When I was hired as an activities director for an assisted living community near Valley Forge, PA, I was a newly minted college graduate with an English degree and four years of volunteer experience. Sure, I had a lot of passion for the senior population, but I knew almost nothing about the practice of working with and for them.
I quickly learned that I had much to learn; that crucial first year was really a trial by fire.
And, as my office was in the Alzheimer’s wing, I got full exposure. More than once, my desk chair was used as a toilet when my office was mistaken for the bathroom. On numerous occasions, I was called in to help when the nursing assistants were overwhelmed by the challenges of providing highly personal care or when a resident expressed reluctance to swallow pills. I helped serve meals in the dining room. I sat with residents who experienced sundowning (agitation, confusion, and other negative behaviors that occur when the day transitions into evening, due to causes such as being overtired or overstressed) and tried to talk them through their discomfort, panic, and anxiety.
I did much more than plan and lead activities, although everything I was doing was an activity in its own right . . . which leads me to my recommendations for best practices in activity programming for dementia care:
1. All activities, even unplanned ones, can be meaningful.
Activities don’t have to fit in a box on a calendar or whiteboard, and they don’t have to be held at intentionally carved-out hourly intervals throughout the day. There are countless opportunities for activities often right beneath the noses of all dementia care unit staff. Making the bed. Meal time. Watering the plants. Tidying up the room. Each of these things, small and simple though they seem, can provide rich opportunities for engaging a resident who is perhaps not interested in bingo, movies, or other group activities.
2. Simplify your schedule, routine, and approach. Always adapt.
I always found that the simpler the activity, the better it was for everyone (including the activity director, who is nearly always pressed for time and resources). That doesn’t mean dumbing things down, it means stripping away the nonessentials and getting to the heart of what makes a successful activity: meaningful interactions and purposeful occupation. Want to host an afternoon tea? Great. Don’t burn yourself out trying to find the daintiest napkins, the prettiest tea service, or the most prestigious teas. Cups, spoons, tea, condiments, napkins, and scones are all you really need. Also, don’t try to set it all up on your own. Get the residents to help you prepare for the event so they feel a sense of ownership about the activity. Discover that no one in the group particularly likes tea? Don’t take it personally—just adapt—and bring out a pot of coffee.
3. Engage the residents.
I remember walking through the halls of that first community where I served, arm-in-arm with one of the residents, who only spoke Spanish. We would have lovely conversations, even though I didn’t speak or understand Spanish. Consequently, she did most of the talking, but I listened actively. I did my best to match her emotions (if she frowned or looked angry when she spoke, I frowned too; if she seemed to be asking a question, I would nod or shake my head in agreement or support) so that she could feel comfortable about speaking freely. I think those walks may have been among the few times that she was really and truly engaged with anyone in the wing, and I was happy to foster that opportunity for her, even though “walking the halls with residents” wasn’t listed on my daily activities planner.
4. Do some field research.
Talk to the family members and friends who come to visit. Talk to the residents themselves. Find out what they enjoyed doing before they moved to the facility, and organize your programming efforts accordingly. CPI’s Life Story Questionnaire [PDF] is a great help!
5. Use peer mentors.
In most Alzheimer’s care facilities, residents will be in varying stages of dementia at any given time. If you’re doing a group activity, consider pairing up residents who are still in the earlier stages with those who may be further into the disease process. Be sure that their personalities complement each other so that you don’t create unnecessary conflict or tension. This is an approach used often in Montessori-based dementia programming that works well in terms of engaging and empowering both the mentor and the mentee.
6. Do intergenerational activities whenever possible.
Music therapy and pet therapy programs are quite successful means for getting people who rarely smile or speak to light up and communicate, but bring a baby, a toddler, or any young child into the room and everyone, everything else disappears. Deep connections are made; the presence of the young life sparks something in the residents that no other activity can match.
For more information on best practices for activity planning in dementia care units, check out the post I wrote for the Alzheimer’s Association called “Change and Adapt, but Don’t Stop: How to Provide Meaningful Activities for Those With Alzheimer’s and Related Dementias.”
Before settling down as a full-time freelance writer, Michelle Seitzer spent 10 years serving in various roles at assisted living communities in Pennsylvania and Maryland, then worked for several years as a public policy coordinator for the Alzheimer’s Association's PA Chapters. She also served as a long-distance caregiver for her beloved grandfather, who died of complications from Alzheimer's in 2009. Michelle has blogged for SeniorsforLiving.com, a senior housing resource company, since November 2008, and is the co-moderator of the first #eldercarechat on Twitter. Connect with her on Twitter and Facebook!