Card Making Activity

Above is a handmade card one of my clients made. Below, with the assistance of my talented client and my wonderful cell phone picture taker, are the photos and instructions on making this card ... or using your imagination ... any homemade card. Please excuse the picture quality. I find the cell phone is less intrusive then my big dinosaur of a digital camera.

These are the products we used for this project: A printed piece of paper, a solid piece of paper, a pre-made, folded, cardstock card and matching envelope from Oriental Trading , a CTMH stamping Ink Pad, a pair of scissors and a sponge dauber. Of course you can use just a plain piece of heavy white 8.5x11 paper, cardstock or light colored construction paper and fold it in half. You'd just have to disregard the first few instructions. Of course, you could always use the "tearing technique". Just click that link for more instructions.

The first thing we did was trace the scalloped edges of the card onto the solid colored paper. As you can see my client found it easier to fold the card over the solid paper. This helps to keep the solid piece of paper from sliding around.



Next, cut along the lines the best you can.



Sometimes it's hard to cut the scallops so it's probably best to take your time and not rush. Some clients may be able to do this just fine, others may need a little help or a break in the middle of cutting to rest their hands before they resume the project.


To leave a white edge scootch the blue paper up a half inch and fold the excess over the back of the card. Make a crease at the fold. Cut off this extra piece. Of course if you have a craft cutter you can use that but most clients may not know how to use one and would prefer to use scissors. Remember if there are steps they have trouble with, give them a chance to do it themselves then offer to help them. It's so tempting to just say "Hey, let me give you a hand!" then do it yourself without giving them a few chances to try it themselves. If your fingers are itching, then have enough product on hand so you can make one for yourself!




Ok so now adhere the solid color to the white card. A glue stick would be the easiest adhesive to use. My client used double stick tape.


Next, distress the white part with red ink. You can use any color ink but we chose red because my client likes red. Using the dauber or you can use an old kitchen sponge, a wadded up piece of tissue (preferable clean) or even your finger if you don't mind having a red finger, smudge the edge of the paper with the ink. It's a great effect.



Next cut out the printed images ... as few or as many as your client wishes. On detailed images your client may need help. As you can see here my client is cutting around the image first to make it more manageable to cut. In the next photo she is starting to do more detailed work.

And here is the finished product. The flowers have been adhered using double sided tape. For your projects you may wish to use a glue stick or tape runner. As you can see this client is very talented and is able to do some fine, detailed work. For a client who isn't as capable, just find images that are larger and less detailed or better yet .... stamp them with stamps and inks!! I'll touch on stamping in another post.

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ETA (Edited to Add) - the original card posted has stamped images on the solid blue background. My talented client was being very creative and making her own printed background paper, with stamps and inks, while working on this project. I'll touch on stamping in another post.

My Client's Artwork and Projects

I thought I'd share some of the wonderful things my clients have made or worked on. I won't be including names or actual photos of my clients faces, obviously, for privacy reasons but their personalities and talents will definitely come shining through. You will have to forgive the quality of the photos as I've taken most of these using my phone instead of my digital camera. I find the phone less intrusive than my digital camera.

In this project the client above is pinning a sewing project. This piece of flannel is going to be a finished pet pad.

This is another sewing project. In this project the client is hand sewing the edges of a kid's quilt.

Greeting Card

Acrylic Painting

Cat on a Carpet



Wildflower and Cupie Doll Face

Person in Chair Sculpture

Person in Chair watching TV Sculpture

While going through these photos it reminded me of another suggestion ... it's always a good idea to cover your work surface with some sort of easy clean-up, wipeable, covering or vinyl tablecloth. It's a good idea to try and find something that is a light, solid color. Something with a colored print can make a client confused or impair their focus on the tasks at hand.

Alzheimer's Behaviors

Alzheimer's clients can display a wide variety of behaviors. Their actions and reactions can be random and unpredictable. These are not behaviors that they can control and they aren't "doing it on purpose". As caregivers all we can do is try our best to keep them safe, healthy and comfortable. It's not always easy but there are suggestions and tips to follow.

I've added some links and suggestions from various sources below:

Alzheimer's Association Behaviors - What causes dementia-related behavior like aggresion and how to respond ...


Alzheimer's Society - Unusual Behaviors - Repetition, Restlessness, Shouting, Lack of Inhibition, Night time waking, Trailing and Checking, Hiding and Losing things and being Suspicious.


Information Obtained From the Alzheimer's Association:

Repetition:

Introduction:

The person with Alzheimer's may do or say something over and over again – like repeating a word, question or activity. In most cases, he or she is probably looking for comfort, security and familiarity.

The person may also pace or undo what has just been finished. These actions are rarely harmful to the person with Alzheimer's but can be stressful for the caregiver.

How to Respond:

• Look for a reason behind the repetition. Try to find out if there is a specific cause for the behavior.


• Focus on the emotion, not the behavior. Rather than reacting to what the person is doing, think about how he or she is feeling.
  
• Turn the action or behavior into an activity. If the person is rubbing his or her hand across the table, provide a cloth and ask for help with dusting.
  
• Stay calm, and be patient. Reassure the person with a calm voice and gentle touch.
  
• Provide an answer. Give the person the answer that he or she is looking for, even if you have to repeat it several times.
  
• Engage the person in an activity. The individual may simply be bored and need something to do. Provide structure and engage the person in a pleasant activity.
  
• Use memory aids. If the person asks the same questions over and over again, offer reminders by using notes, clocks, calendars or photographs, if these items are still meaningful to the individual.
  
• Accept the behavior, and work with it. If it isn’t harmful, let it be. Find ways to work with it.
  
  

Aggression

Introduction
Aggressive behaviors may be verbal (shouting, name-calling) or physical (hitting, pushing). These behaviors can occur suddenly, with no apparent reason, or can result from a frustrating situation. Whatever the case, it is try to understand what is causing the person to become angry or upset.

Possible causes
Aggression can be caused by many factors including physical discomfort, environmental factors and poor communication. If the person is aggressive, consider the following:

Physical discomfort
Is the person tired because of inadequate rest or sleep?

• Are medications causing side effects?
  
• Is the person unable to let you know he or she is experiencing pain?
  

Environmental factors

• Is the person overstimulated by loud noises, an overactive environment or physical clutter?
  
• Does the person feel lost ?
  

