Dementia Journal
September 2015



Teepa is an advocate for those living with dementia and has made it her personal mission to help families and professionals better understand how it feels to be living with dementia related challenges and change. Her company, Positive Approach, LLC was founded in 2005 and offers education to family and professional care partners all over the world. Her goal? Making a mind at a time.  

Balancing the Day Through Dining stone_balance_sand.jpg
by Teepa Snow, MS, OTR/L, FAOTA

Maintaining a healthy life balance helps all human beings manage stress and optimize a positive sense of self and control. Anyone who has ever worked an 80 hour week, been without sleep for days on end, or been unemployed for an extended period of time is aware of the negative impact that an unbalanced life has on a person. Typically, changes in patterns of eating and drinking are early indicators of changing stress levels, physical health, mental health, and cognitive well-being. Over-indulging or under-consuming, changes in types of foods and drinks chosen, as well as increases or decreases in frequency of intake can be hallmarks of many significant issues with well-being and health. Depression and anxiety both impact appetite and desire for food and drink. At the same time, what we eat and drink, when we do it, and how much we take in all influence our stress levels, sleep patterns, and ability to effectively use our brains and bodies to live our lives well! So before we talk about meals and dining, let's talk a little about how we could, and possibly should be filling our day. The better we balance everything, the less we need to rely on "comfort" eating, "fast-food", "caffeine pick-me-ups", and other artificial means to "get through the day".
There are essentially four categories that describe a person's Use of Time to fill a 24 hour period. A balance among these activities has been shown to promote a sense of well being and reduce stress and distress. Recognizing the value of meals and healthy eating and hydration practices, quality of life will often increase and can be determined by a balance of activity in these four areas.
  • Work Time involves activities, actions and interactions that make a person feel valued and appreciated for their skills and abilities. These are a person's work in the world and how they spend their time supervising or helping others. It includes completing jobs or tasks that are (or were) part of a job or volunteer role or chosen profession in someone's life.
  • Self-Care Time involves activities, actions and interactions done to meet our own personal physical and environmental needs. These activities, for example, might include time spent bathing, dressing, going to the bathroom, shopping, planning, cooking or eating meals, managing our health needs, vitamins and medicines, doctor or dentist visits, managing finances or paying bills, and other personal chores such as house cleaning, laundry dishes, yard work that keep our personal health and fitness at our preferred level.
  • Leisure Time involves activities, actions and interactions chosen just because we want to do them. They give us pleasure or joy! This use of time is spent on things we simply enjoy. They may be active or passive, solitary or involve a group of like-minded individuals. They often include spending time with others socializing, visiting, and might include singing, playing an instrument, games, puzzles, walking, exercising, dancing, gardening, crafts, art, music, photography, reading, and watching television or movies.
  • Restorative Time involves activities, actions and interactions that re-energize us. These activities will serve a person by helping them to calm or center, rest, relax and feel better if there has been stress. These type of activities are typically quieter and will sooth and lead to personal peace. Sleeping, napping, praying or meditating, listening to music, holding hands, sitting with someone you like, quiet walks, rocking, watching birds or fish, petting a dog or cat, are examples of this use of time. 
So how does eating and drinking figure into all of this? For many of us, food and drink can fit into several categories of time use, depending on the context and the environment. For many women, and some men, cooking, meal preparation, and meal provision is a work activity. We do it regularly, we receive praise and appreciation for providing something that others enjoy and it may be seen as our major contribution to the running of a family or organization. For others it is a way to nourish and hydrate ourselves so that we can do other activities we love and need to do. It is said that some people live to eat while others eat to live. When it comes to leisure activities and food, we associate celebrations and social, sporting, and faith-based events with special meals, foods, drinks, eating behaviors, or gathering cues. Finally, there are some food items and drinks that are used and can signal a change in alertness and arousal levels. Herbal teas, a cup of hot chocolate or warm milk, a bowl of ice cream, or a warm chocolate chip cookie many help a person wind down, settle in or feel right at home.
Over the course of dementia, how food and drink is viewed, used, and abused can and will vary. Even care partners can miss the changes in consumption and use of food and eating and drinking rituals and routines that may be driving some challenging situations and creating stress and distress. One of the challenges for care partners is to be aware and investigate what is still working and happening and what is changing and needs modification, so that meals, foods, drinks, routines, and rituals are supportive and beneficial. Considering the importance and meaning of food and drink and their preparation, delivery, sensory presentation, and intake is a constant re-evaluation process as the PLWDs abilities and interests are changing. Making sure there is a mix of activities that will meet social, physical, mental, and spiritual needs for each individual is a complex and ever-changing task. Families and communities must work together to successfully create options and programs that work so that dining offers opportunities for feeling valued, finding joy, meeting needs, and restoring oneself when dementia is progressing.
Meal times are a great place to start when examining how you can make a difference in someone's day. It is one of the activities that all of us participate in throughout the day.  When it comes to dining, there are some simple activities that not only help set the stage for meal times but also bring balance to the WHOLE person and the WHOLE dining experience.
Before Meal Time:
  • Consider gathering for a social time with some fun, opportunities to sing-a-long or play some visually oriented brain teasers.
  • Consider offering small servings of warm drinks, water (flavored and colored), or juice should be offered as folks come to the dining area.
  • Hand care/cleaning (using foam, or washcloths in select cases) with lotion and hand hygiene checks can be offered.
  • Have an individual or small group work on simple food preparations & getting drinks together.
  • Each person should be offered drink and food - greet prior to serving (emphasis on making sure a person's mouth is moist (hydrated) before offering food item).
During Meal Time:
  • Offer drinks (choice of 2 when possible.) Try to have only one on the table at a time, if making choices or busy eating surfaces creates more distress.
  • Prepare plates for safe and independent consumption to the side and then serve once the individual has been seated, if the person requires help to get food into bite-sized pieces or condiment addition is provided by the care partner to avoid a sense of being treated like a child.
  • Know preferences BUT provide choices and offer alternatives, so that the person gets to practice choosing.
  • Serve meals in courses so there is less on the table top at a time, but keep it flowing, if the person has difficulty waiting for the next thing..
  • People needing assistance are usually helped by having someone sit to their dominant side and provide the cueing or physical help as needed (using Positive Physical Approach and Hand Under Hand)


