To put this content in perspective for you, here is an overview of how the content of Volume 3 fits in to the learning sequence of the preceding two Volumes. Volume 1 in this series, Vol. 1 CD: Alzheimer’s & Low Functioning 1-to-1 Activities with MDS Based Care Plans!- provided you with seven key activity projects that I have found, through my years of consultations to ICF and SNF facilities, to be appropriate for the vast majority of your low-functioning and Alzheimer’s residents.

Vol. 2 in this series, Resident Interviews DVD: Semi-Comatose & Low-Functioning 1-to-1 Activities with 91 Care Plan Goals, starts by providing you with activities for your total-care semi-comatose residents and continues up the ability level continuum ending with advanced-stage Alzheimer’s activities.

This Volume, Vol. 3 Seminar DVD: Advanced-Stage Alzheimer’s & Low Functioning Small Group Activities with 99 Care Plan Goals, continues up the ability level continuum where Vol. 2 left off. This Volume, Volume 3, provides you with the next level of Activities, starting with advanced-stage Alzheimer’s activities and ending with early-stage Alzheimer’s residents. However, rather than just providing you with low functioning activity ideas for advanced to early-stage Alzheimer’s, the purpose of this Manual is to teach you a Four-Step process for implementing each low-functioning activity, whether individually or in a small group.

If you have paged through this Manual prior to reading this Introductory Commentary, undoubtedly you have noticed the diagrams of Activity Projects, like Push Ball. If so, you may have thought to yourself, “Gee, these are simple ideas! I can just look at the diagram of Push Ball and figure out what that idea is!”

Since this course focuses on activities for the advanced to early-stage Alzheimer’s and Low Functioning portion of your resident population, by the very nature of these residents, who have limited physical and mental ability, the projects have to be, well… “simple.” However, after viewing the seminar DVD, I’m hoping it should be abundantly clear to you at this point in time that the subtleties of implementation with Low-Functioning and Alzheimer’s residents can be in fact quite complex. I guarantee if you overlook the subtleties in implementing, for example, the first Activity in Part II, entitled “Push Ball” to be described, you may end up saying to yourself…
            “Push Ball didn’t work with my Betty, who is in the advanced-stages of Alzheimer’s!” or
            “My Betty did not respond to “Push Ball”!” or
            “My Betty cannot do a thing! All she does is sit there! The “Push Ball” idea doesn’t work!” or
            “Nothing can be done for this totally 'out of it' resident!”

And guess what, you have just created a whole plethora of excuses…. regarding why you do not have to work with, in fact, your Betty, or, in fact, any of your Low-Functioning and Alzheimer’s residents! So here you sit! You have purchased this course, it has ideas, as validated by the slides on the DVD, which work with the Low-Functioning and Alzheimer’s portion of your resident population; but you may “blow these ideas off,” flippantly flipping through this Manual, glancing at the diagrams, saying to yourself, “Oh, is that all there is?! I knew all this anyway!” and tossing this Manual aside. These course materials then get buried under a stack of papers or activity catalogues on your desk. And guess what? Your Betty, Millie, and/or Ernest, who are some of your Advanced Stage Alzheimer’s and Low-Functioning residents that comprise probably 70% of your resident population, sit there and/or lie in their room hour after hour, and possibly even week after week, with the staff walking past them, and saying to themselves, “Nothing can be done for him! Nothing can be done for her!” Oh, yes, I know. Perhaps I am being all too bleak and negative. But here’s what I’m really trying to say…

“Look at these ideas! Read this material! The ideas are simple, but the key is in how they are implemented.
This course contains the answers you have been looking for!
Something can be done with those residents you have previously felt were unreachable!”

You know from the slides and lecture in the seminar DVD that you are receiving practical activities that work. This Manual is filled with simple ideas you probably have been aware of or have already tried. So, briefly review one of these simple ideas. Then ponder over it thoroughly. Reference often the step-by-step procedures used to successfully involve your low-Functioning residents in that activity, should you deem it appropriate.

The four-part implementation procedure I will be using in various forms throughout this Manual is as follows, and can be the basis of a CMS Care Plan Progress Note. When you try a project with a resident,
1. Observation: What small part of the activity… is the resident able to do? Not able to do?
2. Assessment: What needs to be changed? More assistance? Less verbalization? Positioning? Size? Length? Color? Thickness? Different staff member? More use of resident’s words? Use more gestures rather than words?
3. Creativity: How do I implement these changes? Moving working surface? Changing time of day? Gluing corrugated cardboard that is easier to grasp? How can I incorporate past interests to increase motivation?
4. Sensitivity: What is my resident’s reaction during the activity? Positive? Negative? Should I continue?

Often times, I will abbreviate these four steps with the words “Observe and Assess.” So, whenever you see the phrase “Observe and Assess,” let this serve as a red signal flag to you. “Observe and Assess” hopefully will serve as a red signal flag to draw your attention to start activating your brain to think about how the implementation procedure outlined in the Manual can be altered, changed, or molded to better fit a resident in your facility. I have given you my best in this course. I hope you will give it your best. Instructor's Guide a

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