iCan: Hearts and Crafts Programming with a Purpose

At Evolve Senior Living, we are passionate about changing the existing paradigm of memory disorders in this country, which leaves people sidelined, defeated and depressed. The cycle of condemnation discriminates against people suffering with memory loss.  While they try to desperately hold onto their former self, they sometimes act out in frustration. Often this "behavior" is treated with anti-anxiety medications leaving them in a stupor and despondent.  Additionally, many of these medications are benziodiazapines, which have a side effect of loss of balance and often leading to disastrous falls. Their quality of life continues to erode as they are sedated after surgical stabilization and often become depressed or even more behaviorally unstable, which may also be treated with increased dosage.

Families have come to us for a solution to this cycle of condemnation. We tell them that instead of focusing on the things that their loved ones can't do, why don't we look to maximizing quality of life through participating in activities they still can do. This is where iCan comes in.

The iCan approach allows us to understand a person not only as someone who suffers from illness, but also as someone who inhabits healthy parts and personality that remains even though it seems to be hidden by illness. People with memory impairments are like everyone else – they attach personal meaning to their activities. So when our residents engage in meaningful activities, then activity becomes therapeutic. 

This multi-faceted interdisciplinary approach to activities and social and leisure programming provides specialized stimulation to create structure and support in meeting the physical, psychosocial, cognitive and spiritual needs of each resident.

Memory Care Programming Goals:

1) To provide new, flexible “best practices” in the delivery of activity therapy by combining hands-on experience with current exciting memory disorder-related research.

2) To provide value for all staff, residents and families as key participants in the activities.

3) To dramatically improve resident quality of life as a result of using proven quality standards for activities and by focusing on enhancing remaining abilities.

4) To blend affordable multimedia technology with activity design principles as an effective method of meeting each resident’s needs for respect, confidence and creativity.

5) To reduce the number of preventable falls by providing continuous engagement.

Programming Components

A therapeutic, multi-faceted, interdisciplinary approach to activities, social and leisure programming provides specialized stimulation to create structure and support in meeting the physical, psychosocial, cognitive and spiritual needs of each participant. This is especially important for people who are confined in a secured unit or are homebound and unable to freely experience the outside world where most of the rest of us readily access a wide array of activities and stimulation during the course of our everyday lives. 

 

The best practices components listed below allows Evolve Senior Living staff to focus on residents' wellness and holistic needs, rather than losses the disease causes. The following research-based programming is scheduled to align therapeutic activities with common behaviors that typically occur during the day. This provides stimulation within each resident's capabilities that is failure-free and success oriented, at specific times when they are most likely to respond favorably. 

 

