Positive Changes in Long Term Care

Meaningful pastimes in the nursing homes

One of my job requirements is to put together the activity programming on the memory care wing. I have earned a few certifications from the National Council for the Certification of Dementia Professionals , but felt I was lacking in the activity aspect of the job. Though I had led activities in memory care for over thirteen years and had created some of the programming, I didn’t feel completely qualified. I also wanted to better serve readers of this website.

To solve that problem I signed up for a program to earn my Activity Director Certification. And, Wow! What an education I’m getting! I highly recommend the programming to anyone who wishes to enter the field. I am currently working through Activity Director Certification Services program facilitated by Theresa Thorland, CTRS/ACC/MS/MA. One part of the program that captured my imagination is the culture change movement.

Positive Changes in Long Term Care

Although most of you are caring for loved ones at home, I wanted to share some of the positive changes in long term care. The focus has been moving from merely providing health care to enhancing quality of life. Therefore, we are no longer simply housing and doctoring people. Now, the industry is focused on providing person-centered individualized care in an effort to make living in a nursing home more satisfying. What a much needed change!

The change has been occurring since the 1970’s, but is now driven by the Pioneer Network. I strongly suggest you visit their website. They share a wealth of information covering the span of in-home care to long-term care. This page shares information about these choices while this page provides more detail about person-centered care and culture change. I hope you check them out.

More Choices….

Basically, the change is reflected in offering and providing more choices for those we serve. Residents are no longer expected to follow the schedule and routine of the facility. Instead, they are now encouraged to maintain the routine they followed at home. Some residents rise in the early hours and others may sleep until eleven. Likewise, they go to bed when they would like. Some nap or watch television in the afternoon, some go to bed shortly after dinner. Therefore, the individual routines within a facility now resembles those on the ‘outside,’ instead of a ‘one size fits all’ schedule.

No one is required to have breakfast or bedtime snacks, though they are offered to all. There are more choices in meals. Don’t like the eggs and bacon for breakfast? Oatmeal, fruit, yogurt, even ice cream are available. Beverage choices are also varied and available.

Some choose to have a beer or a glass of wine after dinner. Also, fine – unless the doctor deems it unsafe. Medical professionals weigh benefits and risks while focusing on the individual and what is best for them – physically and mentally. Additionally, the meal times are longer, allowing people to come and go as they please.

More Activity Choices

Gardening is another activity choice for positive change in long term care! Sowing seeds, tending to plants, and eating the produce! Share stories about making end of the garden soup here!

There are more activity choices as well. Though most homes still offer bingo, there are now classes for painting, crafts, cooking and baking, spiritual and cultural topics, game shows, and other games. Sensory and exercise segments are also available. Clubs pop up as the clientele changes. People are engaged in technology through use of laptops, tablets, and smart phones. Volunteers engage in sharing their talents and skills by assisting in gardening, singing and entertainment, helping with group activities, and assisting on trips.

Additionally, residents venture outside the facility more often. Trips are planned to visit restaurants, wineries, shopping malls and stores, concerts and plays, as well as scenic drives to parks and to enjoy fall foliage or Christmas lights. Residents choose the destinations; activity staff handle the logistics.

Getting the community involved….

Intergenerational activities abound. The youngsters in the community help by becoming make-up artists and dates for proms, by helping to create crafts with residents, by reminiscing and learning with them, and by entertaining. Student ‘shadowing’ opportunities are more available as well, enabling students to ‘try out’ working in healthcare before committing to a specific field or track of education. Everyone benefits. The students gain valuable experience. The facility gets extra help. The residents interact and bond with the next generation.

Animal visitors

Therapy animals and family pets are welcomed into the homes to visit and provide engagement opportunities for those who love animals. Some facilities house large bird environments, fish tanks, and other shared animals with residents choosing to feed or care for the animals…. or not.

We had a large, sleepy dog visit the memory care wing a few days per week. The dog would lay on the floor, occasionally moving enough to lick up a crumb from snacks being served. She would lazily wander from person to person for pats and pets. The smiles she left behind were priceless!

Getting to know you

Really getting to know the new arrivals has been another positive change in long term care. Please do not misunderstand. The front line staff members – the nurse aides in particular – have always made an effort to make real connections with residents. They truly know those they serve! They learned by talking with the person and their loved ones. . . by becoming friends.

With the culture change, this process is more structured and includes everyone who will be working with the new person – from nurse aides, to therapists, to doctors. It begins with staff asking the right questions to discover individual preferences, strengths, and abilities right from the beginning. Questions are asked of everyone in the resident’s life in an effort to capture a vivid picture of the person. Ideally, everyone is part of the care team.

Everyone benefits…

By listening and responding, the facility benefits by providing the resources necessary to keep the resident happy and fulfilled. The family gains peace of mind. And, the person living in the facility benefits by getting what they need to have meaning, purpose, and quality of life.

Another positive change! Getting to know you… and your preferences… Which would YOU prefer? One of these? All of these? NONE? Using their music – check it out here!

