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Healthcare Training Institute - Quality Education since 1979

Section 14
Bean Bag Rolling, Activity Apron, Doll

Table of Contents | NCCAP/NCTRC CE Booklet

Bean Bag Rolling

As illustrated on Track 4 of the DVD with Fannie, Bean Bag Rolling is a good activity to use with a lower-functioning or semi-comatose resident who has:
         --little to no attention span
         --little to no eye contact
         --no meaningful verbalization 
Elizabeth, Lillian, and Mary, interviewed on the DVD that accompanies this Course, are examples of the levels of resident with whom you might try Bean Bag Rolling.  Bean Bag Rolling usually ends up being what I would call a totally physically assisted activity.  Thus, it is excellent for your semi-comatose residents.

The way you construct a bean bag for Bean Bag Rolling is to buy a bag of any type of round, hard beans at the grocery store. Navy beans work well.  Sew a 6" square bag.  Fill the bag half to ¾ of the way full with beans, and sew the open end.  Or, go to a Toys-R-Us store and see if they have bean bags as part of a Toss Across type of game.  Then, of course, there are always our friends at Google.com to search the web for possible suppliers.  To implement Bean Bag Rolling, place the bean bag in the resident's hand.  You might ask something like, “Fannie, can you roll this bean bag for me?  See if you can roll this bean bag for me.” Usually with this level of semi-comatose resident, you end up totally physically assisting the resident to roll the bean bag.  Here's how you do this.  Similar to the Squeeze Hand activity in a preceding section, cup your hand around the resident's hand and roll the bean bag.  Also see the illustration and explanation for Squeeze Hand in the Gestures portion of this Manual.  This illustrates what I mean by "cup your hand around the resident's hand."

The Philosophy of "Expect" and "Assume"
To provide your Fannie with a successful experience while you are cupping your hand around hers and making the rolling of the bean bag possible, you might say something like, “Good, great!  You are really doing a good job!” or “See if you can roll this some more for me.”  Your verbal comments are a way of providing your Fannie with hearing a structured communication that she may not have gotten in any other way.   However, some CNAs are truly gifted regarding encouraging residents to become involved in, for example, washing their hands, rather than doing everything for the lower-functioning resident. 

You never really know what gets through to this level of semi-comatose or Advanced Alzheimer’s resident.  Bean Bag Rolling is also another good activity for a volunteer, a CNA, or an interested family member to do.  Oftentimes, family members cut their visits short because they are at a loss regarding what to do during the visit.  With Bean Bag Rolling, located in a bag taped to Fannie’s nightstand, labeled "Help Fannie roll this Bean Bag to exercise her hand," your Fannie is provided with a structured "visit" and that extra little bit of mental stimulation and TLC. 

If the Bean Bag Rolling appears to irritate or annoy the resident, it should, of course, be stopped immediately. As mentioned previously, there is a responsibility with any heavy-care resident to be sensitive to the activity program offered to him or her.  As you observe your semi-comatose or advanced Alzheimer’s resident's reaction to Bean Bag Rolling, ask yourself, "Is this something that appears to be, or feels like it is improving the quality of his or her life?"  Sometimes the only way to assess or evaluate this is to be sensitive to your resident's normal mode of behavior and to evaluate his or her reaction once the activity is started.

What is normal?  In summary, upon walking up to a resident, ask yourself, "Does Fannie normally jerk her head about and flail her arms?  Or does she only jerk her head and flail her arms when she is doing Bean Bag Rolling?"  Your Fannie might be trying to tell you something.  In short, she may be telling you, “Don’t do the Bean Bag Rolling with me!”  The following point bears repeating. There is a responsibility with these low-functioning and Alzheimer's residents to be sensitive to their needs, wants, and desires related to the only way they are capable of communicating.  And the only way to assess this communication is to be sensitive to your resident's normal mode of behavior…
--before trying the activity
--during his or her involvement in the activity
--and after it is over.

Residents with whom to try Bean Bag Rolling

Culture Change Implementation: Place Bean Bag Rolling in an Activity Project Bag left in resident’s room for CNA, volunteer, etc. use.

Activity Apron
The last track of the DVD that accompanied this Course contains slide(s) illustrating implementation of this activity.)