Poor communication

• Are you asking too may questions or making too many statements at once?
  
• Are your instructions simple and easy to understand?
  
• Is the person picking up on your own stress and irritability?
  
• Are you being negative or critical?
  

How to respond

• Try to identify the immediate cause. Think about what happened right before the reaction that may have triggered the behavior.
  
• Focus on feelings, not the facts. Try not to concentrate on specific details; rather, consider the person's emotions. look for the feelings behind the words.
  
• Don't get angry or upset. Don’t take the behavior personally. The person isn’t necessarily angry with you. Be positive and reassuring. Speak slowly in a soft tone.
  
• Limit distractions. Examine the person's surroundings, and adapt them to avoid similar situations.
  
• Try a relaxing activity. Use music, massage or exercise to help soothe the problem.
  
• Shift the focus to another activity. The immediate situation or activity may have unintentionally caused the aggressive response. Try something different.
  
• Decrease level of danger. Assess the level of danger — for yourself and the person with Alzheimer’s. You can often avoid harm by simply stepping back and standing away from the person. If the person is headed out of the house and onto the street, be more assertive.
  
• Avoid using restraint or force. Unless the situation is serious, avoid physically holding or restraining the person. He or she may become more frustrated and cause personal harm.
  

Agitation

Introduction
A person with Alzheimer's may feel anxious or agitated. He or she may become restless and need to move around or pace. Or the person may become upset in certain places or focused on specific details. He or she may become over-reliant on a certain caregiver for attention and direction.

Causes of agitation
Agitation may be caused by a number of different medical conditions and drug interactions or by any circumstances that worsen the person’s ability to think. Situations that may lead to agitation include:

• Moving to a new residence or nursing home
  
• Changes in the environment or change in caregiver
  
• Misperceived threats
  
• Fear and fatigue resulting from trying to make sense out of a confusing world
  

Treating agitation

A person with agitation should receive a thorough medical checkup, especially when it comes on suddenly. The treatment of agitation depends on a careful diagnosis, determining the possible causes and the types of agitated behavior the person is experiencing. With proper treatment and intervention, the agitation symptoms can be reduced.

There are two distinct types of treatments for agitation: behavioral interventions and prescription medications. Behavioral treatments should be tried first. In general, steps to managing agitation include (1) identifying the behavior (2) understanding its cause and (3) knowing how to respond.


Preventing agitation
To prevent or reduce agitation:

• Create a calm environment. Remove stressors, triggers or danger; move person to a safer or quieter place; offer rest or privacy; limit caffeine use; provide opportunity for exercise; develop soothing rituals; and use gentle reminders.
  
• Avoid environmental triggers. Noise, glare, insecure space and too much background distraction, including television.
  
• Monitor personal comfort: Check for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation; ensure a comfortable temperature; be sensitive to fears, misperceived threats and frustration with expressing what is wanted.
  
• Simplify tasks and routines.
  

Identify triggers

Identifying what has triggered agitation can often help in choosing the best response to the behavior. Often the trigger is a change in the person’s environment:

• change in caregiver
  
• change in living arrangements
  
• travel
  
• hospitalization
  
• presence of houseguests
  
• bathing
  
• being asked to change clothing
  

How to respond

• Listen to the frustration. Find out what may be causing the agitation, and try to understand
  
• Provide reassurance. Use calming phrases such "You’re safe here." "I’m sorry that you are upset." "I will stay until you feel better."
  
• Involve the person in activities. Try using art, music or other activities to help the person relax.
  
• Modify the environment. Decrease noise and distractions, or move to another place.
  
• Find outlets for the person's energy. The person may be looking for something to do. Take a walk, or go for a car ride.
  
• Check yourself. If the person is agitated, do not raise your voice, and do not corner, restrain, criticize, ignore, argue with or shame the person.
  

Confusion

Introduction
The person with Alzheimer's may not recognize familiar people, places or things. He or she may forget relationships, call family members by other names or become confused about where home is. The person may also forget the purpose of common items, such as a pen or a fork. These situations are extremely difficult for caregivers and families and require patience and understanding.

How to respond

• Stay calm. Although being called by a different name or not being recognized can be painful, try not to make your hurt apparent.
  
• Respond with a brief explanation. Don't overwhelm the person with lengthy statements or reasons. Instead, clarify with a simple explanation.
  
• Show photos and other reminders. Use photographs and other thought-provoking items to remind the person of important relationships and places.
  
• Offer corrections as suggestions. Avoid explanations that sound like scolding. Try "I thought it was a fork, " or "I think she is your granddaughter Julie."
  
• Try not to take it personally. Alzheimer's disease causes your loved one to forget, but your support and understanding will continue to be appreciated.

Hallucinations


Introduction

A hallucination is a false perception of objects or events involving the senses. When individuals Alzheimer’s disease have a hallucination, they see, hear, smell, taste or feel something that isn’t there. The person may see the face of a former friend in a curtain or may hear people talking.

If the hallucination doesn’t cause problems for you, the person or other family members, you may want to ignore it. However, if they happen continuously, consult a physician to determine if there is an underlying physical cause. Also, have the person’s eyesight and hearing checked, and make sure the person wears his or her glasses and hearing aid on a regular basis.

• Offer reassurance
  
• Respond in a calm, supportive manner.
  
• A gentle tap on the shoulder may turn the person’s attention toward you.
  
• Look for the feelings behind the hallucinations. You might want to say, “It sounds as if you’re worried” or “I know this is frightening for you.”
  
• Avoid arguing with the person about what he or she sees.
  
• Use distractions
  
• Suggest that you take a walk or sit in another room. Frightening hallucinations often subside in well-lit areas where other people are present.
  
• Try to turn the person’s attention to music, conversation or activities you enjoy together.
  
• Modify the environment
  
• Check for noises that might be misinterpreted, such as noise from a television or an air conditioner. Look for lighting that casts shadows, reflections or distortions on the surfaces of floors, walls and furniture.
  
• Cover mirrors with a cloth or remove them if the person thinks that he or she is looking at a stranger.
  

Sleeplessness and Sundowning

Sleeping problems experienced by individuals with Alzheimer’s and caregiver exhaustion are two of the most common reasons people with Alzheimer’s are eventually placed in nursing homes. Some studies indicate that as many as 20 percent of persons with Alzheimer’s will, at some point, experience periods of increased confusion, anxiety, agitation and disorientation beginning at dusk and continuing throughout the night.

