Monday, December 28, 2009

Gifts from the Heart

As a policy, our center as well as the individuals are not allowed to accept money from clients or the families for personal gain. Therefore, if anyone wants to reward us for a good job with money, the amount will be delegated to our program costs and it is a nice tax write off.

What about if clients want to give money to another? This incident has happened quite often as clients interact with one another daily and friendship began to form. Money is exchanged especially on birthdays. A recent incident had the staff come up with creative ideas for goody bags. One of our clients' had a birthday within that week. She insisted that she give money to other clients because they were going to be there to celebrate with her, and she was also very appreciative. To acknowledge her effort but not to have her wallet go empty, we suggested she can make cupcakes, write thank you cards, or even bring the drinks.

Here are a few more ideas that can be gifts for guests at a party:

-If you have a garden, pick flowers and tie a bow around it.
-Fold origami
-Take pictures of the group and give it to them
-If you are a singer, sing them a song

If people are there to celebrate with you, it really does not matter what you give them because your presence is enough.

Saturday, November 14, 2009

Cooking with our Clients

Living in a city such as San Francisco, we are exposed to many cultures. Every nation has its own contributions and something as special as food should be shared amongst everyone.

On a recent trip to Ensenada, Mexico, I went on an excursion called "Taste of Mexico". This was a cooking course to learn what is popular in Mexican cuisine. One of the appetizers we learn to make was guacamole. At our center, we have made guacamole and salsa before, however, I learn that is is not hard to make it into a cooking class with our clients.

Here is the list of ingredients:

avocado
tomato
onion
cilantro
garlic salt
jalapeno (optional)

That is a simple list, but of course you can fine tune it anyway you like. Make sure you also have a cutting board and a knife (plastic can be okay).

The easiest thing is just to put all the ingredients together, one at a time. While you teaching the steps, give them a little history about Mexico and how independence day in Mexico is not celebrated on Cinco De Mayo.

Sunday, November 1, 2009

Halloween at the Center

Halloween may appear to be a celebration for the young, but it is much more than that at our center. Beginning with the month of October, we decorate the center with lots of colored pumpkins, real pumpkins and the aroma of pumpkin pie. In addition to the orange-colored fruit, we also put up posters and hangings of witches, ghosts, and anything we relate to Halloween.

There are numerous activities one can plan for a group. To encourage cognitive activity, our center does a word game with "Halloween". To play this game, we give everyone a copy of the word, then have our clients find words that are three letters or more from one word. You may be surprise at how many words a client can come up with. For Columbus Day, we came up with over 120 words. Another activity using their senses, they can watch a pumpkin carving. We ask clients to draw a face on the pumpkin, and the staff will carve it for safety reasons. Next, we will have our clients take out the seeds, wash them, and roast them in the oven with a little salt. Another idea just for fun is the Halloween Party. Encourage your clients to dress up. Provide them with hats, capes, masks, or jewelry. Another way to involve clients is to ask them what kind of food and beverages they will like to have at the party.

Happy Halloween and be safe!

Monday, October 26, 2009

Productivity or Product of Waste?

Part of our assignments is to develop daily activities where we think will be appropriate for our clients. The conflict arises when the person you present it to is not necessarily as enthusiastic about your idea as you may be.

Today, I would like to talk about disappointments one might face at their place of employment. When a job requires creativity, innovation, and dedication, just how much worth can be measured for each factor? The problem I ran appears to be the generational gap. Age has nothing to do with mentality but I will discuss why that is an issue at work. When a co-worker who is very old-fashioned and set in their ways, novel ideas for music, movies, and activities are often restricted or prohibited to be implemented. As much as we adore Elvis and the Beatles, there is room for musical artists who made music since the 50s. When I tried to introduce a mixed CD with Stevie Wonder, Whitney Houston, Tina Turner, the music was immediately turned off. None of the clients made a comment that the songs were offensive.

Some of our art ideas come from the internet. Apparently, it is too complicated. Anything beyond coloring and cutting has to be altered. So I ask myself, if I am spending time to do research, am I being productive for coming up with new ideas or is it a waste of my time to prepare activities when it will not be on the calendar?

Monday, October 19, 2009

Music

One of our clients, name withheld of course is manic. She refers to herself by the third person. She says her husband is dead. She thinks people are trying to kill her. She is always getting up and wandering around. However, when we manage to get her to sit down, put in a CD, and play a song she recognizes, she is there jazzin' around, snapping her fingers, and singing to the lyrics.

We underestimate the significance of music and its affects on the elderly. For me, music usually serves as background ambiance, fainted in the loud noise of traffic, or just lost when I am studying or running. I forget that my mood changes to certain songs or the memories that triggers.

When serving a population, you will need to understand how to select songs based on how appropriate it is, and yet, not limit the selections based on age. I am going to to put in a song that I hear while everything is dancing at the club for my clients. However, I am also not going to play a song based on an assumption they will like it because it is by Frank Sinatra. This is all about trial and error. You do not need to play the entire song. If there are no offensive or explicit language, try it.

Recently, I had songs from Madonna (her earlier stuff), Whitney Houston, Stevie Wonder, Aretha Franklin, Earth, Wind and Fire, and Lionel Ritchie. It was tested when we did our morning exercise and the response was mixed. None was negative. Backstreet boys and Boys II Men did not make any impact.

We try not to play the same music for many reasons. Your CDs get scratched. You start to tune the music out instead of enjoying it. You do not know what else you can play. Our clients may have Alzheimer's, but they do not need to have a deja vu moment everyday.

Thursday, October 15, 2009

Artist of the Month- Art Idea

We wanted to introduce Faith Ringgold, someone many of our clients are unfamiliar with at the Center. She is a wonderful painter who narrates her stories on quilt. For more information, you may go to this website:

http://www.faithringgold.com/ringgold/bio.htm

To honor her work, staff members sat in groups and read aloud her accomplishments and display her art on our bulletin. Most of the images were found online. To engage our clients to demonstrate their creativity, we had cut plain fabric, preferably a white or beige color, worked with fabric markers and crayons, and allow our clients to freely draw whatever they wanted. Encourage your clients to draw what they are passionate about or even simple objects such as a key or a heart. For our clients who were experiencing artistic block, you can show them magazines so they pick an image or get pictures of birds and flowers.

