by Lisa Thubron-Grey, Lanark Lodge Perth, ON (Sep. 6, '12)
I thanked you briefly at the end of the 2 day session I attended in Kingston........today!
I told you how "privileged I felt".....privileged to have had the opportunity to listen to you speak about your knowledge, experiences, the successes, the barriers and most of all, your passion for dementia care.
With only 6 years’ experience in the healthcare field (4 years PSW, and 2 RPN), I quickly learned that my most enjoyable ones were when I was working with individuals with dementia. I can only hope that as my "skills and abilities" evolve, my "needs and interests" will grow.
Several times in life you're asked the question "Who is your mentor? Who is someone you look up to?" After this opportunity I will let you know now that your name WILL be mentioned.
We know that dementia is a progressive decline in abilities, but I learned "how much of this decline is caused by disuse?" And how much of this "disuse" are we responsible for?....TOO MUCH!!!
"Habits- an overly learned routine" -This is our job and we need to get this done- How many times do we see/hear this?
From this course I take away an opportunity. One that I PROMISE you I will share.....it may only be 1 person....but I WILL share.....And I believe you repeated several times "baby steps"
I came home today and was so moved by your presentation I excitedly told my husband, and phoned my best friend (whose chosen career has nothing to do with healthcare) all about this experience!!!
I thank you again!!!
I haven't yet created an "agenda" for myself, but I know that tomorrow my first "baby step" is to thank my director of care for giving me this opportunity.....and once I "check it off"...I know I have "something to look forward to" which gives me another "meaningful contribution" in my career. Sincerely, Lisa Thubron-Grey
by Kristy Boyes, Victoria Village Manor
I have always had a passion for working with those with dementia. When the opportunity to take the Montessori Methods for Dementia Workshop came along, I knew it would be worthwhile and interesting. Little did I know it would shift my focus entirely when it came to programming for those with dementia.
Behaviours such as aggression, agitation, repetitive requests and pacing in long term care can be very challenging and stressful for other residents, staff and family members. Many people believe that these behaviours are a normal part of the disease process. We now know that behaviours in dementia are usually the result of unmet need(s) and we have to ask the question, “Why are they happening?”
As a Recreation Assistant on a dementia unit, I began implementing Montessori type activities soon after attending the workshop. As it turned out, the timing was right. We had been experiencing some challenging behaviours and for a few days had “hall monitors” assigned to keep watch. I was actually thrilled when I was assigned to this duty one day. Instead of walking the hallways watching for something to happen, I would take this opportunity to spend a whole day implementing Montessori activities and principles! I had just begun the process of creating roles and routines for residents and this day would allow for effective observation, implementation and evaluation.
It may sound like it would take a lot of time and effort to plan activities for a full day at the last minute, but there really was not much planning required. I had the materials and supplies available and knew the residents’ abilities and interests based on their assessments and from working with them day to day.
As I started my hall monitor shift at 7:00 am, many residents were sleeping, but a few were up and already looking for something to do. We used the carpet sweeper, dusted the railings, read from magazines/newspaper and went to breakfast. Who knew that recreation programs could begin before 10am! As the day went on, I was able to implement small and large group programs as well as focus on 1:1 Montessori type activities. We danced; we sang, read from the Montessori Carry on Reading books, worked in the garden, engaged in sensory stimulation activities, sorted, arranged flowers, sanded wood and folded the laundry! By gearing each activity to small groups based on abilities, interests, strengths and stage of dementia, each resident was able to engage in purposeful, meaningful activity during the day without feeling overstimulated. There was only one thing missing from that day... BEHAVIOURS!
As I was leaving from my hall monitor duties, the staff thanked me for keeping everyone busy and happy. I learned a significant amount by spending quality time with residents that day; 1) Montessori principles and activities DO WORK; 2) there are voids which need to be filled day to day to prevent boredom (an increase in Recreation Therapy funding would be beneficial); 3) a prepared environment which is supportive of cognitive loss is essential; 4) training and educating others is the only way these methods will work to their full potential. Together, we can focus on person-centered dementia care which promotes socialization and individuality while preventing responsive behaviours from happening in the first place.
Ms. RS lives in a retirement community and is in the moderate to advanced stages of dementia. She spends most of her day sitting watching television. She uses minimal speech and is rarely engaged in conversation. At regular intervals she will start making repetitive sounds, which becomes irritating to other residents and staff. Some residents will become agitated as a result and “act out” in their own way. Thus begins the snow-ball effect of responsive behaviours.
Having witnessed the behaviour from Ms. RS, and ensuing behaviours from other residents, I decided to try to engage Ms. RS first in conversation, as I did not know her, and later in some Montessori Methods for Dementia™ activities.
