Social Service Designee / Activities Director
Chapter 5

Dementia and Activities

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Dementia Care in Long-Term Care Facilities: A Person-Centered Approach

Understanding Dementia

Dementia is not a single disease but a general term for the impaired ability to remember, think, or make decisions that interferes with everyday activities. Alzheimer's disease is the most common type, but others include vascular dementia, Lewy body dementia, and frontotemporal dementia. Dementia is progressive, meaning symptoms worsen over time. Key symptoms include memory loss, confusion, poor judgment, mood changes, and communication difficulties.

According to the CDC, more than 5 million people in the United States live with dementia. In long-term care, understanding the individual’s unique history, needs, and abilities is critical for providing respectful and effective care.

The Role of the Social Service Designee (SSD) and Activities Director (AD)

  • SSD: Coordinates psychosocial support, advocates for resident rights, facilitates emotional well-being, and supports families.
  • AD: Plans and implements individualized activities to promote engagement, cognition, and quality of life through meaningful, person-centered programs.

Teepa Snow’s Positive Approach® to Care (PAC)

Teepa Snow is a leading educator in dementia care, known for her Positive Approach® to Care (PAC). Her methods emphasize understanding the progression of dementia and adapting our care to meet individuals where they are.

Key Concepts of PAC:

  • Use positive physical approach™: Approach from the front, offer a handshake, get at eye level.
  • Adjust communication style: Speak slowly, use short phrases, and smile. Focus on connection over correction.
  • Recognize different dementia stages using the “GEMS™” model: Sapphire, Diamond, Emerald, Amber, Ruby, and Pearl – each representing a stage with unique abilities and needs.
  • Offer activities that match retained abilities to reduce frustration and enhance dignity.

For more on Teepa Snow’s work, visit her official site: https://teepasnow.com/

Example: Teepa Snow Activity Samples

  • Hand-under-Hand® Technique: A method of guiding movement safely and respectfully by placing your hand under the resident’s hand for activities like brushing hair, drawing, or puzzles.
  • Music and Rhythm: Using familiar songs to activate memory and mood; even non-verbal residents may tap along or hum.
  • Sorting Tasks: Folding towels, matching socks, or color sorting offers sensory stimulation and a sense of purpose.

Meaningful Activities for Residents with Dementia

  • Reminiscence Boxes: Create themed boxes with items from past eras—music, photos, household items—that can spark memories and conversation.
  • Pet Therapy (real or robotic): Animals provide comfort, routine, and emotional stimulation.
  • Nature Walks & Garden Time: Supervised outdoor activities can reduce agitation and increase mood stability.
  • Modified Games: Use large-piece puzzles, simplified bingo, or ball tosses tailored to the resident’s abilities.

Realistic Scenarios and PAC Response Guidance

Scenario 1: Resident is Accusing Staff of Theft

Situation: A resident with moderate dementia believes their personal item (a wallet) has been stolen by staff and is visibly agitated.

Positive Response:

  • Use a calm, reassuring tone. Approach slowly and at eye level.
  • Validate their concern without correcting: “That must be really upsetting. Let’s look around together and see if we can find it.”
  • Engage them in a “search” activity which redirects the energy into problem-solving and helps de-escalate the situation.

Scenario 2: Resident Becomes Aggressive During Bathing

Situation: A resident with dementia resists bathing and begins shouting and striking out.

Positive Response:

  • Pause and give space. Return later with a calm approach.
  • Use the Hand-under-Hand® technique to offer guidance while maintaining control.
  • Offer choices: “Would you like to wash your hands first, or your face?” Providing perceived control helps reduce fear.
  • Play calming music or use lavender aromatherapy to create a relaxing environment.

Scenario 3: Resident Wandering or Attempting to “Go Home”

Situation: The resident is at the door, saying they need to pick up their kids or go home for dinner.

Positive Response:

  • Don’t argue or remind them they live in a facility.
  • Use redirection: “Before you go, can you help me with something?”
  • Engage them in a calming or meaningful task that feels purposeful, such as “mail sorting” or watering plants.
  • Later, guide them toward a relaxing area or scheduled activity.

Key Takeaways for SSDs and ADs

  • Focus on remaining strengths, not lost abilities.
  • Engagement should be sensory-rich and emotionally affirming.
  • Use the GEM™ model to adapt communication and activities to the person’s stage of dementia.
  • Documentation of behavioral triggers and successful interventions can improve consistency of care.
  • Build trust with families through education and support related to dementia behaviors.

Additional Resources

Conclusion

Dementia care is both an art and a science. By applying Teepa Snow’s Positive Approach® to Care, Social Service Designees and Activities Directors can foster dignity, engagement, and joy in every stage of dementia. Your efforts bring light into what can otherwise be a confusing and isolating experience for residents.