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Programming for Deaf and Visually Impaired Elderly Vision and hearing loss are particularly prominent in the older adult population. The most common senses that are “lost” are sight and sound. These senses are specifically controlled by the visual and auditory cortex, respectively. It is possible to lose the senses of taste, smell, and touch, but these are much less common. While vision loss can have a profound negative impact on a person's perception of the world, hearing loss diminishes a person's mode of communication and can lead to social isolation. Leisure pursuits for the deaf and visually impaired aging are paramount to preventing feelings of isolation and lack of independence brought on by physical deficits. Visual and auditory loss can make everyday activities more difficult and significantly contributes to the sense of exclusion from society. Adapted leisure opportunities offer those moments of inclusion that seem to be without disabilities and significantly improves overall quality of life. Compensating for Sensory Loss Studies conclude that when you no longer need to use that part of the brain to process images (for example), more energy and processing power is shifted to the senses of hearing and touch. The brain automatically compensates to improve your ability to move through the world. Such is the case for blind individuals who often use a technique called “clicking”, in which they make small clicking sounds and then interpret the echo they hear to determine the environment around them. This echolocation technique can even allow people to determine specific objects and walk normally without bumping into walls or obstacles. Look for senses that remain intact to help your resident navigate and relate to his/her environment. Sense of Touch: Using the sense of touch feel the shape, surface texture, weight and size combined to identify the unknown object which cannot be seen. Sense of Taste: Offer a variety of food items and ask what ingredients can be identified. Often a specific food will be remembered from childhood days – encourage those memories. Sense of Smell: A particular fragrance can also evoke memories. Perhaps apple or pumpkin pie made with grandma’s love and care. A fragrance distinct to flowers, candles, colognes or spices can be identified and all may elicit memories from days past. The “Golden Rule”: Focus on the senses that still remain to lead the way to programming success. Tapping into the remaining senses helps to keep minds active by doing things that require inquisitive thought and intellectual problem solving strategies. Stimulating and success oriented programming allows residents to feel useful again, despite their physical disadvantages. The Hearing Impaired The hearing-impaired elderly are often at risk of having social challenges and not being able to fit in with mainstream groups. This is largely because “communication” is primarily language-based. But there are many available types of leisure pursuits for the hearing impaired that help foster communication and contribute to a feeling of community. A little ingenuity will go a long way towards the discovery of hearing impaired leisure pursuits. These include: Computer Skills: Computer savvy skills are integral for keeping up with those that are not close by. Studies have shown that older adult with computer skills were less likely to experience mild cognitive decline as they aged. Art: From drawing and coloring to painting and weaving, art promotes creativity and expression. Hearing-impaired adults can work with clay and ceramics, as well as all types of sewing activities. Bingo: Options for the hearing impaired are available. Such as large calling cards with a yellow background that can be held up for those who can't hear the numbers being called. Video Games: Video games are no longer just for children. Studies revealed that video games improve cognitive reflex and help to sustain cognitive processing for adults over 60 years of age. Board Games: Board games and card games are suitable for hearing impaired seniors. Generally hearing impaired with no visual loss can read game board “how to play rules”. Sports: Other options for those who are hearing impaired with good mobility include playing pool, foosball, bocce ball, and shuffleboard. Headset: If the resident is not completely deaf, a good set of headphones can make listening to music or audio books enjoyable again. The Visually Impaired Age-related vision loss is common as we grow older and can often be corrected with glasses, eye drops, surgery and other medications. Some eye conditions however, such as macular degeneration, glaucoma, cataracts and other diseases may evolve into blindness or partial-blindness presenting considerable challenges to those affected. There are many game products are available in adaptive versions for blind seniors. https://www.maxiaids.com/board-games Some of these games include: Monopoly: All of the properties and spaces are in large type and accompanied by braille. All of the cards are in braille and large print. The dice and money notes are in braille as well. Checkers: Each space and piece is marked in a way that the blind and visually impaired can enjoy this game just as much as sighted people. Bonus points for knowledge of braille not being required to play. Chess: There are bumps on the white pieces to differentiate them from the black ones and the black spaces on the board are slightly raised. Scrabble: There is an overlay grid that prevents shifting pieces, as