​The early design of most Alzheimer’s and dementia communities focused primarily on safety, with secured doors and other devices to protect residents. In this type of setting, staff often spent their days redirecting residents, creating an environment of “sorry you can’t go there or do that.” But today’s leading providers strive for more of a “yes, you can” approach.
According to the Alzheimer’s Association, the planning of activities for individuals with Alzheimer’s should be focused on the person, activity, approach, and place. Activities should be well-planned and customized to each person based on individual interests.
Staff Role Vital
The approach that staff take is also important. Staff can help create a sense of purpose for residents through activities, as long as they are encouraging and create a comfortable and supportive environment.
A sound activity program reduces the stress and frustrations that residents may experience each day, helping to eliminate behavioral challenges such as anger, agitation, depression, and wandering. Examples include the establishment of a daily routine and consistent daily living activities such as bathing, dressing, and eating.
These can be augmented by activities that are fun, educational, and reminiscent of residents’ earlier days with their families or relate to their past occupation or hobbies—all designed to encourage and support physical and mental well-being and socialization, reducing anxiety, depression, and isolation. These can include light exercise, crafts, games, field trips, listening to music, pet therapy, computer classes, yoga, and spa treatments.
Sometimes, it’s the simple things that provide the greatest value. Trivia games, discussing events in history, and sharing family photo albums can stimulate precious memories and discussions of days gone by. Some communities will simulate the planning of a wedding, baby shower, or other events to stimulate residents’ memories and help them reconnect with their loved ones. Planning and talking about the event can be very enjoyable for the residents.
Engage The Familiar
Activities that promote cognitive skills can be helpful, but tasks should not be too difficult. And, although creating a consistent plan for all residents that includes typical activities of daily living is important, residents can respond differently based on their stage of Alzheimer’s or dementia.
As a result, flexibility and experimentation are important as staff strive to create the most effective program for each individual. According to a Johns Hopkins University white paper, reminiscence is an activity that can be particularly beneficial to the resident with dementia while also strengthening family bonds, by using objects, art, music, or other items with personal meaning to connect to the past.
“Sorting old photos or making a scrapbook may trigger shared memories from your loved one’s youth or early adulthood, which can add to a family’s sense of history,” the paper says. “An emotion-linked aroma like that of freshly baked cookies may encourage the individual to talk about his or her childhood.”
Families are an important source of information in program planning and can be invaluable in suggesting activities that will help their loves ones reconnect with their memories. Asking residents’ families to complete a biographical questionnaire or participate in an interview with facility staff can be extremely helpful.
Interviewing residents can be even more valuable. These discussions should focus primarily on their past, as that is what they will most easily remember. It’s important to ask residents about their families, occupations, hobbies, and important events in their life.
The key is not to press for answers but to let the discussions develop naturally. When an interview is conducted correctly, staff may be surprised by the touching stories residents tell them.
After successful interviews with residents and family members, staff members are better prepared to customize activity programs to residents’ interests. For example, if a resident has always loved painting, then staff could start a painting class or provide the resident with art supplies and a place to paint.
In addition, family members should be encouraged to take part in activities and events (See Provider, November 2010 for more information about family involvement). This can be therapeutic not just for the residents but for the family members as well. However, staff should caution the family to have realistic expectations about their loved ones’ abilities and encourage participation without being critical.
The most important aspect is focusing on the enjoyment of the activity, not the specific achievement.
Staff Training
Specialized training will be of great value in helping staff encourage residents to become more involved with activities. Training should include an understanding of the aging process, proper Alzheimer’s and dementia care, and the behavioral and social needs of the residents.
To avoid agitation among residents, staff should avoid correcting them if they answer questions incorrectly. For example, some facilities’ activity programs have a morning activity that starts with, “Today is Monday, July 26, 2010,” followed by a discussion of current events and events in history.
If a resident insists that the date is Tuesday, July 26, 1965, staff should move on without correcting the person. The key is for staff to be trained to live in the residents’ worlds and not frustrate them by insisting that they are wrong. 
The design and features of memory care communities are constantly evolving. As management and staff listen and observe the needs of their residents and the expectations of their caregivers, they can adjust their programs and features accordingly.
The Physical Setup
An interior design scheme that creates the perception of a barrier-free environment, for example, offers operators and activities professionals a place for residents to wander. A purposeful design that enables residents to feel like they can explore freely without barriers, while still maintaining a safe, secure community, can have a positive impact on residents.
Hallways may be designed in a complete circle or square so residents feel they can go where they please and never run into a dead end.
Life skills “stations” are a more recent development in memory care programs. These enable residents to find comfort in practicing daily routines and life skills that were previously part of their everyday lives, such as folding laundry, hobby work, or gardening.
In addition, some facilities have added computer-based, memory-stimulating programs such as Dakim Brain Fitness, which shows evidence of helping residents with Alzheimer’s and dementia remain more active through cognitive stimulation. As new generations of tech-savvy seniors enter senior living communities, even more technological advances will be required to meet their needs and expectations.
Day Care Programs
Other new approaches support family caregivers trying to juggle multiple responsibilities as well as seniors who are not quite ready for full-time residency.
Senior day programs make it possible for non-resident seniors to spend four, eight, or 12 hours at the community to enjoy social opportunities, games, and a wide range of activities, while avoiding the loneliness and isolation created when the primary caregiver is at work.
Similarly, some communities have begun to provide professional overnight care to offer a respite for weary caregivers. A “dusk-to-dawn” program offers overnight accommodations, normally from 7:00 p.m. to 7:00 a.m., including holidays, for seniors with sleep disturbances, confusion, Alzheimer’s, or wandering habits.
For those residents who have difficulty sleeping, staff members provide therapeutic activities to help them relax and eventually fall asleep.
No matter what innovations in memory care programming and technology may be on the horizon, the best providers will continue to create an environment that allows residents to explore and enjoy life. Creating a true home where residents with Alzheimer’s and dementia can walk, explore, and enjoy their time in a comfortable, barrier-free environment sets certain communities apart. 
Click HERE for more information about what other providers are doing to enhance activities for residents with Alzheimer's and related dementias.
John Moschner is director of operations for Senior Management Advisors, www.seniormanagementadvisors.com, an operator of full-service independent living, assisted living, and Alzheimer’s care residential communities in Florida and Georgia. Contact Moschner at jmoschner@smaservices.net. Marki Greer is memory care program director for The Cottage at Plantation South Dunwoody, a senior living and Alzheimer’s care residential community in Dunwoody, Ga.