When it comes to supporting people living with dementia in New Zealand today, day care centres play an important role. Their aim is usually twofold: to provide an engaging environment for visitors and to offer respite for their partners and/or full time care givers. This article focuses on the first aim: providing a stimulating environment.
What do people with dementia need?
People experiencing cognitive decline (dementia) tend to withdraw. They experience the world around them differently from others, and as a result are cautious to interact with people around them. They can become socially isolated which negatively affects their physical and mental health and general well-being. Day-care centres aim to reduce the impact of cognitive decline by providing social interaction, physical exercise and mental engagement. Most centres offer activities such as games, music, quizzes, storytelling, physical exercise, creative expression, eating together and the like.
The truth is, this model does not work for every person experiencing cognitive decline. People living with dementia want to live a purposeful life just like the rest of us which will vary from person to person. Some do like games or having a conversation, others prefer to be outside and be involved with day to day things as much as they are still able to.
Home4All wants to provide a model focusing on **empowering** people living with dementia. A recent study (1) identified four aspects important to empower people with cognitive decline / dementia:
- Having a sense of personal identity
- Having a sense of choice and control
- Having a sense of usefulness and being needed
- Retaining a sense of worth
Obviously these four aspects of empowerment can only be addressed taking into consideration the stage of cognitive decline the person is in.
At Home4All, our aim is to empower our visitors (people experiencing mild to moderate dementia) to use their lifelong skills, by engaging them in day-to-day activities they enjoy and can carry out with (or without) support from others. The ‘farm type’ environment consists of a large property (~200m2) set in a residential area with lawns, a flower garden, vegetable garden, large workshop (60 m2), several chickens and a dog. We support 8-10 people in their dementia journey and aim to give them the best experience of the week.
Ian – a problem solver, proud of his successes
Knowing and acknowledging who people are, empowers them to be confident in their identity. One of our visitors, Ian, is a born problem solver. Talk about a problem and he will immediately come up with solutions. For example, when we remove the nuts and bolts from the crossbars some of those are very hard to undo. Ian will always find a way to get it done and is ever so proud when he succeeds. A couple of these moments during the day let him go home with a smile on his face, telling us he had a good day.
Offering a choice is often challenging for people living with dementia. They do not want to make mistakes, as this is what they experience often in the early stage of cognitive decline. Presenting them with too many options creates confusion – it helps to narrow things down to a few more manageable choices for the person to choose from.
Kaye – choosing activities with happy memories
Why people make certain choices is not always clear from the get-go, but you might discover the reason along the way. One of our visitors, Kaye, is naturally cautious about making a choice if different options are presented. Recently I asked him to choose from a range of activities, one of them was digging a section of the vegetable plot. He is an 82-year-old fit gentleman and to my surprise he chose the digging. Digging is physically exerting, so we stayed close to make sure he was alright. After an hour he was still digging and appeared to enjoy himself. When I asked him why he enjoyed the digging (as he had an office job all his life), he mentioned it brought back happy memories of working as a child with his dad in the vegetable garden.
Having a sense of usefulness and being needed empowers people living with dementia. Like us, people living with dementia want to be useful to the people around them. Excluding them from activities that lie within their ability does not benefit their wellbeing. Especially normal day to day activities like laying the table and being involved in the washing up are a great way to make them experience reciprocity.
Chris* – an eye for detail and a sense of achievement
Activities that preserve their skills and talents is another great way to achieve this. Sometimes we need to encourage them, as they “forget” they still have those skills and talents. One of our visitors, an emeritus academic, took great satisfaction in ordering materials for the workshop like screws and bolts etc. This reflected his academic process in the past of ordering and analysing data and he applied his eye for detail to make sure the materials were exactly what was needed. He was very pleased to see everything neatly organised in one of the storage boxes – this gave him a great sense of achievement.
When it comes to the theme of retaining a sense of self-worth this is often challenged by their level of insecurity. People around them tend to take over and make decisions for those living with dementia. This can be frustrating and undermine their confidence.
Dave – feels valued for his mechanical skills
One of our visitors, Dave, was a mechanic all his life and loves to mess around with appliances and machines. When Dave comes to Home4All we try to have an appliance for him that he can take apart. While doing this, we notice that old skills and insights surface like asking for a special tool to do the job, a tool we had never even heard of. At the end we thank him for doing such a good job and confirm his expertise was needed to get the job done. When he goes home in the afternoon, he mentions he’s had a perfect day; although he does not remember exactly what he has done, he does remember feeling valued.
There are many more examples that we can give of our visitors responding positively to the environment we place them in. At Home4All we aim to create a natural “farm” type environment which provides a variety of activities visitors can choose from. The environment challenges them and provides them with self-worth and dignity. We only offer support when they need it and, miraculously, those occasions are far less than we expect. We know their dementia cannot be reversed but we can increase the level of satisfaction, self-worth and well-being of our visitors by empowering them.
Literature
- van Corven CTM, Bielderman A, Wijnen M, Leontjevas R, Lucassen PLBJ, Graff MJL, Gerritsen DL. Defining empowerment for older people living with dementia from multiple perspectives: A qualitative study. Int J Nurs Stud. 2021 Feb;114:103823. doi: 10.1016/j.ijnurstu.2020.103823. Epub 2020 Nov 10. PMID: 33253930.
* Names have been changed to protect people’s privacy.