While experts are not certain how or why these behaviors occur, many attribute them to late-day confusion, or “sundowning,” caused by the following factors:

• end-of-day exhaustion (mental and physical)
  
• an upset in the “internal body clock,” causing a biological mix-up between day and night
  
• reduced lighting and increased shadows
  
• disorientation due to the inability to separate dreams from reality when sleeping
  
• less need for sleep, which is common among older adults
  

Tips for reducing evening agitation and nighttime sleeplessness

• Plan more active days. A person who rests most of the day is likely to be awake at night. Discourage afternoon napping and plan activities, such as taking a walk, throughout the day.
  
• Monitor diet. Restrict sweets and caffeine consumption to the morning hours. Serve dinner early, and offer only a light meal before bedtime.
  
• Seek medical advice. Physical ailments, such as bladder or incontinence problems, could be making it difficult to sleep. Your doctor may also be able to prescribe medication to help the person relax at night.
  
• Change sleeping arrangements. Allow the person to sleep in a different bedroom, in a favorite chair or wherever it’s most comfortable. Also, keep the room partially lit to reduce agitation that occurs when surroundings are dark or unfamiliar.
  
• Nighttime restlessness doesn’t last forever. It typically peaks in the middle stages, then diminishes as the disease progresses. In the meantime, caregivers should make sure their home is safe and secure, especially if the person with Alzheimer’s wanders. Restrict access to certain rooms or levels by closing and locking doors, and install tall safety gates between rooms. Door sensors and motion detectors can be used to alert family members when a person is wandering.
  

Once the person is awake and upset, experts suggest that caregivers:

• approach their loved one in a calm manner
  
• find out if there is something he or she needs
  
• gently remind him or her of the time
  
• avoid arguing or asking for explanations
  
• offer reassurance that everything is all right and everyone is safe
  

Suspicion

Introduction
Memory loss and confusion may cause the person with Alzheimer’s to perceive things in new, unusual ways. Individuals may become suspicious of those around them, even accusing others of theft, infidelity or other improper behavior. Sometimes the person may also misinterpret what he or she sees and hears.

How to respond

• Don't take offense. Listen to what is troubling the person, and try to understand that reality. Then be reassuring, and let the person know you care.
  
• Don’t argue or try to convince. Allow the individual to express ideas. Acknowledge his or her opinions.
  
• Offer a simple answer. Share your thoughts with the individual, but keep it simple. Don’t overwhelm the person with lengthy explanations or reasons.
  
• Switch the focus to another activity. Engage the individual in an activity, or ask for help with a chore.
  
• Duplicate any lost item. If the person is often searching for a specific item, have several available. For example, if the individual is always looking for his or her wallet, purchase two of the same kind.
  

Unpredictable Situations

Introduction
People with Alzheimer’s disease can act in different and unpredictable ways. It is important to remember that the person is not acting this way on purpose. Whatever the behavior, try to identify the cause and possible solution.

Bold behavior
Individuals with Alzheimer’s disease may forget that they are married and begin to flirt or make inappropriate advances toward others.

When there is unusual, inappropriate behavior, try to distract the person with another activity or lead him or her into a private place. Avoid getting angry or laughing at the person.

Inappropriate dressing
The person may forget how to dress or take clothes off at inappropriate times and in unusual settings. For example, a woman may remove a blouse or skirt simply because it is too tight or uncomfortable.

Help the person dress by laying out clothes in the order they need to be put on. Choose clothing that is simple and comfortable.

Shoplifting
The person with Alzheimer’s may not understand or remember that merchandise must be paid for. He or she may casually walk out of the store without paying — unaware of any wrongdoing.

Have your loved one carry a wallet-size card that states that he or she is memory-impaired. This may prevent the person with Alzheimer’s disease from feeling embarrassed.

Wandering

Introduction
It is common for a person with dementia to wander and become lost; many do repeatedly. In fact, over 60 percent of those with dementia will wander at some point.

Wandering can be dangerous - even life threatening - for the person who wanders. The stress can weigh heavily on caregivers and family.

Keep your loved one safe by knowing the risk factors for wandering and enrolling in MedicAlert® + Alzheimer's Association Safe Return®, our 24-hour nationwide emergency response service for individuals with Alzheimer’s or related dementia that wander or who have a medical emergency. You can't know when wandering will happen, but you'll know what to do when it does.


What is wandering?
Many people with dementia do not fit the textbook definition of wandering, "To move about without a definite destination or purpose."

People with dementia who wander often have a purpose or goal in mind. They may be searching for something that is lost or trying to fulfill a former job responsibility.


Who's at risk?
Everyone is at risk for wandering. However, a person may be at risk for wandering if he or she:

• Returns from a regular walk or drive later than usual
  
• Tries to fulfill former obligations, such as going to work
  
• Tries or wants to "go home" even when at home
  
• Is restless, paces or makes repetitive movements
  
• Has difficulty locating familiar places like the bathroom, bedroom or dining room
  
• Checks the whereabouts of familiar people
  
• Acts as if doing a hobby or chore, but nothing gets done (moves around pots and dirt without actually planting anything)
  
• Appears lost in a new or changed environment
  

Causes

• Wandering can be caused by several factors, including:
  
• Medication side effects
  
• Stress
  
• Confusion related to time
  
• Restlessness
  
• Agitation
  
• Anxiety
  
• Inability to recognize familiar people, places and objects
  
• Fear arising from the misinterpretation of sights and sounds
  
• Desire to fulfill former obligations, such as going to work or looking after a child
  

Tips to reduce wandering

• Encourage movement and exercise to reduce anxiety, agitation and restlessness
  
• Ensure all basic needs are met (toileting, nutrition, thirst)
  
• Involve the person in daily activities, such as folding laundry or preparing dinner
  
• Place color-matching cloth over doorknobs to camouflage
  
• Redirect pacing or restless behavior
  
• Place a mirror near doorways. The reflection of a person's own face will often stop him or her from exiting the door.
  
• Reassure the person if he or she feels lost, abandoned or disoriented
  

Tips to protect a loved one from wandering and getting lost

• Enroll the person in MedicAlert + Safe Return.
  
• Inform your neighbors and local emergency responders of the person’s condition and keep a list of their names and telephone numbers.
  