Teepa demonstrates using Hand Under Hand to offer dining assistance
Teepa demonstrates using Hand Under Hand
to offer dining assistance


After Meal Time:
  • At the end of the meal, provide a warm damp cloth to wipe their hands and faces prior to leaving the table.
  • Encourage people to clean up dining area - move tables, wipe chair arms, sweep, wipe table tops.
  • Go to living area, settle in, feet up - let food digest, offer newspapers, magazines, books.
  • Music on - low and calm.
It is important to take into consideration the individual and the meaning and value of food and drink in a variety of contexts as it may relate to that person (social, spiritual, physical, physiological, sensory and emotional.) Do you know their personal history? What does meal time mean to them? Was it a time for family to gather and share or did they historically enjoy meals alone? Create an environment that is comfortable and inviting.  No one likes to eat when stressed! 
You will want to use the GEMS as a guide to help recognize where the person is in the change process and what care and environmental supports will optimize their function, promote participation and enjoyment, and minimize their risks of negative events and problematic situations. Take time to notice and address concerns and progress, provide the 'just right' amount and type of assistance. You can create an environment that maximizes the dining experience for people with dementia as the condition makes itself known.  It's really all about finding moments of joy everywhere - even in dining.

presented by the The Pines Education Institute and Teepa Snow

Caring for your special someone with dementia is a challenging task. You want to give the best possible care and quality of life, but wonder at times whether there is something you are missing.   Teepa will show you in "The Art of Caregiving" how to provide the most comfort for mind, body, and soul for your person with dementia. Get detailed, easy-to-follow explanations for daily tasks.

