Part 1 of this article should be posted nearby.  If you read that, you know that I struggle discussing “activities” with families who tour our memory care homes.  For me, the good news is that by writing this down, I realize I need a tool or handout to help me.

I came to the word Engagement in the first part of this article.  I defined it.  Now I’ll take a shot at suggesting simple solutions.

Environment

In our homes, which are just regular neighborhood houses before we retrofit them into care homes, we start by creating the best setting we can for a resident with cognitive deficits in which to live.

Exercise relieves stress.  Chances are our elders have trouble exercising, and probably didn’t enjoy regimented fitness anyway, so we keep it simple and pour a sidewalk around the yard for a safe walking path.  Those who use walkers or other assistive devices, as well as those who don’t need them can take a spin around the path and enjoy the benefits of fresh air.

Second, we have a water feature in the yard.  The sound of flowing water soothes most people.  Combined with the aesthetic view of a fountain or waterfall, chirping birds, busy squirrels, and shady trees, this provides a calm environment that creates…well, a calm and peaceful place to live.

Inside the home, we have the family bring in furniture, photos and paintings, and other reminders of home.  We use plates and glasses at meal times that are functional over using something that may look nice but does not result in the best nutrition and dining enjoyment.

Our TV programming is minimized, sometimes being replaced with radio, and always, the viewing and music is soothing and suitable for our elders.  We purposefully want a low-stimulation environment to minimize agitation and confusion, which result from overstimulation.

Caregivers are trained in redirection, speaking in respectful and kind tones, and steered away from reality orientation.  To put it simply, we meet the residents where they are on any given day.

Our meal times, bed times, bathing and daily living functions are on the schedule of the resident, not on our schedules.

We bring health care to the homes, rather than transporting the residents to the care.

The “schedule”

Now that the environment is set, we generally, and I repeat, generally plan breakfast around 8am, a cognitive activity like reading the positive articles in the paper or a word game around 10am, bathing, a meal at noon, physical activities around 2 to 3pm such as walking or range of motion, the evening meal at 5pm, and soft lighting and lower stimulation after 6pm.  

We know residents will ask to retire early, so we really reduce the stimulation after the evening meal.  We know a symptom called Sundowning will begin around 4pm, so we draw the blinds or help the affected residents find a peaceful place such as their room or in a chair outside at that time.

We know those who are 95 sleep more hours per day than those who are 75, so we anticipate this.  

Success in Every Day Living

Here’s an observation:  People don’t change from being sedentary, inactive 75 year olds into active, enthusiastic 85 year olds the day they move into a care home at age 85.  

At admission, we seek out information about likes and dislikes, past occupations, favored food and past times, interests, religious needs, family relationships (positive and negative), and anything that will help us get to know our residents well.

We know success in adjusting to the new home takes 2 hours for some, 2 months for others.  Generally, we expect to see the beginnings of successful living in 2-3 days.

Every day living for typical 85 year -olds might include sweeping, feeding the birds or pets, preparing parts of a meal, loading a dishwasher, folding laundry, working puzzles or reading, so we find and continue those activities.

In later stages of cognitive impairment, we read to residents.  We ask them to sort things into matching groups.  We lay a “fidget quilt” across their laps that has objects sewn on that can be handled (see our featured image for an example).  

We give them love, laughter, play with balloons, and generally engage them in everyday activities.

Summing up

In that last sentence, I got in both words.  “Engage,” and “activities.”  So to coin a popular phrase of the day, “that’s how we roll around here.”

I hope these articles have been helpful and relieved your anxiety as a family caregiver.  Loving your elders makes you my hero.  In our homes, we try to be like you and work in what we know, and in the end, we see happy, adjusted residents.  We hope you see the same.