by Mirjam Berger, Th.M.
Corporate Director of Spiritual Health Services
ACPE Certified Educator
What is Godly Play?
GODLY PLAY™ is an imaginative, Montessori-based approach to religious formation developed by the Rev. Dr. Jerome W. Berryman and used by many faith groups around the world. It is a creative and playful way of bringing stories of faith to life on an experiential level. It uses two and three dimensional figures to tell the story in a vivid way and then invites – through wondering questions - engagement with the story. Traditionally, this method is used in the faith formation process of children.
In 2015 Lois Howard wrote an inspiring booklet “Using Godly Play with Alzheimer’s and Dementia Patients”. In it she outlined her experience of using this method since 2006 in Lexington, Kentucky. Her writing inspired chaplains at Ebenezer to follow in her footsteps. In March and April of 2018, our team (including chaplains in training) engaged in two days of hands-on training in Godly Play with Minneapolis Godly Play trainer Susan Mallison. Her enthusiasm and curiosity about bringing stories alive with older adults in varying stages of dementia was instrumental to our success. Another amazing supporter is Jon Lundberg, President of Ebenezer and Fairview Post-Acute Care. An avid woodworker, he created several wooden figurines that are being used in the process of telling Sacred Stories. We are also very grateful to all donors who through Ebenezer’s Foundation generously supported this project.
We decided that our goal was not to help participants remember the stories but to facilitate a way for each person to connect with the Sacred while also being in community with each other. Our context in larger long term and senior care settings in Minnesota is one of growing cultural and religious diversity. We wanted to create a welcoming and inclusive atmosphere for everyone while drawing on different sacred stories. We called it “Sacred Story.” What we discovered continues to amaze us.
Initially we anticipated 4-6 people would come and listen to the story and engage with it. To our surprise, at one of our communities we regularly have between 15-20 participants, at another 6-10. Not everyone knows or remembers the others’ names all the time. We introduced name tags so that residents could see and hear each other’s names frequently. Calling each group member by name is a crucial aspect of this model, to create community and to be known by each other (and the Sacred) by name. Interestingly, one of the residents whose Alzheimer’s disease had progressed significantly was so delighted to see her name in writing. For her, to be in that circle of friends, to be known and to recognize her own name was the most meaningful part of this day’s Sacred Story time. As we sing together and then hear, see, and feel a Sacred Story, we open up new and different ways to experience the Divine. Wondering questions invite each participant to connect with the Sacred in their very own way. Residents may recall memories that resonated with the stories being told, such as reconciling with a sibling, welcoming back a child into one’s family, or helping a stranger in need.
The stories we tell include the parable of the Great Pearl (which touches on what may be the most important thing in one’s life, and what it feels like to give everything away), the Ten Best Ways to live by (traditionally known as the Ten Commandments) and the story of the Exodus (a story about suffering, liberation, freedom, divine intervention and joyful celebration).
Recently when I told this last story, using our “desert bag” filled with sand, I was deeply touched by the reaction of one resident who kept saying: “This is my story, these are my people.” We then spent time together speaking about the resident’s childhood and family. The smile and warmth reflected on the resident’s face as we talked was enlivening.
When we conclude our Sacred Story time, we go around in the circle and offer silence, thoughts or prayer, deepening on each resident’s desire. Those who voice prayers out loud frequently pray for their families. I hope that many families know that despite their sad experience of no longer being recognized as son, daughter, spouse or friend, their family member may well be reaching out in an unseen way, and praying for them.
Many older adults want to stay in their home as long as possible. There is an assumption that staying in your home means you are independent, but the reality is it can often lead to loneliness and isolation. The health effects of long-term isolation are measurable and include chronic health conditions, depression, anxiety, dementia and even premature death. One study reported the negative health effects of long-term isolation are equal to smoking 15 cigarettes a day.
Loneliness is on the rise overall, but those most affected are those 80 and older according to a 2016 study.
Older adults who are most at risk are often:
The best remedy for loneliness is staying connected. Staying connected, interacting with others, and staying socially engaged with friends and your community can help keep fight loneliness and the health risks that are associated with it.
How can a move to Senior Living help fight loneliness?
When people move into a senior living community, the older adults often tell us, “I wish I would have moved sooner.” And their family members tell us, “We’ve seen our loved one blossom in the last few months!”
We invite you to visit us today. Talk with our residents to hear how their health and their lives have changed for the better after moving to senior living.
