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2014 OPTIMA Award: An engaged journey

September 23, 2014
by Pamela Tabar, Editor-in-Chief
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What if dementia care was really about keeping residents connected and engaged every day, instead of about mourning the memories that are fading away? This year’s winner of the Long-Term Living OPTIMA Award has taken dementia care programming far beyond reminiscing, brain-games and once-a-day-activities; focusing instead on challenging residents to learn and interact with each other—all day, every day.

Eleven residents, all with diagnoses of varying stages of dementia, sit around a long table, wearing food-handling gloves. The staff leaders (all CNAs) pull in a cart laden with fresh fruits, explaining that the group needs to help prepare the fruit salad for the big Hawaiian luau meal planned for later, as the culmination of “Hawaii Week.” The leaders pass out bananas while asking the residents: “What needs to happen first?” “Peel them,” one resident says. As the peels are set aside, the room fills with the fragrance of bananas, prompting some residents to pipe in with their memories of picnic banana sandwiches or eating banana cream pie. Using the (safely dull) table knives, one resident cuts thick banana chunks for the community bowl, while another resident labors over her micro-thin slices, constantly asking, “Is this OK?” Another resident chooses to eat the whole banana himself. Meanwhile, the leaders talk about the texture and smell of bananas and ask what kinds of desserts bananas can be used for. Monkeys somehow come into the conversation at one point, and that’s OK—because it’s the engagement that matters.

This is just one of the many activities the residents at The Atrium at Drum Hill take part in every day. Drum Hill, North Chelmsford, Mass., is part of the Benchmark Senior Living chain, which encompasses 50 sites across Massachusetts, Connecticut, New Hampshire, Rhode Island, Vermont and Maine. Benchmark’s memory care programming asks residents to stretch their brains all day, every day.

As an all-memory-care community, Drum Hill’s 50-bed residence has served as the advanced site for Benchmark’s dementia care programming, which began in 2012. The goal is to engage residents in meaningful activities that cross the spectrum of the brain’s processes—tapping into the intellectual, physical, social, emotional, spiritual and purposeful community interactive aspects of thought processing and communication.

| Related article: Six dimensions of engagement |

Above all, it’s about resident participation. Instead of insisting that a question must produce a certain answer or a “correct” memory, the caregivers (called associates) focus on simply having a discussion that helps residents join in. They call it “quilting a conversation.” One resident’s distant memory could prompt another resident’s current-day thoughts, which could prompt yet another resident to talk about a particular event he enjoyed back in 1975. But it’s all actual, active, daily conversation—and it’s one of the most difficult things to get residents with dementia to do on a regular basis.

Activity programming, once viewed as a single session or activity in a resident’s day, has become Benchmark’s whole purpose and vision. The logic behind it is that even as dementia progresses, residents can still continue to remain engaged people if they are given a forum that stimulates the social, emotional and intellectual parts of their minds on a constant basis.

“It’s a myth that people with dementia can’t learn new things,” says Joshua Freitas, director of memory care innovation and services. “People think it’s puzzles and games that exercise the brain, but it’s really learning new things.”

One of Benchmark’s resident “engagement boxes” is called “A Day at the Beach.” While interacting with the real-life materials in the box, residents can sink their fingers into a container of sand, rub suntan lotion on their arms and touch seashells while listening to the sounds of waves—a multiplex brain-wave orchestra that accesses multiple parts of the brain’s processes simultaneously. The box is both a process and an avenue, Freitas explains. The activity taps into various parts of the resident’s brain processes, including emotional responses, intellectual thoughts, old memories—and the formation of new ones.

Freitas, CDP, CAADCT, who also is certified by the National Certification Board for Alzheimer Care as an Alzheimer educator (CAEd), refuses to be called the “inventor” of Benchmark’s programming, citing the many progressive thinkers he has encountered during his studies as a music therapist and its dementia care applications. But his energy is contagious; he visits the Drum Hill community every week, and he knows every resident by name. Too many memory care programs ask residents only to recall the past, instead of focusing on what their brains are still capable of learning anew, Freitas says. “I want to push the standard in the industry, because I think it’s set too low.”

Resident engagement can still be activated in many other parts of the brain, says Krystee Ryiz, Benchmark’s corporate director of programs and customer engagement. Indeed, the residents often participate in activities meant to serve others, the key “community purposeful engagement” part of the programming. Drum Hill’s residents have sewn cat beds and made homemade dog biscuits for the local animal shelters, while reading about animals and watching videos about the relationship between people and pets. No one cares if some of the kitty beds turn out too small—it’s the resident participation in the project—the activation of resident brains toward a meaningful task—that matters.