• Keep your home safe and secure by installing deadbolt or slide-bolt locks on exterior doors and limiting access to potentially dangerous areas. Never lock the person with dementia in a home without supervision.
  
• Be aware that the person may not only wander by foot but also by car or by other modes of transportation.
  

Tips for preparing for emergencies

• Keep a list of emergency phone numbers and addresses of the local police and fire departments, hospitals, and poison control as well as the MedicAlert + Safe Return emergency response number.
  
• Keep a list of physicians phone numbers and current medications (with dosages)
  
• Keep copies of legal documents (living will, power of attorney, etc.)
  
• Check fire extinguishers and smoke alarms
  

TTT Breakfast Sandwich

This is a great activity and TTT that I do with one of my Alzheimer's clients. It's easy and yummy!

I use a breakfast sandwich microwave maker thingie to make it easier. They're about $3 in Walmart, dishwasher safe and just so easy to use. You can of course use any microwave safe dish or container to make these.

Here's what you'll need:

1 English Muffin

1 Egg

1 Sausage Patty or Redi Made Bacon

1 Slice of Cheese

Spray Oil

As with any of the posted TTT kitchen activity recipes, have your clients do what they are able to do according to their abilities. Let them try to participate as much as they can, sometimes they can suprise you :o) Cue them as needed and prompt them for discussion and reminiscing.

Split the English Muffin into two and toast in toaster or toaster oven. I love toaster ovens and have personally gone through 3 or 4 of them in the past 19 years of marriage from constant daily use. It's an invaluable tool when you have kids.

Give a quick spritz of oil to your microwave safe container.

Crack the egg into the container and scramble a bit with a fork. You can add a little milk if you want but it's not necessary.

Drop the sausage patty into the egg and top with a slice of cheese ... or ... if you are using the Redi Bacon, cut a couple slices in half and add to egg, then top with cheese.

Microwave for about a minute and 30 seconds 1:30 on high.

If you are using precooked bacon, decrease the time by 20 seconds and only microwave for a minute.

Let rest for one minute.

As always, since microwaves vary, if it's not done you can cook it at additional 20 second intervals if needed. You may have to play around to get the exact time. For my testing I'm using my microwave which is a GE Profile SpacemakerXL Sensor. When I cook with a client in their home I find cooking times vary.

Add to Your Shopping List:

English Muffins

Eggs

Sausage Pattie or Pre-Cooked Bacon

Cheese

I picked my ingredients up at a Super Walmart in Plymouth MA.

Cost at the time of purchase:

A Sleeve of a dozen English Muffins was $1.98

A Doz. and a half eggs (18) were $1.50

A Sleeve of 18 Sausage Patties $4.99

A Lg. Package of Indiv. sliced Kraft Cheese $3.99

BTW these freeze exceptionally well. Just take the breakfast sandwich, already cooked and asembled and place in a freezer bag. When ready to eat, take the frozen sandwich out of freezer, take out of freezer bag, wrap in a paper towel and microwave for a minute. Still yummy!

TTT 1 Min. Micro Cake Dessert

Have you all seen these?

They're Warm Delights by Betty Crocker. They're quick (3 minutes) and delicious, although, that's a matter of opinion but I like them and so do my clients so that's all that matters.

They're also pricey.

Thanks to tangeemct at the Grocery Game I now have an inexpensive TTT (tummy tempting tasty) recipe and a new kitchen activity for clients with just about all levels of dementia.

Ok are you ready?

Get a box of cake mix. Any kind will do.

Get a Tablespoon.

Get a teaspoon.

Get out the Mayo.

Get a small microwave safe bowl or crock.

You can do all the measuring and have your client do the stirring or .... you can ....

Have your client measure out 4 Tablespoons of the cake mix into the micro safe bowl.

Have your client measure 2 Tablespoons of good old H2O into the bowl with the cake mix.

Have your client measure one heaping teaspoon of Mayo into the bowl.

Mix well. Mix again. Mix until all the dry ingredients are wet. Scrape the bottom to get some of that hidden powder.

Pop that bowl right into the microwave and cook on high for one minute.

Be careful it's HOT!

It's also done.

You can add chocolate chips, nuts or whatever you want do the mix to make it more yummy. You can also add frosting, powdered sugar, chocolate syrup or ice cream toppings after it's done to make it even more yummy.

If you find it a little too wet after the one minute you can pop it in for another 10 seconds and continue cooking at 10 second invervals until it's done.

You'll have enough cake mix left over for many wonderful TTT desserts for days to come.

There really isn't much time to reminisce or encourage socialization while making this dessert but there'll be plenty of time to do both while enjoying the dessert with a big glass of milk! Enjoy!

Add To Your Grocery List:

Cake Mix (any kind)
Mayo

Optional:

Chocolate Chips
Nuts
Ice Cream Toppings (Chocolate or Caramel)
Frosting

Don't forget to try Carrot Cake with cream cheese frosting ... it's delish!

1 min. Micro Cake

4 Tblsp. Cake Mix

2 Tblsp. Water

1 heaping teaspoon Mayo

Mix

Microwave 1 min.

TTT Salmon Burger Patties

I've had a couple requests for this TTT Salmon Burger kitchen activity and recipe.

There are so many variations in making these that it's pretty much goof proof. I have to admit I never measure the ingredients for this recipe. I find the old eyeball method works the best for me and it gives me a little leeway if there are spills or something is forgotten. I've also discovered that some clients may not have everything on hand for this recipe so "winging it" has always worked well for me. Here's one of many original recipes that can be found on the Internet:

1 can salmon
1 1/2 tbsp. lemon juice
1 tbsp. Worcestershire sauce
1/2 tsp. lemon pepper
1/4 tsp. garlic powder
4 tbsp. finely chopped onion
2 tbsp. finely chopped bell pepper
1 egg
1/2 c. bread crumbs


Here's my recipe

1 can salmon (drain and remove bones)
2 cups of plain boxed bread crumbs
1 heaping Tbsp Mayo
1 Lg. Egg but 2 wouldn't hurt
A pinch of Seasoned Salt

(the next 3 ingredients are optional depending on what your client has on hand)
A pinch of Pepper
1 Tbsp of whatever mixed herbs you have on hand I love McCormick's no salt Garlic and Herb Blend
2 squirts of lemon juice

I've made this without pepper, herbs and lemon juice and these still came out perfectly yummy anyway.

