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Jewell Homer, our Life Enrichment Manager, gave feedback.
Implementation Date: March 26, 2022
Feedback Received: April 1, 2022
Underlining Goal: Used as a one-on-one, the goal of the activity is to target agitation and anxiety, specifically, during the sundowning period of dementia (although, it can be used at other times) when such behavior becomes disruptive to other residents in the community.
There truly is never a dull moment in my memory care community in the late afternoon and early evening. Although some of the behaviors that transpire provide entertaining lunch stories the next day for my office mates, the rise in falls during this time is serious. Most people familiar with dementia will know this period is referred to as the sundowning time, and it is brutal at times in our community. However, depending on various factors, disruptive outbursts also occur at other times in the day. Regardless of when, behavior issues and falls put a strain on staff, nursing and activity staff, as well as the other residents. Nursing staff often must investigate what might be causing the high anxiety level in a resident. There is often an underlining message or meaning.
One cause might be the need to get clean clothes on if the resident has soiled themselves due to incontinency. For the activity staff member leading group activities, it is very hard to engage the people in the group when one of their neighbors is escalating. Not to mention it being hard to hear, the other residents comfort level is affected, and they start to escalate too, demanding to know ‘is anyone going to help her?’ and ‘what is she screaming about?’. The frequency of these situations warranted something be done to help such resident come to a calmer level and staff needed more tools to facilitate this. That is why, after investigating and consulting staff, I decided to offer the music devices as an intervention method and part of my service-learning project.
What I did for the devices was repurpose multiple Ipod Minis that had been used previously in a more systematic way for use for particular residents, while also preparing some based on genre/era for any resident that might benefit. I was able to use my knowledge of 1940s, 1950s, and later generation music to categorize the Ipod content. I have already had the opportunity to test the devices on several residents who needed them. One woman was shouting out in a group setting, and I walked with her back to her room and gave her the device I thought she would enjoy the most. I knew she liked Elvis Presely, so I gave her the one that I knew had a lot of his music on it. Once I helped her get the headphones on her, in a very short time, she started singing and smiling, forgetting, briefly, whatever she had gotten worked up about. She said, “John Martin, you always take care of me.” “You know me.” She started talking about how much she loved it.
While I would still end up listening to her confused accounts of the morning, I successfully was able to encourage her to enjoy the music as well. With this work on implementing this component of my project, I have definitely learned about the importance of personal choice as a means of diversity, very crucial to effective dementia care, and also more about multiple means of reaching residents with dementia with hearing loss, aphasia, and other limitations.
After I formally implemented the devices and told the staff about them in training, I asked the larger Life Enrichment Manager, Jewell Homer, if she could review their effectiveness. She agreed and mentioned trying them on a resident who had been discussed in the previous morning’s standup as having decreased agitation. Staff had ruled out medication or a urinary tract infection as reasons for the agitation. Noticing the resident was agitated the following afternoon, I called Jewell down and she saw firsthand the devices’ power. Although at first it seemed like the resident was not going to be willing to keep on the headphones, after five minutes, she kept them on and starting singing and patting her lap to the music. By dinner time, the resident was calm enough to head down to eat. Jewell’s only suggestion was that I provide more detailed information on the playlists in the binder with the sign-out form.
My biggest feedback for myself is to continue to work on communication with nursing staff on the floor, asking their opinions and feedback on my music devices and larger service-learning project. This is uncomfortable for me because of how disgruntled they are with their jobs. I need to not be too shy to give them direct communication as well. In my new management role of leading them to do activities, this is extremely important for my success. I feel like they are testing my fear level and seeing if I will tip-toe around them as they try and avoid doing the new things I am asking them, and I must demonstrate confidence and foreknowledge, so they will follow my lead. This applies with implementing these devices too.
The next steps to my service-learning project will be developing more elevated movement/performance opportunities for residents and continuing to improve the live entertainment aspect on the floor, as the budget allows.
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