By Denise Medved
Note: These ideas and suggestions for working with Memory Care residents are based on my own personal experience working with clients who have moderate to advanced cognitive decline, dementia, Parkinson’s, Alzheimer’s and other brain and memory-related challenges over the past 10 years. Additional input is provided from many of our 900+ Educators who also work in Memory Care settings. We will refer below to those Certified Ageless Grace Educators teaching the classes or individuals as EDUCATORS, whether they are actually PTs, nurses, programmers, etc.
- Having caregivers bring clients into a group settingstimulates the brain and causes a social interaction and anticipation that “something out of the ordinary – a special event” is occurring. The clients tend to participate more and gain greater benefits if they are in a group setting, during a specific class time, when they are taken by caregivers into another room for group participation. They are inspired not only by the Educator teaching the class, but by the others around them, to participate more fully. One-on-one coaching with the Ageless Grace tools can also be quite effective, however greatest engagement occurs in even a small group of 3-4 people. The more people there are in the room, the more they seem to participate (i.e. in classes of 8-10 or more for example).
- Most communities or care centers actually schedule class timesfor the residents to participate 2-3 times a week if not more. That also puts them on a schedule and their “body clock”, if not their memory, gets accustomed to attending (i.e. Monday, Wednesday and Saturday at 10:30am in a specific room in the building).
- Family participation in the class or one-one-one coaching with the resident and the Ageless Grace Educator tends to also stimulate those with more advanced cognitive decline. When the caregivers, programmers, marketing team, etc. can invite family and friends (another advantage of a specific time for the class on specific days, so the family members and friends know when the best time to come and participate with their loved one will be each week), it engages not only the client but also the loved ones …and it helps them ALL emotionally, socially, mentally and physically. It provides something for the family members to “do” with their loved one, whereas they often feel helpless to engage with their loved one otherwise during regular or periodic visits.
- Certainly one on one, but also in a group setting, it helps tremendously if the Ageless Grace Educator will call the clients/students/residents by name throughout the class and offer encouragement or praise. GOOD JOB ROSEMARY! Or THAT’S IT EARL! Or COME ON RUTH, GET YOUR HANDS UP IN THE AIR AND SHAKE IT UP! Memory Care clients will often start the tool or exercise and then “wander off” mentally into sitting or staring – and when their name is called or they personally are asked to do something specific, they engage once again.
- Looking the memory care client directly in the eyes as you call their name or suggest ideas to do makes them clear that you are asking THEM to participate. In most cases, they very much want to participate and succeed at doing something they are asked to do and feel as if they accomplished some small task they were asked to do.
- The Educator needs to animate, smile, laugh, and make noises as they are leading the group or individual. The more engaged the Educator is, the more likely the residents or clients are to respond.
- Memory care clients and residents especially respond to noises or sounds the Educator is making while showing them the tools or exercises. They may or may not make the sounds themselves, although it is good to encourage them to make the sounds – SAY IT WITH ME! – they tend to respond to the “out of the ordinary” sound effects of the tools we use in Ageless Grace. (i.e. Wheeeee! as you kick your legs, POW! as you punch your hands, cheering as you wave your arms overhead, meowing like a kitten when they use the Zoo-ology tool for example, making the sound of the saw as they pretend to use a hand saw in Power Tools, etc.)
- If the Educator is seated in front of the class or group, sometimes it helps for the Educator to stand up and demonstrate what they are doing right in front of a non-participating client, move from one to the another, showing what they are doing in order to engage them, then sit back down – and get up periodically to get physically closer to the client or residents. Again, eye contact is important with each individual in the group, so sometimes if the Educator is sitting too far from them in front of the group, the client can’t see/feel/sense that the Educator is actually talking to or including them — and they will isolate.
- VERY IMPORTANT TO REMEMBER – – use imagery, ideas and suggestions from their childhoods – things they can remember from elementary school or earlier. As you know, the short-term memory fades first and it literally “works its way back” as their cognitive decline advances. So they might start remembering things they did in their twenties, then in their teens, and the childhood memories are the ones that remain longest. Use suggestions like roller skating, throwing a ball, swimming, riding a bicycle, waving at their friends across a field, running along the sand at the beach, using a push lawn mower, pulling weeds out of the garden, writing on the chalkboard at school, spelling simple 3 letter words with their hand or foot in the air or even just one or two letters of the alphabet, have them make simple circles, or lines or a triangle in the air with their hand or foot; when they count, count no higher than 1-8, sometimes it needs to be one number repeated several times (i.e.4 – 4 – 4 – 4 – 4 – and then draw the 4 in the air with their hands.)
