In 2006, the Centers for Medicare & Medicaid Services (CMS) issued new guidance for activities that specifically directed facilities to improve activities for residents with Alzheimer's disease and other dementias. Facilities are expected to provide all residents with their own, personalized activities program, which includes special, individual plans developed for residents with varying stages of dementia. Even those with advanced dementia are expected to be included in some type of “person-centered” activities.
Multisensory rooms and specialized dementia programming provide group activities in an environment that is success-oriented, failure-free, purposeful, and meaningful. Our multisensory room at the Portage County Health Care Center in Stevens Point, Wisconsin has been in use since March 2007, and I have developed a list of 24 goals for use of these programs (“24 Goals for Multisensory Room Programs,” p. 21). The Dementia-Specific Programming (a new outcome-based program that I developed specific to our facility and residents) was initiated in April 2007. Residents have shown progressive positive outcomes as a result of these and other specialized programs, which target 20 different outcomes. Some of these target outcomes are increased vocal attempts, increased physical movement, decreased anxiousness/agitation, improved attention span, and improved memory recall, to name a few.
Various sensorial materials used include (but are not limited to): relaxing music/CDs, videos, and DVDs; entertaining videos appropriate to residents with dementia; manipulatives (tracking boards, nuts and bolts, PVC plumbing pipes, magnetic boards, bead boards, stacking peg boards and other all-in-one boards, with no loose pieces that residents might put in their mouths if they are using unassisted); a waterfall; a bubble wall; fiberoptic lights; a water fountain; chimes; lighting effects/various equipment; aromatherapy/diffuser; projector with effects wheel; lava lamps and other tabletop features; and various other sensory items.
Who should be included in multisensory room and small group dementia-specific programs? Individuals with dementia/cognitive impairment; those who display repetitive, self-stimulating actions (i.e., rubbing, picking, etc.); those with limited or absent verbal skills; those who do not benefit from a group setting; those who have patterns of agitation and anxious behaviors; those with limited responses or who are nonresponsive; and individuals with chronic pain issues.
Unlike typical activity programs that place pressure on the resident to perform—which for dementia residents leads to anxiety, agitation, and frustration—these programs introduce pleasurable experiences that provide residents with the opportunity to attain happiness and purpose, and to improve their quality of life. Residents have control because there are no rules. These programs also actively engage the residents in activities that gently stimulate their senses throughout the day.
A Day in the Life
A typical day (although there really are no “typical” days on a dementia unit) includes: AM care and breakfast, nursing staff take care of any physical needs, then take the residents to the multisensory room and set up activities for them. Activity staff are on the unit for a 9:00 a.m. small group, which typically works on cognition, reminiscence, and memory recall skills; earlier in the day is best for this type of activity with residents with dementia. I have purchased or otherwise created numerous supplies and props for activities that allow us to incorporate the 20 targeted goals of the program. Our groups used to last 15 to 30 minutes if we were lucky, but now they last 30 to 45 minutes. The staff need to make way for the large group program offered at 10:00 a.m. Some of the residents take part in the large group, and others use the multisensory room or engage in some other form of independent activity.
Lunch is at 11:30 a.m., followed by attention to personal needs. At 1:30 p.m., either small group or one-on-one interactions are offered on the unit. At 2:00 p.m. there is usually another large group activity that some residents are able to participate in. Many residents do require an hour's nap in the afternoon. This reduces sundowning for some residents. At 3:30 p.m., small group or one-on-one sensory programs are offered again on the unit. These can be either relaxing for residents who typically sundown, or they can be more active and focus on some of the same skills we worked on in the morning session, especially for those who napped and are well rested.
Supper is at 4:45 p.m. At 6:00 p.m. the evening dementia programming in the multisensory room begins. From 6:00 to 6:30 p.m. there is light physical activity or creative expression—some activity to wear off any leftover energy from the day, but not enough to overstimulate residents. This is their winding down time for the evening hours. From 6:30 to 7:00 p.m. there is one-on-one massage (within the group), aromatherapy, and use of the multisensory room equipment, which focuses on the five senses. From 7:00 to 7:30 p.m. there is story time and reminiscing. The activity leader reads out loud and asks simple, prompting questions about the story to engage residents. At this point most, if not all, those in attendance are drifting off to sleep. This is the goal of the last program—to have them so relaxed they can be put to bed and sleep restfully for most of the night.