While doing the project, one of the clients remembered when she was a teacher and had the kids draw. Although the images did not resemble anything, it was best to encourage. That principle applies with adults as well. The idea of this art project is not to stir a competition to see who is the next Matisse, but to allow clients to express themselves in a positive manner.

All these supplies can be found in an art store, Michael's, or a thrift store. I would advise against using Sharpies because they are permanent, hard to clean, and more expensive.

Tuesday, October 13, 2009

Desserts

When thinking of a dessert for elderly clients, consider not just what they will like, but what they can eat. It is simple to think of the usual soft serve ice cream, jello, or pudding. And that is what they like. Sweet, easy to on the teeth food. However, as a racially blended society, we often like to open our clients to new tastes and enriching them with eye-pleasing delicacies.

In our journey, I want to introduce you to something I am familiar with. If you had pass by a place late night eatery with mainly Asian diners, mostly Chinese and Vietnamese, you will notice a colorful clear bowl. Inside that bowl, there are balls of cantaloupe, watermelon, kiwi, and strawberry with a blended fruit juice. Something that you might not be able to see is sago, a tapioca-like texture. Sago is very easy to cook, boil and rinse with cold water. You can find sago at Ranch 99 or other types of Asian market. This dessert is very healthy and seasonably friendly. The sago can be mixed with any fruit you like to blend (mango, strawberries, honeydew). I prefer this dessert over cakes and pudding because it is light and the colors are so pretty.

Below is a picture of the dessert you can try. Yelp is a good website for you to find dessert places that will serve this.

http://www.yelp.com/biz_photos/lwHhXgzuW8yYqILkwrhxdQ?select=EiY8dFePIf2OZjV2bEgLGw

Thursday, October 1, 2009

It is okay to be a BIG KID

Do you ever hear someone say they are too old to do something? "That's for children." "You can do that because you are young." Bless their hearts, our motto is you are capable to do anything at any age. If a woman can give birth at the age of sixty, I think age is really nothing but a number.

Of course, we do not recommend that an elderly client go out and swim with sting rays, we try to experience with activities which may bring out the child in us. Duck, duck, goose is not something we try because of the mobility restrictions in our clients. However, singing a classic tune such as the Alphabet Song, finger painting (using non-toxic paint), or playing a game of kickball. When we do hear our clients say things such as that is for kids, we encourage and offer to be partners in an activity to show them it is appropriate for all ages. With movie selections, please do not think animated movies are juvenile. Cartoons are often appropriate because of the decent language and colorful scenes. A movie you have seen ten, twenty years ago can be seen again.

You will always have a client or family member comment negatively on the age appropriateness of a certain event, activity, or show. However, calmly explain to them we can do things to have fun so just enjoy.

Quality and Meaning of Acitivities: Enough Stimulation?

The Series: Elements of Planning and Coordinating Successful Activities
4. Quality and Meaning of Activities: Enough Stimulation?

Quality and meaning of activities are another factor when we plan and coordinate successful activities. Our clients with Alzheimer’s disease and related dementia need to have frequent stimulation physically and mentally in order to retain their current functioning level. Every activity is supposed to help clients reaching their goals and an activity should maintain certain quality and meaning in itself when it is carried out.

What do we mean quality and meaning in regards to activities?
a. Quality of Activities
-Our clients with memory impairment have symptoms of forgetfulness, inability to take care of themselves gradually, and incapability of thinking reasonably. However, they need to be treated as grown-up and senior individuals in the respectful way. Successful activities for them should not be one for children. Here is the quality of activities comes up to be discussed.
-Is a planned activity simple enough for the targeted clients?
-We mean “the quality of activities” that is simple enough that the targeted clients can participate in, enjoy, reach their aimed goals, be protected safely from expected happenings (except unexpected happenings/incidents as these could happen even in a well-calculated situation/environment).

b. Meaning of Activities
-We engage and interact with senior individuals who have been through their lives that may be filled with a lot of happiness, sadness, anger, and grief. We, as activities professionals, should consider their lives fully to plan and coordinate meaningful and respectful activities. In that sense, meaningful activities could be related to the result of our activities assessment (was discussed in “Assessment of Participants in Activities: Activities Version of Care Management”).
-It is ideal if we can plan an individual meaningful activity per a client; however, it will not be possible to do so due to time limitation, staffing, functioning levels and so on.
-At our Day Care Center, we are still able to stimulate clients in few groups by providing reminiscence-related activities that clients as a whole group can appreciate, enjoy recalling their past, discuss and exchange their memories. We strongly believe these activities are very meaningful and give positive stimulations to our clients.

Saturday, September 26, 2009

A "Stitch" of Memory

Planning an activity is not always easy. There are many things one must consider before moving forward. If you want someone with alzheimers to paint, you have to make sure you provide them with non-toxic, washable paint. I have witnessed clients who spill the paint all over the clothes they wear everyday or lick the paint from their fingers. To prevent harm, there are safety measures we take and staff has to be very careful in watching over our clients.

One of the activities at our center was to have our clients sew drawstring purses. Our first concern was needles. The sharp, prickly tools can be dangerous for those who are vision-impaired or have shaky hands. When choosing a group, we picked a small group (about 5-6) and made sure they were suitable for the task. Instead of using the regular needles, we had special needles that were thicker, and less sharp, but still got the job done. The threading was done by staff and if needed, staff also cut the cloth for the purse.

What you want to do with this activity is to cut out two pieces of clothe that are the same size. -Have the clients sew 3 of the sides, leaving one side for the opening.
-Next, fold the opening side down a little.
-Later, pick a thick yarn and cut it so it is longer than the width of the purse.
-Last, sew the yarn inside the folded side. Leave room for the yard to pull in and out.

