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4. How to Give Care and Live Life in the Early and Middle Stages of Dementia

5. Early to Middle Stages of Dementia:

6. Diamonds -Many facets, still often clear, can really shine
-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
-Misplaces things and can’t find them
-Resents takeover or bossiness
-Notices other people’s misbehavior and mistakes
-Vary in lack of self-awareness
-Use old routines and habits
-Control important roles and territories, use refusals

7. Common Diamond Issues:
Unfamiliar Settings or Situations
Hospital stay
Housing change
Change in family
Change in support system
Doctor/dentist visits
New diagnoses
Traveling or vacations
IADLs
Money management
Transportation/driving
Cooking
Home maintenance and safety
Caring for someone else
Pet maintenance
Medication administration

8. Be Prepared for Repeats!
Expect repeated stories, questions, requests
For repeated stories, use “tell me about it”
Write down or repeated stories because you may need them for supportive communication later in the disease
Make sure you are connected to respond
Repeat a few of their words in a question
Answer their question, then:
Go to new words, use enthusiasm!
A new place
Add a new activity (possibly related)

9. How to Help Diamonds: - Apologize: “I’m sorry!” or “I didn’t mean to…”
Friendly, not bossy: leader to leader
Make it temporary with “Let’s just try…”
Share responsibility, not take over
Use as many old habits as possible
Give up being ‘right’
Go with the flow
Give another ‘job’ when taking one away

10. 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

11. Bad Helper Habits to Break:
Saying “Don’t you remember?”
Not recognizing or accepting differences
Trying to force changes in roles or responsibilities
Trying to take over completely
Taking responsibility for saying “No”
Accepting things at face value
Arguing with them

12. Emeralds -Not as clear or sharp, more vague -On the go, need to ‘do’
-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

13. Common Emerald Issues:
Doesn’t do care routinely, but thinks they did
Makes mistakes in sequence but are unaware
Repeats some care routines over and over
Resists or refuses help
Gets lost, can’t find where to do care
Limited awareness of real needs such as hunger, thirst, voiding, bathing, grooming because they have other ‘stuff’ to do

14. More Emerald Issues: Afternoon or evening: “Got to go home!”
Daytime: “Got to go to work!”
Looking for people/places from the past
Losing important things, thinking others stole/took them
Doing private things in public places
Having emotional meltdowns
Treating strangers like friends and vice-versa

15. How to Help Emeralds: - Provide ‘subtle’ supervision for care
- Think “So What?”… is it worth it?
- Provide ‘subtle’ supervision for care
- Provide visual prompts:
- Gestures, objects, set-up, samples, demonstrations
- Hide visual cues to ‘stop’/prevent behavior:
- Put away, move out of range, leave
- Use the environment to cue
- Use humor, friendliness, support

16. 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

17. Bad Helper Habits to Break:
Noticing and pointing out errors
Telling, not asking: “You need to…”
Trying to take over, offering “Let me help you”
Putting hands on, ‘fussing’
Reality orientation, arguing, or lying
Trying to use ‘distraction’
Trying to go back and ‘fix’ something
Treating them like a child
Reacting instead of responding
Rejecting topics of conversation
Not going with the flow!

18. Ambers -Caught in a moment
-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 space
-Do what they like and avoid what they do not

19. Common Amber Issues:
Getting into other’s things, taking other’s belongings
Bothering others
Not able to make needs known
Not understanding what caregivers are doing
Not liking being helped/touched/handled
Not liking showers or baths
Repetition of sounds/words/actions

20. How to Help Ambers: - Provide step-by-step guidance and help
- Give demonstration, show
- Hand-under-Hand® guidance, may be able to do on their own after a few repetitions,
- Offer something to handle, manipulate, touch, or gather
- Limit talking, noise, touch, other activities
- Substitute, don’t subtract

21. 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

22. Bad Helper Habits to Break:
Talking too much, showing too little
Keep on pushing
Doing for, not with
Stripping the environment
Leaving too much in the environment
Getting in intimate space
Over or under stimulating
Getting loud and forceful

