a. A Leader but Not a Follower, Success Story
Here is the story how Harold became involved by being offered a leadership position. The story has been broken down into three components that resulted in Harold's success.

Harold was the former policeman who cut out the coupons for me as described in an earlier section. Here’s another way that Harold became involved. With this approach, I combined several approaches previously explained. I inherited from the previous Activity Director a two hour Bingo game. Yes, two hours of calling Bingo numbers.

1. Step One: Take an "Us" against "Them" Approach
Now something I hadn't told you about Harold, is that not only was he ambulatory and fairly alert, he also had a very deep, rich, announcer-type voice with a lot of resonance. I had talked to Harold about joining the sing-a-long, but he wouldn’t have anything to do with singing. Remember he was a former policeman. So here is another way that I motivated Harold. I took an “us” against “them” approach. Now listen how I set this up. At this time he was back in his room and there were no other residents around. I said, “You know, Harold, those women (because I knew that was his attitude) they have to have that two-hour Bingo game every Wednesday!” He replies, “Oh yeah,” in sympathic agreement. So I set up an "us" against "them" positioning.

2. Step Two: Very Small Simple Task
Then I said, “You know after calling two hours of Bingo numbers my throat really gets dry, and I could really use a break. I notice in the afternoons you usually walk past the back of the dining room to get yourself a cup of coffee or a Coke. Do you think you could call, oh I don’t know, two or three Bingo numbers for me while I walked to the back of the dining room and got myself a Coke, and I could rest my voice a little bit?” Notice I said only two or three Bingo numbers, I didn’t say two or three games. He said, “Well, I don’t know, I'm not sure.”

3. Step Three: Feel He is Helping
I said, “Oh come on Harold, help me out. You’re my buddy aren’t you?” Think of your residents like Harold. How do you motivate him or her? Would an "Us against Them Approach" or "Giving a Small Task" or an “I Need your Help” approach be worth trying? So here are three different motivational approaches I have used here:
1. those other residents, who want the two hour Bingo game, taking an “us against them” approach;
2. suggested a small task of calling a few Bingo numbers; and
3. “I need you help.”
So it came time for the two-hour Wednesday Bingo game. Harold is walking past the back of the dining room. I sit up really tall and I smile and catch his eye. Harold walks with a cane. He was a very distinguished looking man with a full head of white hair. He walks to the front of the dining room and sits down. I get him all set up. He calls a couple Bingo numbers, I go back to the back of the dining room and I get a Coke. This becomes a regular practice on Wednesdays.

Great Reality Orientation: Now, all of a sudden Harold has a reason to remember…what? In order to be there on time he needs to remember two things: the day of the week and time of the day. Nursing likes Harold to stay oriented. This was a fellow who was starting to say, “Hey, did I have lunch today?” Harold needed to be needed.

There were some additional benefits to Harold calling the Bingo numbers. On the days that he called the Bingo numbers, he made sure that he brushed the dandruff off of his sweater. He had on his nicest sweater. He combed his hair very nicely. Here are some other changes that took place when Harold started to call Bingo numbers. You know how you try to put the hard-of-hearing residents in front of the Bingo game? This began to change. Alert residents would say “I’m sitting in front,” “No, I’ll sit here today!” Over the weeks the junk jewelry from all the past Bingo games started to be worn. There was one resident, she must have had on twelve bracelets and necklaces. Thank goodness there wasn’t an airport within ten miles, or she would have set off the metal detectors!

So do you think Harold would have played Bingo? No, you are right. Harold would not have played Bingo. But, to be the person in charge, the person calling numbers and to help me out, these are the motivational approaches that worked with Harold. So think about your Harold's male or female ego and what his or her ego motivators are. Harold now had a reason to remember the day of the week and the time of day. So Harold's involvement in Bingo had benefits on many levels.

Below write the names of residents who might be motivated by leading or being in charge of an activity:

Culture Change CNA Inservice: Brainstorm about residents CNAs feel might be motivated to become involved if they were the “Leader.”

b. Competition: Who Are You Comparing?
This section provides a method to facilitate your analysis of the words you use, during your activities in which competition is involved. Assess from the following story if your words are acting as motivators or de-motivators.

Another activity I inherited from Kitty, the previous Activity Director, was five mornings a week the residents played plastic bowling in the lounge. Keep in mind one hundred beds in the 200 bed facility were skilled! Half of those in the facility couldn’t even get out to the lounge. However, the history of plastic bowling in the lounge was that everybody in the lounge got their turn to play. There was a resident in a wheelchair whose hand was in an extreme contracture. At this time I did not know about the plastic ramps you can use for plastic bowling balls to help a resident who has grasping problems. So to assist the resident with contractures, I would hold the ball to her hand, she would be slumped over in her chair, and if we were a little successful in our efforts, we’d get the ball to hopefully go somewhere in the direction of the pins.

Now there was a resident whose name was Margaret. Margaret was a mildly mentally retarded resident that would harass the other residents. She was the kind of resident you would like to take by the hand and lock in her room for the course of the activity. Just kidding, of course! But she was a real morale problem for the other residents. What she would say is, “What you got her bowling for!? Look at that, she can hardly even hold the ball!” It’s very important in competition situations, and also in nursing rehabilitation situations, that you do not compare one resident with another resident. By comparing I mean stating, Mary got down three pins, and you Maragret got down seven pins.

