PAC Certification Skills Day It’s All In Your Approach! Introductions and opening activity: Introduce the Goal of the day: Awareness, knowledge and PAC skills. Briefly introduce team. Opening activity to help learners get to know one another and to introduce one of our PAC learning objectives: VVT, 3 Zones of awareness, Agenda, Relationship. Partner work-30 seconds to share 1. origin of name. 2. one thing they learned about their multiple intelligence. 30 seconds to intro one another stand up at table to shorten time rather than have them come to front of class. Learner also adds a visual of what they think their partner is (introvert or extrovert) AELC

PAC Mission: Use our talents and abilities to develop awareness, spread knowledge, and teach skills to transform what exists into a more positive dementia care culture. PAC Vision Statement: Positive Approach® enhances the life and relationships of those living with brain change by fostering an inclusive, universal community.

Introduction: Beliefs The relationship is most critical, not the outcome of one encounter We are a key to make life worth living People living with dementia are doing the best they can We must be willing to change ourselves AELC for role plays based on Relationship 1-What did you notice about the PLWD? (VVT) 2- What did you notice the mentor do? Activity Agenda vs Relationship AELC

Can we be Sapphire in all interactions? Set up role play, make sure the learners will be able to see. Ask the learners: what do you notice? What does the mentor do? Learners will often like to jump to (why) and assumptions. The skill is noticing. Ask the Learners to take out their Diamond and Ruby cards and read over prior to role play. Use group work to explore what stands out for them about each GEM to set them up for observation as well as what the mentor does. Diamond - Have mentor already set up to approach on dominant side. Its time to go home. I want to go home. You want to go home. Say name (Linn) is there something you need to do there or something else. Set up role play so that mentor approaches on side that the Ruby is using so that learners can see the interaction. Ruby – rubbing hand on table to leg. Enter in visual field and offering hand for them to explore. * Internal cert course Diamond: These people! Are you the boss around here? I am the boss. Every day I have a paper at my door and now these people come in at night and put them up here. I pay a lot of money to live here! What are you going to do about it? Emerald: I need something….you need something. Can you tell me more about it? It comes every day. It comes every day. Response: It comes every day. Can you show me what you do with it?

Unaware Novice/Aware Proficient Accomplished Master PAC Skills Levels: Unaware Novice/Aware Proficient Accomplished Master Talk about Global Deterioration Scale Allen Cognitive Scale Ability Model

INTELLECTUAL CAPACITY INTENT I'm sorry I was trying to help EMOTION I'm sorry I made you angry INTELLECTUAL CAPACITY I'm sorry, I had no right to make you feel that way THAT HAPPENED I'm sorry, it should not have happened THIS IS HARD I'm sorry, this is hard, I hate it for you Practice Validation and the I’m Sorries

PAC Positive Language: Person Living with Dementia (PLWD) Care Partner Assisting With Doing With, Not To Substitution, Not Subtraction Unmet Needs GEMS® State Expressive Communication Validation Talk about Global Deterioration Scale Allen Cognitive Scale Ability Model

Learning and Memory Center: Hippocampus: Big Change Learning and Memory Center: Way-finding Learning and Memory Time Awareness , Episodic memory-dementia cuts the timeline. Way-finding, dementia washes away the roads. Time: of day, time of life, passage of time Amygdala –limbic system structure I want what I want when I want it Fight, fright, flight Impulses, fear, pleasure: sex, sweet, salty, fat

The person’s brain is dying Brain Failure Four truths: At least 2 parts dying Progressive No medical cure Terminal The person’s brain is dying

Normal Brain Brain with Alzheimers Autopsied brains two men – same age, same build, one with Alzheimers 1/3 size by end Normal Brain Brain with Alzheimers Used with permission from Alzheimers: The Broken Brain, 1999 University of Alabama