During this activity, I learn many things about my clients. One recalled that you had done this before because she was a dressmaker. Another said she used to make hats. The memory that was generated created a positive atmosphere. They remember the times when they were working, and creating things on their own. This shows that activities is not just about following directions. It is also about being productive and just know that some memory loss does not mean loss of all memory and ability to have fun.

Wednesday, September 23, 2009

Too Many Opinions

In our lives, we have either asked for advice or give it to someone. Whether we take one or give one, there are so many varying opinions that makes it hard to know if one's dilemma is taking the right turn. If you want strong viewpoints, there is no need for an advice columnist, our elderly clients are not afraid to tell you what to do.

Part of our daily programming is to provide our clients with news, current events, or what is popular. It is entertaining and also allows our clients to relax and practice some decision-making. Sometimes, what we like to do is turn to the back page of the San Francisco Chronicle and see what advice Dear Abby has to give to the hopelessly confused or to be the tiebreaker. In this week, a guy had wrote in to Abby from North Carolina and said he throws is dog's poop in his neighbor's trash because his house is too far away when he walks his dog. This article received numerous laughter from our clients and most of them had something to say. I was surprised to learn all but one client had the same opinion. They all thought the guy was wrong for throwing his trash in someone else bin. I guess I did not think it was so bad because I am guilty of similar behavior. But the best thing to do is sit and listen. As long as our clients are not attacking each other, the best to do to lead this is to not do anything unless if there is silence. Then you can ask questions. What if he was half an hour away from home, is it more okay for him to throw it away? What if he recycled a bottle instead of adding to trash?

The client's contributions to our activity is most important. We plan activities for them. So even if I hear something I do not agree with, I remember is is just another viewpoint. If someone's opinion is not the majority, it does not suggest it is wrong. An advice columnist is a good way to stir conversation and we love hearing what our clients have to say. There are lots of surprises and you also learn something about your clients that is not written on charts.


Phillips, J. (2009, September 21). Is putting bag of dog's doo doo in neighbor's trash bin a don't?. San Francisco Chronicle, pp. C8.

Monday, September 21, 2009

Assessment of Participants in Activities: Activities Version of Care Management

The Series: Elements of Planning and Coordinating Successful Activities
3. Assessment of Participants in Activities: Activities Version of Care Management

Activities at the Day Care setting need to be thoroughly assessed, planned, and coordinated before carrying out. There are various assessment tools in activities that are used at diverse day care centers; however, the following components of activities assessment are based on our experience at our center as activities professionals.

We believe that the assessment of participants in activities should be comprehensive from our participant’s functioning levels to goal/purposes of activities.

a. Participants’ Functioning Levels
-Our distinguished activities consist of physical, cognitive, intellectual, and social aspects. In order to protect every client during activities, each client’s functioning level should be assessed.
-Physical functioning level of each participant is crucial. Is a client ambulatory or non-ambulatory? With a cane, on a wheelchair occasionally, or a wheelchair-bound? How about arms, hands, shoulders, neck, skin, and foot? Vision problem? With glasses? Verbal ability to express herself/himself? Appropriate and safe shoes? Shoe laces are tightly knotted? Comfortable cloth? Every little thing in the physical functioning assessment should not be ignored before conducting activities. These assessments will be able to protect clients from harmful incidents during activities.
-Cognitive functioning level also needs to be assessed. As our center has clients with wide cognitive ranges from mild to late stage of memory impairments, cognitive functioning assessment should be done carefully. Is a client able to follow instruction and direction during activities? How is a short-term memory? Repetition?
-Physical and cognitive functions are connected each other. Some clients may retain a higher cognitive function with a severe physical limitation. Others may have lower cognitive function but they may physically fit and movable.
-What makes our clients feel achieved within their functioning levels? Limitations of physical and cognitive functions sometimes make clients have difficulties to feel achievement.

b. Participants’ Interests
-We investigate what our clients like to do for activities at our center as much as possible. Daily conversation and interaction with clients frequently tells us what they want and need. Especially, what they used to do for fun could be the key to lead us meaningful and successful activities.
-In addition, their past hobbies, occupations, roles in families, their nature of being themselves, personality, and current interests give us wonderful hints to plan reminiscence-related and/or therapeutic activities.

c. Goals/Purposes in Activities
-The last component of activities assessment, we believe, is to set up goals/purposes in activities before conducting activities for both staff members and our clients.
-As activities specialists, making clients with memory impairments feel achievement through various activities is our first goal at the Day Care Center. The second goal is to enhance clients’ quality of life by engaging with them through activities.
-For our clients, their goals in activities are diverse and multi-formed. Ideally, each client should have individual goals in activities; however, in a group setting, such as our Day Care Center, it could be delicate to establish individual goals for each client due to time restriction and staffing. Instead, we set up goals for clients as a group in activities, based on physical and cognitive functioning levels we stated earlier in the above.
-Then, how do we make them reach their goals in activities? Some need more socialization than others. Others require obtaining physical strength. We negotiate and combine several aspects of activities to make our clients group reaches their goals so that the quality of life, we hope, automatically is enhanced.

Assessment of participants in activities is composed of a great amount of perspectives, including participants’ functioning levels, their interests, and goals in activities. Our assessment tool above crucially plays a significant role in planning and coordinating activities. Moreover, we emphasize on interaction, communication, and socialization with our clients to assess them in activities beside the above tool.

Thursday, September 17, 2009

Making Each Person Count

I look at my mom, barely saying five words to her when she gets home. Somehow I cannot strike up that conversation. It has been like this for years. There are exceptions when we make minor jokes about my dad, or there is a family event. It is strange how I can easily strike up a long conversation with someone who delivers my pizza, than making friendly repertoire with the woman who deserves it most.

The lesson today is really about each individual in your life. I would like to focus on our clients. I wonder how often their loved ones or significant others spend time and ask them questions and wait for the answers on what they like or what they did.