I love making Salmon Burger Patties over Ground Beef Patties because 1. the Salmon isn't as "yucky" on the hands 2. the Salmon has more protein (or so I've been told) and 3. the Salmon just tastes better.

Before you begin you'll want to preheat your oven to 350 degrees and prepare a baking pan with a spray of oil. After having your client wash their hands, spread a piece of waxed paper or something down to protect your work surface. Open the can of Salmon and let your client scoop it out into the bowl with a spoon. Now this is the hardest part - there are little tiny bones in the Salmon. Sometimes you can see them right away and other times you can't. Picking out the bones is a great activity for the client but if they don't get them all ... it should be ok. Most are so tiny they disintegrate while cooking. Just give the Salmon a quick feel through before you add the additional ingredients.

After the bones are removed (again, most are really tiny but make sure the larger ones are picked out) let your client add the additional ingredients. Depending on their abilities, either let them measure out the ingredients and add them or have them pre-measured so they can just add them in. Once all the ingredients are in the bowl the fun begins! Let the client dig right in there and start mixing with their hands. Encourage socialization and reminiscing by asking your clients if they've ever done this before or ask what it remind them of or prompt them to talk about cooking with their mom's. I find many of the elder ladies love to talk about their mom's and helping their mom's in the kitchen when they were young. I actually have a dementia client who can't remember cooking for her many children but she always has stories about her mother's cooking.

Once everything is mixed well have your clients make patties. You may need to demonstrate by making one first. This should yield about 5 or 6 depending on the size you make. I make mine burger bun size. Once made, place on the baking sheet. This is where Paula Deen makes a brief visit ... add a little pat of butter to the tops of each patty before cooking. This will keep the patties moist and add that yummy butter flavoring that is always good on fish ... Mmmm.... Bake them for ... well, until they're golden brown. I've honestly never timed them. Maybe ... 30 minutes?

If anyone makes these please come back with a comment on how long you baked yours and I'll add it to the blog.

These can be served hot on a burger bun (buns with sesame seeds are very yummy and will add to the presentation) with lettuce and tomato. You can add a little tartar sauce (mayo and sweet relish) or a little dill sauce (buy pre-made, scratch recipes are time consuming). Whatever isn't used can be put in the fridge for up to 3 days or in the freezer in freezer bags.

With this activity you'll be encouraging reminiscing and socialization, motor coordination, sensory stimulation (the house will fill with the wonderful odors of baking Salmon patties) and you'll be assisting your client in making their own meal.

Add to Your Grocery List:

1 Lg. Can Salmon
Sm. Container Bread Crumbs (plain or seasoned)
Mayonnaise
Eggs
Seasoned Salt (Garlic Salt will also work)
Pepper
McCormick Salt Free Garlic and Herb Blend
Lemon Juice

**note - this is not my photo, it's one I found in a multitude of places on the Internet. I can't give credit to the original photographer since there's no way of knowing who it may be. So, thank you to whomever staged then took this photos, it is very delicious! **

TTT Sandwich Wrap

This is an easy activity as well as a Tempting Tummy Tasty (TTT).

Any sandwich wrap will do. This one is a Spinach wrap. After having the client wash their hands, have them take one wrap and lay it out on the work surface you are using (counter, table, tray, walker tray...) have them spread a tiny bit of cream cheese along the far edge of the wrap. Next have them place a slice of their favorite cheese and favorite luncheon meat on the wrap. If they like lettuce, tomato, onion etc. have them place a small amount (two lettuce leaves, a slice of tomato cut in half) on top of the deli items. A little squeeze of their favorite sandwich or salad dressing over the top - not too much though- and you're almost done. Have the client start to roll the wrap up and away from them. The wrap should end up being sealed with the cream cheese. Hold the wrap like a rolling pin and make slices 1 inch apart. Ta-Da! A great kitchen activity and a TTT (Tempting Tummy Tasty).

Add To Your Grocery List:

Sandwich Wrap
1 Tblsp. Cream Cheese
1 -2 Slices Deli Meat
1 -2 Slices Thin sliced cheese
1 -2 Lettuce Leaves
1 -2 Thin slices tomato
1 Tblsp. some kind of dressing or sandwich spread

Activities: Games, Gadgets and Gabbing

There are a wide variety of games and gadgets out there that can be used during 0ne-on-one interaction. I'll give a few examples and a variety of ways to use them, both traditionally and creatively. From past experiences, one of the best category of games I've tried are the memory games. The memory games can help combat memory loss, aid in memory recall, stimulate personal memories from long ago and can engage emotional stimulation. I'll touch on some easy "Do It Yourself" age appropriate Memory Games in another Post.

Games:

• Cards - most seniors have played cards in their time. A deck of cards doesn't take up much room in your activity box and they're inexpensive, so be sure you always have a "large print" deck on hand. You can play a card game of their choice or in the case of a confused client, have them match the colors or numbers. Have them add the cards together or tell you which is higher or what number would come next. You'd be surprised at all you can do with a deck of cards ... right down to building a house of cards! If you're reading this now, you have access to the Internet which means you have an unending resource for card games and their rules in case you aren't sure how to play "Hearts" or "Whist". A lot of the folks used to love playing Cribbage, which is another inexpensive, easy to transport game that will motivate fine motor skills, cognitive skills, problem solving skills, math skills .... you get the idea.


• Board Games: I include dice games in this category as well.... Scrabble, Blockus, Checkers, Chess, Memory, Connect Four, Backgammon, Mancala, Domino's, BINGO, Dice, Yahtzee, Boggle ... the list is endless. Look in your closets and under your beds. Look under the living room chairs and couches ... look under your neighbors couches. Hit the yard sales or ask relatives for games they no longer use. Anything is fair game, even games with missing pieces. These don't need to cost much or anything at all. Games can be played traditionally or non-traditionally according to your clients abilities and attention span. I had one of the best evenings playing Blockus with a dementia client. We played for over an hour using our own rules. She beat me ... 3 out of 4 games ... it must have been beginners luck, there's no other explanation :o) She talked about it to her family the next day and the family was amazed that she played the game, stayed focused and remembered playing it. Be creative. When my kids were very young I used to swear that their aunt, my sister, could find 10 different ways to play with one toy. She's amazing. She inspired me to give this a try. You don't need a lot of games or gadgets, just have a few ways to use the ones you do have.
  