Amygdalae: Dangerous Need Risky Want Dislike Alert/Aware Like

Primitive Brain is in Charge of: Survival: Autonomic protective – fright, flight, fight + hide or seek Pleasure seeking – meeting survival needs and finding joy Thriving – Running the Engine: Maintain vital systems: BP, BS, O2sat, Temp, pain Breathe, suck, swallow, digest, void, defecate Circadian rhythm Infection control Learning New and Remembering: Information Places: spatial orientation Passage of Time: temporal orientation Thrive to survive declines but the DESIRE to survive stays

Positron Emission Tomography (PET) Alzheimers Disease Progression vs Positron Emission Tomography (PET) Alzheimers Disease Progression vs. Normal Brains Normal Early Loss Late Loss Healthy Child The amygdala continues to fire. Left- Fright Flight and Fight Right- Pleasure and Joy, wants turn to needs G. Small, UCLA School of Medicine.

Positron Emission Tomography (PET) Alzheimers Disease Progression vs Positron Emission Tomography (PET) Alzheimers Disease Progression vs. Normal Brains Early Alzheimers Late Alzheimers Normal Child The amygdala continues to fire. Left- Fright Flight and Fight Right- Pleasure and Joy, wants turn to needs What is still left and where/how are we able to assist in these areas? Primitive Brain Primitive Brain G. Small, UCLA School of Medicine.

Executive Control Center Impulse Control Be Logical Make Choices Start-Sequence-Complete-Move On Self Awareness See Another’s Point of View Left Right How could these brain changes impact daily life? AELC Left Right

It’s time for an Adult Experiential Learning Cycle (AELC) with the GEMS®: -Experience -Share -Process -Connect -Apply Set up role play, make sure the learners will be able to see. Ask the learners: what do you notice? What does the mentor do? Learners will often like to jump to (why) and assumptions. The skill is noticing. Ask the Learners to take out their Diamond and Ruby cards and read over prior to role play. Use group work to explore what stands out for them about each GEM to set them up for observation as well as what the mentor does. Diamond - Have mentor already set up to approach on dominant side. Its time to go home. I want to go home. You want to go home. Say name (Linn) is there something you need to do there or something else. Set up role play so that mentor approaches on side that the Ruby is using so that learners can see the interaction. Ruby – rubbing hand on table to leg. Enter in visual field and offering hand for them to explore.

What do you notice about the PLwD? What did the Care Partner do? Diamonds: What do you notice about the PLwD? What did the Care Partner do?

Diamond Role Play: Diamond: “Are you the boss around here?” Support: “You’re looking for the boss around here?” Diamond: “Yes, the boss.” Support: “Hi, I’m (Support’s Name), the boss.” Diamond: “Well, I need to go home right now.” Support: “(Diamond’s Name), you need to go home right now to do something or just to be there?”

What do notice about the PLwD? What did the Care Partner do? Rubies: What do notice about the PLwD? What did the Care Partner do?

Ruby Role Play: Ruby: Rubbing right leg (monocular visual regard) Support: Bring chair in to right side at supportive stance, move back out and re-approach using PPA™ “Hi (Lead’s Name), it’s (Support’s Name).” Ruby: Keep eyes focused on your own hand, do not respond to your name or the person until they get their hand into your visual range. Support: Sit down and slowly move your hand, palm-up into visual range at the same height as their hand – wait and possibly wiggle fingers if they don’t move towards you. Once they start to move towards you, shift into HuH® and pump hand. Be sure to be smiling. Ruby: Slowly make your way up their arm to their face with your eyes. Smile when you see their smile.

What do you notice? Pace Visual Cues Verbal Cues Physical Cues What do you want to try? Similarities and differences for Diamond and Ruby: Pace, VVT Cues Transition to PAC Language: abilities, doing the best they can, People LIVING with Dementia

Show Tell Touch See Understand Feel

GEMS® Based on Allen Cognitive Levels A Cognitive Disability Theory – OT based Creates a common language and approach to providing: -Environmental support -Caregiver support and cueing strategies -Expectations for retained ability and lost skill Each state requires a special ‘setting’ and ‘just right’ care to shine Each state has specific visual, verbal, touch communication cues Promotes graded task modification Accounts for chemistry as well as structural brain changes Encourages ‘in the moment’ assessment of ability and need Watch Care Skills video: AELC each GEM after watching Teepa PRACTICE

