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.
Thursday, October 1, 2009
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.
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.
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.
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.
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.
Subscribe to:
Posts (Atom)