  • Failure-Free - Activities that encourage participation at any functioning level, from low to high functioning while still building self-esteem of the participants. Participants are not at risk in these activities of being singled out or embarrassed.
  • Exercise - Seniors with memory impairments tend to be less careful ambulating than other seniors who are constantly aware of, and fear the consequences of a fall. Unfortunately, seniors suffering from memory disorders are at a significantly higher risk for falling than the general elderly population. Morning exercises and physical activities at least every two hours throughout the day keep joints limber and reduce the frequency of devastating falls. Elderly people need to support their own weight and/or walk at regular intervals throughout the day when physically capable. This helps them to maintain body strength and muscle mass while improving their coordination, circulation and avoid pressure sores. Elderly can also experience dizziness when standing up.  This is caused by blood pooling in their lower extremities (orthostatic hypotension). It is vital to let them stabilize on their feet for a minute after they have been sitting, or lying for an extended period to prevent dizziness and a potential fall. 
  • Grooming - Residents who are well-groomed feel better about appearing in public than those who do not dress appropriately and groom for their day. People with memory disorders are at risk of remaining in their homes in bedclothes without grooming, and therefore, are at higher risk for isolation and vulnerable to depression.
  • Current Events - It is important to provide residents a window on the world and keep them informed regarding top stories in the news. This connects them to important events outside their senior living community and stimulates residents to maintain cognition.
  • Reminiscence - This is the act or process of recollecting past experiences or events. Programs such as trivia, finish the phrase, memories that relate to holidays or the current month, or taking them back to "the good old days" can help to connect them to their past and ease the fears they experience daily in failing to remember people, places and things.
  • Long-Term Memory - These are memories that many people hold onto until late in their disease progression.  These are activities that encourage working with familiar life-long tasks of everyday living such as sorting laundry, setting a table, winding yarn, reminding them what they did in their life, by cueing and using memory stations, and encouraging interaction with these familiar items. Programs that cue residents to access their long-term memories can highlight to them what they can still do which builds self-esteem and confidence.
  • Short-Term Memory - These are memories in the immediate past present of days or weeks. Normally the first symptom noticed by families. Programs that offer structure, a calendar or written daily agenda, note cards to refer to. Using familiar photos, family albums, pictures of favorite foods or activities recently completed can help build confidence and reduce fear and anxiety.
  • Cognitive Stimulation - This offers a range of enjoyable activities providing general stimulation for thinking, concentration and memory, normally in a small social group setting. It is aimed at general enhancement of cognitive and social functioning. These activities include word games, puzzles, music and practical activities like baking or indoor gardening. All activities were designed to stimulate thinking and memory. Improvements for participants following cognitive stimulation show a much higher functional status.
  • Psychosocial – Many residents achieved a lifetime of intellectual achievement.  The relationship of leisure activities or other forms of intellectual stimulation such as social interactions, help with stress reduction and overall cognitive stimulation. Offering stimulation that reaches back to life-long passions and work helps to reflect on the past and validate the present. Creating activities surrounding lifetime accomplishments, travel destinations and other achievements give a sense of life purpose to participants.
  • Eye-Hand Coordination - Exercising the participant's creativity and fine motor skills can help build a sense of accomplishment. The more you build upon remaining abilities the higher the quality of life they will enjoy.
  • Socialization – We are social creatures, but as people begin to lose their memory and become aware of their losses, they tend to seek isolation to avoid embarrassment and confrontation. Small group programs will enable each participant to offer what they can without being singled-out. Programs such as a group exercise activity (parachute) or finish the phrase or wheel of fortune all offer a venue for socialization with other residents while allowing them to express themselves within their individual comfort zones.
  • Arts and Crafts - These activities can build self-confidence and offer a sense of accomplishment. Creating a door hanger or any form of artwork is fun and helps to build self-confidence. Higher functioning residents who help lower functioning residents with their art projects feel a sense of pride and contribution. Assisting others helps to overcome their own insecurities. Art therapy also helps to restore brain function through eye-hand coordination.
  • Multimedia Interaction - Researchers surveyed people with memory disorders and reported that travel and engaging with nature and science were most important to them in terms of their quality of life. Surveying families can help identify life-long interests such as travel, nature, sports, ancient history, oceans, cooking or science. Nature series programs are a great way for people to access long-lost interests. Exposure to these themes helps participants remain connected with their passions.
  • Sing-a-long - Many people with long-term memory will respond well to sing-a-longs and music therapy where they can participate. They often surprise themselves with how well they remember popular songs of their younger days. Musical bingo, holiday sing-a-longs and other singing games offer a great social and confidence-building venue for residents to connect with fond memories.
  • Spiritual and Religious - Remaining spiritually active is very important for elderly people who often become more religious later in life. A program that offers interdenominational services or even religion-specific services can help residents remain connected with their faith. At the heart of our being exists a core set of virtues – gifts that represent the essence of the human spirit and the content of our character. These gifts are universal, not defined or limited by gender, nation, race or religion. They are inherent in the human experience.  Research shows that seniors need to keep in touch with their spirituality to live life fully. Living virtues provide empowering strategies that inspire the practice of virtues in everyday life through simplicity which support our residents to cultivate their virtues – the gifts of character.
  • Low-Functioning - Sensory stimulation is needed for even the lowest functioning participants to offer distraction and engagement. Programs that offer simple exposure to stimulate participant's sense of touch, taste, smell, site and hearing can provide engagement and reach into the spirit of someone who may be otherwise disengaged or isolated. In many cases, it is impossible to tell if a participant is responding mentally to these stimuli, but research has shown that many people with advanced dementia are engaged by sensory stimulation even though they may be unable to physically respond to it. Bubble painting, name that smell, feels like, sounds like, tastes like, or edible art like “Hello with Jell-o” can bring stimulation and quality to life.
  • Sequencing - Sequencing and muscle memory are among the last cognitive skills to erode. Sorting silverware, folding napkins, word-find, or playing with musical instruments can restore confidence that participants can still access those skills and be successful in manipulating their form and function.
  • Non-verbal Communication - Much of what we perceive about each other is not what is said, but how it is communicated.  Activities designed to have fun with non-verbal cues can offer both verbal and non-verbal participants a fun and engaging experience. This would include an activity such as telling residents that you are going to communicate non-verbally with your face and body and ask them to guess your mood. Use happy (smiling and joyful) sad (mouth turned down and sorrowful) afraid, amorous, hurt, and yes, confused!  This can be fun for residents and then we ask them to show how they look for each of these emotions.
  • Behavior Modification - Many residents with memory impairment experience anxiety disorder. This is common in the late afternoon and often referred to as "sundowning." Physicians normally treat this disorder with medication. For many residents, these medications, while effective, can leave patients depressed, dispirited and lethargic. There has been ample research with essential oils and auditory stimulation that offer evidence to moderate behaviors without medication. Aromatherapy is the art of using essential oils to benefit ones physical, spiritual and psychological well-being. Aromatherapy can provide sensory stimulation or relaxation, increase self-esteem, and work against a sense of self-isolation. It can provide opportunities to communicate non-verbally, and enhance reminiscence, memory retrieval, and mood stabilization. Binural beats or delta tones are very low frequency auditory processing artifacts, or apparent sounds, the perception of which arises in the brain for specific physical stimuli. Delta tones have been used extensively with people who suffer from insomnia to induce relaxation, meditation, creativity and dissimulate the brain activity. Binural beats reportedly influence the brain in more subtle ways through the entertainment of brain waves and have been claimed to reduce anxiety and provide other health benefits such as control over pain.
  • Other therapies - Horticultural therapy is an interaction between people and plants. This process has a powerful benefit that gives someone receiving care the opportunity to become a caregiver themselves, as they nurture their plantings. The benefits to a dementia population are many. Not only the physical benefits of utilizing fine and gross motor skills, but also the emotional benefits of working with plants include the sensory and mental stimulation, decreased anxiety, and improved orientation to reality with the stimulation of long-term memories. Pet therapy is another way seniors can stay connected to their past and is for many an opportunity to be the caregiver that is calming to both resident and pet alike. 
  • Entertainment - Everyone loves to be entertained, whether its live music, multi-media or audio tracks. Having paid entertainers perform for the residents, or even an open mike night can bring that musical stimulation many people crave and enjoy right into their community. Often school bands or dance groups can be arranged to come and perform for the residents which can offer the group experience performing before a live audience. Regardless of the source or reason, seniors love to be entertained, it stimulates so many emotions and offers a significant boost in their quality of life that is always enjoyed with eager anticipation. Where words fail, music speaks— it is the universal language and the sound of life. 