GEMS®: A Positive Framework Sapphires: True Blue - Healthy Brain - Slower but Fine Diamonds: Clear/Sharp – Routines and Routines Rule – Change is Hard – Cutting Emeralds: On the Go with Purpose – Naturally Flawed – Time Travel Ambers: Caught In a Moment of Time – Caution Required – All About Sensations Rubies: Deep and Strong – Others Stop Seeing What is Possible – Stop and Go – Big Motions or Still Pearls: Hidden in a Shell – Immobile - Beautiful Moments to Behold AELC

General Vision Changes: Sapphires: loss of about 45 degrees of field Diamonds: tunnel vision Emeralds: binocular vision Ambers: see parts, not whole; loss of object recognition Rubies: monocular Pearls: movement, familiar/unfamiliar

Receptive Language Changes: Sapphires: high-pitched harder, crowded and loud spacing more challenging Diamonds: slower, missing consonants Emeralds: missing about ¼ words, needs pauses, does better with rhythm Ambers: 2/4 words, misses much, catches some key words out of context Rubies: social chit-chat, music, rhythm, tone of voice Pearls: familiar and friendly, calm or excited

Expressive Language Changes: Sapphires: word finding a little slower, may be pauses Diamonds: varies with affect, word-finding problems, mis-speaking in times of stress Emeralds: gets stuck in social, repeats phrases or words, intonation matters Ambers: repetitive, variable volume, echo Rubies: less articulated speech, babble, hum, or sing, rhythmic vocalizations Pearls: sounds to single words, responsive

Dexterity – Hand Skills Sapphires: still intact, slightly slower Diamonds: slower, limited with bilateral skilled integration Emeralds: individual actions are there, sequencing is challenging, more forceful Ambers: heightened use of hands, skilled tool use decreased, strong Rubies: whole hand with limited finger use, can hold and carry but difficulty with release Pearls: grasp strong, limited opening

Body Skills: Sapphires: sustained, slower Diamonds: details not as good, globally fine Emeralds: better with dominant side, errors Ambers: strong more than skilled, limited safety awareness Rubies: whole body not segmented, front OK, back not Pearls: reflexive, great trouble with gravity or speed or movement

People Awareness Skills: Sapphires: sustained, slower to ID Diamonds: recent questionable, older/deeper better Emeralds: recognize like/don’t like Ambers: can get lost in old-new relationships, will like or not like in the moment Rubies: like or not like, familiar versus not Pearls: voices, faces, touches, smells, familiar or not

Place Awareness Skills: Sapphires: sustained, may get ‘turned around’ Diamonds: familiar feels best, gets lost in the community and in unfamiliar places Emeralds: is OK if what is seen is OK, but may seek the old familiar in task or social Ambers: OK if ‘here’ feels OK, otherwise will seek ‘there’ Rubies: may or may not have a destination, more a movement or stillness pattern Pearls: knows if what is experienced is comforting

Time Awareness Skills: Sapphires: lifelong, crunched or expanded Diamonds: more the past than now Emeralds: lost in episodes or caught in loops Ambers: in the moment, not the task or sequence Rubies: in the experience, not the time Pearls: time has much less meaning

Situation Awareness Skills: Sapphires: sustained, may be tough to think at times Diamonds: old moments drive new interactions Emeralds: has moments of time travel Ambers: more sensory awareness than intellectual awareness, immediate not big picture Rubies: only in moments, less body aware Pearls: more inside than externally aware

Visual Cue Options: Signs Pictures Props or Objects Gestures Facial Expressions Demonstrations

How Can We Give Information? Visual Cues - Show Verbal Cues - Tell Tactile Cues - Touch Practice giving cues, use VVT or task to be done cards: Mentor role plays a GEM PLWD does what mentor is doing, learner practices giving cues

