Connecting Children and Elders with Dementia

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1 Connecting Children And Elders with Dementia

Beth A. D. Nolan, Ph.D. Director of Research and Policy [email protected]

Find additional videos and resources at www.teepasnow.com

Steps to Success: Intergenerational Programming

#1 Planning Ahead • Starter Activity • Kid-focused – Elders watch… • One leader for the kids, one for the elders • ID those who want to watch, do, not-engage • Integrated activity • Elders look like the “leaders” • Still kid-focused • Transition activity • Elder-focused – they’ve got some place to be! • Not a huge “Good-bye!” – see ya later…

2 #2 Setting up the Environment • Visual • Props are a must! All else goes away • Show + tell for everything • Have 2-25 yr olds practice show + tell after a “Huh?” • Sound • How is noise handled in the room? • How much kid-noise can each elder handle? • Physical Space and Set up • Kids introduced to the public space after Elders • Space for the kids up front (so elders can watch) • Space in the middle to pair up 1 kid-1 elder • Space in the back for elders to watch/escape • THINGS: no “favorite” anything and everyone has their own! © Positive Approach to Care® – to be reused only with permission. 7

#2 Setting up the Environment

Do the ‘right stuff’ in the ‘right place’ Pay attention Match what you do Create & Use to the lights, to where you are… Storage sounds, seating, work surface, Make set-up & space… clean-up part of the activity

Change it around – if Use the space you need to well - to make it Plan and place work! for BEST effect

Keep ADULT-activities adult and kid-activities Give out tools and kid! materials ‘just in time’ Make it look friendly Make sure supplies, Get me to want to come activities, and games are Control the activity so meaningful clients are successful – Play & laugh with folks, not overwhelmed not at them - not out of synch

#3 Know Your Audience(S!) What do we know about children? What do we know about dementia?

• Know the GEMS State of your kids • Know the GEMS State of your elders!

3 GEMS® Dementia Abilities -

Based on Allen Cognitive Levels to to bere -A Cognitive Disability Theory – OT based - -Creates a common language and approach to providing: ✓Environmental support ✓Caregiver support and cueing strategies ✓Expectations for retained ability and lost skill ✓Promotes graded task modification -Each Gem state requires a special ‘setting’ and ‘just right’ care

✓Visual, verbal, touch communication cues Snow, Positive Approach, PositiveSnow, LLC

-Each can shine used only used only withpermission -Encourages in the moment assessment of ability and need Teepa ✓Accounts for chemistry as well as structure change

The GEMS…

Sapphires: True Blue – Healthy Brain Diamonds: Routines & Routines Rule - Clear/Sharp Emeralds: Green/On the Go with Purpose– Naturally Flawed Ambers: Caught In a moment of time – Caution Required Rubies: Deep & Strong – Others stop seeing what is possible Pearls: Hidden in a Shell – Beautiful Moments to Behold

#3 Know Your Audience(S!)

Kids • 0-2 Pearls and Rubies • 2-6 Ambers to Emeralds • 7-12 Emeralds with Diamond moments • 12-14 Diamonds • 15-25 Diamonds with Sapphire moments

4 #4 Assigning Tasks • 1st Activity -Kids-focused activity • Kids’ job to show the elders • Elder watch and comment • Assesses who are your Watcher/Doer/Go-away • 2nd Activity • Co-activity – Elders to ‘help’ the kids • Kids informed ahead of time of how it will go • 1-1 Elder-kid. Tables by GEMS State • Leader to use props to show/guide w/o touching other’s stuff • 3rd Activity –Transition activity • Everybody has their place to be. • Kids have to go with a song • Elders transition to song to come down…

#5 Running the Program • 1st Activity -Kids-focused activity • Kid-friendly, GEMS State abilities appropriate • 2nd Activity • Activity related to what the kids did! Builds upon. • Avoid activities where you recreate something demo’d (There’s no right or wrong, then!) • Each person can build upon a larger collective OR take their own piece home • 3rd Activity –Transition activity • Everybody has their place to be. • Kids have to go with a song • Elders transition to song to come down…

Give Simple Information:

- Use Visual Cue (gesture/point) combined with a Verbal Cue: -“Its about time for… “ -“Let’s go this way…” -“Here are your socks…” - Don’t ask questions you don’t want to hear the answer to! - Acknowledge the response/reaction to your information - Limit your words and keep it simple - Wait!

5 Positive Action Starters (PAS) 1. Help – Be sure to compliment their skill in this area, then ask for help. “I could use your help…” 2. Try – Hold up or point to the item you would like to use, possibly sharing in the dislike of the item or task, “Well, let’s try this.” 3. Choice – Try using visual cues to offer two possibilities or one choice with something else as the other option. “Coffee or Tea?” “This? Or something else?” 4. Short and Simple – Give only the first piece of information, “It’s about time to …” 5. Step by Step – Only give a small part of the task at first, “Lean forward….”

Teepa’s Engagement Rules 1. Use Music at least once a program – as the activity, as the transition 2. Something Productive for each Sapphire, Diamond, Emerald, Amber & Ruby resident 3. Play with people but keep it adult for anyone 14 and over! 4. Smooth out Transitions – (See #1! ☺) 5. If they can DO something support their doing it 6. Encourage helping and ALWAYS say THANK YOU 7. Respect space preferences – introverts/extroverts 8. Match Sensory Experience to Preferences -Sight, sound, smell, touch, taste

The GEMS…

6 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

Supporting Diamonds:

- Encourage continued participation with choice to assist with set up and running - Give another ‘job’ when taking one away - Make it temporary with “Let’s just try…” - Share responsibility, not take over - Give up being ‘right’ in discussions - Apologize when you upset them, even when you did not do anything ‘wrong’

7 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

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

8 Supporting Emeralds:

- Keep engagement times shorter - Use a ‘children’s version’ format - Use strong visual cues and prompts - Keep words friendly and familiar - Provide subtle supervision - Pick up on their cues and respond - Celebrate moments of joy

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 space -Do what they like and avoid what they do not

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

9 Supporting Ambers:

- Provide step-by-step guidance and demonstrations - Meet their needs and preferences - Hand-under-Hand® guidance, may be able to do on their own after a few repetitions - Offer something safe for them to handle, manipulate, touch during a worship or celebration - Limit talking, noise, touch, other activities - Celebrate moments of joy

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 for actions -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

10 Supporting Rubies:

- Slow way down - Focus on connecting - Use music and rhythms - Use touch with care - Celebrate moments of joy

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 may be 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

11 Supporting Pearls:

- Offer to be there - Sing and pray with them, but don’t be afraid to be silent - Listen to them, even if words are few and far between - Use calm, rhythmic movements and voice - Connect, so that you can let go

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