Programmatic Frequency

 

Many memory care communities’ feature "bare bones" memory impairment programming. Typically 4 activities daily: after breakfast, before lunch, after lunch, and before dinner, with some adding a movie after dinner. A more deliberate approach to incorporating the frequency and variety into the program to make it therapeutic for persons suffering from Alzheimer's disease or related dementias would be beneficial. Most of the programs feature birthday, bible and bingo along with some form of paid outside entertainer on a twice-monthly basis. The more often residents are engaged in a group activity the easier it is to supervise them and prevent them from potential falls and resultant injuries. So not only are the residents more engaged from continuous activities and enjoy a stimulating quality of life, but they are safer. Empirical data collected during our 5 years studying the effects of continuous engagement on fall frequency in dementia specific communities suggests that incident rates of falls and fractures can be reduced from an industry average of 6 falls per 1,000 resident days to 3 falls per 1,000 resident days.  This cuts the number of injuries in half resulting in fewer hospitalizations, fewer residents suffering, fewer potential liabilities and fewer lost resident days to the community.

 

Our aim is to support quality of life beyond building a secure and safe environment. We look for habits and routines that seem to be of importance to people with dementia. One important task is to determine what they actually are able to do and what they want to do on their own. It is also the case that technology at times will not play any role at all if they are not integrated into the user’s daily routines or personal interests. On the other hand, when technology is integrated it also becomes invisible and hard to separate from the interlacing of activities and habits of which daily life is woven.