dance
- Re-look at a old skill and make it easier
- Share a tasks
- Do something without touching things
- Get someone to do something without words
- Give positive feedback and say “thanks”
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Pay attention
to the lights, sounds, seating, work
surface, space…
Manage the Environment
Do the ‘right stuff’ in the ‘right place’Match what you do
to where you are…
Use the space well
Plan and place for
BEST effect
Create & Use Storage
Make set-up & clean-
up part of the activity
Change it
around – if you
need to - to make
it work!
Keep it ADULT
Make sure supplies, activities, and
games are meaningful
Play & laugh with folks, not at them
Give out tools and materials ‘just in
time’
Control the activity so clients are
successful – not overwhelmed
- not out of synch
Make it look friendly
Get me to want to come
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Take a Look, Listen, Feel:
- Lighting: adequate, non-glare, focused
- Sounds: background, distracting, volume
- Feel:
-Temperature
-Space: crowded, intimate, personal, public
-Work surface
-Seating surface
-Walking surface
-Familiar? Friendly? Fun? Forgiving?
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Enough Supplies
& Materials
The right
equipment for
clients’ needs
Good
quality
lighting
Skilled
leadersh
ip for the
activity
Good
work
surfaces
Seating
that
works
Enough
help for
each
person
A Back-Up
Plan
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Two Options:
Doing:
Filling socks: rice socks,
bean socks, corn socks
Adding herbs: lavender,
citrus, eucalyptus, mint
Putting a sock inside
another sock
Heating the socks
Rubbing the socks over
muscles
Emptying socks out
Making:
Fruit salad: from fresh
Fruit salad: from canned
Fruit salad: from pre-cut
Fruit salad: one fruit and
yogurt
Fruit salad: dried fruit,
granola, and yogurt
Putting the fruit salad in
small cups or bowls
Serving the fruit salad
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How Do We Create
Meaningful Activities?
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Key Activities to Consider:
Productive - Work
Enjoyment - Leisure
Wellness - Personal Care
Restorative - Rest
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Productive Activities:
Helping another person
Helping family members/caregivers
Completing community tasks
Making something
Sorting things
Fixing things
Building things
Creating something
Caring for things
Counting things
Folding things
Marking things
Cleaning things
Taking things apart
Moving things
Cooking/baking
Setting up/breaking
down
Other ideas
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Active: Passive:
Socials
Sports
Games
Dancing
Singing
Visiting
Hobbies
Doing, Talking, Looking
Entertainers
Sport program/event
Presenters
Living room or lobby sitting
TV programs: watched
Activity watchers
Being done to
Leisure Activities:
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Cognitive: Physical:
Table top tasks
•Matching, sorting,
organizing, playing
Table top games
•Cards, board games,
puzzles
Group games
•Categories, crosswords,
word play, old memories
Exercise
Walking
Strengthening tasks
Coordination tasks
Balance tasks
Flexibility tasks
Aerobic tasks
Personal care tasks
Self-Care and Wellness
Activities:
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Rest and Restorative
Activities:Sleep/naps
Listen to quiet music with lights dimmed
Look at the newspaper
Look at a calm video on TV screen
Rock in a chair
Swing in a porch swing
Walk outside
Listen to reading from a book of faith
Listen to poetry or stories
Listen to or attend a
worship service
Stroke a pet or animal
Stroke fabric
Get a hand or shoulder
massage
Get a foot soak and rub
Listen to wind chimes
Aromatherapy
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Good Activities
Are Ones That Involve:
- Plants
- Animals
- People
- Music
- Objects
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A Few More Ideas:
- Set aside a few minutes – use a timer!
- Breathe
- Smile, laugh, look for some funnies
- Remember a good time
- Think about what you do get out of the
relationship
- Use at least one of Teepa’s 10-Minute Stress
Tamers
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What is There is To Laugh
About?- What the person says
- What the person does
- What the person says versus what is done
- Your mistakes and ‘oops’ moments
- Your moments of joy
- Your moments of insight
- Their moments of insight, awareness, or humor
- Other people and their behaviors or words
- Things you see, hear, read
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Teepa’s 10 Minute Stress
Tamers:- Sit quietly in calm surroundings with soft lights
and pleasant scents.
- Aromatherapy: lavender, citrus, vanilla,
cinnamon, peppermint, fresh cut grass.
- Breathe deeply: rest your mind and oxygenate
- Soak: in a warm bath, or just your hands or feet
- Read: spiritual readings, poetry, inspirational
readings, or one chapter of a book you like
- Laugh and smile: watch classic comedians,
Candid Camera, America’s Funniest Home
Videos, look at kid or animal photos
- Stretch: front to back, side to side, and across
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Teepa’s 10 Minute Stress
Tamers:- Beanbag heat therapy: fill a sock with dry beans
and sew or tie closed, heat in a microwave for 30 seconds at a time, place on tight muscles and massage gently; relax for ten minutes
- Remember the good times: record oral memories, scrapbooks, photo journals, keepsake memory picture frames, or just jot
- Do a little on a favorite hobby- Have a cup of decaffeinated tea or coffee- Play a brain game: crosswords, jigsaws, jeopardy,
jumbles- Look through a hymnal and find a favorite and hum
it all the way through- Garden: work with plants
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Teepa’s 10 Minute Stress
Tamers:- Books on Tape: rest your eyes and read
- Soothing sounds: music you love, music
especially for stress relief, recorded sounds
of nature
- Listen to coached relaxation recordings
- Pamper yourself : think of what you love and
give yourself permission to do it for 10
minutes
- Neck rubs or back rubs: use the ‘just right’
pressure
- Hand Massages: with lotion or without
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Teepa’s 10 Minute Stress
Tamers:- Take a walk
- Sit in the sun
- Rock on the porch
- Pray or read a passage from scripture
- Journal: take the opportunity to “tell it like it is”
- Cuddle and stroke a pet
- Have that cup of coffee or tea with a special
friend who listens well
- Pay attention to your personality:
-If you rejuvenate being alone, then seek solitude
-If you rejuvenate by being with others, seek
company
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Breathe!!!
Take a deep breath in
Blow it all the way out
Take another breath in
Blow it out
Take one final breath in and
Sing it out….
Feel what happened to you
Look at what happened to the people around you
Think about how and when you might do this
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No part of this may be copied, or changed in any format, sold, or used in any way other than what is
outlined within this under any circumstances without express permission from Positive Approach to Care.
Copyright 2017, All Rights Reserved
Teepa Snow and Positive Approach to Care
DISCLAIMER
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