For more information about loneliness and isolation, the AARP Foundation offers its online resource Connect2Affect. There you can find a self-assessment to determine your risk factors and tips on how to stay connected. Click here to take your self-assessment. Resources that informed this article include Government’s Role in Fighting Loneliness by Emily Holland, as published in the Wall Street Journal, and the Blue Zones Power 9 ® by Dan Buettner.
Apathy. It’s one of the approximately 500 symptoms you might well find under the umbrella term of dementia. According to Microsoft Word, apathy’s synonyms include lethargy, boredom, unconcern, droopiness, and dispiritedness. For a person with dementia, this state of being may result in the inability to initiate activity, and/or spontaneous thought. Many of us, when feeling bored or droopy, have the ability to switch gears, maybe go for a walk, call a friend, or otherwise think of some activity to cheer ourselves up. Persons with dementia may not be equipped to do that. Instead, they’ll need structure, routine and activities figured out by others.
Initiating activity involves planning, organization and motivation. Planning can be complicated, involving lots of steps. For a person with Alzheimer’s disease (whose short-term memory is very limited) or for a person with frontotemporal degeneration (whose executive function is seriously compromised) “complicated” can easily translate into “overwhelming”. When things are too hard for a brain with dementia, frustration often results, and motivation dissipates.
To be sure, it can be hard to observe and absorb these changes when a family member was formerly a champion self- starter; creative and keeping busy all the time. We have to remember that the changes of dementia are disease-related, and brain-based. It is not because the person is just being stubborn, difficult, rebellious, or is out to exasperate us. The person is simply reacting to their situation with the brain that they have to work with today, not from the brain they used to have. We must have compassion for the reality of a broken brain, if we are to give care and responses that will encourage and accept the person where they are at, and in so doing continue to strengthen our relationship with that person, and best serve their needs.
Here are ten tips from the Association for Frontotemporal Degeneration about what you as a care partner can try when your family member with dementia exhibits apathy. These suggestions were created specifically for persons who care for those with frontotemporal degeneration, but I believe there is much here that can be helpful to those who care for persons living with other forms of dementia as well:
--Marysue Moses, Ebenezer Dimensions Program Coordinator
Here is a recent article about our community
By S. M. CHAVEY | email@example.com | Pioneer Press
May 19, 2018 at 6:15 pmOppidan Investment Company CEO Joe Ryan, talks with Bev Lane during Grand Opening celebration at Shorewood Landing Senior Living center in Shorewood on Thursday, May 17, 2018. (John Autey / Pioneer Press)
Earlier this year, Joe Ryan heard his sister sing karaoke for the first time.
His sister is in the early stages of dementia and lives in a seniors community near Lake Minnetonka.
“She was as happy as she’s been in a few years,” Ryan said.
When Ryan’s mother was struggling with dementia a few decades ago, she didn’t have the daily access to stimulating events that his sister has. And Ryan felt like there were no solutions back then.
“We wanted the best-of-class for mom in terms of a community that she could be a part of … but we had a difficult time finding that level of care,” Ryan said. “I felt like I wasn’t able to help.”
It’s too late for Ryan to help his mother, who died several years ago, but it’s not too late for him to help hundreds of others in his mother’s honor, and that’s what he is dedicated to doing.
Ryan is CEO of Oppidan Investment Co., a national property-development firm based in the Twin Cities that has partnered with Ebenezer Management Services to improve care for people who have memory loss.
Oppidan has made donations of $100,000 to their facilities in the Twin Cities — Highlands of St. Paul Senior Living, White Bear Heights Senior Living, Shorewood Landing Senior Living in Shorewood — and will be donating to Pillars of Prospect Park and Pillars of Mankato.
Although the program has cost Oppidan more than half a million dollars, Ryan hasn’t hesitated.
“My mom and dad taught me to leave the world better than I found it,” Ryan said. “We’re very philanthropic in our approach and that’s inherent in the way we all think here at Oppidan.”
TRYING TO MAKE LIVES LESS LONELY
The goal of the donations is simple: Provide residents with experiences that make their days a little better.
“For those that are afflicted with dementia-related issues, it’s a very lonely place,” Ryan said. “We were hoping to make it a little less lonely.”
Those experiences include a variety of activities, often within the creative arts. Drum circles, interactive Shakespeare sessions, weaving and watercolor are just a few examples.
Once, residents painted with different colors of scented frosting. Another time, they learned to recite poetry. They regularly listen to and sing along with musical instruments.
