Caring for Dementia Patients: Why Routines are So Important
Hey, What am I supposed to do?
Why Developing A Daily Routine is Essential for People with Dementia
People with dementia get along much better, individually and collectively, when following a routine. Daily routines that include showering, shaving, preparing meals, laundry, job, and caring for family, etc. are associated with procedural and long term memory. The ability to participate in basic routines generally remains intact until end stage dementia.
Confusion, distraction and impaired ability to plan and complete a task independently are common symptoms of dementia. The question “what am I supposed to do?”can nag at the mind of someone with dementia, particularly if they’re not supported to keep busy.
Consistent, thoughtful, well-planned routines, with familiar faces and regular activities can help people with dementia feel needed, useful, more connected to their environment, and provide a sense of comfort and grounding.
My personal morning routine has remained the same for years. I do it without even thinking. All of us have routines we need to follow in order to feel confident and prepared for the day.
With cues and prompts,individuals with dementia can continue to do many of the tasks they’re used to doing like brushing teeth, combing hair, dressing, feeding themselves, folding, sorting, stacking–participating in life. Caregiver encouragement and approval can greatly increase the person’s use of abilities for a longer period of time.
Use it or lose it!
Benefits of daily routines in dementia may include:
- Reduced anxiety, agitation, aggression, confusion, repetition and other challenging behaviors
- Increased ability to practice a task or activity–to maintain skills or even become better
- Increased self-esteem and confidence
- Optimal functioning and quality of life
- Decreased caregiver stress
Familiar Routines ~YOU drive the bus!
As a memory care director, one of the most important responsibilities I have is to plan daily activities that will enhance the quality of life for my residents. Establishing a good routine takes a bit of planning. But it’s well worth it.
We all know life happens when you are making plans, so flexibility is a must. But I try to stick to routine as much as possible. As dementia progresses, it becomes necessary to adjust daily schedules to match abilities, interests, and attention span.
I always keep the basics–hygiene, medication, meals, and music–in the same time slots and plan new or adjusted activities in between.
It is common for people with dementia to recognize when a routine has been changed and be upset about it.
A 2-hour bus drive every Monday and Friday was a set-in-stone routine with my residents. Each Monday after breakfast, staff escorted residents to the waiting bus, helped put on seat belts and tuck in blankets around laps, and then off they’d go to explore the world. On Fridays, after lunch and a sing-along, we’d load up and enjoy an adventure until dinnertime.
When our long-time bus driver quit several years ago, the routine was suddenly interrupted.
For a couple of bus days residents seemed to be okay. Sure they were disappointed, but the substitute activities were fun enough to keep their minds off no bus rides.
At least that’s what me and my staff thought.
One Monday morning, while busy in my office, I heard some loud and angry talking coming from the dining room. Chair exercises to 1950s music was next on the docket, so I went out to set up chairs and peek in the dining room to see what all the commotion was about. Breakfast was just ending. But instead of heading into the exercise room, residents crowded around the outside door.
A tiny 93-year-old lady named Muriel, being pushed to the front of the queue in her wheelchair by another resident, was angrily telling a caregiver to open the door and get the hell out of the way because it was time for the bus ride.
I hurried over and told them that there was no one to drive the bus. Jesse had quit and no one had been hired to replace him yet.
There was some mumbling and complaining from the others, but Muriel firmly replied,“We’re going on a ride. Get out of the way.”
When I said there was no one who could drive the bus, she glared at me and said, “I don’t give a damn! Somebody better drive, because it’s bus ride day.”
I shook my head and told her how sorry I was. Jesse–the former bus driver they loved so much–was gone and no one else on staff that day had a CDL.
She stared at me. “YOU drive!!” The group became silent.
Yes, she had dementia. Yes, she was usually very confused, and pleasant and agreeable. But taking an important part of her routine away caused stress and agitation. Stress that spread like wildfire among the other residents.
The moments of lucid thinking and speaking she experienced to make her point with me are not uncommon when someone with dementia is angry or frustrated. Any time a person feels they are not being listened to or understood, if they suspect they are being lied to or tricked, they will rebel. And rightfully so. Residents are not children or stupid.
