An Interview With Jan Allen from Nursing Assistant Monthly

From Nursing Assistant Monthly, a subscription-based continuing education program for nursing assistants. Reprinted with permission from Frontline Publishing, 1-800-348-0605.

"You Are the Guide, Mentor, and Trailblazer"
An interview with Jan Allen, M.Ed., CSW

Jan Allen has almost 20 years experience working with older adults and their families as an Activities Director, an Executive Director of a County Department on Aging, and an Aging Services Director. In addition to supervising several programs, she currently operates a group respite program for people with dementia in Waukesha County, Wisconsin.

What is the aim of an activities program for residents with AD-type dementia?

There are several: First of all, the aim is to provide meaningful activities that are "failure-free," in order to enhance the resident’s self esteem (if even for a moment in time.) Another is to provide avenues for the person’s energies and to help combat the boredom that gives rise to agitation.

Another aim is to be able to help families keep some positive interaction with the client. Just because Grandma’s mind is not "all there" does not mean she can no longer have meaningful and positive interactions with her family. Recently, I went with two friends to visit their 90-year-old grandmother in a group home. The friends were very unsure about how to interact with their grandmother as she was memory-impaired and had been very depressed and withdrawn. Soon after we got there, Grandma mentioned a man with an accordion who came to play for the residents. We began to talk about polka being the "state dance" of Wisconsin and how everyone at every basketball game had to go out and do the "chicken dance" during half time. Then, we started singing every old song we could remember: "I’ve been working on the railroad," "Oh Susanna," "Swanee River," "This Little Light of Mine," "Jesus Loves Me," and on and on. Grandma beamed and even joined in with some of the singing. When we left, the two grandchildren said to me, "That is the best visit we ever had with our grandmother."

What’s the nursing assistant’s role in activities programming for residents with dementia?

I have the utmost respect and admiration for nursing assistants. I think one of their biggest challenges is the pressure to get X number of people bathed, dressed, toileted, and fed. They are my heroes. So, my ideas have to do with helping with the time pressures, not adding more stuff!

First, I see the CNAs as being key to establishing a rapport with the residents. I have found that certain CNAs have a gentle style that dementia folks can "tune in" to. People with dementia sense emotions very strongly. If a person is flustered or frustrated or angry, the person with dementia will "read" that emotion much quicker than they will comprehend the spoken word. I always stress the need for a calm demeanor. If you have a dementia person explode and become aggressive, it just slows you down and keeps you from getting done what you need to get done. There is an old adage, "If Momma ain’t happy, ain’t nobody happy."

In terms of actual activities, I recommend boxes of things that residents can "play with" — decks of cards, dice, colorful buttons and trays for sorting, stacks of pretty material of different textures to sort, touch, etc. Some boxes can be more "male" oriented: a small pouch of tools (pliers, a small tape measure, nuts and bolts, pieces of wood of various shapes and colors), picture books about airplanes, tractors, trucks, etc., music tapes of "barbershop quartet" type songs, travel brochures and books, pencil, paper. For the women, I had boxes with hand lotion, nail polish (to be used with supervision!) poetry books, cards, music tapes, soft stuffed animals, dolls, and other things.

Some people feel that toys are demeaning to elders.

It is true that we never want to demean an older adult or make them feel childish. We do not want to give them a toy, for example, if we think it will be insulting to them. However, if I have a shoe box full of matchbox cars and I sit down with the elder and ask them if they would like to see my grandson’s collection of cars — that’s a whole different matter! It’s not so much what the toy is , but HOW we present it.

I personally own a doll collection and "play" with my dolls from time to time. I think it’s perfectly okay to have dolls for AD folks to dress and play with. However, it would NOT be appropriate to say, "Here, Sally, here’s your baby dolly. Now, you be a good girl and go play with her..." However, if you said, "Sally, this is a doll someone donated to the center. Isn’t she adorable?" And you discussed the doll in grown-up language without insinuating that the elder was "childish" to look at it or play with it — then you are providing a great thing for that elder.

What kinds of activities seem to work best?

Successful activities are simple. Offer some choices (but not overwhelming ones), make sure they are fun, and do not involve tons of directions. We want our AD folks to have some choices, but if you put 55 colors of magic marker in front of a mid-stage AD person, they will likely "freeze" and not be able to choose at all. However, if you lay three colors down and say, "look at these lovely markers. Do you see one you like best?" Then, they can usually select one they like.

It is not the product, it is the process. You want to have a good time. You want the elder to have a good time. You want to give them a chance to pass time in a way that they can enjoy. Many activities can be modified for AD folks. I had a ceramic program when I was an activity director. The AD folks would assist in painting on the glaze of the pots. It was a simple task that could be done with very little instruction. "Hi Fred. Here’s your pot. Here’s your brush. Would you like to paint this pot for me? Thanks!"

How do you feel about TV for residents with dementia?

I am not entirely opposed to TV for AD folks. I think that TV is rather like chocolate — okay for a treat but not good for a steady diet. We use TV in our respite program primarily to show videos after lunch for a "rest time" and especially in conjunction with a theme day or other special activity.

It has been my experience that unsupervised and unstructured TV is usually responsible for a lot of agitation. It’s often not soothing.

What do you feel is the most important thing for CNAs to understand about residents with dementia?

That YOU, the nursing assistant, are the key to whether that person successfully survives in the scary "real world." You are the guide, the mentor, the trailblazer, the pioneer who helps them figure out this new and hostile world that they wake up to every day. For us, the real world is pretty normal and something we understand. For dementia folks, it is a great and scary mystery. Imagine, for a moment, that you wake each morning in a new room, with a new bed and with a stranger in a bed near you. For a dementia person, that is EXACTLY what happens each day. When they go to sleep the night before, they close their memory on that day. So, when they wake up, it is as if they are seeing that bed, that window, that picture, that chair, and that CNA for the very first time. You are their guide to get them through one more day of not quite being able to piece all this confusing stuff together. So, my gratitude goes out to nursing assistants, our "Lewis & Clarks" of the Land of Dementia.

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