- Singing simple songs they learned as children stimulates their memory and they will sing along with at least part of the song – repeat the chorus several times and don’t go into the verses. Have them say aloud repeatedly for BREATHE OUT LOUD words like HURRAH! Yee-haw! Yippe-tai-yai-yay! HOWDY! during the exercises or tools. If the Educator sings even phrases here and there in the song, the clients or residents will most often join in.
- If the Educator will play music with singing voices in it, such as a group singing I’M LOOKING OVER A FOUR LEAF CLOVER, or CRUISING DOWN THE RIVER, and sings along, it encourages the clients to sing along also as they row the boat or write the number 4 in the air with their finger.
- MUSIC is a large part of the Ageless Grace program and it’s effectiveness on those with the most advanced cognitive decline is obvious. They respond to music – especially music selected based on the personal experience or life history of the memory care client or resident.
(Note: Two people in my Memory Care classes participate somewhat to 40’s swing tunes and big band music and performers like Bing Crosby, the Andrews Sisters, Dean Martin, etc – which MOST residents seem to love – but they come wide awake and lively when I use stirring classical music like a part of the 1812 Overture by Tchaikovsky. They have been classical music lovers in past years. I have them conduct to the music and play the instruments we hear in FRONT ROW ORCHESTRA – and they come to life with great joy when I use classical music! It is almost miraculous.)
- For those who can respond, I ASK them, do you like Frank Sinatra? Do you like Benny Goodman? Who do you like best? Do you remember Jimmy Durante? And whatever they respond to is what I choose to play for them or talk about… so as we are doing SAVING FACE for example, the Educator might be saying REMMBER ALL THOSE CRAZY FACES AND FUNNY JOKES JIMMY DURANTE USED TO MAKE? REMEMEBR HIS BIG NOSE? And then we will all make crazy faces and laugh and say HA-CHA-CHA-CHA over and over like Jimmy Durante used to say.
- If the client doesn’t respond with their music suggestions, ask their families what music and artists their loved one liked, if they used to dance to big bands, did they sing in church choir, did they play a musical instrument…then choose your music for that client (if in a one on one) accordingly – and if in a group, use 2-3 songs that you know each client might like. (Note: In one Memory Care class I teach, I use a couple upbeat gospel songs, a couple Broadway show tunes, a couple classical short pieces, and some big bands in a typical 30 minute class because I know there are clients that respond better to one or more of those genres of music.)
- If the Educator is working one on one with client, use short Ageless Grace tools or exercises scattered throughout the day rather than going nonstop for 30-45 minutes. Break it up – do a tool, talk a bit, sing a bit, do a tool, talk some more about childhood things, ask questions, do a tool, sing a song, etc.
- Those with more advanced cognitive decline tend to do best with 30 minute or less classes or groups… in some communities or care centers, they offer 10-15 minutes in the morning of Ageless Grace, 10-15 minutes after lunch, 10-15 minutes late afternoon…or a 30 minute class at 10:30am, then 10 minutes early afternoon, etc…
- Since Ageless Grace and the 21 Tools or exercises are so simple and adaptable and imaginative – the Educator can literally tailor their 10-30 minute session with a client specifically to that person and their memories and their life experiences (i.e. swim like you used to on the swim team, did you do the breast stroke?, did you dive?, cheer like you used to when you were a cheerleader, let’s knit like you did when you made all those sweaters for your children, let’s climb a ladder like you did when you were a fireman, etc.)….and in a group the Educator can include many general experiences that the entire group is likely to have had(i.e. cheering at a ballgame, digging with a shovel, jumping rope, rocking a baby or baby doll in their arms, “rumbling” their feet as fast as they can on the floor.)
- Use their names repeatedly; make eye contact, use imagery and ideas from their childhoods, and use music from their youth that they personally love!