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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.


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Developing Activities

That Have Meaning

Those Living with

Dementia


How Does Skill Change Over

Time With Dementia?

- Interests

- Helper cues that help

- Environmental cues that help

- Ability to focus and change focus

- Sensory awareness and processing

- Motor skills: gross and fine

- Decision making and reasoning


Progression of

Dementia: The GEMS®

Sapphires

Diamonds

Emeralds

Ambers

Rubies

Pearls

3


Sapphires:

- Us on a good day

- Clear and true to ourselves

- May feel ‘blue’ over changes

- Can typically choose our behavior

- May have other health issues that affect

behaviors

- Recognize life experiences, achievements

and values

- Can follow written info and hold onto it


Diamonds:-Sharp, hard, rigid, inflexible, can cut

-Many facets, still often clear, can really shine

-Are usually either Joiners or Loners

-Can complete personal care in familiar place

-Usually can follow simple prompted schedules

-Misplace things and can’t find them

-Resent takeover or bossiness

-Notice other people’s misbehavior and mistakes

-Vary in lack of self-awareness

-Use old routines and habits

-Control important roles and territories, use refusals


Diamond Interests:

- What they feel competent at

- What they enjoy

- Who they like

- What makes them feel valued

- Where they feel comfortable but stimulated

- What is familiar but intriguing

- What is logical and consistent with historic

values and beliefs

- Whoever is in charge

4


Emeralds:

-Changing color

-Not as clear or sharp, more vague

-On the go, need to ‘do’

-Flaws may be hidden

-Time traveling is common

-Are usually Doers or Supervisors

-Do what is seen, but miss what is not seen

-Must be in control, but not able to do it

correctly

-Do tasks over and over, or not at all


Emerald Interests:

- Doing familiar tasks

- Doing visible tasks

- Historic tasks and people and places

- Engaging with or helping others

- Finding important people or things

- Having a ‘job’ or ‘purpose’

- Being an ‘adult’

- Getting finished and doing something else


Ambers:-Amber Alert- Caution!

-Caught in a moment

-All about sensation and sensory tolerance, easily

over or under stimulated

-May be private and quiet or public and noisy

-No safety awareness

-Ego-centric

-Lots of touching, handling, tasting, mouthing,

manipulating

-Explorers, get into things, invade others’ space

-Do what they like and avoid what they do not

5


Amber Interests:

- Things to mess with (may be people!)

- Places to explore

- Stuff to take, eat, handle, move

- Visually interesting things

- People who look or sound interesting, or

places that are quiet and private

- Textures, shapes, movement, colors,

numbers, stacking, folding, sorting


Rubies:-Hidden depths

-Major loss of fine motor finger and mouth skills, but

can do gross motor skills like walking, rolling,

rocking

-Comprehension and speech halted

-Wake-sleep patterns very disturbed

-Balance, coordination, and movement losses

-Eating and drinking patterns may change

-Tends toward movement unless asleep

-Follows gross demonstration and big gestures

-Limited visual awareness

-Major sensory changes


Ruby Interests:

- Walking a routine path

- Going forward

- Watching others

- Being close or having space

- Things to pick up, hold, carry, push, wipe,

rub, grip, squeeze, pinch, slap

- Things to chew on, suck on, grind

- Rhythmic movements and actions

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Pearls:-Hidden in a shell: still, quiet, easily lost

-Beautiful and layered

-Spends much time asleep or unaware

-Unable to move, bed or chair bound, frequently fall

forward or to side

-May cry out or mumble often, increases vocalizations

with distress

-Can be difficult to calm, hard to connect

-Knows familiar from unfamiliar

-Primitive reflexes

-The end of the journey is near, multiple systems are

failing

-Connections between the physical and sensory world

are less strong but we are often the bridge


Pearl Interests:

- Internal cues

- Pleasant and familiar sounds and voices

- Warmth and comfort

- Soft textures

- Pleasant smells

- ‘Good’ tastes

- Smooth and slow movement

- Just right touch and feel


What Do People with

Dementia Need?- Daily Routine!!!!

- Help to fill their day with meaning

- A Balance of:

-Productive activity: feeling valued

-Leisure activity: having fun

-Self-care activity: wellness, health, personal care

-Restorative activity: sleep, rest, and re-energizing

- A Match-Up for Preferences:

-Large Group, Small Group, 1:1, Alone

-Active versus passive

-Sensory options: visual, auditory, tactile, olfactory,

gustatory

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Know each

PERSON!

Understand

ACTIVITIES!

Make & Use a

SCHEDULE!

Build staff

SKILLS!

Manage the

ENVIRONMENT!

Resources to

succeed

What Does it Take to Have a

Day with Meaning and Joy?


