Memory Care with Teresa Youngstrom
Activities For People Living With Dementia
(upbeat music) - Hey, care partners. Welcome back. This is Memory Care with Teresa Youngstrom, and I'm so glad you're here. You know, this is where we talk about all the different aspects of dementia, people with memory loss. These are individuals that need personalized care. And there's so much more to it than meets the eye. You know, I thought I understood dementia, but I was wrong, proven wrong by my own mother. And let me tell you, once you've done this personally, you have a whole new perspective on how to do memory care. And so I'm thankful I have the opportunity and this platform to share with you. I hope that you like, subscribe, and share so that more individuals across the country and across the world can get great information from someone who's been there and done that. So today, you know, what we're gonna be talking about today is how to find appropriate activities for people with dementia. Because I've been to communities where, you know, frequently they might just have everybody at a table doing the same activity. And you know, what that can be tough, because, you know, today I might be different than I was yesterday. And those folks that care for someone at home, what a huge advantage to personalized care, to be able to do what she loves. But Tiva Snow has some great ideas on not only the staging of this terrible disease, but also then what things they may like or dislike at these different stages. So I'm helping today to give you some great tools about appropriate activities. And let's get started. Okay, moving forward. So it's important to know, you know, what makes an activity appropriate. And then, but you need to know the abilities, you know, of the certain stages that they're at. And then we need to talk about the actual activities for you to try. And so that's my goal today, is to go through all of that with you today. So what makes an activity appropriate? So we need to pause and consider how the brain really works. If you think about it, this is brain failure. And so things stop working and things decline. So how can we be part of the solution and not part of the problem with your loved one, or maybe with the person that you care for in community? I hope that I have caregivers here who are getting great information to take back to their community also. So let's move forward. You know, when we think about the way we learn, when your kids are small, wow, lots of encouragement, lots of guidance, lots of demonstrating, lots of reinforcement, but constant supervision, you know, when they're little, when they're four, five, six, you know, they need constant supervision and maybe even some naps, right? And I think, I know that I implemented those things as I needed them. But then as we get older and we get into the teen years, things change a little bit. And what I've noticed is that they don't need naps. They don't need, they still need guidance and encouragement, but we start to get more independence because the goal with raising children is to launch them into independent, educated, well-balanced individuals who then can, you know, earn a living and understand how to care for themselves and care for the people around them and live a great life, right? But their brains are still growing at that teenage, like I said, and they still need, you know, they don't really have safety awareness. What does that mean? You know, maybe when you're a teenager, you, you're 18, you graduated from high school and you think, you know what? We could drive to Florida from Cincinnati overnight, spend two nights and be back, you know, in two days. Okay, well, at my age, that doesn't sound like a good idea. I have a lot more safety awareness. I have a lot more knowledge and experience and to understand that just 'cause you have $50 in your pocket, doesn't mean you can afford to go do some adventures like that. But when we're young, frequently we feel invincible and that's really tough and that safety awareness can take a while to develop in our brains. You know, for young men, sometimes it's late 20s, mid to late 20s, before they develop some of this safety awareness. So we still have curfews with our teens a lot of times until they earn, they've shown us they're responsible enough to not need that type of care and that type of supervision. Well, I think what we need to realize is when it comes to dementia, it's brain failure. And it may be, for me, it's easy to understand that, okay, maybe we're going back down. These are not children and don't you ever treat someone with brain failure like a child? No, I've never said that. We are respectful, but we can notice some certain things. And that is that we need to go back in what would be their developmental stage and they're going to need even more encouragement, more support and chances are we're going to have to add supervision. What? They're an adult, yeah, I know. But if my safety awareness is compromised, right? If my ability to find the right word or do the right thing or remember that I turned on the stove, safety awareness definitely comes back in. And if they live long enough, depends on their co-morbidities, right? What else health lies is going on besides brain failure? But they can live a long time and so we will have to add more support and more supervision and maybe even that nap. We definitely did that with my mom and I'm telling you, it helped her get through the evening much better. So the reverse learning, right? Not difficult, but it's kind of a counterintuitive for a lot of people to think that their parent might need supervision. We have to do it very carefully and with a lot of respect. And frequently we still want to address them as our parent and we have to be so careful not to become descending. And also to recognize, do they even have awareness of the disease or are they in denial? Do they not see the disease? Or maybe in the morning they have awareness, honey, I