well as braille markings on said pieces. Here are a few topic oriented books that may be of particular interest to the visually impaired: Touching the Rock: An Experience of Blindness - by John M. Hull Autobiography; instructive and profoundly touching. The Country of the Blind - by H. G. Wells A mountaineer named Nunez slips and falls into a valley cut-off from the rest of the world where inhabitants are all blind. If You Could See what I Hear - by Tom Sullivan Blind from birth, Tom tells you stories that will make you laugh out loud. Stars Come Out Within - by Jean Little Autobiography of Canadian children's author Jean Little, blind since birth. A Dolphin in the Bay - by Diana Noonan A young boy's relationship with a dolphin helps him overcome his fears. Tips for Communicating with Visually Impaired People In general, observe first -then ask if your resident requires help - ask for instructions on how they want you to help. Don't raise your voice – or be excessively louder than normal volume. Use normal language- there's no need to avoid words such as "look", "see". Don't point or say 'over there'- be specific; "It is on the bed to your left". Identify yourself as you enter- "Hi Mary, it's Linda". It is acceptable to describe colors, patterns and shapes. Never patronize- do not assume that you have to make things 'easy' for them. When walking, describe the terrain- number of steps, texture of walking surface (carpet, grass . . .). Always respect the person's individuality, dignity and independence. What Is Available? Reach out to clubs and organizations for those who are deaf to encourage individuals who are deaf-blind to participate in social activities to reduce isolation. YMCAs/YWCAs Church leagues/synagogue leagues Community leagues Local associations for the blind Ski for Light - https://www.sfl.org/ University- or college-affiliated programs Local deaf club Lastly, but most importantly- Remember that your program must be “interest based” and “person centered”. You will always have a successful program when you ask your residents to guide you. Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org ENROLL Now Our MEPAP 1&2 Courses 2 Course Formats www.ActivityDirector.org - 1.888.238.0444 Structured Class (16 Weeks) - Begins the First Tuesday of each Month ... Starts Tuesday October 1st ... Self Paced Class (13 Weeks-1 Year) - Enroll and Begin Anytime Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. We envision facilities that feel like homes and that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe the exchange of education and wisdom between the most talented teachers and passionate students is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network. Copyright © 2019 Activity Directors Network, LLC All rights reserved. Our mailing address is: 2010 US HWY 190 W Ste 120 Livingston, Texas 77351

Resolving Resident Conflict – Combative Behavior [Part I] Residents in long-term care may experience chronic cognitive impairment or confusion which may manifest into combative behavior. It is imperative to recognize that a resident’s combativeness could be the residents’ effort to communicate need for care. Healthcare professionals must always be mindful that the behavior is not personal in nature; as in emotional feelings of dislike or misplaced, unwarranted fear. Communication issues can occur when a resident has limited (receptive) abilities that fail to translate to a normal dialog appropriately. Reduced information processing speed and capacity can be attributed to problems with comprehension. Even simplified sentences can put a strain on residents’ brain processing resources to assimilate more information than he/she is capable of understanding. Aging adults may also be (expressively) compromised with less ability to form comprehensible sentence structures, largely due to declining working memory capacity. The healthcare professionals’ ability to assess, understand and take action to prevent combative behavior “before it occurs” will significantly reduce communication breakdowns and help the resident to be more fully accepting of his/her personal care. What is Combative Behavior? Any physically aggressive act that causes or is intended to cause hurt or damage to another person or object and even to self may be an indicator of combative behavior. Some types typically encountered in long-term care may include: Physical acts- punches, fighting, kicks to endanger others Resisting care- aggressively hampering efforts to accomplish ADL’s (bathing or dressing) Verbal aggression- arguing, cursing, threatening or accusing Catastrophic reaction- sudden mood swings, outbursts, or lack of self-control What may cause combative behavior? Psycho-social: Resident feels threatened by life changes and frustrated at a perceived loss of control. Unable to communicate adequately, a resident may misinterpret efforts to provide care or may be unable to control his/her feelings, or may withdraw from interaction due to conflicting thought processing. Environmental: Room lighting that is either too bright or too dim, blaring radios, television, intrusive central facility intercom announcements, clutter or constant staff traffic distractions, unanticipated room changes or routine changes, lack of consideration for how the resident likes his/her belongings arranged or reorganizing without resident involvement. Other areas that should be respected include the halls, nursing stations, dining rooms and any and all locations residents can easily navigate as part of their daily living. Dementia: A declining