Part of the program, not specified in our responsibilities is socialization with people who are the most vulnerable in our community. A while ago, Department of Aging held a poster contest. Come up with artwork and a message that has to do with the senior population. The winners came up with "Seniors are our National Treasure". The message we try to convey is often the very message that is ignored, perhaps not consciously but it is because we do not know how. The easiest thing now is to just listen. Sit comfortably next to them. Tell them you really want to hear what they have to say. Sometimes, it is not easy listening. We all have problems of our own. But imagine that the five minutes you spend listening to what they want to do or what food they do not like, it might make it easier to take care of them. The bonus is that it makes you feel better about yourself because you actually made a difference without spending a penny. Do not count the people, but count the smiles you brought to their faces.

Cornerstones of Care Education Series at IOA

Capacity: What is It? How Do We Assess It? What happens When We Loose it?
This is the title of the last installment in the educational series from the Institute on Aging, titled Cornerstones of Care.

Capacity:
legal competency or fitness (capacity to stand trial), or
an individual's mental or physical ability
(source: Merriam-Webster Dictionary).

Why is the concept of capacity or competency so important to those who care for our aging population and for those who reach the age of 65? Here are statistics that shed some light on the importance of this ongoing discussion. In the year 2010 the US Census Bureau projects our population to have over 40 million people over the age of 65 (or 13% of the total population) and within this group 3-5% will suffer from dementia. At the age of 85 and above, the incidence of dementia is estimated at 40-50%, which combined with our growing longevity, will result in a population of 7 million Americans with some form of dementia by the year 2010. The threshold of competency, which in the majority of cases translates into financial competency, is one to watch carefully and in need of continuous fine-tuning and examination.

What is the impact of dementia on capacity?
Here is a list of symptoms of dementia:
- difficulty learning and retaining new information
- difficulty recalling relevant personal historical information
- difficulty understanding simple concepts
- difficulty expressing preferences and choices
- loss of mental flexibility
- impairment of judgement
- distortion of reality (psychotic delusions)
- vulnerability to undue influences/exploitation/abuse

Daniel C. Marson (Professor of Neurology and Director of the Alzheimer's Disease Center at the University of Alabama at Birmingham), defines capacity as 'competency' in these words:
"a theshold requirement, imposed by society, for an individual to retain decision making power in a particular activity or set of activities." Professor Marson, the key note speaker of the day, is introduced by moderator Erika Falk (IOA, SF Elder Abuse Forensic Center) as the 'financial capacity guy', with his added insights from a law degree from the University of Chicago. He demonstrates that when money is involved, the law comes into swift action, and the court rooms become the arena where our concepts, such as capacity, are redefined.

Where is the rule book for deciding who's no longer able to make financial or medical decisions? In a study presented by Marson it becomes clear that only with training and understanding of the various dementias can physicians make accurate assessments, which go unnoticed in routine examinations. The grasp of the limits of capacity or competency in clinical terms can then be of use in the court room, and applied to the laws surrounding the autonomy of the individual.

The legal, social and medical environments where today's developments in the definition of capacity take place, are represented in a panel discussion with speakers Judge Joyce Cram (Contra Costa County), Mary Counihan (formerly Director of Adult Protective Services) and physician Elizabeth Landsverk, (ElderConsult Medical Associates). In brief lectures about their professional experiences it becomes clear that our society is moving toward greater understanding of the challenges of our aging population.

For more information on these series go to: www.ioa.org/research/continuing_education/

Tuesday, September 15, 2009

Quick Morning Meeting: Getting Started

The Series: Elements of Planning and Coordinating Successful Activities
2. Quick Morning Meeting: Getting Started

9:30 is the time we start our quick morning powwow that is the second important factor to lead us to successful activities. Every morning before our clients arrive on their vans is filled with a quiet and tranquil moment at our Day Care Center. Every staff member is surrounded by a calm atmosphere before our clients’ arrival.

Generally, communication among staff members is the most significant factor in any team setting. In order to be an effective and efficient team player, each staff member communicates frequently, listens to other team players actively, and builds trustful work relationship consciously. Respectful and professional manner also need to be emphasized. As well as being a competent team player, we are also required to be individual decision makers who are confident to make prompt decisions for our clients.

Our typical morning meeting includes the followings:

a. General Daily Schedule
-Daily schedule, including a timeline, lunch break, and staffing, need to be clear as the time frame tells us how we work efficiently and take care of our clients safely.
-30 minutes lunch break at our Day Care Center needs to be taken when we work over 6 hours. This must depend on every center and contract. Staffing needs to be discussed.
-Who is working and how long? Regular staff members who work everyday know the daily routine, timeline, and knowledge about every client. On the other hand, on-call staff members who come to help us when we need them can follow the routine and work very well; however, when it comes to experience and knowledge about clients, it sometimes becomes crucial and they tend to need more instructions.

b. Specific Assignments
-Once staff members are notified a daily schedule in general every morning, then specific assignments that includes toileting, news and exercise, kitchen duties, and activities are distributed.
-When we share our assignments, we use the assignment list that has every category mentioned above and the activities coordinator fill in staff members’ names next to each assignment. Specifically for toileting, it gets complicated as every client has his/her habit and custom. Their toileting habits, frequency, and levels of care, are also considered.
-It is very important to know as activities professionals that certain clients tend to use the bathroom more frequently than others due to specific reasons or just find comfort and companionship (was discussed in “Going in Pairs” on 9/14/09/ by Thia).
-In order to distribute each assignment equally, the activities coordinator needs to pay an extra attention to combination of total clients’ numbers of toileting and other assignments (news, exercise, or kitchen duty).

c. Entertainments, Guests, Events, Volunteers
-Who are coming today for us besides staff members and clients? Entertainers to play music? Family members to visit their loved ones? Volunteer to help us out? Special party? Potential clients to visit and check us out? All these extra guests who don’t have a contact with our clients regularly need to be clarified in the morning meeting due to safety, and liability, confidentiality for our clients and ourselves.
-Every staff member is required to know who comes and goes. Most importantly, we verify guests identity by asking them to introduce us (more safely, with their IDs).

d. Clients’ Updates
-Clients’ updates consist of several aspects, including physical, cognitive, behavioral, and social changes, medication, families’ concerns, and transportation issues. We, as multi-task activities specialists, notice our clients’ slightest change in the above perspectives. We fill ourselves in each other by exchanging own observations on each client.
-It is fundamental to be extra sensitive towards specific clients who show significant changes or rapid decline in short term.
-These drastic changes are reported to the families, doctors, and/or designated third parties (e.g., social workers)

e. Future Activities Ideas/Suggestions
-Last but not least, future activities ideas will be discussed and shared. The most exciting part of our job is to carry out unique and meaningful activities. (Activities related topics will be discussed in detail later.)