Practice: Visual Cues Use TASK TO BE DONE cue cards with ONLY visual cues to get a partner to DO the thing on the card – no words or touching

3 Zones of Human Awareness: Public Space: more than 6 feet away Visual awareness and social interactions Personal Space: 6 feet to arm’s length away Friendly and personal conversations Intimate Space: within arm’s reach Intimate touch or connections Activity: Standing over ,Standing in front, Standing on non dominant side, standing on dominant side AELC

Practice: PPA using the 3 zones as a guide: Get into visual range (public space), pausing at the edge of personal space at approximately 2 arms length away Greet with your hand held still by your face and smile Slowly extend hand for a handshake After the person you are approaching gives permission by extending their hand, move slowly into a handshake (entering intimate space) Move from handshake to Hand-under-Hand® position Move from the front to the side, getting into a supportive stance Get to or below their eye level Use a PPC (Positive Personal Connection) or PAS (Positive Action Starter) phrase PRACTICE basic PPA – walk slowly up to 6 feet and pause – use hand to face to get visual regard(if looking down, use hand lower down and move it slowly up) – then say their name and your name as you move slowly into intimate space – shift into supportive stance to stand in intimate space

A Dynamic Assessment Tool for a Shared Relationship Use the Positive Physical Approach™ With Someone in an Emerald State Activity: What is important to remember and take into consideration with trying to connect and form a relationship? Small group work, write answers up on board to use in identifying steps of PPA. AELC A Dynamic Assessment Tool for a Shared Relationship

Learning to use PPA™ + HuH® + PPC + PAS = Learning to Cook Learning to Sing

Ingredients or a Recipe? Are the Steps of PPA™ Ingredients or a Recipe?

Learning How to Cook = PPA Taking Chef’s training  being a home cook First, a simple recipe, using some ingredients: You are approaching a person in an Emerald state in a common space What are the ingredients? Do items and amounts matter? What is a recipe? Does sequence matter? Do different combinations make a difference? Why does it matter? How will you practice? Vary ingredients or recipes?

Learning to Sing = PPA™ We all sing, however, taking singing lessons: What are the skills you would be learning? Breath control - Scales Projection - Songs Rhythm - Warm-ups What outcome would you be seeking? Being part of a group - Stress reduction Self-satisfaction - Career How is developing your PPA™, PPC, PAS, and HuH® like learning to sing with a trainer?

Core Ingredients and a Basic Recipe: Observe visually Seek visual regard Offer verbal greeting If visual and verbal reactions are OK, progress (if not, pause) Offer friendly social contact: hand shake, eye contact If offer is accepted, transition into supportive position, at a matched height (if not, pause) Transition into Hand-under-Hand® positioning, if accepted, to sustain connection (if not, pause and release and step-move back) Offer a PPC, if accepted, transition to a PAS (if not, pause and try again)

Person Being Approached: Practice using the abilities of someone in an Emerald state: Binocular vision: start off looking downward Vague in language: missing ¼ words Better with step by step cues Take some time to process: count to 3 in your head Try to provide your partner with honest and authentic feedback considering you were in Emerald state

Positive Physical Approach™* (PPA™)* Stop moving at 6 feet out Greet: hold your open hand still next to your face, say their name Offer hand in a handshake position With their acceptance, slowly come in from the front within visual range Move into supportive stance, turn shoulders From the handshake, move into Hand-under-Hand® Get low: sit, kneel, or stand at or below their level Make a connection: PPC, then wait for their response Deliver a message: use V-V-T Cues and a PAS * = if in public space and you start the interaction PRACTICE SESSION 1: Use groups of 3, person being approached gives 1 emotion that they felt with the approach, person approaching gives 2 things they did well and one thing they would like to work on, person observing gives 2 steps that they identified and 1 they have question about. Learners use PPA Cheat Sheets to identify steps PRACTICE SESSION 2: Groups of 3, the observer video tapes PPA and person reviews identifies 2 positive steps and 1 goal to work on, repeat 2x

Positive Physical Approach™ To the tune of Amazing Grace Come to the front, go slow Get to the side, get low Offer your hand, call out their name Then wait….. If you will try, then you will see How different life can be For those you’re caring for.

