A small child gets the job done.
Billy is visiting his Great-Gramma Florence at Daisy Drive Manor today. Billy is two years old and doesn’t understand the reason for the visit. Florence has Alzheimer’s disease. She doesn’t understand the reason for the visit either.
Down another corridor of Daisy Drive Manor, caregivers are struggling with Alfred. They are struggling, to get Alfred to put his clothes on, to wash himself, even to have a drink of juice. Alfred lives at the care home because he has dementia. He doesn’t see any need for all this fussing. Alfred has been labeled as being “a mean and nasty man” to the point that caregivers groan when assigned to care for Alfred.
Little Billy doesn’t know about any of these things. He has just discovered a huge soft, bright ball that is colourfully red, white and blue, and he is mainly interested in having fun with it. Billy only wants to bounce this ball with Florence and have fun. But, Florence has no clue as to what is going on, and she is not the least bit interested in this silly game. By now, Billy has forgotten the reason for visiting his Great-Gramma. He picks up the beach ball, which is almost as big as himself, and bravely toddles over to where “Mr. Mean and Nasty” is sitting.
The staff has totally given up hope in getting Alfred’s care completed, or encouraging him to eat or drink. Billy giggles, gives the beach ball a little throw, and the ball lands right into the lap of Alfred. This of course catches Alfred by complete surprise, he looks up to see this delightful smiling toddler standing there, holding up his pudgy little arms, waiting to catch the ball back. Alfred grins, and gently tosses the ball to Billy, who decides he might just hang onto the ball for a little while. He runs about with it giggling all the time. When ready, he tosses it back to Alfred. This lovely game goes on for some time, attracting a crowd of spectators of other residents who live at Daisy Drive. They are cheering on, each time Alfred catches the ball, or Billy throws the ball. What fun!
A short time later when the game is done, one of the caregivers comes by with drinks of apple juice for everyone. Billy likes the juice and this time Alfred drinks his juice as well. This puts a smile on Alfred’s face.
The interview with Alfred’s caregiver follows:
What seem to be the main obstacles in caring for Alfred?
Just about everything. Alfred doesn’t see any reason for bathing, dressing or eating. When we try to encourage Alfred, he gets agitated with us. And he gets agitated with the other residents as well. I worry for their safety when he gets aggressive.
What do you suggest when this happens?
Alfred benefits from a quiet environment. It is best to leave him alone when he gets agitated, and then come back and try later.
What are some ways you can give Alfred some sense of control in his care?
Alfred likes to be in charge, and he likes to be involved in care and some decision making. The other day his son was helping to hang some pictures, and asked, “Dad, which wall do you want these pictures hung?” The son reported that asking Alfred what he wants gives him a sense of control.
How do you think you could improve the situation?
When Alfred gets really agitated, it is best to leave him alone, give him some time, and try again later. When I assist Alfred in care, I try to give him as many choices as possible. For example: “Which shirt would you like to wear today Alfred, the red one or the blue one?”
What’s your sense of the situation when the small child Billy was playing with Alfred?
It was amazing. Alfred seemed to forget all about himself. The child caught Alfred by complete surprise, there were no expectations from either one of them. They were just having fun.
What transformation did you witness in Alfred?
Alfred was no longer bored. He was less resistant to care. His appetite improved and he started drinking fluids with only a bit of encouragement. And that afternoon, he had a nap. All the excitement with Billy made him tired.
How does this compare with the way Alfred was in the earlier part of the day?
This spontaneous activity improved Alfred’s mood. He really enjoyed the fun and companionship of the small child. He no longer was resistant to care.
Would it be possible to have small children visit Daisy Drive Manor on a regular basis?
That’s a really good point. I’m going to speak to the activities department about that. The other residents love seeing the small children as well. There were smiles everywhere that day when Billy was visiting.
What other ideas do you have that might work for Alfred and others like him?
We could do other meaningful activities and things during the day to alleviate the boredom, such as music therapy, planting in the garden, feeding the goldfish, and pet therapy.
What support do you need to accomplish this?
All of the staff are really busy caring for the residents. However, we could ask the assistance of family members and volunteers. In fact, I know one daughter who could bring her dog to Daisy Drive to visit the residents. They love pets.
When you stand back, what sense do you get about Alfred?
Alfred’s world is shrinking. I think he is afraid; he knows he is losing control of his thoughts and feelings and this frightens him. It would be frightening for any of us.
There is an interesting similarity between small children and persons with dementia. Neither one carries around much of an ego. This explains why we often see toddlers playing side by side in the sandbox, unaware of each other’s presence. In this story Billy only wishes to play. He brings no expectations or ego to Alfred. On the other hand, Alfred finds enjoyment in this time with a small child. He is no longer feeling bossed around by the staff, as though he has been given an agenda, or bored by the inactivity at Daisy Drive Manor. Spontaneous activity with a young child alleviates this boredom.
Boredom is what we feel when our lives lack variety and spontaneity. In a nursing home, such as Daisy Drive, it is critical to create an environment where unexpected and unpredictable happenings can take place but which add value to the day’s routine. Meaningful activities are essential to human health.
There are several benefits to the caregivers and other residents as well, when small children visit the nursing home. Primarily, the person with dementia is happier (Alfred is less resistant to care, and is happy to drink the juice offered). Secondly, staff are happier, no longer having to struggle with the challenging behavior. Finally, when elderly people see small children it brings them a fresh boost of energy, helping to alleviate boredom (Alfred is smiling, thinking of times with his own children).
- allowing time for activities outside of regular care
- offering choices in care
- providing a quiet environment
- facilitating meaningful activity
What Doesn’t Work:
- forcing residents into structured activities
- social isolation of the residents
- caregivers being task-driven