Know each Person

Health Status

medical conditions,

medications,

limitations & abilities

Life History

Who the person has

been…

Personal history and

background

Cognitive Status

thinking, memory,

processing skills

and limitations

Emotional status

psychological

condition and mental

health & limitations

Routines and Habits

patterns of behavior,

daily routines, time use

& schedules

Sensory Status

sight, hearing, touch,

balance, coordination,

temperature regulation


Personal Preferences and

Values:

- Who have you been?

- What did you value?

- Who are you now?

- What do you value now?

- Why does it matter?

- Who gets a ‘say’?

- Who gets to set the priorities?

8


Personality Traits:

- Introvert - Extrovert

- Lots of Details - Big Picture Only

- Logical - Emotional

- Planning Ahead - Being in the Moment


Life Story:

Family: past and

present

Living place(s)

Work history

Leisure History

Music history

People history

Plant history

Animal history

Plant history

Sensory environment preferences

Cultural history and concerns

Food likes and dislikes

Daily routines

Organizations and memberships

Roles and responsibilities

Comforts and Irritants


Design Each Day

8 am – coffee circle

8:30 – songs of joy

9 am – time to ‘go’9:15 – take a hike – walk’n’roll

10 am – cool down & stretch

10:30 – watering hole

11 am - ‘use your brains’games

11:30 - time to ‘go’ – wash up

11:45 – ‘set-‘em up’ crew

12 noon – let’s eat

12:30 – clean up crew

1 pm – music and meditation

1:30 – coupons clipping

2 pm – time to ‘go’2:15 – let’s dance

Make a

schedule and

follow it

Be structured

BUT allow

flexibility

Create a

FLOW for the

day

Build up and

then slow down

Circadian

rhythms

Offer a variety

of activities

every day

Leisure, work,

rest, self-care,

groups and 1:1,

passive and

active

Create Group

schedules

BUT

also build

individual

schedules

Not everything

is for

everybody!

Build a Foundation

of Familiar and Favorite

Activities

Add a few

special events and

something different© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

9


Two Examples:

Paying Bills:

Do it independently

Together – use a calculator

Together – do all of them

Together – do one at a time

You do most, they sign and

put in envelopes

You do all but the signature

They put on stamps

Both take them to the mail

box

Washing Dishes:

Do it independently only

after meals

Do it independently – when

needed to fill time

Together – one wash, one

dry

Do parts

Watch and guide

Carry dishes to/from sink


Learn How To:

- Do something new

- Learn a new type of exercise or activity

- Simplify a dance

- Re-look at a old skill and make it easier

- Share a tasks

- Do something without touching things

- Get someone to do something without words

- Give positive feedback and say “thanks”


Pay attention

to the lights, sounds, seating, work

surface, space…

Manage the Environment

Do the ‘right stuff’ in the ‘right place’Match what you do

to where you are…

Use the space well

Plan and place for

BEST effect

Create & Use Storage

Make set-up & clean-

up part of the activity

Change it

around – if you

need to - to make

it work!

Keep it ADULT

Make sure supplies, activities, and

games are meaningful

Play & laugh with folks, not at them

Give out tools and materials ‘just in

time’

Control the activity so clients are

successful – not overwhelmed

- not out of synch

Make it look friendly

Get me to want to come

10


Take a Look, Listen, Feel:

- Lighting: adequate, non-glare, focused

- Sounds: background, distracting, volume

- Feel:

-Temperature

-Space: crowded, intimate, personal, public

-Work surface

-Seating surface

-Walking surface

-Familiar? Friendly? Fun? Forgiving?


Enough Supplies

& Materials

The right

equipment for

clients’ needs

Good

quality

lighting

Skilled

leadersh

ip for the

activity

Good

work

surfaces

Seating

that

works

Enough

help for

each

person

A Back-Up

Plan


Two Options:

Doing:

Filling socks: rice socks,

bean socks, corn socks

Adding herbs: lavender,

citrus, eucalyptus, mint

Putting a sock inside

another sock

Heating the socks

Rubbing the socks over

muscles

Emptying socks out

Making:

Fruit salad: from fresh

Fruit salad: from canned

Fruit salad: from pre-cut

Fruit salad: one fruit and

yogurt

Fruit salad: dried fruit,

granola, and yogurt

Putting the fruit salad in

small cups or bowls

Serving the fruit salad

11


How Do We Create

Meaningful Activities?