Our morning meeting is just our starting point where no one knows what will happen. However, once we all are on the same page respectfully, our day will go smoothly with good amount of communication.

Nostalgia with a little bit of Chocolate

Warm, melted chocolate. Fresh, tarty strawberries. Hmmm....

Lost in thought but oh so worth it. Fondue has made it's comeback. From About.com, I learn that fondue is very popular in the fifties, sixties, and seventies at dinner parties. Without devouring a heavy meal, yet creating a similar ambiance, we replicated our own Melting Pot at a reasonable budget.

Making fondue is worthwhile, fun, and definitely a team activity. For those who does not like chocolate, we also had melted caramel. Our fondue pots were brought in by staff. It is easy to borrow from a family member or friend if you do not have one. Most sets can be purchased for under $20.

On the dipping side, we have bananas, apples, strawberries, cookies, marshmallows, and other snacks that are easily found at a local supermarket. Here is a recipe for the chocolate found at Recipezaar.com: http://www.recipezaar.com/Chocolate-Fondue-23054.

Remember that the chocolate can be hot so cool the food a little after it has been dipped. Try to divide everything evenly between clients so each person can have a little taste of each item.

http://homecooking.about.com/od/foodhistory/a/fonduehistory.htm

Monday, September 14, 2009

Going in Pairs

A question I got the other day was, why do women often go to the bathroom together? Pondering about that was difficult when I rarely partner up to go to the John. However, I see it as being a companion for someone, to keep them company while they finish their business.

At our center, taking someone to the bathroom is more a necessity than a reason to gossip. Our clients are elderly clients who rely on walkers, wheelchairs and a helping hand to complete daily tasks. More than half our clients need assistance in the restroom. Some needs changing while others need guidance. Usually, we assist our clients at least twice daily. Some can go as much as five times. We have clients who uses Depends and some who do not have it. Although I appreciate Depends for developing products geared towards elderly clients, we have recommendations that we hope will market the item better.

-Create designs or colors to make them look less like diapers
-Make materials biodegradable

To make changing easier, I would also recommend that family members could be instructed to dress their loved ones in loose-fitting pants that either have an elastic waistband or strings to tie. Furthermore, for those clients who are difficult to change because they hate having us take off the shoes, perhaps the bottom can be wider so it can be easily pulled on and off.

Safety is the main concern. As a staff member, we feel no clients should be rushed to sit down or to finish. If some clients have a hard time using the bathroom, one method is to turn on the faucet. Hearing the water increases the urge.

So, there are plenty of reasons to use the bathroom together. While some prefer privacy, others may need something or someone. So the next time someone ask you to escort them to the bathroom, it is very kind of you to grant their request.

Elements of Planning and Coordinating Successful Activities

What elements are considered when you think of successful activities for the elderly with Alzheimer’s disease and related dementia?

Elements of planning and coordinating successful activities, we believe as activities specialists at the Day Care Center, are based on several aspects including consistent preparations and numerous research. The followings are the fundamentals that are derived from our hands-on professional work experience and we consciously pay attention to them when we plan our activities. Once these basic elements are established, then activities for our clients with memory impaired are successfully carried out. We will carefully look at every element with you here in our blog. Each point will be discussed separately in the series of “Elements of Planning and Coordinating Successful Activities.”

The Series: Elements of Planning and Coordinating Successful Activities
1. Daily Routine (is discussed earlier in “Daily Routine: Consistency and Flexibility on 9/11/2009)
2. Quick Morning Meeting
3. Assessment of Participants in Activities
4. Quality and Meaning of Activities
5. Combination with Staff Members and Participants in Activities
6. How to Use Our Staff Members’ Strength and Their Interests
7. Preparation, Time Frame, Safety Issue
8. Tasks in Activities
9. Extra Time for Necessary ADLs (activities of daily living) Cares (including toileting, feeding, and transferring)

Friday, September 11, 2009

Daily Routine: Consistency and Flexibility

The Series: Elements of Planning and Coordinating Successful Activities
1. Daily Routine: Consistency and Flexibility

“What are we going to do today?” This is the question from some of our clients every morning.

Our morning starts with socialization with coffee/tea and small breakfast, followed by sharing current news and 45-minutes exercise. Date and time orientation is necessary to start our day with clients. Our staff and clients complete our fill-in-the-blank white board together while clients finish their breakfast.

Various afternoon activities are accompanied by physical stimulation (e.g., physical games, outdoor stroll, etc) in order to keeping them alert after lunch. We occasionally switch morning routine from afternoon routine due to some inevitable reasons (e.g., entertainment, cooking and baking schedule, guests, etc). We call the switched day as “the Backwards Day.” Excepting the backwards day, we try to follow our daily routine.

It is important to consistent with our daily routine at our Day Care Center. The first reason is that our clients with memory impairments tend to feel comfortable to follow set-up basic routine. They would be panic when the routine changes subjectively. The panic and confusion can be avoided by reassuring them repeatedly.

The second reason is that some clients with higher cognitive functioning remember and expect to enjoy the activity mentioned on the calendar. We don’t have to disappoint them by changing activities without mentioning to them.

However, it is also essential, I believe, being flexible regarding planning and coordinating activities. As nobody knows what will happen next with memory impaired clients, unexpected incidents or happenings could occur. Here is the time that flexibility comes in. When planned activities need to be switched from one to another, we respect our clients and tell them immediately if possible.

