Eleanor Feldman Barbera, Ph.D.

Greetings from Montana! I was in Billings last week conducting a training session for the Montana Department of Health. An enthusiastic group of over 100 LTC staff members from various departments joined the discussion and I came away with some excellent suggestions on how to engage residents with dementia.

The subject of how to best provide care for people with dementia without using antipsychotic medications was a particularly hot one at the conference. As well it should have been.

The topic is particularly timely given that CMS has increased its antipsychotic reduction goal from 15% (below 2011 levels) this year to 25% next year and 30% below for 2016. As G. Allen Power, MD, pointed out in his recent McKnight’s article, antipsychotic medication reduction should be preceded by educating staff members about alternatives to medication.

One important alternative is offering activities that enrich the lives of people with dementia so that they’re engaged in positive pursuits that build on remaining strengths.

Many participants in the Montana training were from the recreation/activities/life enrichment departments and they shared some great ideas they’ve successfully used to engage residents with dementia. These include:

• Off-campus trips to a variety of locations, including many of the scenic outdoor attractions in Montana. “A lot of work, but worth it!”

• A “whack-a-mole” game where residents use water pistols to shoot down plastic cups decorated as moles. A game such as this allows residents to release anger in a healthy, socially acceptable manner. (It was suggested that since I’m from New York City, we use a “whack-a-rat” version, but I think New Yorkers might enjoy “whack-a-pigeon.” Pigeons, or “flying rats,” as some people refer to them, are much more ubiquitous and annoying but get less media attention.)

• A read-aloud book club in partnership with the local library that’s drawing increasingly large numbers of residents as word spreads about the program. The stories are age-appropriate, yet conjure pleasant childhood experiences of being read to by loving parents.

• An intergenerational square-dance event that brings in square-dance callers and local high school students who each pair with a resident and dance along with them. If square dancing doesn’t appeal to your residents, this activity could be adapted for regional differences to include polkas, the electric slide, the hora, etc.

• One recreation therapist shared an individualized activity provided by the wife of a man with dementia. She brought in a large box of photos of people from her husband’s life and the two of them went through the box of photos every week, looking at the pictures. When her husband could no longer remember an individual, she removed the photo from the box, thus creating a “success experience” when he went through the photos the following week.

I confess that I’m something of a recreation department wannabe and I get excited when I hear about activities that bring zest to the lives of elders. If you’re running an innovative group for people with dementia, please share it in the Comments section below.

Eleanor Feldman Barbera, PhD, author of The Savvy Resident’s Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.