Gadgets: A whole lot of items can fall into this category ... anything that doesn't fit into any of the others. I'd re-label this the "Free Style" category of activities but it wouldn't fit in with my "G" words title :o) I'll be adding to this list over time as I remember the activities I used to do with my clients.

• Dixie Cups - Are there any Dixie cups in the house? Check your car for empty coffee cups (I probably have enough for all of us). Take three. Take a balled up tissue (preferably clean) and put it on the table. Do you know where I'm going with this? It's the old "Cups and Ball" game. Find the tissue ball! If you practice this at home, you can get pretty good at it. Let your client give it a try. This is also a great activity for Alzheimer's clients who have progressed a little further into the disease. When you're done, see if the client can balance one cup on top of the other two. Make a game of it. Use your imagination.
• Pick-Up Sticks - Create your own or pick up an inexpensive set. Think back to when you were a kid ... remember how it goes? If not, you can make up your own rules. It's a fun, non-threatening game that will stimulate problem solving skills, eye-hand coordination and fine motor skills. It's also a lot of fun!
• Lacing Cards - These would be for the more advanced Alzheimer's or Dementia client. You can pick lacing cards up in any toy store but the themes are usually very childish. Remember you want your activities to be as age appropriate as possible. You can make your own Lacing cards with cardboard, fabric and a hole puncher or better yet, use old greeting cards. Quick instrux: Glue greeting card closed to increase durability. Mark your design with a pen. Using a small hole paper punch, punch out the holes. Make sure they aren't too close that the holes will rip. Using a shoe lace (sparkly ones are great on Christmas cards) let the client "lace" the card. If you don't have a lace, use yarn that has one end dipped in wax.
• Manicure Kit - This is another great idea from my Visiting Angel's BFF M.M. Thanks MM! It's an inexpensive way to pamper your client while engaging in a 0ne-on-one activity that will stimulate a few senses (especially the sense of touch, site and smell) . It opens up the dialog for reminiscing as well. All you need is a NEW nail file (for each client - never use a used one), a bottle of acetone free polish remover and a couple bottles of pretty nail polish (it's always nice to offer up a choice). You could also throw in a nice scented hand lotion as well if you really want to pamper your clients. Just remember to make sure all the lotion is off the nails before you polish or the polish won't dry properly.
• Create a Memory Book: I started helping an Alzheimer's client create a scrapbook using photos of herself and her family. As it turned out the client didn't enjoy this activity and actually had a considerable increase in agitation whenever we tried to work on it. I decided, with her family's permission, to finish the scrapbook on my own. I presented it to her this past Christmas. She cried tears of joy. She keeps this scrapbook on her dining room table and looks through it almost daily. Although she didn't enjoy working on it, she absolutely loves having it. The photos and journaling are a pleasant reminder of who's who in her family.

Gabbing: One of the best ways to get to know your client is by chatting, socializing, reminiscing, having a face-to-face, a sit-down, a jaw session ... whatever you want to call it. It's also a great stimulant. Talking about the weather is nice ... boring ... but nice. Talking about something the client used to do is even better. What hobbies did your client used to enjoy? Not a topic you know anything about? Research it! Be informed so you can have a meaningful conversation. Help them reach down and grab those forgotten memories and bring them to the surface. Put a little effort into your conversations. Motivate your clients' minds!

• I have a client who, in the past, made her own braided rugs. I knew nothing about braided rugs. I knew more than nothing about braiding rugs. I couldn't even tell you what kind of material was used. So, I went here ... and here ... and researched this topic so I had something to prompt her with as well as have some sort of information to contribute to the conversation. I'll never braid my own rug. I have no desire to but I do have a new found appreciation for the braided rugs I walk on each time I visit this client. I also have a new found appreciation for the woman who meticulously made these braided rugs.

While gabbing can be a bit boring, monotonous or repetitive or all the above, it's up to you to make it stimulating. I've mentioned previously about the magazine called Reminisce. It's a great convo starter. It's a great stimulant. It's a great magazine. You can pick up a bi-monthly subscription or find a used copy on Ebay for cheap.

If you wanted, you can also make your own conversation cards. Just print off old photos from Google Images and paste onto cardboard. This is inexpensive (paper, ink, glue and last nights pizza box) and can be a great memory jogger for your clients. Better yet, have them help you adhere the photos to the cardboard. Cover the cards in Hodge Podge, applied using a sponge brush, to make them long lasting. It's a wonderful, meaningful, task-oriented, goal-attaining activity. Sometimes a simple photo will open up a whole lot of wonderful memories.

So, while you gab, use visual cues, it can make a world of difference.

Reminisce ... the magazine!

Yes, there really is a magazine called Reminisce. It's filled with poems, stories, quips, quotes and recipes from days gone by. It's a great tool during one-on-one interaction with your clients.

You can sign up for a bi-monthly subscription of Reminisce or check on Ebay for used copies. It doesn't matter which copy you get, they're all wonderful.

Here's just a sample page from the February/March 2008 issue of Reminisce ... (please click on the article to enlarge).

According to Food.Gov I'm Bad

While doing a little research, I found this plate diagram on the food.gov site. This is their "eat well" plate. It sections off the amounts and types of food a person should have on their plate. If you click on the photo it will enlarge. YIKES it's really large. Sorry about that.

I will be the first to admit I don't follow this plan when feeding octogenarian clients. Why? .... because when I have an 80+ yr. old client who's not on a restricted diet and wants to eat 3 cherry tomatoes, one heaping tablespoon full of tuna salad, one slice of deli ham and a 1/4 cup of ice cream for lunch I'm going to give her 3 cherry tomatoes, one heaping tablespoon full of tuna salad, one slice of deli ham and a 1/4 cup of ice cream for lunch. I'm actually thinking of one 96 yr. old woman in particular and she has earned the gosh darn right to eat whatever she wants ... as long as she eats something other than sugar cookies, cakes and donuts. Following the food pyramid or "eat well" plate is difficult enough for us but even more difficult for the elderly, especially if they are showing no interest in eating in the first place.