am losing it. Honey, I need you here. They might have more fear and they may realize they need you, but then as the evening hours, that's sundowning, the brain's tired, you know what? It might be get out of my blankety blank house. I'm a millionaire and I don't need you, which is what I was told by a lady I was caring for. So also I have seen that sometimes a spouse or the primary caregiver, maybe it's a daughter or son, if they live together, they can be too close to the situation to really see what's going on. And so sometimes it's good to have an outside view of an assessment of what's really going on and so that we can have the appropriate care as this person declines. And I would say, set up your care before you need it. Set up the care before you need it, okay? Don't get caught with needing care and not being able to have what you need, okay? So let's talk about TIPA snow again, 'cause really when I talk about these different, appropriate activities, you know, TIPA has a really great, she's just really great to start there, but she's really good on focusing what they still have, not what they've lost, okay? And realize that dementia looks different on each of us. And so when you think about staging this, you know, frequently families wanna know, well, what level are they? What stage are they? And I understand that a little bit, but what I've learned is that to me, it's where are they right now when I'm coming in? 'Cause with my mom, she could be in a different place in the morning, noon and night and it could just change and I needed to be ready to adjust depending on where she was. And so what's cool about TIPA came up with this really great staging system called the gems. What? I know the gems, it's really, really great. Copyrated by TIPA, I'm gonna give her full credit for this 'cause it's her thing, it's great. But this is my favorite, you know, this TIPA snow gems from positive approach. She really is great about not calling someone a one or a five or a six and not calling them an early, a mid or a late who wants to be early, mid or late, right? I don't, but what if you called them something beautiful? What? Yeah, what if you called them something beautiful, like a gem, okay? So TIPA talks about these activities need to be productive and because really we all need purpose and these activities need to be enjoyable, right? Otherwise they're not gonna do it and they can be passive or active. But we also need to remember these, they are loved ones need us to be tuned into their health and their hygiene and home care. And then guess what? Everybody needs time to rest and recharge. And so we aren't trying to put them on a treadmill and keep them busy, busy, busy, busy, busy, busy, because it doesn't work like that. It's not real life, it's not, you know, they'll just get angry at us. And so, but we have to have a balance of these things. All right, definitely need a balance. And so I'm gonna go through some different stages with you about finding balance and talking about TIPA snows gems, okay? Gems. So I told you she had something beautiful. And so would you rather be a sapphire or a level, you know, a level one? I'd rather be a sapphire. So sapphire and TIPA's world, I'm just gonna go over these. There's a, I could talk for two days straight on all the different things that are involved in each of these stages, but I have 30 minutes today. So we're gonna get it done. But sapphire is true blue. That's you and me. That's when our brains are working well. That's when we have the ability to discern, we know when we make a mistake, we have the ability to recall. And for the most part, you know, depending on how old we are, our brains are aging. And so it might take you a little longer to come up with an answer for something, but you also have all that experience and knowledge to pull from when you're, you know, past the halfway mark like me. And so, but she calls that a sapphire. It's clear, it's sharp, you know, likes routines and rituals. And we like familiar activities. And, but that's a sapphire. And then the next stage that she has, you can see on our little gem there is the clear one. And what is that? It's a diamond. A diamond's gonna be clear, sharp. But the thing about a diamond is that, you know, frequently there are a few flaws and a diamond can also cut you. Diamonds are sharp. Yeah, they can cut you if you push the wrong button. So when we're talking about activities for someone who's in the diamond stage, it's early on, they may or may not have awareness that they're in this stage, okay? They're usually frequently very able to care for themselves. We see these folks and assisted livings all the time. Diamond stage, you know what? They probably can't manage something in their life like managing the checkbook or maybe, you know, are they driving still or not? Has their peripheral vision become too compromised? But people at the diamond stage they go for familiar activities. What do they like to do? And so don't rush them. Don't rush anybody with dementia, right? And then frequently asking them to help you do something is really, really a good idea. So some examples, what activities we could do with folks in the diamond stage. We definitely baking, right? Baking the same items, you know? And it doesn't have to be complicated, but maybe they don't know the recipe any longer. So maybe you're doing the recipe. You know what, Mom, let me see if I know that I can do this recipe. You be here and you can stir and break the eggs and that's up, you're good at that. But just see if I can put it together 'cause it's always been your recipe. And I just wanna see. So if you would help me. And so maybe she, you know, can stir, break the eggs, things like that. Also shopping, they may still enjoy shopping. They're individuals, if they do great, put that on the list of a great activity, but maybe they don't. We had a gal that we took shopping. We had a budget set set by the daughter. And she, of course, thought