Top Five Human Needs and Emotional Indicators of Distress Five Expressions of Emotional Distress Five Human Needs Angry irritated – angry – furious Sad dissatisfied – sad – hopeless Lonely solitary – lonely – abandoned/trapped Scared anxious – scared – terrified Lacking Purpose disengaged – bored – useless Intake Hydration, nourishment, meds Energy Flow tired or revved up directed inward or outward Output Urine, feces, sweat, saliva, tears Comfort 4 Fs and 4 Ss Pain-Free!!! Physical, emotional, spiritual Talk through positives and changes to make with basic PPA and getting connected. What about when there is distress – what might be causing it? Review Emotional distress covering Physical needs – connect back to amygdala. Break-out with unmet need in groups of 3.

Breakout Session: Unmet Needs Before Approach: Mentor leads What do you notice? Body position and language VVT cues What would you like to try? How will you do this? After Approach: Mentor leads Were you able to figure out the unmet need? What 2 pieces worked well in your PPA™? What is one thing you would change? Try it again BREAK OUT SESSION Role-play unmet needs with GEMS state. PLWD has GEMS card to guide actions. Mentor uses cheat sheet to coach learner before they try and approach to find out what the unmet need is.

Vision Center – BIG CHANGES Activity: Scuba, binocular and monocular vision. AELC PRACTICE Visual cues with cards AELC Vision Center – BIG CHANGES

Vision Changes: With each new level of vision change, there is a decrease in safety awareness. 1. Less Peripheral Awareness 2. Tunnel Vision 3. Binocular Vision Object/Use Confusion Monocular Vision 6. Limited Visual Regard With dementia there is not a loss of vision or that people can’t see, is it generally that there is more time spent NOT visually regarding the world. Although it is possible get regard with cueing and interest Activity: Care Partner approaches PLWD with 1-scuba vision, 2-binocular vision 3-monocular vision after each approach PLWD identifies their emotion, Care Partner identifies 2 things they noticed about themselves or the PLWD.

Understanding Language – Big Change Language on the Left, Rhythm on the right. Activity: It can take a healthy brain 21 seconds to come up with an answer that takes thought. Count 21 seconds. How long do we give a PLWD time to respond? Ask a question and then count to see how long we give until we expect a response. 55% of communication comes from facial expression and body language 38% comes from HOW the words are spoken (tone and inflection) 7% comes from the meaning of the words themselves Use this sentence (or make up your own) to highlight losing one out of every four words. Emotion and attitudes play an important Unless someone like (you) cares a whole awful (lot), nothing is going to get (better) it’s not. What do you think? Understanding Language – Big Change

Hearing Sound – Not Changed When someone doesn’t answer or understand, what do we often do? Use this sentence and simply get louder without giving them the fourth word: Unless someone like (you) cares a whole awful (lot), nothing is going to get (better) its not. What do you think? --Tone, pitch, volume, intensity – leave out consonants for alternate example… Hearing Sound – Not Changed

Keep it simple Directed Matched to visual cues Practice: Verbal Cues Keep it simple Directed Matched to visual cues Practice cues and use same questions as visual cues

Positive Personal Connections (PPC) Greet or Meet: introduce yourself and use their preferred name: “Hi___I am ___” or “I am___ and you are?” Say Something Nice: indicate something about them of value Be Friendly: share about you, then leave a blank Notice Something: point out something in the environment Be Curious: explore a possible unmet like, want, or need

White Matter Connections Formal Speech and Language Sensory Strip Motor Strip White Matter Connections Big Changes! Automatic Speech Rhythm – Music Expletives Preserved! Right Left Decreased ability in the Sensory Motor strip and touching are primary ways that Caring FOR and not WITH cause difficulties. 4 most sensitive areas. Activity: Eyes Closed Hands behind back. Open Loop AELC Close loop with HuH Touch Cues with Cue Cards Formal Speech and Language Center Huge Changes! Left