It's up to us, as caregivers, to make sure healthy alternatives are provided and offered up in interesting ways to tempt our clients' appetites. It doesn't mean those healthy foods that are offered will be eaten. They have the right to refuse. All we can do is try. Sometimes when you're faced with the choice of a client not eating at all and heading toward malnourishment or eating 3 cherry tomatoes, one heaping tablespoon full of tuna salad, one slice of deli ham and a 1/4 cup of ice cream for dinner ... you pick the latter. The former is unacceptable.

I'll get into easy recipes and tempting tummy tasties in another post. I'll also get into "hiding healthy" into everyday dishes.

Warm it Up

There's no hard and fast rule that says you'll get a $50.00 fine for warming up a glass of juice or Ensure. I currently have two clients who dislike cold drinks. Trying to get either of them to drink a cold, refreshing glass of cranberry juice is like trying to get my husband to go grocery shopping with me. It isn't going to happen. Both ladies enjoy their beverages warm. So, try warming them up!

Believe it or not a warmed up Ensure is awesomely delish. I know this because one of my clients tells me every time I give it to her. She ooh's and ahh's with exclamations of delight. I serve it to her in a fancy dancy tea cup and call it "sweet coffee latte". She'll extend that little pinky finger and sip it like it's made out of 14 k gold.

I have another client who nukes her OJ. Personally this is very unappealing to me but this is how she prefers it so who am I to tell her it's better cold? To her, it's better warm.

This also goes along with heated milk, warmed-up apple and cranberry juice. Don't assume that because we like it cold that they do also. Many of these folks grew up drinking tea and coffee throughout their day and prefer hot or warm beverages to cold. Ask them or offer them a cup of each, one cold, one warm and see which they prefer. Thinking outside the box is creative thinking. Creative thinking on our part helps our clients succeed.

Once you find their preferences (which keep in mind, could change at any time) then stock their fridges with items they can prepare the way they prefer. If they prefer warm drinks be sure they have coffee, tea, milk, apple juice/cider, Ensure, cocoa and any other juices that are able to tolerate heating (there are many). If they prefer cold, any juices, milks, soda's etc. that they enjoy should be stocked.

BTW a warm apple juice or apple cider can really hit the spot on a chilly day.

The Ensure site has a lot great looking recipes using Ensure. I haven't tried any yet but I'd love feedback from anyone who has. Here's the site ... Ensure Recipes. BTW right now if you sign up at the Ensure site you'll get a free shake or $ off a 6 pack.

Presentation is Everything

My Visiting Angel BFF M.M. once told me that the color RED entices Alzheimer's clients to eat. Thanks MM for that tip. It's a good one!!

Let's see .... which do you find more tempting?

Here you have a hunk of yummy lasagna on a white plate.


Here you have the same hunk of lasagna with a side of salad on a cute plate sitting on a red placemat.











Which is more temping to you? Yes, me too. As a matter of fact, after I took the photo, I ate what was on the plate.

Presentation is everything when you're trying to entice someone to eat. Especially if that someone doesn't have an appetite. One of the desires a person with Alzheimer's loses is the desire to eat. The urge isn't there. They don't recognize being hungry. They lose all interest in eating. Some will eat just because it's "time" to eat. At 12 noon an Alzheimer's client may eat just because for 80 years they always ate at noon. Some may not want to eat but they will because of conditioning. Others may refuse to eat all together which contributes to rapid weightloss and illness. One of our jobs as a caregiver is to make sure our clients eat. So ... make it interesting. Catch their attention. Introduce a little .... RED!


7/14/09 Here's another example of presentation .... most everyone knows what Mott's Apple Sauce is and most of our clients eat this at one time or another. Instead of just plopping a single serve apple sauce and spoon in front of your client .....

.... try presenting the apple sauce to them.

It took me all of 40 seconds to open the apple sauce cup, dump it into a cute dessert dish and add a dollop of strawberry preserves to the top. When I presented this to a client (I found a similar dish in her cabinet) it was as if I were presenting her with a diamond necklace. The client had already strongly refused the apple sauce in the single serve original container but reached out to take my lovely creation. I picked this cute dessert dish up at the local Salvation Army store for a quarter for my purposes here. After I took the photo I handed it to my hubby who said, "Oh, what's this?" in that "oh I'm getting something yummy type of voice." It was a quarter well spent. Presentation is Everything.

Here's a photo of the dish I made up for my client, at her home ... photo was taken with my phone:

A Few Activity Ideas

Here are just a few activity ideas you can do with your clients. Of course, each one would need to be modified according to each client's ability, level of dementia, tolerance, focus and attention span. I'll be adding to these intermittently. A good approach is to think of activities that young children enjoy, but find a way to make them age-appropriate for each client according to their level of ability and focus. You don't choose these activities because your client is a child or childish, you choose these type of activities for their level of difficulty and the time it takes to complete them.

Painting .... watch for sales at Michael's and AC Moore, use their 50% off coupons (you can probably find a down loadable printable on a web search). Pick up one of their mini painting kits or purchase materials separately. I have one of those cheapo wooden easels that have a tiny drawer that holds tubes of acrylic and water paints and a couple paint brushes. I actually picked this up at The Christmas Tree Shop for about $10 and it included everything. I also pick up a few inexpensive "faux" canvas' and keep them in my activity box (which is usually in the back of my car). You can also pick up a big pack of white cardstock (thick white paper) at Walmart very inexpensively (this can also be used for greeting cards, which I'll post about later). It's not about how much talent they have or how well they paint ... it's all about working with their creative side or their right brain side. It will stimulate them as well as bring a sense of pride when they complete an attainable goal. It's all about working with their emotions, visual stimulation, auditory stimulation, tactile stimulation and motor skills. It's never about "painting".

• I have a gentle, sweet, quiet little 96 yr. old woman who said she had never painted a day in her life. She said her brothers were the artists, not her. It took a lot of coaxing to get her to pick up a brush and start painting. She needed a lot of encouragement and a little cueing. Wouldn't you know she made the most beautiful painting of pink tulips on a bed of purple and blue violets. She was so proud of what she did. It was a task with an attainable goal and she more than exceeded what she thought she was capable of doing. I had a tear in my eye that day. When I get a chance I'll post a photo of her beautiful painting.

Stained Glass or Suncatchers: Another great idea is the stained glass or suncatchers kits that you paint. You can pick up the individual plastic images and a strip of stained glass paints at Walmart for a couple bucks. Don't forget to pick up a suction cup hook while you're there. This is a great task that also provides a constant visual stimulation (hang it in a sunny window). It's also great as a conversation starter.