The first thing I noticed was that in trying to make conversation with Ms. RS, the repetitive sounds stopped. She would then start listening and looking at me as I made conversation. She was not able to carry on a conversation, but would rather offer one or a few words. Sometimes she would try to repeat what I said with minimal success; repeating one or two words, with a few others being garbled. She was very interested in listening to what I was saying; making comments about what was on the television screen she was watching, comments about the colour of what she may have been wearing and how it suited her (at which point she would smile with pleasure), the type of day it was outside, etc.
I decided to try asking Ms. RS if she would like to play a game. She agreed, tentatively, not seeming to really understand what I was asking of her. I introduced a two colour sort, demonstrating where to place each of the two colours on the template and then asked her to try. She had some difficulty trying to grasp the laminated card between her fingers, but managed to do so slowly and placed it on the template in the correct spot. She placed the second coloured card on the same spot as the first (incorrectly). Picking up the card, I asked if she would like to leave the card where she placed it or if she may like to place it on the matching colour. I handed the card back to her for her to decide as she did not have the speech capacity to express her desire in words. She replaced the card in the original spot. I thanked her and asked if she would like to do the activity again. Upon a positive reply, I demonstrated again, repeating the action a couple of times to show what was expected. She placed the cards in the correct spot when they were offered to her again. After thanking Ms. RS I asked if she would like to do the activity again sometime. She smiled and agreed!
Ms. RS also began joining the morning group exercise session and at first was just an observer. Working with her to try to catch and throw a beach ball started slowly as she did not know what to do and had difficulty grasping. At first I would place the ball in her hand, demonstrating how to hold it and would encourage her to throw it to me, again demonstrating the movement. Over time, slowly but surely, she began to “get it”. She now loves tossing the ball back and forth.
A pattern developed with Ms. RS. Whenever I would hear her repetitive sound-making, I would approach her and engage in her in conversation. Over time she stared adding more and more distinguishable words to her replies. The frequency of the repetitive sound-making was reduced significantly as she did not do it when she had something to do. When I engaged her in an activity or conversation she would stop making the sounds, listen to me and would either respond with a few words or repeat-sometimes more successfully than others, what I had just said. If the phrase was short she could repeat it perfectly. If the sentence was a bit longer, the latter part of the sentence would end up garbled.
I also noticed that Ms. RS tries to sing when she hears music or a song being performed, so I printed a few song sheets with lyrics to the chorus of the well known tunes in large enough words for Ms. RS to read (I discovered through the sight test that in fact she could read some words). I asked Ms. RS if she would like to sing with me. With an affirmative reply we attempted the first song chorus, with me showing her the lyrics on the laminated page we held together. She was able to read most of the words. Between the cueing on the sheet and my voice cues, she was able to sing most of the song, missing only a few words!!! She remembered the melody on her own.
We went on to sing two more choruses to other well known songs from an era recognizable to her with the same wonderful results. The activity was repeated over and over again, alternating between the three song choruses for about half an hour. It was great fun!
Interacting with Ms. RS over time, her minimal vocabulary has increased significantly. The singing of songs seems to have greatly contributed to that success! Singing has become a regular activity with Ms. RS and other residents have since been drawn into the singing circle with much pleasure and similar results.
Ms. LTR is in the moderate stage of dementia and speaks infrequently. She may doze off in her chair or “zone out” in the middle of an activity with whatever she may be doing coming to a halt. A gentle touch to her hand or calling her name a few times will usually result in her looking up and becoming aware again. She needs one on one attention so that she can maintain engagement for any length of time. She will look at you if you get her attention and speak with her, but she rarely responds with words. She may just nod or shake her head. She does not generally respond in group activity.
I asked if she would like to read a “Carry on Reading Book”, offering a couple of choices. She nodded in the affirmative and made her choice of book by nodding when presented with a book. At first I pointed to the beginning of the page and asked her to read. She did not start reading, so I read the first page and the cue at the bottom which said: “Next reader please” letting her know to turn the page at that point.
At the start of the next page again I asked her to read and she did. At the end of the page, I pointed to the cue “Next reader please” and asked her to turn the page. She did. We alternated reading the pages and after a few prompts, she remembered she was supposed to turn the page when she read “Next reader please” and started turning the page on her own when the time came.
Ms. LTR and I have read books many times together since that first time. She sometimes “freezes” during the reading but with a gentle touch on her hand or calling her name, she will become alert again and continue. She will often read two or three of the Montessori readers in one sitting, sometimes reading the whole book herself, without any page reading from me. From a tentative beginning, a few weeks later, Ms. LTR now reads on her own or with a small group of other residents. Her voice, originally very soft, has grown stronger. She now has read medical articles printed in a font size and format appropriate for her, to a fellow resident and physician who is visually impaired. How incredibly wonderful for all involved!