For residents who are in the later Stages of Alzheimer's and are extremely disoriented, you might make or buy an activity apron for them.  Mabel, interviewed on Track 6 of the DVD, is the type of resident with whom you might try an activity apron.   As you have observed, many disoriented residents like to have something to hold in their hand or manipulate, like a doll or towel to “fold.”  Cuddling a doll, i.e. baby, and folding laundry are, of course, in your resident’s long term memory.  Thus cuddling and folding, for example, are some of the last memories to be lost.  However, the challenge with a resident holding something to cuddle or to fold is that a few minutes, or even seconds, after the resident is given the doll or towel, it falls from his or her lap onto the floor.  So the purpose of the activity apron is to hold the item in the resident’s lap.  You can purchase an activity apron from the internet by searching under the key words "activity apron."  However, a basic premise of Culture Change is to have all staff providing activities.  Thus, I feel leaving projects in the residents’ rooms in my mind is essential to facilitate this level of staff involvement.  You may be more likely to leave inexpensive Activity Aprons you or a volunteer have made in a resident’s room.  Agree?

With this in mind, if you wish to make activity aprons, here's one method.  
1. Cut two squares of solidly-colored, cotton material, 24”x24”. 
2. Seam around the edges with the right sides together. 
3. Sew three sides on a sewing machine. 
4. Turn the fabric right side out, and sew across the open edge turning in the raw edge. 
5. Use this same process to sew two apron straps 24” x 3” for ties from the remaining fabric. 
6. Sew the ties to the right and left top edges of the apron.  You now have a basic apron, i.e. a 24”x24” apron with two ties at the top and on either side, as illustrated in the drawing. 
7. To affix items to the apron, sew two to four 5” to 8” lengths of yarn, ribbon, or another washable type of string. 

You may find, like I, that the key to success for an Activity Apron is to tie implements or items to the strings that are significant to the resident’s interests or long-term memories.  CMS F-Tag 248 Guidelines refer to this concept as “Person Appropriate.”  “Person Appropriate” refers to the idea that each resident has a personal identity and history…  For example, you might tie a mixing spoon, ring with keys, wallet, small note book, dish towel, doll (to be discussed in detail next), stuffed animal, hair brush, wire mixing whisk, measuring spoons, or paint brush to the apron.  Also, you can tie paper to the apron by hole punching five to ten sheets in the upper left hand corner.  (See "Apron Success Stories" below for information regarding matching these items with your resident's “Person Appropriate” interests.) 

However, with some residents, you cannot actually tie the apron behind the resident.  If he or she is in bed or in a chair, you might just tuck the ties of the apron behind him or her, because having the resident lean forward in order for you to tie something may make the late-stage Alzheimer's resident feel like you are tying them into the chair.  Or, as you know, some residents are too large or too rigid to lean forward; in this case, tucking the ties behind them is your only option.  As stated earlier, the obvious function of the Activity Apron is that the resident's item(s) can be held on his or her lap and won't fall to the floor.  Thus, you can get around the challenge of providing the resident with a work surface.

Activity Apron “Person Appropriate” Success Stories
Success #1 - Once I implemented the Activity Apron with a resident, Hazel, who had been a former school secretary.  I felt that due to her many years as a school secretary she undoubtedly handled thousands of papers and forms in her lifetime. Hazel would sit for hours on end simply paging through the papers affixed to her Activity Apron.  (See above regarding how to affix papers to the apron.)  However, rather than using blank paper, we actually got some old forms, obviously of a non-confidential nature, from the office.  Hazel sat, seemingly in awe and amazement at just being able to sit and turn the pages of the forms that were "meaningless" to her.  But, as I stated earlier, she had worked with papers for years as a school secretary, and handling the papers seemed to be gratifying to her.  Did she experience success?  You bet!  Who is your Hazel?  Who is your mid-to-late-staged Alzheimer's resident that could benefit from an Activity Apron to provide him or her with a successful experience?
 
Success #2 - With another resident, Harry, whose family said he was quite the handyman around his house, we tied a paint brush to the activity apron.  Harry never actually held or picked up the brush, but he would smile when it caught his eye.  Thus, I felt the paint brush created a friendly, familiar environment for him.  Do you have a Harry for whom an item from his or her past could make the facility environment more familiar to them?