Although losing a driver was something we couldn’t prevent, it caused a very big problem.
And Muriel was right–it was bus day according to the long established routine.
How to Create A Daily Care Plan for Dementia Patients
My daily schedule is posted in a prominent place for residents, staff, family, and outside agency visitors–home health and hospice nurses, aides, social workers, and therapists–to view. And hopefully follow.
All of us appreciate knowing what’s going on. It’s good to know who, when, where, why and how.
So, when someone asks me “What am I supposed to do?” I answer: “Let’s check our schedule.”
Certain activities such as toileting, showering, and medication administration don’t need to be spelled out. This provides residents with a sense of dignity; their privacy and rights are being respected.
Items to include on a daily schedule:
- Meal and snack times
- Free or rest time
Knowing the personal histories of my residents helps me better plan appropriate and enjoyable activities.
To do this, first consider past and current interests–hobbies, travel, family and career, pets, likes/dislikes–and abilities–level of understanding, attention span, physical limitations, and sight and hearing issues–of each participant. Poor eyesight or hearing are common reasons among older adults for refusing to participate in social activities.
Remember these criteria can change quickly, so I’d suggest not making concrete plans for more than a couple of months.
Several months ago, assisted and encouraged by care staff, 9 of my residents put together a couple of jigsaw puzzles. Ability levels varied, as did interest, but they completed it and were quite proud when I took pictures.
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Due to declines in ability to follow through with the process of sorting pieces and fitting them together correctly and failing eyesight, a majority of residents couldn’t put a puzzle together today. It would cause too much stress and embarrassment.
Not a problem, because knowing this, I can simply plan something else they are more capable of and happier doing.
“Filler activities”, such as printed coloring pages, jokes, trivia, matching/opposites games, folding or sorting, or doll or pet therapy are excellent to have on hand for those times when an activity is not received well, is cancelled for any reason or someone requires one-on-one attention.
Currently, there are five residents in my community who are nearly blind as a result of macular degeneration. And most of them wear (or should wear) hearing aids or amplifiers.
Because of seeing and hearing limitations, they don’t like to watch a lot of TV. At least the shows that require you to follow a plot and the character’s expressions and actions. My choices are to leave TV off or find programming that suits the needs of the whole group so no one is left out.
Most often, my residents would rather sit in a circle in stuffed chairs in our cozy living room to chat and read and learn.
A few things to consider when planning activities:
- Time slot--What time of day are people most awake (plan your exercises, walks, guest performances here), what are the scheduled times for toileting and hydration breaks (plan breaks here), and if you need assistance for specific activities be sure to plan them when your staff isn’t toileting or feeding someone or on break. Also, make appointments for your performers and volunteers to stick by–although you are flexible, residents don’t like to wait for someone who is “coming soon.”
- Seating arrangements–Lucy and Myra don’t get along well, so I don’t seat them near each other. Ruby is blind, but can hear discussions and participate best when sitting closest to the activity. Arrange people where they can enjoy and participate the very best.
- Lighting and Glare from the windows–these will affect Sally’s ability to see her newspaper and read aloud to the group. The position of the portable whiteboard is important, and visual aids/words on the board work best when they’re large and legible. Turn lamps on and overhead lights off, close blinds or move chairs/whiteboard/piano/activity items to a better position–whatever is necessary.
- Distractions in the environment–TV and music should be turned off when talking and playing games. Staff/visitors may need to be reminded to speak quietly or take their conversations away from group activities. Ensure comfortable room temperature–remember older people get cold easily. Appropriate dress, along with handy lap blankets or sweaters helps keep people comfortable.
- Toileting and hydration breaks–Residents will feel more comfortable to begin each activity when their needs are met.
- Pet and Doll therapies–Who will and will not benefit/enjoy participation.
I keep an updated list of all this info handy when creating dailies.
Examples below are smaller to save space here. Notice the 15 minutes in between activities and before lunch and dinner–these are great toileting, moving to a new location and or taking medication breaks.
Daily Care Plan Template
Use your imagination to create simple, necessary and engaging routines. Celebrate each day you have together!
Please leave comments, questions, suggestions, requests, experiences below and I will get back to you very soon.
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