brain disorder affecting both personality and thought processing. It is an organic brain disease caused by a number of illnesses (including Alzheimer’s) that is considered progressive in which the afflicted individual begins to lose touch with reality and is unable to understand the world they have found themselves surrounded by. Unskilled care-giving: Staff unknowingly contribute to behavior issues when they take a position of authority, display gestures that startle or frighten, administer care roughly or in hurried fashion, display impatience, or speak in loud or demeaning conversation. Multi-faceted underlying illness: A comprehensive assessment must be done to determine the probability of other underlying medical illnesses that further contributing to aggressive behavior; and may include non-organic external elements such as alcohol or drugs abuse, medication interactions and lack of sleep. Interventions – The 'Never List' for Resident Agitation 101 NEVER enter a residents’ room in numbers of two or more staff members as it may put the resident in defensive mode. If safety is a concern, ask a supporting staff member to wait outside the room NEVER wear a stethoscope, hanging earrings or shiny jewelry around your neck. NEVER ask the resident to do more than two or more tasks at once; keep your instructions to one-step at a time. NEVER approach a resident quietly by surprise. Allow him/her to see you coming. NEVER forget to introduce yourself every time with a smile; even when your resident knows you. NEVER display your emotions through body posture; emotions are easily expressed non-verbally in body language. NEVER speak to your resident while competing with multiple stimulus such as a radio, television or music. NEVER take action to do something before explaining what you are about to do it in simple terms; ascertain that he/she understands. NEVER approach a wheelchair bound resident face on for your own safety. NEVER underestimate that the resident may also be just as confused and surprised by his/her own behavior as you are. NEVER correct or point out word usage errors expressed by your resident; use visual cues at this time Never, never instruct or state limits when dealing with an agitated resident. Be particularly mindful of certain command statements in the heat of the moment as they only tend to escalate the level of resident transgression: NO – STOP THAT DON’T DO THIS DON’T DO THAT PUT IT DOWN NOW LEAVE IT ALONE STOP GETTING UP While it is impossible to anticipate how one resident may interact with another resident and or staff member, each facility must be prepared to handle difficult interpersonal or behavioral issues. The goal is to prevent escalation from resulting into physical altercations. Behavior modification techniques and strategies must be a standard in-service education for all staff members to develop expertise in dealing with conflict and/ or other related issues involving safety and well being. When aggressive behavior is mismanaged, it affects families, staff and disrupts other residents. But when handled in a respectful, positive way, conflict can be quickly dissipated and restore peaceful harmony within the community. QUIZ 1. TRUE or FALSE A resident’s combative behavior is often a sign that he or she does not like you or is afraid of you. 2. TRUE or FALSE Resisting care, verbal aggression, fighting and catastrophic reactions are common forms of combative behavior. 3. TRUE or FALSE Dementia, the type seen in organic brain diseases such as Alzheimer’s, is the only true medical cause of combative behavior. 4. TRUE or FALSE Combative behavior often occurs when a resident is unable to communicate adequately, misinterprets efforts to provide care or is unable to control feelings. 5. TRUE or FALSE Loud television, speakers or people coming and going, and very bright light do not really trigger combative behavior. 6. TRUE or FALSE Unanticipated room or routine changes can trigger combative behavior. (ANSWERS: T, F, T, F, T, F) Next Week: Part II – Discover Patterns That Lead to Outbursts Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org Join the Activity Consultants Help Desk or Share the Link with a Friend.. BUY Now Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. We envision facilities that feel like homes and that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe the exchange of education and wisdom between the most talented teachers and passionate students is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network. Copyright © 2019 Activity Directors Network, LLC All rights reserved. Our mailing address is: 2010 US HWY 190 W Ste 120 Livingston, Texas 77351

Activity Directors Network invites you to share the award-winning documentary Age of Champions with your community. Age of Champions is the story of five competitors who sprint, leap, and swim for gold at the National Senior Olympics. You’ll meet a 100-year-old tennis champion, 86-year-old pole vaulter, and rough-and-tumble basketball grandmothers as they triumph over the limitations of age. Sharing the film with your community is a powerful way to inspire the adults you serve, engage your staff, and support your organization’s mission. More than 700 senior residences are already using the film to enrich their programs and promote the message of lifelong health and wellness. Sign up now to purchase the Age of Champions Screening Kit, which includes the DVD, discussion guide, promotional materials, and fun giveaways for your audience. Enter the discount code “activity” and save 10% on your order.