Molding Clay or Putty: I'm not talking about Play-doh, ew, that stuff smells horrible and have you ever tried to get it out of carpets?? I'm talking about the non-toxic molding clay or foam clay or putty stuff you can find in any store (even the supermarket). I picked up some non-toxic foam bouncing putty from the dollar store. It was in a container that had a piece of plastic running down the middle to separate the yellow foam putty and the pink foam putty. I presented it to one of my Alzheimer's clients. She immediately went for the pink colored putty. Once held in her warm hands the putty became more pliable. She shaped it into a person, a dog, a cow, a tv (her favorite past-time), a flower, a car .... for a good 45 minutes she stayed on task "creating" different things with this $1.00 putty. It was fantastic. We had a lot of laughs. Again, it isn't about making something "good", it's about exercising the fingers, hand and the mind. It's about the client reaching an attainable goal and feeling good about themselves. In this particular case it also created a lot of giggles and happiness from both of us. It also brought forth some recognition and reminiscing. So hit the dollar stores and see what they have that you can use with your clients. You never know what will "spark" their imagination.

One of my 87 yr. old clients made this pink person sitting in a chair watching tv. Amazing, don't you think?

Here is one more sculpture she made, just today. This is a sculpture of a cat she had decades ago. The cat is standing on a carpet. This woman, in her youth, braided and made all the carpets in her home. She was and is still creative. Today this woman would never be able to make another braided rug but being creative in other ways brings her joy. It's up to us to help them find other creative outlets.

Puzzles:

Another great interactive activity with an attainable goal is a puzzle. You can pick up an inexpensive, 50 piece puzzle at a variety of places. These can be of cute animals (kittens are always nice for the women or dog and trains for the men) or any subject that seems interesting. It's probably best to have one for males and one for females in your activity bin. Back in the "olden days" folks used to sit around listening to the radio while doing puzzles. It's a great tactile stimulation activity that will also encourage fine motor skills and cognative stimulation. I was lucky to find a little pixie puzzle that has 50 little pieces to it in the dollar store for ... no, not a dollar, but 2 for a dollar. Ha! I found that my clients prefer the smaller pieces to the larger. I'm guessing the larger pieces bring back memories of doing "kiddie" puzzles. Remember those? Anyway, if you can't find a mini puzzle locally, they have some HERE. You can also check out their crushed box section for markdowns. I just spotted a mini truck puzzle, 120 pieces, for $3.95.

Even though we may sometimes use what are considered "children's" toys, they don't have to be presented as children's toys. Like anything else, it's all in the presentation. Self-Esteem and integrity are important and treating your clients as the adults they are will help them keep their integrity.

I'll be adding more activities in future posts.

Stuff to Get Started

Over the past 26 years I've been the Director of Activities in various multi-level nursing facilities, had my own in-home child daycare, have freelanced for years (and continue to do so) for an online media company and most recently have been working for Visiting Angels as a PCA (Personal Care Assistant).

Through the years I've worked with a variety of senior citizens; some with dementia, some with Alzheimer's, others who were afflicted with various diseases or illnesses. I've learned so much about myself from the patients and clients I've worked with.

I've always had an interest working with the elderly. After all, they've experienced what we have yet to live.

One of the saddest things I've ever had said to me was from a man I'll never forget. He was a young resident (late 60's) of the nursing home I was working in at the time. He lost both legs to diabetes and refused to wear his prosthetic legs.

• I have to admit here that I personally have difficulties with any type of amputation. Long story short, I had an uncle who lost a finger when I was very young. He used to tease us kids by sticking his little finger stump in our faces every chance he got. Needless to say it kind of freaked me out a bit. I had another incident, also when I was very young (8 or 9) where my father and I were at a breakfast place and we ran into a woman he knew from years back. He was standing behind me with his hands on my shoulders, introduced me to the woman and then, as any good dad would do, suggested I shake her hand by way of a proper greeting. I extended my hand to the woman. Unknown to my father, she was in an industrial accident a few years prior and lost most of her fingers. She shook my hand anyway. It definitely left a negative impression.

Anyway, back to my story, this man, Bill, used to lay there, not talking to anyone, refusing to eat, mad at the world. His wife would visit, he would ignore her and she would leave crying. This went on for months. I visited him each day and each day he ignored me. I had finally had it and decided I was pulling out all my tricks. I went for my usually morning visit, walked into the room, changed his daily wall calendar and didn't say a word. Instead I started singing. "Good Mornin', Good Mornin', You haven't said a word to me, Good Mornin', Good Mornin' to You. Then I did a little soft-shoe dance. Debbie Reynolds and Gene Kelly would have been proud. To my amazement Bill, started crying. I went over and held his hand until he finally said to me, " I have no purpose anymore. I have nothing to look forward to." I kindly replied, "Bill, you lost your legs, not your life. Get your butt down to PT and learn how to walk again so we can dance." I soft-shoed it out the door. I was young, pretty and much, much thinner 24 years ago. That afternoon I noticed Bill and his wife, Cathy, were finally chatting. She came to me after her visit and thanked me for bringing life back to her husband Bill. I kept up my visits each morning, sometimes singing, sometimes doing a little jig and sometimes, just sitting to chat. After a few months Bill joined the other residents in the dining hall. He had to attend in a wheelchair but he continued with PT and was able to finally walk with a walker and assist. We did have our dance.

Everyone needs a purpose. Everyone needs something to look forward to. Everyone needs to have a little bit of "self".

Through simple activities and tasks, no matter how silly they may seem, you can help a client achieve a sense of "self", a sense of purpose. A flicker of hope. When a client with dementia or Alzheimer's participates in activities, it can slow the progress of the disease by encouraging positive thinking and happiness within the mind of the client. Socializing and Reminiscing is great but add an activity or task and it's even better. I'm hoping to share some easy one on one activities and ideas that I've done with past nursing home residents and current in-home care clients.

I'm also putting together some easy recipes that you and your clients can do together; dishes that will appeal to clients with little to no appetite; easy tricks to stimulate your client's appetite; and easy to eat foods that will encourage independent, healthy eating.

Meals-on-Wheels is great but there's always room for creativity :o)