You will learn : 
  • how to best approach and interact with a person with dementia
  • hands-on caregiving techniques to ease daily caregiving tasks, such as moving assistance, bathing, eating, transfers, and dressing
  • why knowing a person's life history, personal preferences and personality traits that matters
  • about stress management and the importance of caring for yourself
  • to minimize resistance and increase positive interactions
  • about different types of dementia, such as Vascular Dementia, Lewy Body Dementia, and Frontotemporal Dementia
The Art of Caregiving 
The Art of Caregiving
  Order this DVD from the Dementia Care Academy

Also available in Spanish!

Order El arte de Cuidar  (Spanish-only version of "The Art of Caregiving")
Are you looking for a resource in french?

L'art des soins liés à la maladie d'Alzheimer: des strategies innovatrices
Pr esented by the Alzheimer Society Montreal and Teepa Snow

À l'invitation de la Société Alzheimer de Montréal, Teepa Snow, réputée spécialiste des troubles cognitifs, montre comment les personnes atteintes perçoivent le monde ainsi que comment les proches aidants et les professionnels de la santé peuvent adapter leur approche pour favoriser une meilleure communication et améliorer la qualité de vie de chacun. Interprétée en français, cette formation de cinq heures examine en profondeur les techniques de soins centrés sur la personne.

Produced by the Alzheimer Society Montreal, renowned dementia care expert, Teepa Snow, teaches how a person with dementia perceives the world and how care partners can change and adapt their own behavior to improve communication and quality of life for everyone involved.  This french dubbed 5 hour training offers profound insight into person-centered care techniques that professionals and family members can use to "make a difference."


Dining with Independence, Dignity, 
and Accessibility 
by Sarah Gorham and Stone Morris, Co-founders/Chefs

As dining consultants in senior assisted living memory care and skilled nursing facilities, we've had the opportunity to see how residents with cognitive and physical limitations dine over the past 2.5 years.  Dementia residents and physically challenged residents have special dining needs that perhaps many may take for granted if not presented with this challenge as caregivers do every day at mealtime.  Residents that can no longer use utensils to eat; residents who will not sit down to eat and wander at mealtime; residents that are too agitated to even want to eat or 
Traditional Spaghetti with Meatballs
sit down at a table; heavily medicated residents; and residents that have difficulty chewing or swallowing their food. Ultimately these challenges can result in resident weight loss, less independence and dignity, as well as additional stress at mealtime for both the resident and caregivers.  

So dining is not a one size fits all. What dining program that works in an independent or assisted living dining room may not work in your memory care or skilled nursing dining rooms. We have seen great strides in the senior assisted living dining scene over the past couple of years and we applaud these efforts!  Chef prepared restaurant style meals, fine dining standards, farm to table initiatives, dine anytime options, and "iron chef competitions" for culinary staff and menu development that ultimately enhances the resident
Grind Dining Spaghetti with Meatballs
 dining experience.   Our question is:  What if a resident cannot use utensils, or has difficulty chewing or swallowing their food?  What is their dining experience?

What we have found is that residents with cognitive or physical limitations too many times do not experience the same foods, nutritionally balanced meals, or quality dining standards.  Residents on a "finger food diet" have received fried chicken nuggets, French fries, fish sticks, or a peanut butter and jelly sandwich while the other residents are eating and enjoying foods from the "regular" menu. These marginalized residents sit in their bibs at the dining room table and are served food very similar to what a toddler may eat. Worse yet, if a resident has difficulty chewing or swallowing they may receive cut-up pieces of meat in gravy in a little bowl or  put on a puree diet that may need to be spoon 
Traditional Thanksgiving Meal
fed to the resident.  We have termed this "sad dining" and as dining consultants knew there needed to be a better solution and dining program for residents with cognitive and physical limitations.

So the next question is: What if you could provide your memory care or skilled nursing residents the same delicious food choices available to other residents? Now you can!  Enter the Grind Dining™ solution and program for residents who have difficulty eating at mealtime. The Grind Dining™ solution uses your menu, your quality ingredients, and your talented staff to transform meals into bite-sized portions that are nutritional, visually attractive, easy to handle, easy to chew and swallow, and may be eaten without caregiver assistance. No
Grind Dining Thanksgiving Meal
 more separate menus are needed and residents with cognitive or physical limitations are no longer marginalized!