For instance, we plan to do baking activity after lunch; however, one client has an emergency at lunch table. Before the panic attacks the rest of our clients, we immediately call the paramedic to take care of the client and switch from the original plan of baking to sing-a-long activity in the other room in order to distract them and have a quiet moment until an emergency is taken care of. Emergency scenes need to be taken away from the rest of the group.

Or sometime, the day just doesn’t work at all with anything. It could be because of clients’ mood and frequent care in the bathroom and so on. Staff members’ frustrations to handle with these emergencies are very contagious to clients. Then we can be flexible to do something more calm, mellow, and therapeutic (e.g. coloring, short movies, sing-a-long, trivia, etc).

Due to being consistent with some levels and flexible towards our daily routine, at the end of the day, clients fortunately forget our hectic moment at the Center but remember their laughter from happy activities.

Thursday, September 10, 2009

Artist of the Month













To enhance our programming and to introduce an element of surprise and wonder, we feature an 'Artist of the Month'. Our first artist is Andy Warhol, who was born on August 6th, 1928.
We dedicate one of our wall panels to this theme and decorate it with a short biography, quotations and reproductions from calendars and internet sources. The public library provides colorful books and catalogues, which we display on a table nearby. We design an easy coloring activity with a coloring page that features Marilyn Monroe in a pose reminiscent
of Andy Warhol's work.
And 'voila!', a mini museum is born at our center.
For the month of September we choose Grandma Moses, because of her self taught charm and the potential to inspire the late-blooming artist in all of us. Once again, the public library sends the biographies and colorful picture books to a nearby branch, and with today's internet library catalogues, picking the right publications is done in a cinch. With Grandma Moses' work, looking at the paintings, naming and remembering landscapes, houses and farms is a delightful activity.
The artists are chosen from handy website, where the birthdays of a number of famous American and international painters and sculptors are listed:
www.arts.ufl.edu/ART/RT_ROOM/artist_birthdays/birthday.html

Go with the Flow

Our Day Care Center has a full of surprise, amusing moments, and small happiness with some hectic occasions. Taking care of over twenty clients with Alzheimer’s disease and related dementia per day is a quite handful work. Their functioning levels are various from mild to late stages. Someday this activity works, someday this doesn’t but the other activity works. It does completely depend on the flow of our day.

When we coordinate and plan our daily schedule, we look at our daily routine, preparation and quick morning meeting, participants’ functioning levels, their interests and traits, purpose/goal of activity, quality and meaning of every activity, combination with staff members and clients, how we use our staff members’ strength and their interests, time frame, and extra time for necessary ADLs (activities of daily living) cares including toileting, feeding, and transferring. (Each of these elements regarding coordinating activities will be discussed separately in the series of "Elements of Planning and Coordinating Successful Activities.")

Even though our day is completely planned well, nobody knows what will happen next. It is fine if the daily schedule doesn’t go well. It is fine if our activity ends in failure. Everything is an experiment. Even though it is important to follow our basic routine (will be discussed the next posting in "Daily Routine: Consistency and Flexibility"), go with the flow. As long as our clients are happily entertained, actively interacted, physically and mentally stimulated, and safely protected, our day becomes one of the successful days.

Still, our clients gain something important and meaningful moments from being with us, participating in activities, having meals together, touching their hands and smiling, and talking and listening to others in the group setting. In return, we, as staff members, are given valuable and precious lessons by them.

Questions to ask after Labor Day

When you're in school, you may hate taking tests. All those questions about historical events and famous buildings may not be something students would want to answer when they come back to school after a long weekend.
We love trivia at the center. After Labor Day, one of the activities we had our clients participate in was Trivia & Auction. There are many websites and books where questions about Labor Day is easy to answer and our clients love to yell out the answers before we give it.

You can visit this link:

http://www.funtrivia.com/playquiz/quiz30563122fd590.html

The way our trivia and auction work comes in two process. The first process, we ask them multiple choice questions, True/False, and fill-in-the-blank. I wait awhile after each possible answer and give them a chance to raise their hand if they think it is the correct answer. Those who answer correctly, we would give them ten dollars in "funny money" that resembles "Monopoly" money. After all the questions are asked, they count up their money, and we auction off donated items. These items include: chocolate, clothes, jewelry, photo albums, and other accessories.

There are problems that we do fun into. Sometimes, a few clients raise their hands on every possible answer and other clients may be upset. The way this was handled is that you keep reminding them the rules. Just raise for one answer. Another way is to not wait until all the options are given but stop after the right answer.

For example,

Question: What is an owl?
Answer: 1. Plant
2. Animal
3. Food

So stop after number 2. You do not have to read number 3.

My experience from going through the trivia is that I found some of the questions may be hard. Therefore, feel free to make up your questions if you do not find simple multiple choice. For Labor Day, there were not many questions. So I made up these questions.

1. What does an optometrist specialize in ....
a. Eye
b. Nose
c. Chin

2. Does a photographer take your ...
a. Wallet
b. Picture
c. Curtains

3. What does a podiatrist examine ...
a. Feet
b. Hands
c. Hips

Those are a few examples. Be creative and when someone answers correctly, they feel better and smart. Trivia questions serve to engage cognitive processes and improve analytical skills.

