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The Value Of Roles And Routines In Dementia Care

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If you were asked to make a list of everything you have to do today, this week, this month and even this year, how long would that list be? For most of us, just thinking about all we have to do can make us feel overwhelmed and exhausted. No wonder we often feel tired and worn down.

Now think for a minute about those living with dementia. What jobs, tasks and activities would you find on their list? When you take away the time they spend eating, sleeping and engaging in personal care, what is left? Often, the answer is: "Hours of boredom."

In fact, you may find there are often about 12 or more hours a day where many have nothing to do. Why? The answer often lies in the fact that many people do not know how to adapt either leisure activities or the tasks of daily living to the abilities of the person with dementia. OR, out of concern and kindness, providers of care take over the task. Let's put living back into the lives of those with dementia.

This blog will focus on the jobs, tasks and/or roles that we need to put back into the lives of those who are bored and living with dementia.

Active, purposeful engagement in daily life is a key component of quality of life. However, it can sometimes be difficult to find tasks that can keep individuals with dementia engaged and busy throughout all waking hours of the day. This challenge can be addressed when you consider each person's unique needs, preferences, strengths, habits, skills, interests, and abilities. Each day should consist of opportunities to be engaged in purposeful activities (chores, roles or jobs) and/or leisure activities that have been modified to match the level of ability of the individual.

The main reason we want to put chores, roles or tasks back into the world of those living with dementia is that each person needs to enjoy a life filled with meaning and purpose, regardless of physical and mental health. My favourite expression, which speaks to this, is "The purpose of life, is a life with purpose." How do we create days filled with meaning a purpose for those living with dementia?

Step 1: The first thing you want to do is learn as much as you can about the background of the person with dementia. If you are family member this should be relatively easy. What household tasks were part of this person's life? Make a list. Think about how each day was spent, from the time the person got up in the morning until he/she was tucked in for the night. If the person worked, what did he/she do? What elements of that job could he/she do now if you modified the tasks? Identify things that could be incorporated into each day.

Once you have uncovered all the tasks that made up a day in the past, create a list that consists of what you might have them do now.

Examples of jobs/tasks/chores might include:

• Setting, clearing or washing/wiping the table
• Washing dishes
• Polishing (silver, golf clubs, shoes, windows or table tops)
• Folding (towels, laundry, socks)
• Making beds
• Clipping coupons
• Washing or peeling the vegetables
• Hanging the laundry on a clothes line and/or taking it off
• Filling containers (e.g. - a tea box of assorted teas, sugar, salt, pepper, spice containers)
• Cleaning everyone's eyeglasses
• Winding the wool
• Put rope back onto a large spool
• Unwind the Christmas lights
• Put lids back on containers
• Sand an old piece of furniture (e.g. - a small table, a planter box or a large table)
• Paint the furniture
• Sweep or vacuum
• Shred confidential papers
• Sort and roll the change
• Polish a horse sadle
• Stack wood

Step 2: Build in memory supports. Ensure that all required cues are in place for the person to complete the task successfully. The goal is to set each person up for success when completing a task. Use images and/or written details AND, for those who need help with doing things in the right order, break tasks down into steps that can be easily followed (e.g. - first do this, then this, etc.).

Telling a person with dementia what to do is not enough -- they often need the details in print and/or images in front of them. If the person has the job of setting the table, make sure there is a template to follow that helps the person to know where each item will be put. If the job is to put dishes away, the cupboards should have words or images on them to indicate where things will go.

Step 3: Once you decide what this person can still do, and would be interested in doing, adapt the task to the abilities of the person and then create a schedule that will become a routine to be followed daily.

Step 4: Invite the person to do the task by asking "Would you like to do this chore/job/task. (Don't ask, "Could you..." They often say no.) Demonstrate what has to be done to ensure the person understands what he/she needs to do to complete the task successfully. When necessary, repeat the instructions. When the job is done, thank the person for completing the task and ask him/her to check if off the schedule (which will provide a reminder about what he/she has done today).

Once a routine is created, the person may not need to rely on the written schedule. Always provide positive feedback when they are completing the task. There is nothing more rewarding than seeing bright smiles when a person has been told he/she has done a great job!

The types of tasks you give a person with dementia depend on what they are interested in doing and what they are able to do. Let's focus on exposing abilities and adding meaning and purpose to each day.

Gail Elliot, BASc, MA
Gerontologist & Dementia Specialist
Founder, DementiAbility Enterprises Inc.

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