1. Promoting Wellness and Well Being After the Diagnosis: Creating Days that Have Meaning and Joy Teepa Snow, MS, OTR/L, FAOTA

2. Beliefs People with Dementia are Doing the BEST they can We must learn to DANCE with our partner We are a KEY to make life WORTH living What we choose to do MATTERS We can change the WORLD with help We must be willing to CHANGE ourselves We must be willing to STOP & BACK OFF

3. How Can We Become Better Care Partners? Be willing to try something new Be willing to learn something different Be willing to see it through another’s eyes Be willing to fail & try again

4. Ten Early Warning Signs memory loss for recent or new information – repeats self frequently difficulty doing familiar, but difficult tasks – managing money, medications, driving problems with word finding, mis-naming, or mis- understanding getting confused about time or place - getting lost while driving, missing several appointments worsening judgment – not thinking thing through like before difficulty problem solving or reasoning misplacing things – putting them in ‘odd places’ changes in mood or behavior changes in typical personality loss of initiation – withdraws from normal patterns of activities and interests

5. The Basics for Success… Be a Detective NOT a Judge Look, Listen, Offer, Think… Use Your Approach as a Screening Tool Always use this sequence for CUES – Visual - Show – Verbal - Tell – Physical – Touch Match your help to remaining abilities

6. Now for Progression… think GEMS not just loss Sapphires Diamonds Emeralds Ambers Rubies Pearls

7. Now for the GEMS… Sapphires – True Blue – Slower BUT Fine Diamonds – Repeats & Routines, Cutting Emeralds – Going – Time Travel – Where? Ambers – In the moment - Sensations Rubies – Stop & Go – No Fine Control Pearls – Hidden in a Shell - Immobile

8. 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

9. What Are We Offering People? List Your Current Activities – Monday-Sunday For Each Listing: – What type of activity is it? P, L, S, R – Is it working well? – When Do You NOT Have something happening? – What is MISSING?

10. What Does It Take To Make a Day Have Meaning and Joy? Know each PERSON! Understand ACTIVITIES! Make & Use a SCHEDULE! Build staff SKILLS! Manage the ENVIRONMENT! Resources to succeed

11. 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

12. Personal Preferences & 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?

13. Personality Traits Who are you? Introvert-Extrovert Lots of Details – Big Picture only Logical – Emotional Planning ahead – Being in the moment Who is the person you are trying to help?

14. Introvert - Extrovert Introvert Likes to be alone Likes to think it out Likes personal space Needs alone time Private Extrovert Think out loud Talk it out Seek out people Share a lot Not good with boundaries

15. Life Story Family – past & present Living place(s) Work history Leisure History Music history People history Plant history Animal history Plant history Sensory Environment preferences Cultural history & concerns Food likes & dislikes Daily routines Organizations & memberships Roles & responsibilities Comforts & Irritants

16. 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

17. Understand Activities 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 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? What type of activity is it??? Self-care, leisure, work, rest… Spiritual, social, physical, cognitive, passive, active, solitary

18. 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 & guide Carry dishes to/from sink

19. Build Care Partner Skills Environmental Management skills Using space & keeping up the place Problem-solving skills Figuring out what to do when it does not work right 1:1 Interaction Skills Do you work with your partner(s)… Group Leading Skills Getting people together & having fun Customer Relations Skills With families, clients, volunteers Documentation Skills Record keeping and reporting Practical Hands-on Skills Crafts, games, cooking, working… Planning & Time Management Skills What to do & when to do it! Peer Relationship Skills Helping each other Observation skills What you see, hear, sense…

20. 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”

21. 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

22. Take a look, listen, feel… Lighting- Enough, non-glare, focused Sounds – background, distracting, volume Feel – – Temperature – Space – how crowded – intimate, personal, public – Work surface – Seating surface – Walking surface – Familiar? Friendly? Fun? Forgiving?

23. 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

24. 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 Fruit salad - from canned fruit Fruit salad – from pre-cut fruit Fruit salad – one fruit and yogurt Fruit salad – dried fruit & granola & yogurt Putting the fruit salad in small cups or bowls Serving the fruit salad

25. How Do We Create Meaningful Activities? How to spend the time…

26. Key Activities to Consider Productive -Work Enjoyment - Leisure Wellness – Personal Care Restorative - Rest

27. Productive Activities Helping another person Helping family members or 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….

28. Please Help Us Clean Up…

29. 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

30. Playmate Hey, hey, hey playmate Come out and play with me And bring your dollies three Climb up my apple tree Call down my rain barrel Slide down my cellar door And we’ll be jolly friends forever more.

31. 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 & Wellness Activities

32. 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…

33. Rest & 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 & rub Listen to wind chimes Aroma therapy

34. Offer a Shoulder Rub & a Hand Massage

35. GOOD Activities ones that involve… Plants Animals People Music Objects

36. How Does Skill Change Over Time With Dementia? Interests Helper cues that help Environmental cues that help Ability to focus & change focus Sensory awareness & processing Motor skills – gross and fine Decision making & reasoning

37. Let Go: How it “used to be” How it “should be” How you “should be”

38. Identify What you’re good at…and what you’re not Who can help…and how they can help What really matters

39. Care Partners… Be a partner, not a boss Be an advocate, build a team Do with me, not for me or to me… Learn the ‘SO WHAT?’ philosophy… Learn to let go not give up Learn what you are good at, & what not… These ideas are for you TOO!

40. Final Note… Evaluate… How is it going…? – What’s working? – What’s not working? Is it time to change? – Dementia is progressive – Activities will need to change Its about letting go NOT giving up…

41. I Will Change! (to the tune of This Little Light of Mine) By Teepa Snow

42. 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!

43. No more just “Getting’ it Done” I’m gonna DO with you No more just “Getting’ it Done” I’m gonna help you thru No more just “Getting’ it Done” We’re gonna work, we two Cause if I do it ALL, we BOTH LOSE!

44. 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!

45. Contact INFO DVDs www.pinesofsarasota.org Web site – www.teepasnow.comwww.teepasnow.com