We support the Pioneer Network's New Dining Standards and the residents "Right to Choose". We choose to provide and support the culture change within senior assisted living by enhancing the quality of life for those with cognitive and physical limitations and providing a dining program that promotes Independence, Dignity, and Accessibility for each and every resident.  Let's make a difference...

Let's make a difference...

                                          - Sarah and Stone

For more information, please contact Grind Dining.

PAC Approved Certifications and Trainings 

You have three more oppor tunities to build your
PAC Skills in 2015.  
San Diego, CA - Trainer workshop
participants, coaches and Teepa.



PAC Approved
Certification Dates for 2016

Here is your "sneak peek" at the certification dates for next year.  Registration for these events is coming soon!
Jan 14-15, 2016                                      Texas                                                                  COACH
Jan 28-29, 2016                                       Nevada                                                     CONSULTANT

Feb 11-12, 2016                                     Ohio                                                                TRAINER

Feb 25-26, 2016                                     Washington                                                     TRAINER

March 17-18, 2016                                 Florida                                                                 COACH

April 14-15, 2016                                    Massachusetts                                        CONSULTANT

May 13-14, 2015                                    Ontario                                                     CONSULTANT

June 9-10, 2016                                     Virginia                                                             TRAINER

June 23-24, 2016                                   Georgia                                                  ENGAGEMENT

July 14-15, 2016                                     Kansas                                                            TRAINER

Sept 1-2, 2016                                        North Carolina                                                 TRAINER

Sept 29-30, 2016                                    Illinois                                                     ENGAGEMENT

Oct 13-14, 2016                                      TBD                                                                          TBD
Dec, 2016                                               Nashville, TN                                                       COACH
                                                                               (first week of December - exact dates TBD)

Dec 3-4, 2016                                         Illinois                                                               TRAINER
                                                                (first week of December - exact dates TBD)

*Dates and locations are subject to change 

YOU are invited... become a PAC Certification Event Sponsor.   Teepa and the PAC Coaches are traveling the world in 2016 and we would like you to be a part of this tour.   

How does a Sponsor benefit from hosting a Certification Event?
  • Teepa and the PAC Team come to you!  On-Site Certification Training and Care Skills Workshop for staff professional development.
  • $500 discount for one Certification Attendee or a $250 discount for two Certification Attendees.
  • Your organization's name and logo on the Positive Approach website.
  • Public relation opportunities with families, communities, organizations and local advocates through shared social media marketing.
  • Dementia Care Provision DVD provided to your facility. This training DVD will bring awareness to your team, new hires, and provide a foundation for taking the Positive Approach™ philosophy and training to the next level.  We will include a 1 year licensing agreement for you to get started ($900 value.)

What are a Sponsor's requirements?

  • Provide the following: a training room that holds up 25 learners at tables with chairs, screen, projector, break-out areas for small groups, a white board, learner beverages and light snacks.
  • Provide on-site technology and housekeeping support.
  • Provide list of local recommended hotels and a caterer.
  • Share the opportunity widely with local and regional dementia care advocates.
If you have a team, a group of colleagues or an extensive local network that is interested in obtaining a PAC Certification, let us know. PAC Certification sites are chosen based on geographical area, learner interest, and response time.

If you are interested in becoming a 2016 Certification Event Sponsor and your are located in one of the areas listed above, please contact us today!