Key Activities to Consider:

Productive - Work

Enjoyment - Leisure

Wellness - Personal Care

Restorative - Rest


Productive Activities:

Helping another person

Helping family members/caregivers

Completing community tasks

Making something

Sorting things

Fixing things

Building things

Creating something

Caring for things

Counting things

Folding things

Marking things

Cleaning things

Taking things apart

Moving things

Cooking/baking

Setting up/breaking

down

Other ideas

12


Active: Passive:

Socials

Sports

Games

Dancing

Singing

Visiting

Hobbies

Doing, Talking, Looking

Entertainers

Sport program/event

Presenters

Living room or lobby sitting

TV programs: watched

Activity watchers

Being done to

Leisure Activities:


Cognitive: Physical:

Table top tasks

•Matching, sorting,

organizing, playing

Table top games

•Cards, board games,

puzzles

Group games

•Categories, crosswords,

word play, old memories

Exercise

Walking

Strengthening tasks

Coordination tasks

Balance tasks

Flexibility tasks

Aerobic tasks

Personal care tasks

Self-Care and Wellness

Activities:


Rest and Restorative

Activities:Sleep/naps

Listen to quiet music with lights dimmed

Look at the newspaper

Look at a calm video on TV screen

Rock in a chair

Swing in a porch swing

Walk outside

Listen to reading from a book of faith

Listen to poetry or stories

Listen to or attend a

worship service

Stroke a pet or animal

Stroke fabric

Get a hand or shoulder

massage

Get a foot soak and rub

Listen to wind chimes

Aromatherapy

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Good Activities

Are Ones That Involve:

- Plants

- Animals

- People

- Music

- Objects


A Few More Ideas:

- Set aside a few minutes – use a timer!

- Breathe

- Smile, laugh, look for some funnies

- Remember a good time

- Think about what you do get out of the

relationship

- Use at least one of Teepa’s 10-Minute Stress

Tamers


What is There is To Laugh

About?- What the person says

- What the person does

- What the person says versus what is done

- Your mistakes and ‘oops’ moments

- Your moments of joy

- Your moments of insight

- Their moments of insight, awareness, or humor

- Other people and their behaviors or words

- Things you see, hear, read

14


Teepa’s 10 Minute Stress

Tamers:- Sit quietly in calm surroundings with soft lights

and pleasant scents.

- Aromatherapy: lavender, citrus, vanilla,

cinnamon, peppermint, fresh cut grass.

- Breathe deeply: rest your mind and oxygenate

- Soak: in a warm bath, or just your hands or feet

- Read: spiritual readings, poetry, inspirational

readings, or one chapter of a book you like

- Laugh and smile: watch classic comedians,

Candid Camera, America’s Funniest Home

Videos, look at kid or animal photos

- Stretch: front to back, side to side, and across



Tamers:- Beanbag heat therapy: fill a sock with dry beans

and sew or tie closed, heat in a microwave for 30 seconds at a time, place on tight muscles and massage gently; relax for ten minutes

- Remember the good times: record oral memories, scrapbooks, photo journals, keepsake memory picture frames, or just jot

- Do a little on a favorite hobby- Have a cup of decaffeinated tea or coffee- Play a brain game: crosswords, jigsaws, jeopardy,

jumbles- Look through a hymnal and find a favorite and hum

it all the way through- Garden: work with plants



Tamers:- Books on Tape: rest your eyes and read

- Soothing sounds: music you love, music

especially for stress relief, recorded sounds

of nature

- Listen to coached relaxation recordings

- Pamper yourself : think of what you love and

give yourself permission to do it for 10

minutes

- Neck rubs or back rubs: use the ‘just right’

pressure

- Hand Massages: with lotion or without

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Tamers:- Take a walk

- Sit in the sun

- Rock on the porch

- Pray or read a passage from scripture

- Journal: take the opportunity to “tell it like it is”

- Cuddle and stroke a pet

- Have that cup of coffee or tea with a special

friend who listens well

- Pay attention to your personality:

-If you rejuvenate being alone, then seek solitude

-If you rejuvenate by being with others, seek

company


Breathe!!!

Take a deep breath in

Blow it all the way out

Take another breath in

Blow it out

Take one final breath in and

Sing it out….

Feel what happened to you

Look at what happened to the people around you

Think about how and when you might do this


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apply concepts or ideas contained from this presentation you are taking full responsibility for your

actions. Neither the creators, nor the copyright holder shall in any event be held liable to any party for

any direct, indirect, implied, punitive, special, incidental or other consequential damages arising directly

or indirectly from any use of this material, which is provided as is, and without warranties.

Any links are for information purposes only and are not warranted for content, accuracy or any other

implied or explicit purpose.

This presentation is copyrighted by Positive Approach to Care and is protected under the US Copyright

Act of 1976 and all other applicable international, federal, state and local laws, with ALL rights reserved.

No part of this may be copied, or changed in any format, sold, or used in any way other than what is

outlined within this under any circumstances without express permission from Positive Approach to Care.

Copyright 2017, All Rights Reserved

Teepa Snow and Positive Approach to Care

DISCLAIMER

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