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Section 2
Track #2: Caps in a Bowl

Table of Contents | NCCAP/NCTRC CE Booklet
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Transcript of Track #2

For the success therapy activities described in this course, let’s assume you have a resident who can bring their thumb and index finger together, is able to have eye contact when spoken to, and has an attention span of at least one minute. The first and most basic success therapy activity is called Caps in a Bowl. I say most basic because it is a good starting point when you get a new admission to get an idea of what the resident can and cannot do.

The materials are 7 or 8-gallon milk bottle caps and an empty butter dish or a plastic bowl. The two-cup size works best I find. The idea is for the resident to drop the milk cap into the butter dish or bowl thus the name of the project, caps in a bowl. However if upon presenting the cap to the resident they put the cap into their mouth, for example, they are obviously not a good candidate for this kind of activity and will probably need one of the activities I will explain in another course related to the use of magazine pictures for discussion.

Or in other words, if they put objects in their mouth, their activity program would need to be a non-object manipulation type of activity. When you show your resident the gallon milk bottle cap, look at his or her eyes to assess their eye contact. Remember that from the previous track. Obviously if the resident is not able to maintain eye contact with you or with the cap, when you are saying something like “I’ve got a hand exercise for you to try. Would you like to try a hand exercise for me?” they would not be a good candidate for Caps in a Bowl.

On the other hand, some residents may be agitated or uncomfortable with your talking to them or some have a very low energy level and appear too fatigue to even to hold a gallon milk bottle cap in their hand. Always be sensitive to your resident’s agitation and energy level. Stop the activity if you, for lack of a better term, get a gut level feeling, which tells you what you are doing is having a negative impact on the resident. Some residents make continuous verbalizations even though they have excellent hand movement they are unable to focus their attention on the activity. This kind of resident also would not be a good candidate for caps in a bowl.

Assessing the Resident
However for your low functioning resident that does meet the assessment criteria of number
1. Eye contact number
2. Attention span.
3. Low agitation and number
4. Energy level

You might say something like “lets see if you can drop the cap in the bowl for me. Would you like to do that?” place the gallon milk bottle cap between the thumb and index finger and gently pull their fingers apart if they are unable to do so themselves. Thus the cap drops into the bowl. For this lower functioning resident, the care plan goal would read something like “to drop the cap in the bowl with total physical assistance”. The care plan approach might be to move the thumb and index finger to facilitate their dropping of the cap into the bowl.

A note here about sample care plan goals and approaches given in this course, I will give you the base starter phrase or root for the goal or the approach on your care plan. However your corporate policy computer software package state regulations and surveyor interpretation will of course combine to determine how specific this documentation needs to be. For example, in the case of a goal that I present on this Section, you might need to add the following phrases to make the goal measurable.

For example, to make a goal measurable, you might add “regarding the length of time for 10 seconds.” A ratio like 4 out of 5 times; a distance like 2 feet; a percentage like 25 percent of the time and so on. Remember, especially if you are new in your position, your corporate consultant is usually your best source regarding documentation compliance specific.

Now let’s go back to Caps in a Bowl.
If the resident has a little more mental and physical ability, perhaps they are able to hold the cap in their hand. Your care plan goal might then be to drop the cap in the bowl upon request. Thus you might say to the resident “Hester, lets see if you can do this for me”. You demonstrate dropping one or two caps into the bowl slowly one at a time, usually not speaking.

You need to assess if your words are distracting the resident and then gauge the amount of verbalization you are using in initiating the activity. The Care Plan Approach might be to request in a reassuring manner or to demonstrate using resident’s name or to speak at the resident’s eye level. If the resident has a little more ability the next step in difficulty would be to drop the cap in the bowl independently when started.

This mean you would demonstrate how to drop the cap in the bowl, explain to the resident that this is a hand exercise or a game, and they would continue to pick up caps and drop them into the bowl without further direction or prompting. The proceeding is an example of how you can adapt the difficulty of caps in a bowl by varying the level of assistance given to the resident. Let me repeat that, the proceeding is an example of how you can adapt the difficulty level of caps in a bowl by varying the level of assistance given to the resident.

As a review the approaches are as follows, from lowest to highest functioning. To do caps in a bowl with total physical assistance; to do caps in a bowl with physical assistance; to do caps in a bowl with demonstration and instruction; and finally the highest level of functioning would be to do caps in a bowl independently once started. As you will notice in this series I do not give you sample care plan problems to address because one success therapy care plan goal could be used with a limitless number of problems.

For example, in the case of Caps in a Bowl, this activity may address the cognitive and physical problems of: only able to understand simple directions, disorientation to time place and person, stiff finger movements and so on. But if a problem is not currently listed on the care plan that seems to be addressed by this success therapy activity, add one after consulting your corporate consultant for the specific procedure to add problems to your care plan.

Question 2: When would you stop the activity with a resident?

NCCAP/NCTRC CE Booklet
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Table of Contents

Note-Taking Exercise
Caps in a Bowl

What are the assessment criteria for Caps in a Bowl?
1.

2.

3.

4.

What are three Care Plan Approaches for Caps in a Bowl?
1.

2.

3.

What is the progression of difficulty for Caps in a Bowl?
1.

2.

3.

4.

Residents with whom to try Caps in a Bowl

Culture Change Implementation: Place Caps-in-a-Bowl in labeled Activity Project Bag left in resident’s room for CNA, volunteer, etc. use.