Personal identity is stressed. People are no longer ‘the resident in room 212’ or ‘Mrs. Smith.’ Instead, they are spoken to using their preferred name or nickname. Though some may still prefer being called Mr. or Mrs., some ask to be called by their nickname or even referred to as ‘Mom’ or ‘Sis.’ This information is readily available to the staff who honor those in their care by using their preferred name. What a blessing!

A Focus on Friendship

Sharing the bounty with friends…. Meaningful relationships with family, friends, and staff…

People living in long term care now have a larger network of friends – staff and other residents become family. Using their preferred name, as well as honoring their individuality and their choices, enhances the creation and building of friendships. The focus changes from ‘taking care of’ people to becoming partners in care. The staff serves those in their care by helping them do what they want to do when they want to do it! It gives me hope that, if I end up in long term care some day, I will still be able to live my life out loud -as I do now!

How do these positive changes in long term care affect those with dementia?

I know it’s difficult to think of the day when you may have to take your loved one to a facility to live. It’s a heart-wrenching decision to leave your loved one with strangers and hope for the best. But, these positive changes have made life for those with dementia much easier in facilities. When we take the time to really get to know the resident and their families, we can embrace them as they are. And, we can meet their needs in meaningful ways.

Perhaps the best aspect of the focus on individuals and their uniqueness is the ease of transition for the person with dementia. Though the environment is different from what they are used to, the use of their preferred name, the flexibility of the schedule to follow their routine, the opportunity to do what they want to do, and the variety of choices provides security and comfort. It provides the framework for familiarity and friendship with the staff. Hopefully, these positive changes in long term care give the resident true quality of life.

Listening to Their Music

How to Enhance Memory and Quality of Life with Their Music

I’ve been researching music and memory. In particular I wanted to know why am I suddenly transported into my childhood kitchen when my husband plays a classic country song – a style of music that really doesn’t appeal to me? This is my mother’s music. A George Jones hit could bring back the smell of bacon, eggs, and coffee. My mom’s humming returns. I can ‘hear’ the sounds of food frying and paper bags crinkling as she prepared our sack lunches for school as well as a hearty country breakfast. If listening to the music from my past could transport me back in time, what would happen if we helped our loved ones listen to their music?

Why is it, too, that some people with dementia who haven’t spoken in weeks, can suddenly sing every word of a hymn or recite the Lord’s Prayer? For answers, I looked to the experts. Teepa Snow has an excellent video on YouTube that explains how those with dementia can still sing and recite. She also explains in the video why the use of ugly words is sometimes prevalent in those with dementia. Take a look HERE, if you’d like to watch. And, check out her organization HERE. She an amazing trailblazer in educating folks about dementia! You won’t regret one minute you spend learning from her.

To sum it up, she shares that language production is often slipping away as a person progresses into dementia. At the same time, though, the rhythm, songs, sayings and poetry, words we don’t say in polite company, and social graces all remain with the condition. (This can sometimes explain why a sibling who lives far away doesn’t ‘see’ the dementia in your parent… The surface language – social chit-chat – remains intact. “Mom sounds fine, ” they say.)

Can music bring back speech?

Let’s use their STRENGTHS to make their lives better. By firing up the right side of the brain by listening to music, we can also enhance that left side a little. What that means is that those who have difficulty speaking can sometimes regain that ability by listening to music for a few minutes. Watch this video or this one to see examples of how this works. Just amazing to see the difference in their ability to speak following the session of listening to music! Music appears to ‘prime the pump’ for conversation.

What to do?

Knowing that listening to music lifts moods, encourages movement and dance, enhances cognition and memory, and gives us a meaningful, purposeful activity to pursue is key. Music can make brighten the day. It can bring a person from despair to hope. Singing can trigger the release of the ‘feel good’ hormone – oxytocin – and help bind us together. So, on to the ‘how to’s…

Use THEIR music, not yours

First, find THEIR music. All the studies about the benefits of music for those with dementia point to the fact that people react better to their preferred music. Makes sense, doesn’t it? Don’t you remember your mom or dad asking you to ‘turn down that noise’ as you rocked out in your bedroom? Haven’t you heard music that irked you – that made your skin crawl?

To find THEIR preferred music, we need to do a little math and a little searching the internet. Most people prefer music they heard between the ages of 10 and 30. So someone born in the late 1930’s would prefer music from the late 1940’s to the late 1960’s.

What if I don’t know my person’s music taste?

There are many styles of music that were popular from the 1940s to 1960s. What if you don’t know that much about your loved one? Or, what if you are a care partner and did not know your person very well before you started helping them?

To find their music, ask them! Keep in mind that many in this generation attended church. Don’t forget to look for hymns or spiritual songs often sung at services. If your person can’t tell you, look around. Find their records or CDs. See what they have in the collection. Most people buy music for themselves or receive it as gifts from others who know them well.

Find music preferences together….

Additionally, search YouTube or Spotify. Look for the music that may appeal to them. Play a song and watch their reaction. If they seem to ‘light up,’ begin moving along, or start singing, you may have a winner. Then, try other music of the same era and style. Write down your findings or create a playlist for them.