Success #3 - Another resident, William, enjoyed placing his hand over a shaving brush that had been tied to the apron.

CMS Survey Benefit!
Also, as an added bonus of the Activity Apron—especially at Survey time—seeing the Activity Aprons provides your Survey Team with "evidence of an activity program being provided to all levels of care."

It’s important with these low-functioning and Alzheimer's residents, as stated earlier, for you to assess whether having the Activity Aprons and the item(s) affixed to them are positive, successful experiences for the residents or not.  For example, as stated in the last section, if your Millie normally does not thrash around and make jerking movements, and the only time Millie thrashes around and makes jerking movements is when the Activity Apron is on her lap, Millie may be trying to tell you something.  Once again, I would like to repeat, especially with the kinds of residents with whom you would use an Activity Apron, you need to assess each time you use this activity whether this is a positive experience for the resident or not.  As you know, often your resident may be unable to say, "Get this darn thing off of my lap!!"   The only way he or she can communicate their preference is through some form of subtle or perhaps not-so-subtle body movement, Vocalization, Facial Expression, etc. 

Create your own Success Stories
I find that the real key to make an Activity Apron work is to place items on the apron that the resident can best relate to.  So try presenting your resident with several different items to assess or evaluate which ones seem to be most interesting to him or her.  Then, after assessing your resident's reactions to several items, affix the item or items that best held his or her attention to the Apron.

"Gee, that Goal doesn't Sound right to me!"
Regarding the Care Plan Goals written above, do they seem to you a little too easy, simple, basic, and very non-grandiose?  Are you thinking to yourself, "Can I really base my Activity Program around having a resident smile at a paintbrush?!  I mean, don't I need more for a Goal?  I didn't think Goals were to be this simple."  My reply is a question.  Do you think the Goal to smile at a paintbrush is simple?  Think a minute.  If you compare the above three goals to the abilities of Elizabeth, Lillian and Mary, which are the last three interviews on the DVD that accompanies this course, you can readily see that these three Goals aren’t easy or simple at all.  Clearly, the above three Care Plan Goals would be far too difficult for those three bed-bound residents.  Agree?  If you are having a case of the "guilties" regarding writing the above, non-grandiose "paint the ceramic pot" types of Goals, when you write your Goals for low-functioning residents, you might think of yourself as "fighting" to prevent a further slide into total unresponsiveness via any means possible.  In this case, your "fight" to preserve their abilities is through affixing a paintbrush, shaving brush, dish towel, or papers to your residents’ laps.  The activity apron improves the quality of the resident's environment by providing mental stimulation at a “Person Appropriate” level for him or her. 

Residents with whom to try an Activity Apron

Culture Change Implementation: Place an Activity Apron in an Activity Project Bag left in resident’s room for CNA, volunteer, etc. use.

Use of Dolls and Stuffed Animals
(The last track of the DVD that accompanied this Course contains slide(s) illustrating implementation of this activity.)

As indicated in the description of the Activity Apron, a doll could be tied to an Activity Apron to prevent it from falling to the floor.  Tying a doll to an Activity Apron works well for residents who are content with touching a doll rather than picking it up, cuddling, or holding it.  At one point in time, years ago, giving residents dolls or stuffed animals was very controversial.  However, I am happy to say that, if a resident has a preference and seems to enjoy holding a doll, this is, of course, an acceptable activity for the resident.  Factors to be considered in providing a resident with a doll or stuffed animal are family wishes, in addition to staff that may be uncomfortable with this practice.  Later in this Manual, under the topic of "Block Stacking," the need for an In-service Training session is discussed concerning how “Person Appropriate” these child-like activities are.  If some staff appear to have a negative, or less-than-supportive attitude toward using toys with residents, you might consider giving an In-service Training regarding benefits of providing specific residents with a successful experience at his or her level.

Residents with whom to try a Doll or Stuffed Animal

Culture Change Implementation: Place a Doll/Stuffed Animal in labeled Activity Project Bag left in resident’s room for CNA, etc. use.