“For me, I have never done anything as powerful as working with persons with dementia, assisting and encouraging them to be more present with their breath, their bodies, and with life,” Anna Vazquez, a music and movement instructor, wrote in an Ebenezer report.
The focus is on the interaction the activities stimulate.
“Dementia doesn’t matter when people are laughing and having a good time and just enjoying what they’re doing,” said Marysue Moses, Dimensions Memory Care coordinator at Ebenezer. “Unfortunately, with dementia, people don’t always have the initiative to start doing these things that will give them that sense of fun and enjoyment. That’s where we come in.”
HOW RESIDENTS RESPOND
Some residents participate enthusiastically. Others require more persuading — like June. (June and other residents’ last names were not disclosed for privacy reasons.)
The British woman was formerly an opera singer and had performed in the musical “Oklahoma” once, but she told memory care staff that she “really didn’t sing much anymore,” according to Moses. She often didn’t feel well and rarely attended memory-care sessions.
But one day, she decided to attend and was asked by the musician leading the session to sing one of the “Oklahoma” songs.
“It was so moving,” Moses said. “Her voice was so creaky and a little warbled, a little rusty at first. But when she hit the high notes at the end of it, her voice just soared across the room and you could hear the singer that she had been.”
Resident Clarence wasn’t immediately invested in the activities, either.
When he attended sessions, he rarely spoke, his head down and his eyes closed. But during a discussion about “Romeo and Juliet,” a leader asked the residents about love at first sight and finding love.
That’s when Clarence put his head up, opened his eyes and began to tell the story of the first time he saw his wife: “What a girl!” he said of her.
“This whole story of a lifelong love came out,” Moses said. “And from then on, he was a much more active participant,” even as his health deteriorated.
Then there was the quiet man with Parkinson’s disease who, during an exercise, roared like a lion so enthusiastically that he earned the nickname “King of the Forest.” And the woman who would spontaneously get up to dance while singing spiritual songs, saying, “Let yourself go!”
In the reports Ryan receives from the Ebenezer staff, he said, there’s at least one story a week of a resident who had a particularly moving experience during one of the activities. He keeps a framed watercolor landscape painting from a patient in his office.
If his mother were still alive?
“She might be doing the singing right along with my sister,” Ryan said. “She wasn’t a singer, but she was a wonderful woman. She’d have participated, that’s for sure.”
When a person with dementia asks you a question for what seems like the 29th time in a row, how do you respond?
Have you found yourself saying (or almost saying) anything like this:
Physical changes in the brain can result in a person with dementia no longer being able to remember that s/he is repeating themselves. These changes also make it difficult for a person to stop a repetitive motion such as rubbing hands together, or tapping on a table. Anxiety and tension, (byproducts of the disorientation and memory loss of dementia) can translate themselves into repetitive motions or questions which others may experience as annoying.
Whatever a person with dementia does that appears “wrong” or “inappropriate” or “unnecessary” to our brains and our way of relating to the world is actually an expression of a need. That’s why I like the phrase “behavioral expression” so much better than the term “behavior” when referring to the challenges that can arise when someone lives with dementia. “Behavior” often implies judgment, that the person is being “bad ”, which encourages us to assume that if the person only tried a little harder, they could control that incessant tapping, stop asking those repeated questions, and avoid using those four letter words that they never used before! The fact is that the person could only exert control over those things if they could STOP having dementia. This is, alas, too much to ask.
We must have patience and compassion for the seriousness of a broken brain. It’s up to us whose brains are in better shape, who have better control over our actions and responses to others to take a deep breath…and focus on helping the person out with whatever need is making itself known, however it may be expressed.
A hungry person might ask “What’s for lunch?” over and over. For this person, giving them a piece of paper with the upcoming “menu” written down may satisfy the question. In addition, getting the person involved in some aspect of meal or table preparation might be an effective distraction.
If a person with dementia is in pain, they might rock, pace or otherwise move rhythmically to express their discomfort. We must be sensitive to the comfort–related needs of the person, and do what we can to alleviate them. Sometimes, giving a repetitive task like winding yarn or folding towels can be a comforting distraction for the person.
Sometimes people may be bored, craving a sense of purpose and meaning. Repetitive movement can be reflective of things the person used to enjoy doing on a regular basis. If your loved one asks you, “What do I do now?” they are in effect asking you to involve them in something that will give them a sense of pleasure, peace, or usefulness. Put something of interest in their hands. Ask them for help with a task. We all need to be of use. This does not stop when we get older or when we develop dementia. An inability to take initiative is usually part of the dementia progression. Do not assume that your loved one is beyond having interest in things that have been important to them. The person may be at a loss as to how to access or activate that interest. In that case, it falls to us to remind the person of their accomplishments and adapt past interests into activities they are able to enjoy now.