Visual Verbal Touch Cues: How You Help and Connect Sight or Visual Cues Verbal or Auditory cues Touch or Tactile Cues

Touching Cues Place an item or tool in hand Touch with a finger or hand Hand guidance Hand on shoulder or back Hand-under-Hand® contact Hug Practice cues and use same questions as visual cues Close Loop

Breakout Session: Practice Giving Cues Give cues based on what on what you notice about the PLWD: Eat/drink Movement/walking Undressing/dressing/changing Clean-up shirt/hair Come to…(dinner, trip, garden, etc…) Time for…(dinner, trip, visit, etc..) Do an activity BREAK OUT SESSION – Lead places tongue in bottom of mouth to give instructions on where to touch without HuH (person being touched has monocular or binocular vision) – Then practice with HuH same scenario where lead gives instructions. AELC

Hand-under-Hand®: Activity: Close the loop. Hands behind back eyes closed and have Care Partner touch the person using HuH. What are the opportunities to use Hand under Hand AELC PRACTICE: Eating and drinking Activity: 1st “feed” and “give something to drink” 2nd use HuH AELC PRACTICE: groups of 3 with video tape and review asin PPA PRACTICE: ADL’s

Try Hand-under-Hand®: To comfort To visually direct - look at To get started - initiate To help with detail - assist To move or change direction

Try Hand-under-Hand®: To get the person to stand To get the person to walk To get the person to eat/drink To get the person to take meds To get the person to sit down PRACTICE: groups of 3 with video and review same as PPA practice

Use the Positive Physical Approach™ Activity: What is important to remember and take into consideration with trying to connect and form a relationship? Small group work, write answers up on board to use in identifying steps of PPA. AELC

Positive Physical Approach™ 1. Stop moving at 6 feet out 2. Greet: hold your open hand still next to your face, say their name 3. Offer hand in a handshake position 4. With their acceptance, slowly come in from the front within visual range 5. Move into supportive stance, turn shoulders 6. From the handshake, move into Hand-under-Hand® 7. Get low: sit, kneel, or stand at or below their level 8. Make a connection: PPC, then wait for their response 9. Deliver a message: use V-V-T Cues and a PAS * = if in public space and you start the interaction PRACTICE SESSION 1: Use groups of 3, person being approached gives 1 emotion that they felt with the approach, person approaching gives 2 things they did well and one thing they would like to work on, person observing gives 2 steps that they identified and 1 they have question about. Learners use PPA Cheat Sheets to identify steps PRACTICE SESSION 2: Groups of 3, the observer video tapes PPA and person reviews identifies 2 positive steps and 1 goal to work on, repeat 2x

Step 1: Stop moving at 6 feet out Pause at the edge of public space Stop moving at 6 feet out Let the person notice you in public space, and give them time to do this Acknowledge the person’s ownership of personal space Respect their space!

Step 2: Greet and Give ‘Hi’ Sign Bring flat, open palm up near face: Visual cue to look at you Say “Hi!” and use their preferred name, if known: Verbal cue to look at you Look friendly by smiling and making eye contact

Step 3: Say Name, Offer Hand Seek permission to enter personal space Show person what you want to do Watch for their reaction/response If there’s hesitation: -Stay in public space -Turn your body sideways into supportive stance -See what happens next – if no better, then hold back

Step 4: Move Slowly Move slowly toward the person while offering your extended hand: Smile and look friendly 1 second = 1 step Respect their slowed processing time Respect their decreased ability to do two things at one time

Step 5: Move Into Supportive Stance Shift toward their dominant side – hand shake side Turn your trunk sideways to the person Stay at arm’s length away Keep your face and chest back

Hand-under-Hand®:

Hand-under-Hand® Assistance: Helps assist doing with, not for Protects them and us! Helps direct gaze – eye-hand coordination Pressure in the palm is calming Helps assist doing WITH not for Protects: Keeps you from hurting their wrist, arm, or fingers Keeps the person from squeezing your knuckles Keeps the person from swinging or hitting Helps direct gaze – eye-hand coordination Pressure in the palm is calming