Wednesday, September 9, 2009

Stress Relief

No job is easy. Even food critics encounter a dish that may be dismal in appearance and equally depressing in taste. Custodial workers have to endure physical exhaustion while public school teachers facing overcrowded classrooms strive to teach the curriculum. Although I cherish and love my job, I believe we cannot be like the Energizer Bunny and keep going and going. The body and the mind needs a break.
Work for me does not stop when I clock out. At home, I often recollect about the activities and the clients. There are too many questions... What should we do tomorrow? How would the clients like it? Which client is appropriate for the activity? Although you may not be about to refrain from thinking about work, always provide an outlet if you are feeling stressed out.
Working out is always good. A combination of good music and moving the body helps me reduce the stress. Walk your pet. Dance. Do yoga. Or even walk to the laundry mat and wash your clothes. Even if you are still stressed, at least you will have fresh, clean clothes. I think even sitting still and just meditating or napping can be relaxing. Doing nothing is sometimes the best option.
Sometimes work is mentally draining and emotionally challenging. We love out clients but they can require a great deal of attention and care. As an activity assistant, I learn my responsibilities are not limited to what is written on my contract. We have to be counselors, dietitians, entertainers, nurses, and friends. There are many tough days and there needs to be an outlet. Find someone who you can talk to. BE CAREFUL! The key word here is CONFIDENTIALITY. Finding someone to confide is wonderful but there are things you cannot reveal, most importantly names. Depending on where you work, there are certain information that are private.
Work will always be there. I know I think about work too much but to bring me back to sanity, I do many things that relaxes the body and makes me happy. If I do not want to do dishes, I buy take out. If I want to talk to someone, I have wonderful co-workers and close friends. Stress relief, we all need it.

Moments of Reminiscence

What makes you happy?

This is the key to live life fully. Some say that a time with family is the most precious thing. The others say that delicious food makes them smile. Some happy memories relate to the present while other unforgettable memories are linked with the past. No matter where these reminiscence derive from, I believe most of happiness comes from insignificant moments that are not so obvious for others.

What if you know you forget something insignificant for others but significant for you? How do you react? How do you protect those precious memories you have in you? Do you feel sad? Do you feel helpless? Do you give up? Do you ask for help? Then, do you know how and where to ask for help?

At the Day Care Center where the team members of this blog work, over twenty clients with Alzheimer’s disease and related dementia actively gain the benefits from participating in well-balanced activities by validating their reminiscence all day. I strongly believe reminiscing one’s own past is one of the simplest therapies to any age group.

Especially, for our clients who are in any stage of dementia, reminiscing moments often visits them in a day. One client recalls their own parents/spouse and looking for them throughout a day. Another client believes that her children are still little in the kindergarten.

When interacting with clients in a reminiscing period, I suggest validating their reality. Their reality is your reality today. The story might be different tomorrow. However, if their reminiscence and memorable stories make them happy at the moment, it is working and is turned to be one of the successful and therapeutic activities.

It is also recommended to ask ourselves the following question; what if we know we lose our precious memories? We will be scared, depressed, and frustrated. When we do so, it would be easy for us to link with clients closely and give us the key to understand why they are agitated and frustrated.

Recommended book about validation therapy
The Validation Breakthrough: Simple Techniques for Communicating with People with 'Alzheimer's-Type Dementia' by Naomi Feil, Vicki De Klerk-Rubin, and Vicki De Klerk-Rubin (Paperback - Jan 15, 2002)

Tuesday, September 8, 2009

More Than Just "Lucy"

How would someone select movies for a group of elderly clients?

Always the tough question. Movies are about entertainment and enjoyment. The dilemma we have is choice. What movie do we pick that can be appropriate, related to the monthly theme, and engage our clients?
At our center, we show a long movie once a month. By long, it is usually more than one hour. At times, we do show short movies such as DVDs from shows like "I Love Lucy", "The Golden Girls", or "That's Entertainment". While most of our movies are amusing to most of our clients, a selective few find some of the viewing materials inappropriate such as sexual innuendos or explicit language.
Not to suggest you refrain from experimenting. What is enjoyable one month can be dull another month. Please do not rule out animations. A client from our center loved 'Kung Fu Panda" and "Happy Feet". Romantic movies should not be excluded either. One of our clients cried when put in "An Affair to Remember". If you do want to show classics, movies with Bing Crosby, Frank Sinatra, Gene Kelley, Julie Andrews, Bob Hope, and Grace Kelly are very musical, comedic, and safe.
There are many choices to what you want to show. If you are a caregiver and watching a movie at home, recent movies such as "Hairspray" and "Mama Mia" are recent and easily obtained.
If you are showing a group and on a budget, go through what you have or even movies you bought for the kids, something will appear. Don't forget the popcorn.

Sunday, September 6, 2009

Birthdays at the Center

In my family, birthdays were only a celebration if you were a child. As we grow older, I think birthdays are often neglected because age and the elderly are not often as cherished as they should be.
Birthdays at our Daycare may be handled differently from retirement homes or nursing facilities. I volunteered at a residential healthcare facility and once a month, residents' birthdays falling on that month would all gather in the community room, have a nice dinner and eat cake.
The numbers at our Daycare is much smaller than that of a nursing facility, therefore we have individual celebrations. Lack of budget does not diminish the fun and creativity with our clients. To save on money, I recommend using the cake mixes that you can buy at any grocery store. The cost will be $2-$4 and it taste good. Furthermore, the staff could make it an activity and have some clients bake it themselves. If you wanted to add a present, it does not have to be costly or extravagant. Simplicity is beautiful. Make your own card and sign it. Wrap up cookies in tissue paper or even take a nice picture frame or something you have readily available. I cannot speak for other people, but I believe what makes a birthday special is spending it with people who cares about you and just want you to have a good time.
You are entitled to blow out candles at any age, even if you are short of breath after the deed is done. Even if our clients do not remember how old they are turning, we are not celebrating age. Instead, we are appreciative that we are allowed to celebrate with such remarkable people.

Thursday, September 3, 2009

A Friendly Game of Bingo

B, 13. B, 1-3. This is what we said.

What?! G? 16? This is what some of our clients hear.