It is a good idea not to discuss plans with a person (appointments, visitors, outings) who has very short-term memory loss. Knowing an event too far ahead of time can cause extreme agitation (as well as, you guessed it, repeated questions) for a person with dementia. This tendency will vary, of course, person to person, but it is necessary to monitor and adapt to the changes as dementia progresses.
Sometimes the need expressed is an emotional one. The person may be fearful, sad, or feeling insecure. That emotion could come out as a repeated question or as a physical expression, i.e., pacing, as the person attempts to express what is inside. Listen for the emotion behind a person’s question or behavioral expression, and respond to that, i.e., “You seem worried. I’m right here if you need anything. “We will be together all day.” Putting on soothing music that the person likes and using gentle touch may provide further reassurance.
If the person seems to need a hug, tell him or her that YOU need a hug, and they will very likely oblige you with one. Then they get to feel that they are giving you something that YOU need. We all feel better when that happens!
--Marysue Moses, Ebenezer Dimensions Program Coordinator
--Information in this post is partially based on material in Coping with Behavior Change in Dementia: A Family Caregiver’s Guide, by Beth Spencer and Laurie White
Few processes are more stressful than deciding upon the best place to move a loved one when it is determined that a move to memory care is the best option. Keep in mind that when this decision needs to be made, it is often critically important, not only for the well-being of the person with dementia, but in order to maintain the health and safety of the family member who is their current care partner.
If you are in the process of making this potentially agonizing decision, here are some questions to ask yourself, and others, as you tour and consider various possibilities:
What does the environment feel like?
-Marysue Moses, Ebenezer Dimensions Coordinator
There could come a time when your parent with Alzheimer's disease or another type of dementia will need more care than can be provided at home. During the middle and late stages of dementia, sometimes 24-hour supervision is required to ensure the person’s safety. As dementia progresses further, round-the-clock care requirements become more intensive.
Making the decision to move a parent into a specialized memory care environment may be difficult, as it is tough to suddenly be faced with a decision that makes it feel like YOU are now in a parental role. But it is important to consider whether or not it is possible to continue to provide the level of care needed in the person’s home.
The questions below, from the Alzheimer’s Association website, are ones to consider when determining if a move to residential care is a good option:
Please see http://www.alz.org/care/alzheimers-dementia-residential-facilities.asp for additional information
--Marysue Moses, Ebenezer Dimensions Program Coordinator
Choosing a senior living community can feel like a daunting task. To help narrow down your options, ask these questions first:
What type of senior housing do I need?
Not all senior housing is the same. There are many options to consider depending on the level of care you need:
Ebenezer offers a wide variety of senior living options in Minnesota – including memory care, independent and assisted living communities and nursing homes. Each is designed to help you live more independent, meaningful and secure lives. For additional help in determining which Ebenezer community is right for you, read “Choosing Your New Home.”
What happens if I need advanced care?
If your care changes, make sure your senior living community is equipped to handle your shifting needs. Can you easily move from an assisted living to a nursing home? Is a hospital nearby if you need it? Can you keep your existing physician? Will your medical records easily be transferred?
Not only does Ebenezer offer all types of senior living communities, but we are also affiliated with Fairview Health Services. This means you have a wealth of resources at your disposal, from top-notch physicians to the latest in Alzheimer’s research. Each day we are working to improve the quality and safety of patient care, which is how Ebenezer and Fairview became pioneers in the secure transmission of electronic health records between nursing homes and hospitals.
Where do I want to live?
Moving into senior housing brings exciting changes, like choosing the exact area you want to live. Do you prefer the familiarity of your current location and want to find senior housing in your own community? Or, do you look forward to moving closer to loved ones who may live in a different area? Perhaps you are interested in experiencing a new neighborhood altogether?
There are more than 67 Ebenezer independent living, assisted living, memory care and nursing homes in both urban and rural settings throughout Minnesota. Since 1917, we’ve been Minnesota’s leader in senior housing, memory care and assisted living. For close to 100 years, our compassionate caregivers have been members of your community. Now, we invite you to be a part of ours.
Schedule a tour today to learn more about the vibrant senior living options at Ebenezer. Call us at 612-672-7262 to find the Ebenezer community nearest you, or visit us www.fairviewebenezer.org