she could buy everything in the store. And we did a little something with the cashier. We told them, back on my card says, please be patient, my friend has dementia. And so the store, cashiers knew, the store people knew that this person was forgetful and had challenges. And they saw the pile of clothes that she brought forward. And I had asked them, when we go to pay, if you could distract her and with something, well, you know what they did, they offered her a job. They told her she was an amazing shopper and dresser and she'd be perfect working here. And she was 83 years old and she was still very sharp. But I'm telling you what, they made her day. The endorphins were just rolling out of her smile. So big, ear to ear that they wanted her to work there. Oh, she said I couldn't. I'm retired and it was just adorable. But it allowed me to pay for one skirt, which was in the budget. And then on the way home, she said, what did we get? And I said, are you kidding? That pencil skirt, it looks so beautiful on you. And she was happy as a clam. So get creative, get creative with how you're doing things. And so going to a coffee shop might be something else that a diamond might like to do. I would make a list of five to 10 things that your loved one likes to do at this stage in the game so that anyone who's there can pull upon this list. And be able to enjoy an activity that fits their level of brain failure, okay? The next level that Tiva talks about is the emerald, the green, you can see on the chart there. It goes from the blue, the sapphire around clockwise to the diamond, and then to the emerald. Let's talk about an emerald and what's there? What color is emerald? Green, what does green mean on the stoplight? Green means go, that's right. So frequently people in the emerald stays are on the go, go, go, go, you know what? And with purpose, they may not know where they're going or what time they're going, but they definitely see themselves as very able and very independent. Do they still need supervision? I would vote yes. They still need some supervision. We see emerald sometimes still in assisted living. If they've been there and they know the routine and the people around them understand dementia and how to work with that person. But they have limited awareness of the changes and they may repeat themselves a lot. So go for familiar activities with this person. Try to establish routines early on. The hygiene routine, if you can establish that early on, is a real winner. But I'm here to tell you again, not everybody has to shower every day. The shower's really overrated. Some of you are going, oh. The shower's overrated. These folks are not playing in the sandbox. I've had family members say they have to shower every day. And I'm like, you know, if that's frightening to them, why would we do that? They're great techniques on how to get someone in the shower. We've let people get in the shower with their clothes on. I mean, when in the world where we ever talk to take our clothes off for people, what? And so there are a variety of techniques for getting the hygiene done. But the sooner you start that routine, the better. OK? We shouldn't use correcting words with these individuals. We should still be encouraging. But I'm saying at the emerald stage, maybe we use fewer words. Because Mayo Clinic says, your tone and body language are a much better form of communication with people with dementia than all the words. They get lost in the words. They might only be catching, you know, they're maybe dropping one in four, or maybe they're only catching one in four, you know? Depending on the damage in their brain and where the dementia is doing its work. So I would use fewer words with these folks and maybe start adding gestures. Good? Not good, good, not good, good. And/or can you help me, you know? And just what can we do to use our hands to demonstrate things with them? Definitely notify your face that you're happy to be there. OK, let's avoid the negatives at all costs. Be encouraging. They may have confusion of time and space. In the evening, it's not uncommon to go to their bedroom and say, no, no, no, no, no, no. And they may have confusion about that. I need to go home. Oh, you need to go home. Repeat it back to them and say, OK, well, you know, I think we'll need to get a few things. And why don't we make a list of everything you need to take with you? Because you've got quite a few things here. Let's grab a cup of coffee or maybe an ice cream or something to start redirecting that desire, that fear that entered into their mind when all of a sudden this didn't look right and I'm afraid and I need to go home. Home can mean a variety of things, guys. Home can mean I got to go to the bathroom. Home might be their childhood home. Because maybe they're in their current home. Home can mean childhood home. Can we take them to their childhood home? Nope. If it's early in the day, you know I had a woman I just met with this week, a gentleman talking about his wife. And she likes to go home. And so he'll put her in the car and they go for a drive. And he said, I hate to tell you I buy her ice cream all the time. And I said, well, you know, she's 83 years old and you know, she's going through this process. And if that brings her joy, whatever brings you joy, OK, we can't fix this bloody disease. Least we can do is bring you some joy. And that helps her get grounded again and come home and be OK at home. So people in the emerald states, they like to know what's coming next. They like to know. So don't correct, use fewer words. But where are we going? When are we going? When are we going? When are we going? Consider, you know, with them they might be hypersensitive to the sensations around them, maybe to noise, depending on if their hearing is good or not. And so maybe be careful of taking them to a restaurant that's way too busy and too much noise. And there have been times when I will put them in the restaurant just facing me