CareNotes

Weathering the Winter During COVID-19 Through Joyful Celebrations of Creativity and Imagination with Residents

This is a guest article by Kera Magarill, MA, Older Adult Behavioral Health Specialist with Washington County Disability, Aging and Veteran Services

COVID has disrupted our traditions and the ways we celebrate and connect with family over the winter holidays, but there are still ways we can offer moments of meaningful connection and joy to our residents while remaining socially distant that help combat feelings of loneliness and isolation. The Washington County Disability, Aging and Veteran Services is offering free training and resources services through Timeslips™ for activity staff, caregivers, and family members. This training meets the dementia training requirements for Assisted Living Facilities, Memory Care and Skilled Nursing Facilities. Please contact kera_magarill@co.washington.or.us to learn more.

Connecting Remotely

A lot of families are challenged by in-person visitation when a loved when is living with dementia or other isolating health factors. Now that those visitations have moved to video-conferencing or phone-based interactions only, we are presented with new challenges. It can be especially hard to navigate a conversation over the phone, especially for someone with memory loss who can feel disoriented by the experience or who might have a hard time hearing or following the conversation. The Timeslips™ Tele-Stories method offers tools for activity staff, families and caregivers to connect with residents.

What is Timeslips™ Tele-stories?

Tele-stories is a Timeslips Creative Engagement™ project for that guides residents, especially those with memory loss, through a creative activity over the phone, through videoconference or even by mail. Timeslips™ is an evidenced-based approach to dementia care that teaches improvisation-based creative engagement to bring meaning and joy to late life.

Tele-Stories Poetry Process

A “caller” can be part of the activities staff, a volunteer or a family member.  Callers can follow the steps below to facilitate an original, resident-created poem or short story that can be shared with others.

Step 1: Ask “Beautiful Questions” over the phone: Ask 1-3 Beautiful Questions that fit to a theme. A beautiful question is an invitation into a shared path of discovery that accepts the person as they are now.  Instead of relying on memory for a “remember when” question (which can feel like a test), try using the power of imagination with a “what if” question that has no right or wrong answer. Here is an example of three “Beautiful Questions” with a theme of “Home for the Holidays”. (Some residents might particularly enjoy this theme, especially for those who ask to “go home”. For others, it might be better to focus on something else that doesn’t trigger strong feelings of going home, like seasons, animals or travel.

• Home for the Holidays Theme – example of “Beautiful Questions”:

1. 1. Observation: What would it look like if everyone was home for the holidays? What brings everyone together?
   2. Sensory: What sorts of sounds would we hear if everyone was together right now? What songs would you sing or play? What sort of foods would we have to eat? What are the smells we would smell? What are the colors we would see? What would the weather feel like outside?
   3. Subjective: What does the word “family” mean to you? What is the best part about being together as a family?

Note: It’s okay if the Beautiful Questions inspire memories of the past, but note we are not asking residents to specifically remember anything. We are asking them to imagine what a scene might be like and focus on the feeling. This allows for the resident storyteller to create whatever world they want to. If the theme brings up overwhelming emotions or feelings of distress, try something more abstract and/or whimsical like, “Imagine a day in the life of a dog,” or “Imagine flying to the moon”.

Step 2: Echo all responses after each question. Repeat verbatim and write down the response as they come (Typing to be a little easier and faster than hand-writing).

Step 3: Read aloud the poem/short story that you have co-created using the responses from the resident without including the original questions. The poem might sound like this:

• Everyone would be smiling. They would have to fly in. The kids are laughing and screaming. We would probably sing Jingle Bells. Fa la la! Macy played the piano. We would eat turkey and ham and pie. Pumpkin pie from the store – I never did like baking. We would smell the ham cooking in the oven. There would be red and green from the tree. It would be nice and warm inside. I don’t like to be cold…or wet. A family is just a group of people who got stuck together, but we make the best of it. I just love being with the ones I love and having someone to laugh with.

Step 4: Title it!  Ask the resident “What title should we give this story?”

• Example response: “Winter with the Family”

Step 5: Finalize and SHARE IT! Type or neatly write out the whole story with the title and a credits to the author (resident).  Send the story to family members, include in a newsletter or post in a visible area for staff to read. Perhaps a lovely hand drawn picture from a young person could accompany the story. Re-read the story/poem to the resident at the beginning of a new session.

• Tips for callers/facilitators:

1. 1. Remember, there are NO WRONG ANSWERS! That’s what makes this process so fun and joyful. Don’t try to orient the resident to reality and don’t correct them. Nothing has to make sense here; the only goal is to share a moment of engagement and creativity.
   2. Things said can be unspoken. Since we can’t see a person’s body language, listen to language, tone of voice, fragments or words or sentences, and other sounds. These all can be captured by the caller as a part of the story and will be useful to help the caller follow the resident’s lead to pace and structure the conversation. Also, pay attention what you are saying and how you’re saying it.
   3. Allow for sounds of silence. If you’re used to working in a setting that uses the energy of a group, shifting to one on one can feel intimidating. You will probably experience more moments of silence. Remember that silence does not necessarily mean lack of interest. Allow space for those gaps in the conversation so residents can process the question and work up to a response. After a few moments, you may want to repeat the question, making it simpler if needed.
   4. Provide positive reinforcement. Provide plenty of encouragement and positive reinforcements throughout. Remind the resident that, “we are just making this up,” and that, “there are no right or wrong answers,” so they feel support rather than put on the spot. If a resident is struggling to follow the questions or is having a hard time hearing, try reading a story to them or singing a familiar song. Maybe a family member or young person can help write the story for them. Celebrate any shared experience of joy and laughter, even if it only lasts for a minute or two.

Find more beautiful questions, creative storytelling tips and other ideas for remote engagement at www.Timeslips.org.