Try other types of music as well. Big Band, Bluegrass, Classical, Salsa, Ballroom music, the sky is the limit! Who knows? You may discover your dad was a ballroom dancer or that your mother knows every word to ‘Sweet Caroline!’

Some lists to try:

Greatest Hits Golden Oldies 50’s, 60’s, and 70’s

Popular Music of the 1950’s and 1960’s

Classic Country 1950’s – 1960’s

Classic Country 1950’s – 1970’s

1960’s Motown, R&B

Big Band music

More Big Band

Lawrence Welk Show

The Rat Pack (Frank Sinatra, Sammy Davis, Jr., Dean Martin)

Polka (Frankie Yankovik and the Yanks)

Nat King Cole

These are collections. Sorry for going overboard, but there is so much music available today! Usually, I like to go song by song to discover preferences. After all, I certainly don’t like all the songs of some of my favorite performers. Why would they? Instead, listen together to find singers and songs that they prefer. I do wish you good luck in bringing more music into your world and theirs! Who knows, you may also find a new favorite! Oops! Almost forgot Doris Day!


Try Quilting: A therapeutic activity for memory care

It’s winter here in western Pennsylvania… finally! The rain has been replaced by snow and the chill is in the air. Time to look for projects to be tackled inside. One project that we have been exploring on the memory care unit is quilt making. We have made quilts of paper and of the traditional fabric. These are not difficult or elaborate pieces – merely squares pieced together and tied with thread or yarn. Their ‘cure’ is in their simplicity.

Memory care residents chose blocks and discussed how to arrange them. The handled the fabric, decided which blocks to use, and instructed the facilitator in laying them out. They wanted to use the pink and purple blocks and this was the final layout.

But, I’ve never done that before…

You may say, I’ve never quilted before and neither has my loved one. That doesn’t mean you can’t try! You will gain so much together. The cutting and piecing of fabric is a sensory treat! Touching fabrics of varying textures and weights, using scissors to cut the fabric, laying the squares into a pleasing design, tying the strings to hold the blanket together, and listening to music or talking together… all of these activities engage the senses and promote quality of life for your loved one.

In the ‘old’ days, sewing quilts or ‘haps’ was a necessity. One couldn’t simply run to the store to buy a new blanket when winter approached. Instead, the ladies of yesteryear would cut squares from worn or too-small clothing and sew together blankets for beds and couches. They were not always the most attractive pieces, but they kept the recipients warm! Your loved one may have made one of these or may have watched a beloved grandmother cut pieces and arrange them into a blanket. They may have even quilted beautiful patterns themselves!

It’s all in the process…

So, how to? This does not have to be an expensive project, but it does take time! This could take months, which is a blessing! In this fast-paced world, you have the opportunity to slow down with your loved one and savor the experience yourself!

The ongoing process answers the three human needs : something to love (you and the project), something to do (Make that quilt!), and something to look forward to (routine – write the days/times you will work on it together). This process is also the very definition of a meaningful pastime! Together, you are making something useful. You two may even decide to give your handmade treasures away – another form of ‘therapy.’

Another lap quilt. Squares are 5 x 5. Notice the use of different patterns in the middle. The fabric for these lap quilts is recycled scrubs from professional care workers.

How To Make a Fabric Lap Quilt.

I started to write out the directions for making a quilt and quickly realized that I prefer to use YouTube videos! Maybe you do, too! I found this super wonderful easy video that explains the whole process! https://www.youtube.com/watch?v=_a2bN7NqoR0&t=498s Professor Pincushion has wonderful, free sewing videos! I’m a big fan.

In the video, she speaks of buying fabrics. You will want to buy the backing and the batting (I prefer synthetic batting over the cotton!), however it might be fun to go through old clothes and recycle them! My cousin makes beautiful knotted quilts from clothing of loved ones who have passed. These special gifts bring back memories of the person through the preferences of what they wore. Cotton blend fabrics work best, though my grandmother used to make them with all sorts of scrap fabric.

She also mentions buying the special quilting rulers, mats, and rotary cutters. (I prefer Fiskars. Check them out on Amazon or Joanne Fabrics.) Though these are a blessing if you are planning on doing the cutting and are in a rush, it could be more therapeutic for your loved one to do the cutting with fabric shears. Safety first, however, so you be the judge as to whether your loved one can still handle them!

If your loved one is capable of cutting, you can trace the blocks on the fabric and allow them to cut them out. Simply make a template from a piece of cardboard. As with any project, please remember that it is the process that’s important, not the finished project! Though it’s nice to have a ‘perfect’ item to give to someone, the key to helping someone with dementia is to enjoy yourselves. Slow down… it doesn’t have to be done yesterday! Enjoy the process and help them to enjoy it, too!

I hope you will try this project! Soon I will introduce a paper quilt project! Also fun, cheap, sensory, and easy!

If you’ve tried this, I’d love to hear from you! Please comment!