The PAC team is ready to travel to you and your learners in 2016!  
Positive Projects:  Alzheimer's Support Network
There are many organizations in the non-profit sector that focus on providing resources to people living with dementia.  The Alzheimer's™ Support Network (ASN) in Naples, FL is going over and above to ensure that everyone in the community has the opportunity to live well. Clarke Pollard and the staff and volunteers of the ASN hosted and participated in one of our PAC Trainer Certification Courses last year. Additionally, they opened their office and invited other learners to participate as well.  The vast majority of the learners successfully achieved certification and continued work with their PAC Coach to build skills and develop new programs.
Over the past year, The ASN has created a major outreach effort and are ACTIVELY using PAC training, skills, and messages to help their community become more dementia Aware and Knowledgeable.  Clarke and the team have created short videos and are developing other programs to train and support businesses and service providers in the Naples area to better able them to assist patrons who are living with dementia.
Each month, ASN host guest speakers and educational meetings each month, as well as support groups designed for different audiences.    They are currently developing their Gold Seal Program - a series of online educational videos aimed at helping local businesses understand brain change and the resulting behaviors.  The content will also provide information on how to assist people living with dementia and some of the challenging situations that they may arise.
For all of their hard work and commitment to building their knowledge and skill, Positive Approach is pleased to recognize the Alzheimer's Support Network as a PAC Dementia Knowledgeable Agency, working towards becoming PAC Dementia Skilled.
Way to Go!!

Some of the programs offered by the Alzheimer's Support Network:
This is a guided tour specifically for dementia patients. Participants see, hear, smell and enjoy the beauty of the great outdoors at one of Southwest Florida's premiere preserves. 
This guided tour has been developed for those with dementia and their caregivers. Participants are able to see, touch, smell and even taste plants. Tours are led by the specially trained docents from the Garden.
ASN is the first organization in the Naples area to become a certified Music and Memory site which uses personalized music as a tool to reduce agitation.
The Skilled Caregiver Class (Building Tools for Caregivers)
Focuses on some of the toughest issues Alzheimer's caregivers face such as shadowing and sundowning.  
A Sampling of over 30 Support Groups ASN Hosts Each Month:
Minders Keepers 
This group is facilitated by  Dr. William Justiz   who is a practicing neurologist in Naples and a member of the Board of Directors. It is designed for patients that understand they have the disease and want to talk about it.  In addition, Steve Salduksa, Ph.D facilitates a caregiver group at the same time.
Early Stage Couples Support Group
This group is for couples who are confronting any form of dementia in it early stages. The person with memory issues should be early in the disease process and be comfortable openly addressing the challenges he or she faces.

Gentlemen and Ladies Clubs 
These groups have met on Fridays and Saturdays for over a decade. The groups meet for 31/2 or 4 hours each week. They are designed for men and women in the early to mid-stages of the disease. They provide appropriate socialization for the individual with dementia and give the caregiver respite for a few words. Based on Teepa's GEMS, the groups welcome both Sapphires and Diamonds. The participants are able to gather in a safe and nurturing environment where they feel accepted for who they are.

Road to Acceptance Support Group
This group is for caregivers struggling to accept the disease and behavioral changes of their loved ones. The group focuses on self-care for the caregiver. This journey is a tough, emotional challenge and we need to acknowledge that and try to help.
Support Group for Spanish Speaking Caregivers
This support group is designed for caregivers that are more comfortable speaking Spanish. The group is a great source of support, provides a nurturing environment and a place to obtain resources needed. It is facilitated by members of our staff who are fluent in both English and Spanish.
Marco Island Support Group
This group is designed for those who live on Marco Island. Some have been dealing with dementia for a long time and others just beginning their journey. There is much to be gained by sharing and feeling understood by others who are dealing with the same issues.
Male Caregivers Support Group
We have a large number of men who directly care for their spouses and partners. Others manage care by utilizing home help, day care and facilities. All situations are stressful and require us to cultivate new skills in addition to those we honed in our work lives.
Adult Children Support Group
This group is for women and men dealing with all the issues surrounding the care of a parent with dementia.

The Alzheimer's Support Network is a 501(c)3 nonprofit located in Collier County, Florida.  There Mission is to make the lives of caregivers easier and enrich the lives of patients. All of their services are provided free of charge.  They offer ongoing private consultations, over 30 support groups a month, a 24 hour helpline answered by staff members, and a wanderer's identification program in partnership with the Collier County Sheriff's Office.  In addition, they offer ongoing caregiver respite programs, monthly education meetings, and a wide range of other services. 
If you live in Naples, please stop in and learn more.  If you live outside of Naples, they invite you to call - (239) 262-8399, email or visit their website.  They can set up an online conference to address your specific concerns. On the website you will find a library of past speakers, and a growing number of useful online tools, articles and other resources.