Hand-under-Hand®: Protects aging, thin, fragile, forearm skin

High Risk:

Step 6: Hand-under-Hand® Go into Hand-under- Hand from a normal handshake Provides protection for them and you Connects you with them while giving them a sense of control Tab 1 Page 20

Step 7: Move to Side, Get Low Get to their level Sit, kneel, or squat Respect intimate space Allow eye contact with limited visual field Gets focus on your face, not your chest or middle

If You Can’t Get Low: Stay greater than arm’s length away Use Verbal Connections If it’s not working, get a seat

Step 8: Make Connection Make a friendly statement Wait for a response or acknowledgement Be sure you have a connection before you start your care

Step 9: Deliver a Message Give visual cues first Offer verbal information next Use touching last and only if the person is aware of your plan

Positive Action Starters (PAS): Help: Be sure to compliment their skill in this area, then ask for help. Try: Hold up or point to the item you would like to use, possibly sharing in the dislike of the item or task, “Well, let’s try this.” Choice: Try using visual cues to offer two possibilities or one choice with something else as the other option. Short and Simple: Give only the first piece of information, “It’s about time to (first task).” Step by Step: Only give a small part of the task at first, “Lean forward.”

Practice PPA™ PLWD: Gives emotional response to the approach Care Partner: Identifies 2 things that went well and 1 thing to change Videographer: Asks, “What would you want to do differently? How would you do that?” Practice with the change at least 2x (drill for skill) If present, Mentor leads group AELC

Breakout Session:Think it Through Before the approach, mentors ask: -What do you notice about the person? -What are they doing? -Where is their visual field and focus? -What is the state of their amygdalae? (annoying- risky-dangerous) -What else do you notice? -Environment -Location -People around -Time of day Based on this information, what will you try in order to make a connection?

Breakout Session (if not on the floor) PPA™ Special Situations: Think it Through… What Can You Do? The person is standing up You enter their room The person approaches you/ starts the interaction The person is blind The person is at a table The person is in a corner or facing a door The person is asleep The person doesn’t offer their hand back The person tells you to stay out AELC

Practicing PPA + HuH + PPC + PAS = WHOA!! 1. Mentor asks PLwD: -How did that feel? 2. Approacher restates what they heard, thanks the PLwD, and steps back to get coached 3. Videographer says to Approacher: -How do you think you did? -Let’s take a look at the video -What are 2 things you did well? -What is 1 thing you would do differently? -How would you do that? -Let’s try 4. Mentor leads: Retry if appropriate with the same PLwD

Top Five Human Needs and Emotional Indicators of Distress Five Expressions of Emotional Distress Five Human Needs Angry irritated – angry – furious Sad dissatisfied – sad – hopeless Lonely solitary – lonely – abandoned/trapped Scared anxious – scared – terrified Lacking Purpose disengaged – bored – useless Intake Hydration, nourishment, meds Energy Flow tired or revved up directed inward or outward Output Urine, feces, sweat, saliva, tears Comfort 4 Fs and 4 Ss Pain-Free!!! Physical, emotional, spiritual Talk through positives and changes to make with basic PPA and getting connected. What about when there is distress – what might be causing it? Review Emotional distress covering Physical needs – connect back to amygdala. Break-out with unmet need in groups of 3.

“This Little Light of Mine” I Will Change! To the tune of “This Little Light of Mine” By Teepa Snow

I am gonna meet and greet Before I start to treat I am gonna meet and greet Before I check your feet I am gonna meet and greet Before I help you eat How I start sets us up to succeed!

No more just ‘gettin’ it done’ I’m gonna do with you No more just ‘gettin’ it done’ I’m gonna help you thru No more just ‘gettin’ it done’ We’re gonna work, we two Cause if I do it all, we both lose!