The way that I handled the harasser, Margaret, in this competition situation is as follows. I kept an Attendance Sheet. Margaret was such a problem for me regarding her harassing the other residents that I recorded in the Attendance Sheet how many pins Margaret got down each day. So I would say, “You know, Margaret, yesterday, you knocked down six pins. Let’s see if you can try to get seven pins down today. Why don’t you go over there and try those three steps you take when you bowl.” Let me ask you, "Who am I comparing Margaret to?" I am comparing Margaret to herself. If I compare her with a less capable resident, my comparison acts as a de-motivator to the less capable resident.

I feel you really have to listen to yourself, listen to your volunteers, because it’s real easy to compare one resident with another. Comparisons between people with unequal abilities actually act as a big de-motivator. However, if you compare that resident with him or herself, rather than with someone else, de-motivation becomes motivation. In summary, by comparing Margaret with Margaret I was able to stop her harassment.

Below write the names of residents involved in a competition-type activity, for example, Bingo, Las Vegas (a card game to be described later).

Goal: To call five numbers in a Bingo game…
Approach: To motivate resident using an “Us vs Them” approach…
Approach: To motivate resident with the idea of being a “Leader”
Goal: To knock down seven pins in the bowling game…
Approach: To motivate resident by saying, “You knocked down six pins yesterday, let’s see if you can knock down seven pins today”…

Culture Change CNA Inservice: Brainstorm about whys they might motivate by “Comparing” that resident to his or herself.

c. Card Game: "Help Your Neighbor" or "Las Vegas"
Speaking of competition here is a simple card game. You might call it "Help Your Neighbor," or "Las Vegas" depending upon the name you feel will be most motivational to those residents playing.
The object of the card game is to turn over all of your cards. An advantage to this card game for your less capable residents is that the residents only have two cards. If you do not have four residents of similar abilities, the staff member or volunteer conducting the game might take the place of a player.
1. Each resident is dealt two cards face up. Two dice are rolled. A small cup helps resident roll the dice.
2. If the resident has the number they rolled the resident turns face down that one card.
3. If they do not have the number they rolled on one of their cards, the first resident to their left turns over a card if it matches the number rolled.
4. If neither of these two have that number the next resident to the left turns over a card to see if it matches.
5. If they have two of the same card the resident still only turns over one card per roll. If no one has that number, the resident to the left of the person who originally rolled, rolls the dice.
6. The dice are passed to the left until some one has all two cards turned over. When this happens, they are in first place.
7. To spread around the success… then the three remaining players continue to turn over their two cards. The next winner is in second place. Thus you have several winners.

Card Game Adaptations for less alert residents:
1. Obviously it does not work to mix alert residents with confused residents.
2. Mask the dice with your fingers so the resident can only see the sides of the dice that are up to help them count the number of dots on the top of the dice.
3. If the resident calls the symbol on the card diamonds you call them diamonds. But if the resident calls them red spots I find it best if I call them "red spots."
4. You might use tape or correcting fluid to mask out the small diamonds in the corners of the playing cards which may confuse the disoriented resident. If your residents are not confused by the small diamonds on the card, there is, of course, no need to mask them out.
5. Putting the dice into a cup helps the resident to roll the dice as mentioned above.
6. Another adaptation would be to only use one dice and only the cards from one to six

Card Game Adaptations for more alert residents;
1. Deal seven cards rather than two.
2. Use the Jack and Queen for 11 and 12.
3. Make the King and/or Ace a “wild card” that matches any number that is rolled.

A note about big prizes: Prizes are a real problem if the resident gets a big bag of candy one week they, of course, will want a big bag of candy the next week. So avoid the temptation to give big prizes. You may automatically be creating a heightened expectation level in your residents and become trapped into providing big prizes each week.

Goal: To count to three in the Help Your Neighbor game…
Approach: To mask the dice with your fingers…
Approach: To mask out the small diamonds in the corners of the playing cards with tape or correcting fluid…

Below, write the names of residents that you feel would be good candidates for the "Help Your Neighbor" or "Las Vegas" card game described above. Also, write the adaptation the resident may need to be successful at this game.

Culture Change CNA Inservice: Brainstorm about residents CNAs feel might be able to, and interested in playing a simple “Card Game.”

d. "Playing a Game" as a Motivation for a Simple activity
Since we are talking about games, I felt it might be a good idea to expand upon the "games" concept as a means of motivation regarding other activities that normally would not be considered "games." To introduce a nonsensical, non-product-producing activity, like dropping a cap into a butter dish, as described in Volume 1, you might motivate involvement by explaining to the resident that the activity is a "Game." Volume 1 explains the idea of "Caps-in-a-Bowl" in detail. The steps of implementation for the "Game Motivational Approach" regarding Caps-in-a-Bowl are as follows:
1. Ask: "Effie, would you like to play a game today?"
2. Demonstrate: "Let me show you how this works." Drop a cap into the bowl, holding the cap at her eye level.
3. Assessment: Note Effie's receptiveness to your interaction at this moment in time. Seconds later it may be different.
4 Work surface: If she has eye contact and/or makes some verbalizations indicating she is receptive to the interaction, provide her with an over-the-bed-table as a work surface.
5. Demonstrate: Drop the cap in the bowl. Use few verbalizations if you feel that your verbalizations will be distracting to her.
6. Motivate: Comment, "Let's see if you can play this game. It's easy. See?"
7. Reinforce: When Effie drops the cap into the bowl say, "Good job! Here, try the game again," as you hand her another cap to drop into the bowl.
Thus, reconsider some of the Low Functioning and Alzheimer's activities presented in Volumes 1, 2 and 3, regarding the use of the word "game" as a motivational approach to encourage resident involvement.

Goal: To drop three caps into the bowl…
Approach: To motivate doing Caps-in-a-Bowl by introducing it as a game…

ActivityProfessional.Com Login