a. Helping Other Residents
Here's an idea regarding motivating a resident to become involved by suggesting he or she helps another resident. You can record simple hand exercises into a tape player and play the tapes for residents in their rooms. Or, consider having a more alert resident bring the cassette players around to residents' rooms who have already been introduced to this activity.

Here's an unusual story about the use of a hand exercise program with a resident who refused to leave her room. Martha was an alert resident. However, she was afraid to come out of her room because her eyesight was so poor and she had fallen before. She could carry on a coherent conversation. However, she was starting to become increasingly disoriented and talk to her sister who had died several years ago. Her disoriented speech was not due to Alzheimer’s. It was mainly due to lack of stimulation. So we played a hand exercise CD in her room. However, as you can guess she would not do the hand exercises. She would just sit there on the edge of her bed and listen to the hand exercise recording. So one day, I went into her room, and I said, “You know, Martha, do you want this record played for you? It’s been in here playing about three times a week, and I notice that you don’t do any of the exercises. Maybe it’s bothering you. Would you rather have something else to listen to or nothing at all?” Martha replied, “Oh no, I like the recording. I love the nice man’s voice.” I was quite surprised by her reply to think that the CD was company for her. How many of us go home and turn on the TV for company? So the hand exercise CD for Martha was a valid activity, and was some form of stimulation for her… it was company.

However, when the same CD was tried with another resident, Hazel, she didn’t like the recording. I think there were too many different kinds of movements on the disc for her to follow. So for Hazel, I made an audio cassette tape myself. On the tape I gave instructions like, “touch you thumb to your index finger, touch, touch, touch.” I custom-made a simple hand exercise taped program for Hazel. Then a more alert ambulatory resident that was motivated by helping others, took the tape players around to residents' rooms. If you would like to see this resident, she is on DVD Track 15 of the course dealing with Recruiting Volunteers. I included this photo with the Volunteer Course because dropping off and picking up cassette players in residents rooms is a good way to get you group volunteer started doing some one-to-ones.

Below write the names of residents who would be motivated by "Helping Other Residents." Then, consider duplicating this table in Word Excel or a notebook and list additional residents.

Culture Change CNA Inservice: Brainstorm about residents CNAs feel they might motivate by mentioning “Helping Another Resident.”

b. "To Please Someone…"
Sometimes a resident can be motivated by being told that involvement in a particular activity will please someone else. Obviously, the "someone else to be pleased" needs to be a person the resident cares about pleasing. Thus, you might think about your residents who…
1. Receive regular family visits
2. Are alert enough to be aware of the family members presence.
Is there any resident in your facility for whom it would be appropriate to motivate by saying, "If you do xx, you will please (for example) your daughter"? If appropriate, a staff member might talk to family members about encouraging their relative to do a certain activity in which he or she may be interested, for example, attending a Bible Study or Sing-a-Long. Obviously, there is a fine line here and you don't want to "guilt trip" the resident if he or she does not become involved, or does not want to become involved. However, sometimes just by referencing a daughter's name, son's name, or doctor's preference, he or she may attend a group activity that in the past the resident has refused to attend.

For example, there was one resident for whom referencing the name of her doctor would act as a major motivator to get her involved. If a staff member said, “Oh, Dr. John would like for you to go out,” then she would reply, “Oh, he would? Then I’ll go.”

Below, write the names of residents you feel would be motivated by "Pleasing Someone." Then write the name of the person they might be interested in pleasing. Consider duplicating this table in Word, Excel, or a notebook and list your residents.

Culture Change CNA Inservice: Brainstorm about residents CNAs feel they might, or have motivated by mentioning “Pleasing Someone.”

b. The Opposite Sex
Remember Harold, the former policeman who called Bingo numbers? How Harold was motivated to call Bingo numbers is explained in further detail in the Track 9 Section of this Manual, "A Leader but Not a Follower, Success Story." If you recall, the women attending began to take more care in their appearance once Harold started to call Bingo numbers. Do you have a resident who is of this alertness level? Or, do you have a resident whose spouse is in the facility?

Below, write the names of residents that might be motivated to attend an activity by mentioning the name of a member of the opposite sex that will be attending. Then, duplicate this table in Word, Excel, or a notebook and list additional residents.