in the wall. And so that maybe that'll, you know, limit some of the environment, energy, and they're focused on me. But you know, at some point, we do decide that then that activity isn't worth them becoming agitated or fearful. And that's our job, is to figure out where they are. And then as they change, can we adjust the activity? So they also might like they need purpose. And so familiar tasks around the house are great folding towels on loading in dishwasher. Maybe think of, you know, yard work. I had a gentleman who could still ride the riding mower and he loved that and they had a fenced-in yard. He couldn't get anywhere. There were no dogs or cats or anything out there. If he ran over flour, oh well, but he was very safe. He knew his routine. And for a long time, that gave him so much pleasure. And it got him away from just sitting in front of the TV. OK, so emerald, green, on the go. They want to be doing things. If they can, they want to be doing things. But they may not know where they're going or how they're going to get there. So then the next color there, what do you see? That gold yellow color. We call that amber. Teepa calls it amber. And on the stoplight, what do you know about the yellow light? Yeah, slow, slow caution, definitely. So these folks are frequently caught in a moment of time. OK? And caution is required. Caution is required. They may have not just a scuba vision at this point, but they may have binocular vision. So even more limited, they really haven't trouble even seeing what's around them. It really can be tough. And it can make it very hard to recognize objects. They frequently don't see the food in front of them. But they might see, you know, George's chicken nuggets across the table and they're reaching over to steal his chicken nuggets. All right, so don't beat him up for that. Make sure the way we serve food is in a way that they see it coming in. And they have an idea where things are. Just little things that are game changers. I would demonstrate what you want them to do. So if you're going to bake with this person, maybe we do it with a few other people and everyone's doing the same thing. And you'll notice this person looking around to see who else is doing and how they're doing it. And so we may not understand the words you're saying, but he watches everyone open the package and pour it in OK. And then they can demonstrate those things, right? If you're going to give them instructions, maybe just one or two instructions at a time. My friend from the Dawn Method, she talks about, don't give them too much instruction. You might say, shoes and socks, socks first, very precise. Instructions, socks first. And so to eliminate the-- I don't know what I'm supposed to do. And then you're upset with them because you're late because they either haven't done anything or they've got the socks on top of the shoes. So who made that mistake? We're the ones who have to adjust. Listen, we're the ones with the solid brain, or I should say sound mind, hopefully. And so as we're giving instruction, it's just so important to be clear and simple. And as we progress around these gems that we're taking the time to make things shorter, more precise and simpler, OK? We definitely need to eliminate items around them that may cause harm, you know, knives. And we had to get rid of plastic fruit. They can possibly eat that sort of thing. And that's terrible. They're very much focused on sensation here. And I certainly saw that with my mom. All of a sudden, hands are in the mouth. Hands are in the mouth. And it's like, wow, she's never done that before. But hands were definitely in the mouth and sensations. You know, they like to explore in this stage. And so tasting things, putting them in the mouth, stacking things. And I don't want to tell you to get baby toys out, but my mom really did enjoy stacking those colored tubes around the base. And she would do that. And she would feel quite accomplished when she had that figured out. So don't rule it out. Don't do it too soon. And if they feel childish with that, then not a good idea. So make this work for your person. Remember, you've met one person with dementia. You've met one person. And we need to personalize care to that person, to our loved one, at the stage where they are, at the gym, where they are today, right? And they might be different tomorrow. So sorting colored items. So think about simplifying some things. But with awareness of where they are in their staging, in their gym, okay? The next color we have there, what is it? Red, ruby red. What is red on the stoplight? I love teapas gems. It just makes so much sense. Right, it's a stoplight. Yeah, so these folks can be very strong still, but they lose fine motor skills. So they might have their strength fingers, but not their skill fingers. Skill fingers, what do those do? Well, how about fork and spoon, a knife? How about toothbrush, hairbrush, washcloth? How about all those things? Pan, pencil, skill fingers. That's when they're eating with their fingers. Sometimes they'll have the fork in the correct hand and then still eat with the opposite hand. And so we noticed these things. So we need to change the way we're doing things. Teepa, of course, has this incredible technique called hand under hand. It's a pack technique that I teach when I'm out. We can't do it all today, but you could look that up, hand under hand technique. Really great if you have someone in the stage where they can no longer use their skill fingers. My mom wouldn't let me wash her face with the washcloth. In hand under hand, I just said, "Go ahead and wash your face, mama." And it was really my hand in her hand, but it was still her arm connected to her body and her brain. And it made her think she was doing it. How cool is that? And it worked like a charm, worked like a charm. Okay, so these folks still may have their, they may be very strong, but without skill. They may get started and not be able to stop doing