23. It’s Not ‘The Dementia’:
It’s What You Choose to Do About It!

24. What Do People with Early to Mid-Stage 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

25. What Does it Take to Have a Day with Meaning and Joy?
Know each person!
Understand activities!
Make and use a schedule!
Build staff skills!
Manage the environment!
Resources to succeed

26. Who the person has been…
Know each Person
Life History
Who the person has been…
Personal history and background
Health Status
medical conditions, medications, limitations & abilities
Emotional status
psychological condition and mental health & limitations
Cognitive Status
thinking, memory, processing skills and limitations
Sensory Status
sight, hearing, touch, balance, coordination, temperature regulation
Routines and Habits
patterns of behavior, daily routines, time use & schedules

27. 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?

28. Personality Traits: Introvert - Extrovert
Lots of Details - Big Picture Only
Logical - Emotional
Planning Ahead - Being in the Moment

29. of Familiar and Favorite Activities
Design Each Day
Make a schedule and follow it
Be structured but allow flexibility
Offer a variety of activities every day
Leisure, work, rest, self-care, groups and 1:1, passive and active
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
Create a flow for the day
Build up and then slow down
Circadian rhythms
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.

30. Understand Activities
What type of activity is it???
Self-care, leisure, work, rest…
Spiritual, social, physical, cognitive, passive, active, solitary
Analyze the Activity…
What do you need to do it?
What skills, abilities, interests?
What is the activity all about?
Doing something or
making something?
Modify and Structure the Activity for Success
Change the materials, the complexity, the setting, the help offered, the task demands, or the purpose of the activity

31. Two Examples: Paying Bills: Washing Dishes:
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
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

32. Manage the Environment
Create & Use Storage
Make set-up and clean-up part of the activity
Pay attention
to the lights, sounds, seating, work surface, space…
Do the ‘right stuff’ in the ‘right place’
Match what you do
to where you are…
Change it if you need to - to make it work!
Use the space well
Plan and place for best effect
Keep it adult
Make sure supplies, activities, and games are meaningful
Play and laugh with folks, not at them
Make it look friendly
Get me to want to come
Give out tools and materials ‘just in time’
Control the activity so clients are successful – not overwhelmed
- not out of synch

33. 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?

34. Resources to Succeed The right equipment for clients’ needs
Enough Supplies
& Materials
The right equipment for clients’ needs
Good quality lighting
Skilled leadership for the activity
Good work surfaces
Seating that works
Enough help for each person
A Back-Up Plan
Resources to Succeed

35. Two Options: Doing: Making:
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
Fruit salad: from fresh fruit Fruit salad: from canned fruit Fruit salad: from pre-cut fruit 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

36. How Do We Create Meaningful Activities?

37. Key Activities to Consider:
Productive - Work
Enjoyment - Leisure
Wellness - Personal Care
Restorative - Rest

38. 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

39. Leisure Activities: 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

40. Self-Care and Wellness Activities:
Cognitive:
Physical:
Exercise Walking Strengthening tasks Coordination tasks Balance tasks Flexibility tasks Aerobic tasks Personal care tasks
Table top tasks
Matching, sorting, organizing, playing
Table top games
Cards, board games, puzzles
Group games
Categories, crosswords, word play, old memories

41. 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

42. Good Activities Are Ones That Involve:
Plants
Animals
People
Music
Objects

43. 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

44. Progression of the Condition
To the tune of ‘This Old Man’

45. 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!

46. 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!

47. 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!

48. 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!

49. 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!

50. 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.

51. DISCLAIMER
The content contained in this presentation is strictly for informational purposes. Therefore, if you wish to apply concepts or ideas contained from this presentation you are taking full responsibility for your actions. Neither the creators, nor the copyright holder shall in any event be held liable to any party for any direct, indirect, implied, punitive, special, incidental or other consequential damages arising directly or indirectly from any use of this material, which is provided as is, and without warranties.
Any links are for information purposes only and are not warranted for content, accuracy or any other implied or explicit purpose.
This presentation is copyrighted by Positive Approach to Care and is protected under the US Copyright Act of 1976 and all other applicable international, federal, state and local laws, with ALL rights reserved. 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

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