I’m gonna laugh and dance with you Not just watch and frown I’m gonna laugh and dance with you Not just stand around I’m gonna laugh and dance with you We’ll really go to town For the power of joy I have found!

True Blue Optimal Cognition, Healthy Brain Sapphires True Blue Optimal Cognition, Healthy Brain

Sapphires: Optimal Cognition: flexible in capacity Normal aging will slow, yet not change ability More time to process with stress True to self: likes/dislikes are the same Able to learn: takes more practice Stress, fatigue or pain can induce Diamond moments Time to recharge or heal can restore to Sapphire

Clear and Sharp Routines and Rituals Rule Diamonds Clear and Sharp Routines and Rituals Rule

Diamonds: Routines and Rituals Rule: likes familiar May resist change or won’t let things go Rigid under pressure: limited perspective Becoming protective: may be territorial or isolate Repeats self: hard to integrate new information Can cover mistakes in social interaction Symptoms may or may not be dementia related

Emeralds On the Go with a Purpose Naturally Flawed

Emeralds: Desires independence: noticeable ability change Vocabulary and comprehension diminishing Communication becoming vague May neglect personal care routines On the go: needs guidance and structure Difficulty finding way to and from places May be lost in time

Caught in a Moment of Time Caution Required Ambers Caught in a Moment of Time Caution Required

Ambers: Caution Required Focused on sensation Will react to how things: look, sound, feel, smell or taste Lives in the moment: not socially aware No safety awareness: typically very busy Difficulty understanding and expressing needs No ability to delay needs or wants Needs help with tasks: may resist Hard to connect with: may exhaust care partners

Deep and Strong Others Stop Seeing What Is Possible Rubies Deep and Strong Others Stop Seeing What Is Possible

Rubies: Others stop seeing what is possible Retains rhythm: can sing, hum, pray, sway and dance Understands expressions and tone of voice Losing ability to understand language Limited skill in mouth, eyes, fingers, and feet Can mimic big movements: gross motor abilities Loss of depth perception; monocular vision Falls prevalent: can only move forward Care Partners will have to anticipate unmet needs

Hidden Within a Shell Beautiful Moments to Behold Pearls Hidden Within a Shell Beautiful Moments to Behold

Pearls: Person is still there Moments of connection take time and will be short Knows familiar: unmet needs may cause distress Unable to move by themselves: fetal position, still and quiet Primitive reflexes have taken over: difficulty swallowing Brain failure shuts down body: diminishes need too eat or drink Care Partners need to give permission to let go

Progression of the Condition To the tune of This Old Man Note: Each verse is sung progressively slower

Sapphire true, you and me The choice is ours, and we are free To change our habits, to read, and think and do We’re flexible, we think it through!

Diamond bright, share with me Right before, where I can be I need routine and different things to do Don’t forget, I get to choose!

Emerald – Go, I like to do I make mistakes, but I am through Emerald – Go, I like to do I make mistakes, but I am through! Show me only one step at a time Break it down and I’ll be fine!

Amber – Hey!, I touch and feel I work my fingers, rarely still I can do things, if I copy you What I need is what I do!

Ruby – skill – it just won’t go Changing something must go slow Use your body to show me what you need Guide, don’t force me, don’t use speed!

Now a Pearl, I’m near the end But I still feel things through my skin Keep your handling always firm and slow Use your voice to calm my soul.

Putting it All Together (Mentors Demo): Identify Some of the Challenging Situations You Experienced in Your Practice: Putting it All Together (Mentors Demo): Identify GEMS® Adapt PPA™ Make a connection Unmet need/situation Task/agenda Adapt HuH® PRACTICE groups of 3 with video same as PPA and HuH practice sessions Use the coaching cycle questions for this breakout

What Have You Learned About You? What Specific Awareness? What Specific Knowledge? What Specific Skill?

What Are You Going to Do About It? What Specific Awareness Do You Want to Work On? What Specific Knowledge Do You Want to Work On? What Specific Skill Do You Want to Work On? Give it five minutes a day! AELC have learners identify drill for skills