Meditation - 
The Mouth:  The First and the Last Frontier

Susan Irene Wranik, MS, MA, CCC-SLP, is a linguist and board-certified speech-language pathologist.  A graduate of Georgetown University and The George Washington University, she works with the geriatric population treating speech, communication, cognitive/dementia, and swallowing disorders. 

Earlier this year, Susan participated in Provider Magazine's LED Talks alongside Teepa and many others.  Her poignant talk entitled 'The Mouth: The First and Last Frontier' 
urges us to respect and honor the finality of life by understanding that "...people do not die because they stop eating.  The stop eating because they are preparing to die."

The Mouth:  The First and the Last Frontier

Living Well...Dementia World News
Red Plates for Dementia 
by Juliet Charney

Would you eat your mashed potatoes if you could not see them? That's the question Boston University Bio psychologist Alice Cronin-Golomb and her research partners set out to answer in their Red Plate Study (2004). Their focus was on helping people who live with Alzheimer's, Lewy Body Disease, and other neurocognitive disorders. As these dementias progress, they often affect vision and hand-eye coordination. Unhealthy weight loss is a dangerous side effect of dementia. Care partners and family members often complain that their residents or aging parents refuse to eat, no matter how much they are coaxed and encouraged. Confusion, depression, and even obstinacy were usually blamed when plates of food remained virtually untouched. 
The traditional approach to brain change and the resulting behaviors is to look for medications to manage them. Today's advocates and researchers are taking a more functional look at dementia. What can be done to improve the quality of life of the people we care for? Cronin-Golomb and her research team tested advanced Alzheimer's patients' level of food intake with standard white plates and with bright-red ones. What they found was astonishing - patients eating from red plates consumed 25 percent more food than those eating from white plates. Common vision problems in Alzheimer's and other dementias such as depth perception, and ability to distinguish color and contrast had been creating the "invisible mashed-potato" effect and making it difficult or unpleasant to eat. 

New Dining Practice Standards  
Pioneer Network is pleased to announce that its Food and Dining Clinical Standards Task Force: A Rothschild Regulatory Task Force has finalized new Dining Practice Standards. These nationally agreed upon new food and dining standards of practice support individualized care and self-directed living versus traditional diagnosis-focused treatment for people living in nursing homes. The Food and Dining Clinical Standards Task Force made a significant effort to obtain evidence and thus the  New Dining Practice Standards document reflects evidence-based research available to-date.  More 
Taiwanese designer Sha Yao created fun, colorful tableware after spending time with her grandmother, who has Alzheimer's. The bright red, blue and yellow plates and colorful easy-grip curved handles are not designed to be child-like. 
Every piece has been custom designed to address the needs of cognitive, motor, and physical impairments.
Sha Yao designed  EATWELL  t a bleware after reading about the Boston University study and learning from it that individuals with cognitive impairment ate 24% more food and drank 84% more liquid when they were served in brightly colored vessels. Following the study, she chose high contrast primary colors. Yao says EATWELL has more than 20 unique features, such as special mug handles designed to prevent accidental tipping by shaky hands.  
You can support Sha Yao's project by making a donation on her  Indiegogo site .
Find out more about this colorful tableware designed for people with dementia on 
Fast Company's  design site.

News from the Dementia Action Alliance

Justice In Aging Advocates for Dementia Training Requirements
In order to identify gaps in state law as well as best practices to inform future improvements, Justice in Aging undertook a survey of the statutes and regulations in 50 states, plus the District of Columbia and Puerto Rico. The results of that survey were published in a five-paper series,  Training to Serve People with Dementia: Is our Health Care System Ready?  The survey and papers were created with the support of the Alzheimer's Association. Each of the five papers are available for download. An accompanying webinar can be viewed here.



If you know someone working or living with dementia who might benefit from the teachings of Teepa Snow, please forward this to them now. 

Be knowledgeable. Be prepared. Be positive.


If this journal was helpful to you, we would appreciate your feedback.  Please share your comments and further interest with us.