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Teaching Them or Reaching Them? Why You May Not Be Getting Through

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By Susan Saldibar

It’s unfortunate that one of the stereotypical images many adult children have of senior living communities is that of an older resident propped up in a wheelchair just sitting in front of a TV for hours. Although it depends on a resident’s cognitive level, watching TV for an extended period is neither beneficial nor cognitively stimulating. The truth is that some residents at lower cognitive levels can’t even process what is happening on the TV show. The adult child observing this during a tour may leave with one thought: “I’m not putting my mom here.”

It is an image that Angela Edney, Occupational Therapist and National Clinical Director with Aegis Therapies, a Senior Housing Forum partner, would love to eliminate. “Residents with cognitive skills below a certain level simply cannot process something like television. It should not be considered an activity for them,” says Angela. She knows, as do a growing number of therapists who work with senior residents with cognitive impairment, that we now have the knowledge and the programs to interact more meaningfully, regardless of the level of impairment. And it has nothing to do with a TV set.

Failure-free programming is about encouraging, not testing.

Angela, along with Susan Almon-Matangos, Speech-Language Pathologist and National Clinical Director for Aegis Therapies, are dedicated to changing the way we approach and interact with individuals with cognitive disorders. “It’s a combination of getting the assessment correct, determining the cognitive level, matching it to the right therapeutic program and using a ‘failure free’ approach that optimizes performance, regardless of the cognitive level,” says Susan. And, it’s important to select activities that fit current and previous interests, hobbies, and the former occupation of the resident.

Failure-free therapy is not a new concept. It’s used most frequently in memory care, primarily for patients with Alzheimer’s disease where it has had considerable success. Now therapy providers, such as Aegis Therapies, are collaborating with facility staff, family members, and volunteers to use it in senior living communities as an effective agent to stimulate more engagement with cognitively impaired seniors at all levels. Here is an example:

  1. Without failure-free technique:  The therapist Karen shows Mary, an 88-year-old resident with Alzheimer’s disease, a series of cards with images. She asks Mary what each image is. The first is an image of an orange. Mary says, “Car.” Karen says, “No, that’s not a car. Let’s try again.” Mary again says, “Car.” Karen says, “Okay, let’s try the next one.”

  2. With failure-free technique:  When Mary says “Car,” Karen might say, “Hmm. Do you like cars?” or “What kind of car?” or “Do you remember a car you had?” In that way, the car becomes a springboard for discussion instead of a test of mental acuity. The therapist encourages the resident to explore, seizing the fragile thread of engagement and building upon it.

“Therapists can use the Allen Cognitive Disability Model to determine the cognitive level of each resident. Then, they, along with the activities staff and family members, can partner together to come up with activities that facilitate active participation and maintain brain health,” says Angela.  

Aegis Therapies utilizes a range of failure-free programs which include sensory motor stimulation, Brain Storms, Montessori-based activities, Memory Magic, GreyMatters app, It’s Never Too Late, journaling, and memory books/wallets. And, they are not restricted to use by therapists only. Aegis Therapies assist facility staff in implementing failure-free programming based on the patient’s strengths, cognitive level, and interests. “Having everyone involved sets up the programs for greater resident success,” says Susan. And the results can be impressive:

  • Greater participation rates

  • Longer periods of engagement

  • Stimulation of language skills, when present

Happier residents, happier families, happier therapists, and happier staff.

Longer term effects can be even more dramatic. Here are some of them:

  • Reduction of resident altercations

  • Reduction of negative behaviors

  • Reduction of required psychotropic medications due to behavior issues

  • Increased self-esteem

  • Increased family satisfaction with outcomes

  • Increased staff awareness of resident attributes

The last two can have a lasting positive effect on both families and the entire staff.

“Think about it,” says Angela. “When therapy and caregiving constantly take the form of teacher/student, it can quickly become frustrating and demoralizing. Not just for the resident, but also for the therapist and caregiver.”

Changing the model from “getting answers right” to stimulating and encouraging engagement creates more interactions and greater participation. And, of course, better results. Using failure-free programming matched to each resident’s determined cognitive level stimulates residents to function at their highest cognitive ability.  

Aegis Therapies has experts in using failure-free techniques in conjunction with the Allen Cognitive Levels to design unique and stimulating activities that optimize response and engagement for those individuals with cognitive impairment. You can learn more about their programs here.

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