Residents to be motivated by the "Opposite Sex"

Culture Change CNA Inservice: Brainstorm about residents who CNAs might, or have motivated by mentioning the “Opposite Sex.”

c. Use of Curiosity: A Success Story
Curiosity and Putting Complainers in Control
I’m sure that you’ve all used a “Guess Box” before. If not, to make a Guess Box, you take a shoebox, or a box of similar size, and put an item in it. You ask the resident to try and guess what’s inside after you give some clues. Here’s an unusual way that this idea of curiosity and the Guess Box worked as a motivator. An activities director in Martinsville, Indiana I consulted with had made a Guess Box. When I came in for my monthly consultation she said, “Cathy, I tried one of your ideas from last month's consultation, and I want you to see how it’s working. It has a little unusual twist.” I said, “OK.” She stated, “Walk down A Wing here, just a little to your right.” Now I knew I was being set-up when I realized I was walking by myself down A Wing. The Activity Director was about three large paces behind me with a big smile on her face. So now I’m walking down A Wing, and I get to a doorway. I can see foot pedals to a wheelchair in a resident's doorway, so I am aware that there is a resident sitting right in the doorway to his room. I get to the door and this resident accosted me with a shoebox. He blares out, “Here you guess! You guess what’s in this box!” I replied, “Yes sir, anything you say.”

Let me tell you about this resident. I will call him Bill. Bill was a real "problem" for nursing. He was very alert and knew every resident's name on A wing. He knew resident's shower schedule! He even knew staff's vacation schedules! He had his watch and he would time how long residents had their lights on. A typical “interviewable” resident CMS surveyors select for an in-depth interview.
6 sec25AM

So how did Bill end up with the Guess Box? I had given the Activity Director the idea the month before. She was going around to all the rooms on A Wing with the Guess Box. Well, she told me, “You know, Cathy, I was in a real bind, because you know I had offered Bill so many other activities in the past, and he would sometimes cuss at me or say it was stupid.” (Oh, another insight into this man that I wanted to tell you is that housekeeping also dearly loved him. If dietary made an error and gave him green beans, which he hated, he would make jet airplanes out of them and throw them on the floor.) The Activity Director stated, "I hated to ask Bill what was in the Guess Box, but also I knew that if he didn’t have his turn, and if I skipped his room, then I'd hear about it." She went up to Bill, and she said, “Bill, do you want to guess what’s in the box?” She said, "Bill grabbed the box out of my hand!" Now here’s a man who chews tobacco, and he told her, “I’ll have something here for you to guess when you come back this afternoon!” Well, she wasn’t quite sure what would happen. However, Bill was the type of resident who would remember that the Activity Director was supposed to come back to his room later. So she knew, for sure, that she had to keep her promise and come back to his room. What Bill had done was put his tobacco pouch in the guess box. It was a very appropriate item for the Guess Box.

By the time I got back to the facility, a month later, he had acquired a whole drawer full of earrings, bracelets, and so on. Now you may ask yourself, where did Bill get these items from? Well, anybody that walked down A Wing played Bill's Guess game. Visitors, family members started bringing in things. He even had a doctor playing his Guess game.

Below, write the name of someone who is your chief complainer, somebody who’s just perhaps a cantankerous old soul. Think of a way you can put him or her in control. Who decided who played Bill's Guess Game? He did. If he didn’t like someone, they didn’t play. Who decided what went in the Guess Box? He did. Do you see all of the control Bill with his Guess game?

d. Motivate by Putting the Resident in Control
Here is another idea related to putting the complaining resident in you facility in control. There was another resident who complained a lot named Estelle. Estelle was very alert, and could have served as a volunteer with other residents. She had an extremely high level of both physical and mental capability. But she had such a bad disposition, to have her working with or helping someone else out, just would not have worked. So here is how Estelle became involved individually without connecting with others as Bill did in the Guess Box game above. Estelle was religious. So on the bulletin board next to the calendar a section of the bulletin board was labeled Mabel’s Bible Verses. The Activity Director gave her a blank 8 ½ x 11 sheet of paper and periodically when she thought of it, maybe two to three times a week, she would write a Bible verse and post it next to the calendar. So that’s where Estelle was in control. She decided how often she posted a Bible verse and which one was chosen. She would periodically talk to Activities or Social Services and ask something like, “Hey what do you think about this verse for today?”
Below write the names of residents that might be motivated by "Being in Control." Then list a possible activity, given their temperament that it would be appropriate for them to be in charge of. Then, duplicate this table in Word Excel or a notebook and list additional residents.

Culture Change Implementation CNA Inservice: CNAs suggest residents whose wanting to be in “Control” could be or is a motivator.

Goal: To play the Guess Box game with other residents and staff…
Approach: To motivate resident with “Being in Control”…
Goal: To post a Bible verse on a bulletin board twice a week…
Approach: To talk to resident about a religious publication she or he is reading…

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