I have always thought that calling bingo numbers were easy. I always thought that if someone does not hear you, you say it a lot louder. My thinking was not always appropriate. What I soon learn was that it was not always about volume, but about enunciation, clarity, and definitely patience and understanding.
Bingo is a game that we play about twice a month. Our clients love it. The game facilitates thinking, hand-eye coordination, concentration, and awareness. When our clients play the game, it reduces any anxiety they had beforehand (eagerness to go home, looking for relatives) and places them at ease because it is simple and straight-forward. Another positive attribute is that this game was not about competition. None of our clients were frustrated that they did not win or angry at someone from their same table for winning. Our winners get the congrats from other clients by a round of applause. If someone were to make a mistake and call out bingo when they did not have it, no verbal abuse or physical abuse occurs. A bingo chip has not flew across the room.
The clients at our center can be hearing impaired, visually impaired, and may have motor problems with shaky hands or lack of grip contributed by Parkinson's. As a caller, please remember mistakes with numbers are bound to happen, either with you or a client. If a client cannot hear you, I suggest repeating the number clearly, and perhaps writing it down and showing it to them. Always encourage and reaffirm that it is just a game, it is nothing to be upset about. If that still does not work, give them ice cream.

Wednesday, September 2, 2009

A 'Cougar' in the Room

To update our clients on current events and spark conversation, our program includes a news segment for about 20-30 minutes. Each of the staff shares their own news, perhaps a poem, or even a personal story. Since it is available to us, most of daily news comes from the San Francisco Chronicle. I usually browse the internet such as CNN.com or MSNBC.com for stories that are interesting, some informative, but most funny or uplifting.
One story that caught my eye was in the Datebook section of the Chronicle about a competition for "cougars". The story was not about felines and their prey, well, maybe a little. The term "cougar" that is familiar to the entertainment world defines a cougar as an older woman who prefers younger men. So the feline in the story is a successful woman over 40 years of age who preys on men 10 or 20 years their junior. Of course, our clients know of one definition for a cougar. When I asked the question, most of the responses was that it was a large cat, some said it was a hunter.
The article engaged the clients about why women want men who are young enough to be their sons. Many of my clients thought it was unusual or even funny. One of the clients who is in her 70s actually said she wanted to give it a try. "Why not?" was her response. Although our program have few men, we asked them for their opinion if they would date someone who is much younger than them. One man said it does not make a difference.
So picking what topics to discuss based on the paper is not easy. I try to avoid talking about deaths or homicides that are ubiquitous in the media. There are too many news stations already talking about the fires in Southern California or of the kidnapping of young girls. To focus on something light will create a positive atmosphere.


Zinko, C. (2009, September 1). Miss Cougar accepts prize in Palo Alto. San Francisco Chronicle p.E1.

Tuesday, September 1, 2009

"Senior Soda Bread"

Our noses were teased with the aroma of freshly baked bread from yesterday's cooking activity. Although not perfectly resembling a sourdough bread bowl, the taste was more satisfying because that was the mark of what we accomplished.
For breakfast, our clients enjoyed a slice of our version of "Irish soda bread". We served it warm with a little applesauce and some fruit filling. With the soda bread, baking soda replaced yeast for the leavening. Other ingredients included: buttermilk, butter, sugar, salt, flour, and raisins. It was a team effort and of course the willing to be a little messy, which all our clients were good sports about it. Before we started, the recipe and steps were printed out for everyone (they were able to take them home) and each individual read instructions to our healthier treat compared to ice cream and cookies. The outcome resembled a giant scone and was soft enough for our denture wearing clients to taste.
Baking is a way for our center to expose our clients to new recipes, new cultures, and hopefully an enjoyable and rewarding experience. Food should be the universal language and sharing it brings people from different backgrounds together. Our recipes come from different sources such as Cooks.com., Recipezaar.com, Living Magazine, or even from the labels of the product. I do not recall where we got this particular recipe, but we made a few changes to accommodate clients with food restrictions (sugar intake) and whatever we had. This recipe also connects with our Native American theme of simplicity and creativity.

Monday, August 17, 2009

Activity Planning for the Fall



This month our team designs the mid Summer and Fall program and we come up with several ideas. We decide to introduce our clients to our local native culture, and choose to highlight the Ohlone people, who inhabited the San Francisco Bay Area for hundreds of years. We want to bring a natural flow to our programming to create easy transitions in our decor and activities. We follow the thread of history with Missions and ranchers, who occupied our land after the native culture disappeared. All this fits into one large landscape on one of our display walls, allowing us to change it gradually with the themes.

The Ohlone
For information about the Ohlone I dive into my own library and search the Internet. I love reading the terrific and evocative descriptions by Malcolm Margolin of the daily life of the Ohlone, and the vivid illustrations of the people, the animals and the natural surroundings. I pay attention to finding reliable resource materials, and search for images of dwellings, artifacts and people.
Here are several activities that allow for different levels of participation:

- making a tule hut and boat with paper and raffia
- coloring an image of an Ohlone family in front of a tule hut
- coloring and cutting out animals and trees: bear, deer, fish, oaks and pines
- weaving a small basket
- looking at and discussing images of the Ohlone

The cutouts are used for the display, and slowely but surely the landscape comes alive!

The Ohlone Way: Indian Life in the San Francisco-Monterey Bay Area, by Malcolm Margolin and Michael Harney, 25th Anniversary Edition



Sunday, August 16, 2009

Adult Day Care: Active Elders

At the Adult Day Care where I work, we take care of elders with dementia, Alzheimer's disease and other forms of memory impairment. We serve a hot lunch, do daily exercises (45 minutes), and offer a variety of activities, including SPCA visits, art and crafts, cooking and gardening, word games, bingo, monthly movies, sing-along, and a variety of guest artists. Most of our clients are picked up by a special bus service around 9AM, and some are brought in by spouses, children or hired caregivers. Some of them live in Board and Care Homes, some with family and a few of them live independently. Around 3PM they return home, after a day without TV, but with a hot lunch, snacks and plenty of liquids. We offer assistance with medication and with the use of the restroom, if needed. Most of our clients love coming to the center, some keep forgetting where they are, but all are safe and continually invited to participate in the program.
Our days are carefully planned around the incoming clients. Our staff to client ratio is 1:5 (this might change with the impending budget cuts), which allows us to accommodate different stages in he progression of cognitive loss, and have our clients stay active as long as possible.
Our calendar and menu are published and mailed every month, and follow the major holidays and seasonal changes with monthly themes and guests. A set daily routine is followed by all, with regular activities in smaller groups in the afternoons.