Do You Remember When? Person Centered Memory Care
How can we keep our loved ones occupied, stimulated and creative even while they are having memory related issues? It is extremely important to keep the person engaged in varied activities during the day. These activities can be both active as well as passive. Even people with dementia can participate in constructive activities while living at home or in health care facilities. The first step in this process is to get to know the person behind the dementia especially if he or she is being taken care of by a health care professional rather than their own flesh and blood.
Caregivers getting to know the person behind the dementia
Your patient was an important person in the past. Your patient could have been the CEO of a large institution, a doctor, lawyer and caregiver as well. All people need to be needed as opposed to be simply entertained. Think of yourself on the most luxurious cruise ship. The first few days you can’t get enough of the extravagant care and courtesy. But after that you begin to get antsy and realize that you would not like to live your entire life as a taker. Many of these patients have been in the driver’s seat in the past and now they are kicked to the rear of the car with no control whatsoever. To preserve some of these past responsibilities, various activities are conceivable.
One method of keeping a patient actively focused is integrating activities based on the Montessori Method of teaching. This method originally developed in 1897 for children with special needs and is now utilized with mainstream students as well. This teaching process has seen amazing results for dementia patients. Independence and respect of the person’s psychological and social development (and even in certain cases their physical development) is the emphasis of this program.
This is called person-centered care that requires knowledge of the person’s life story and the person’s interests and strengths in order to create activities that have individual purpose for them. A person with memory issues and dementia should be the one to determine which activities mean something to them and which do not. The caregiver should not worry about the outcome of the project but how actively the patient is participating. Knowing what the person can do as opposed to what they can’t do will help create successful activities for them rather than frustrating ones. How can a caregiver know if an activity has meaning for the patient? People with dementia often cannot express their feelings openly. If they are able to laugh and smile then you will know that these are signs of noticeable engagement. If the person is quietly observing others who are involved in an activity or helping others are also signs of the person’s interest. Refusing to join, walking away or sleeping are indicators that the person with dementia is not interested.
Short term memory can fade for dementia patients, however, quite often their long-term memories remain intact. For example, if your mother was an expert baker or chef, a food-related activity can bring back memories.
Food Preparation
Ms. Teepa Snow, has created amazing activities and programs for her patients (purposeful activities for dementia). Baking blueberry muffins is one example. In a fascinating video, Ms. Snow has the patients seated around a rectangular table. Before they begin she asks a patient if she had ever baked at home. When she answers affirmatively, Teepa then asks if she would like to bake muffins. Each person, male and female, has a plastic bowl and wooden spoon in front of him. The coordinator goes to each patient and asks a question. Which flavor muffins would you like to try? She then gives the ready muffin mix in a plastic bag to the potential baker. When the person has trouble opening the bag the coordinator exclaims, “Oh these dumb bags they are so difficult to open I have trouble with them myself”. In two sentences the coordinator has accomplished two distinct actions.
Firstly, she is giving the patient a choice by asking what type of muffin she prefers. Secondly, she is preventing the frustration of a package that is difficult to open. Yet she does give the patients a chance to successfully open the package. There are several muffin pans placed on the table between patients. The paper muffin cups are placed strategically on the table ready to be placed in the pans. It is fairly easy for the patients to place the papers in the muffin tin by themselves. Batter is also put into the cups by the patients themselves even if some batter spills out. All is done in a relaxed atmosphere with no judgement or speaking down to. This involvement in food preparation is especially effective for people who refuse to eat or have diminishing appetites. As a bonus food preparation also has physical improvement benefits. Mixing the muffin batter exercises the shoulder and holding the wooden spoon tightly stimulates the lower hand muscles.
Nature Appreciation
Garuth Chalfont is a garden designer. He has designed gardens specifically for memory care facilities. His gardens are environmentally suited to be dementia friendly. For instance, fruit trees and vegetable plants set the tone of the environment so that the patients can help themselves. For instance, the patients pick rhubarb, wash it, cut it up and help to prepare it for cooking. This is called, taking ownership.
The garden has wider and narrow paths for the patients to pass through with a cane, walker, or wheelchair. As they start their tour the paths are wider for speedier strolling, as more interesting flowering plants with contrasting colors come up the path narrows so the patients can slow down and enjoy the beauty of the flowers. There are benches strategically placed in close proximity to the color contrasting plants. There are also animals like rabbits that the can be touched and cuddled. If your parent had a garden you can plan activities involving gardening tools, sorting and planting seeds, and pulling out weeds. These tasks may jerk back memories from when they were younger.
Musical Memory
Music is a universal and effective way to engage people with memory issues including dementia. The part of the brain that identifies music is the one that is often the last to go. Simple drumming or singing old identifiable patriot and religious songs are great group activities. An individual’s short-term memory may fade, but their long-term memory can remain alive. Therefore, songs and music from their childhood can be rescued from their minds.
Ms. Teepa Snow demonstrated a wonderful musical crossword game. On a large erasable white board, Ms. Snow drew a large crossword puzzle. She began with an old well know song like Rock-a Bye Baby and then stopped and asked the patients to fill in the blank. “Rock a bye baby on the __________. The patients then chimed in treetop. If there was a patient who was able to write, she was asked to come up to the board and fill in the letters. What satisfaction you could see on their faces. An added bonus was that when the song was a lively one you could see the patients rock in their chairs, clap their hands and even stand up to the rhythm. This game had both intellectual stimulation as well as physical stimulation.
On the radio show, Tapping Into Musical Memory by Science Friday, Oliver Sacks and Dan Cohen explain that music acts as a window to the memory. Even if a parent cannot remember their child’s (who is standing right near them) name, he can remember the name of a song. Dr. Sacks gave an example of a 94-year-old nursing home resident named, Henry. He was in an advanced state of Alzheimer’s and unresponsive. When asked if he liked music he answered that he was crazy about music. Henry was then asked who was his favorite singer and he answered Cab Calloway and he started singing one of his big hits. Music connects the person to his emotional memory. If you play the music from the patient’s personal youth it will bring back the moment that he heard the music. Music activates the emotional areas of the brain. People can lose language but musical memory is not lost. According to Oliver Sacks and Dan Cohen, this musical memory exercises work on 75% of the advanced Alzheimer’s patients they studied.
The Montessori Method can have enormous contributions for people with dementia. Activities can be easily set up and modified according to a person’s ability and customized based on their own personal history and past talents. The person with dementia should be the one to choose which activities have meaning to them and which don’t. Caregivers and relatives can help to provide information about the person’s past history. Many memory care facilities in Northeast Ohio have begun incorporating these methods when dealing with dementia patients. Everyone must work as a team to use what they know about the person with dementia in order to create the right opportunities for engagement in productive and enjoyable activities. Too often we hear about what the patient can no longer do. By taking the time to learn about the person we can explore the talents and skills they still have. In fact, these patients have been able to learn new skills as well in the right setting.