something or they may not be able to get started. Okay, this is our Ruby stage. We can really make use of rhythm and song. These are things on the right side brain that we can still use humming. If they're prayerful, oh my gosh, you have a huge technique there, especially to settle things down. You know what, mama? We better go to the Lord and pray about this. And she would, because that was part of her, that was a part of her from way back. And so that was familiar that that was something you did. We can also do. And you can even get some exercise out of that. Maybe if they're doing this in the chair, move their legs or, you know, patty cake, clap hands, those are all things that are good. They're physical activity. They make it up and dance with you. How cool is that? So don't overlook these simple things that they can still do. They may have monocular vision. So that may just be their dominant eye. And what does that do for our vision? When we're using one eyeball, depth perception is a problem, isn't it? Okay, depth perception. And so they may be shuffling more and they may be looking up, looking down, looking up, because it's so hard to see where their feet are going and they're afraid they're gonna fall off a cliff or an hole or things like that. So let's use single words to guide them now. Good. Good job. Okay, let's think about just using single words. So they may still walk in a routine path. You see some of these folks. I saw a lady once who walked along the room and she was rubbing her hand on the wall. She couldn't find the chair in the middle of the room, but she wanted to, but all she could do was walk around the edges. They like going forward. Remember, folks that have brain failure do not like to go backwards. They don't like to be pushed backwards. We need a different technique for even sitting them down on a commode or into a chair. If you need help with that, then you need to reach out and we need to talk about it. They may like things to hold in the ruby stage, pick up, they might wanna wipe stuff. They may, they may wanna put things in their mouth too. Okay, frequently the things to chew and suck on. My mom did enjoy a tootsie roll tootsie pop. She didn't chew on the stick. She wasn't a choke hazard, but it kept her hand out of her mouth for a while. May or may not work for you. These are things we just try. Maybe just singing with them through a task. I know something my mom was very fearful about was the hoyer lift. And so I would sing up, up and away. It was so great. She would lock on me and I'm going up, and away in my beautiful home. And she would just watch me as the hoyer took her over and put her in her chair. And then I'd say, "ba." And she'd say, "loon." And I'm like, "yay." And it was a win. So I can sing. I can sing during the hoyer lift every day of the week. And it was better than having her. (vocalizing) This blasted and all the fear with that? No, no, no, no. We'd sing during doing the toenails. I know, I know weird, I know, but that's what I would do. Okay, Pearl, last one, Pearl. So appropriately labeled tepa yur rock star. Because pearls are fragile and they're beautiful gems and they're found inside an ugly shell that has moss and yucco growing on it. This is still a very beautiful person, okay? And they're beautiful moments to behold. And so very little tolerance for stimulation. You might have eyes closed most of the time, but we still need to take great care when we touch them, not to startle them. And when we're turning and repositioning, they're in there. I've had folks say, "Yeah, I'm not even gonna go visit anymore." She's not there. And I'm like, "Oh, she's there." She's there. And every once in a while, they bless us by opening that shell. And we see a moment of them, the real person. And it's so beautiful. But it comes with a lot of patience and maybe some music and maybe some talking to them gently, things like this, because they have multiple system failures at this point, guys. And the body can be pulling in on itself with contractures. Hate that skin issues 'cause they're laying in the bed a lot. We need to turn and reposition. They really respond better to internal cues, right? Hungry, thirsty, gotta go to the bathroom. Discomfort, that's when things get them motivated. But boy, do they really, really need extra at that time, okay? So go slow with everything. We're gonna be calm, rhythmic motions, all right? Maybe use a deeper voice. Let's avoid extending those limbs. That would be painful, you know? If they're contracted like this, this is literally the brain decline, causing these limbs to pull in on themselves. Straightening them would be very painful. We used to put braces and all kinds of stuff in there. Sorry about that. But don't do that. And you know, sometimes at that pearl stage, we really need to give them permission to go home. We need to give them permission to go. We're good, mom. You know what? We'll take care of dad. He's so good. We'd love you and to be able to give them permission to go. Just think about that. It's something that we definitely had to do at a certain time. So let's just remember, the relationship is the most important thing, okay? And put your list in your back pocket when you come in, that agenda, maybe we'll get to that stuff and maybe we won't. I want you to treat them as an individual in this moment of time, okay? Do what you can to allow them to shine. Tip is always talking about brush up that gem and let them shine. I love that part. Okay guys, now you know about the gems. We're not talking about ones and threes and fives. Talking about a person and maybe where they are today. You can find more information about the gems if you go to teepasnow.com, all right? Anyway, this is Teresa Youngstrom with a better approach to memory care. And this is our podcast, Memory Care with Teresa. Again, please like, share, subscribe. And you know what? Above anything else, you've got this. (upbeat music) (upbeat music) (upbeat music)