It is very common for us to take over many of the everyday tasks for people with dementia because we can do it faster or better. It can start in small ways - the buttons on a shirt are tiny so you offer to do them. Over time, it becomes more pervasive - no matter the size of the buttons, the person no longer attempts to button their own shirt. Rather they sit passively as someone takes over this job.
It is important to avoid this progression, even though in the short term it may seem to make sense. By taking over everyday tasks for the person:
- They are less able to do that task in the future due to lack of practice
- They don’t get the benefit of the physical and cognitive aspects associated with doing some steps or completing the entire task ie. fine motor control, range of motion or hand and eye co-ordination
- They lose their independence
- They lose their self-esteem
In the longer term, all of this will have a negative impact on the person's quality of life.
Do you recognize this scenario?
Mrs. A has started to make her bed when her daughter enters the room.
Daughter: You don’t need to do that Mom
Mrs. A: I make my bed every morning
Daughter: You don’t have to, I’ll do that for you. Mom, you must be tired, sit down and rest
This removes Mrs. A from participating in the task and can cause a loss of self-esteem. Why not simply let Mrs. A complete the job? If there is a reason that she needs help (she seems to be unsafe, for example), the daughter could walk to the far side of the bed and say
Daughter: Many hands make light work...Let’s pull the blanket up together
This gives Mrs. A a role in making the bed and helps her to feel useful.
Here is another example:
A care worker is sweeping the floor and Mr. B enters the room.
Mrs. B: Can I help?
Care Worker: No thanks, Mr. B. You don’t need to do that. It’s my job to clean up. Please sit down and rest
This can make Mr. B feel like he is incapable of doing things.
Instead, the care worker could identify a task that Mr. B can work on safely and successfully, maybe seated at a table nearby.
Care Worker: Thanks for offering, I’m almost finished here but you can keep me company. Would you like to sit at this table and help me? I could use a hand…
- wiping the table
- folding these cloths
- looking in the grocery flyer to see if tomatoes are on sale
The first step is to give back the tasks in the person’s activities of daily living that have been taken away over time. Next, give the person a role.
What is a role? A role is a function assumed or a part played by someone in a particular situation. Examples of roles include offering song books to participants at music events, changing the date on the daily schedule board in the morning or collecting the decks of cards at the end of the card games. A role doesn't have to be involved or complicated, but it is a special “job” for the person, something that they are responsible for.
Roles are particularly useful for a person who has difficulty initiating activity and as a result is bored and lonely. The role gives the person a task that they know is theirs to do. When a role becomes part of the routine for the person, it forms a new habit – supporting the person and enabling them to be more independent and increasing their self-esteem.
IN A DE MENTIA FACILITY
When creating a program look for opportunities to assign single step tasks to individuals and provide training so the task can be performed by the individual on a regular basis. Prepare the dementia care environment for the person to be successful, ask for their help, demonstrate the task and provide support as needed until they can perform the task independently.
By assigning roles to individuals in the group and repeating the program on a regular basis, each participant will become more familiar with their role and better able to do it independently. Over time, the individuals will be able to run the activity with less guidance from staff or volunteers, giving them a great sense of accomplishment. Roles include such things as:
- Distribute the cards and/or markers
- Be the “caller”
- Collect the cards and/or markers
- Ensure that all the pieces of the game are put away
- Sort the bingo markers by color
AT HOME FOR PEOPLE WITH DEMENTIA
Give the person jobs to do on a regular basis that become their responsibility. Make sure that they are able to do the job independently, providing appropriate signage or other "cueing" that might be appropriate, then show them how to do the job. Roles may include things such as:
- Emptying the garbage can on a regular basis
- Setting the table for meals
- Getting the mail from the mailbox
- Filling the pet's water dish
We don't normally think about it, but roles play an important part in all our lives. Using them appropriately for people with dementia and Alzheimer's can enrich their lives, helping them retain their self-esteem and independence.