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Members please log in and click this link Routine Chores or Inviting Rituals for your full version of this article. "The end results of all ritual are increased balance, strength, energy and comfort." Angeles Arrien Cultural Anthropologist
Routines vs. Rituals In our everyday care of people with dementia, we often talk about the daily routines we have to carry out. We do not usually connect these with joy. More likely, we see these routines as chores; experiences we need to get over and done with as quickly as possible. The actual experience is not the focus. Routines are regular, unvarying or mechanical procedures. No wonder we cringe when we hear the word routine and then tend to approach a routine job with little enthusiasm or excitement. Rituals, on the other hand, are enriching ceremonies which: ~ lift the spirit and build trust ~ create familiarity and the joy of recognition ~ reduce insecurity and anxiety. Creating ceremony means to transform the environment from the ordinary to the extraordinary with music, clothes, make-up, accessories, scents, lighting and other means. It is also about the way we conduct ourselves. There is a certain celebratory experience of ease and success. Creating Ritual is about the special way in which we perform an activity and the fact that we do it in the same way every time. Rituals build companionship. People with dementia often experience separation, misunderstanding and alienation. One way of healing such suffering is through personalised and meaningful rituals. Personalised, meaningful rituals Developing and fine-tuning personalised, meaningful rituals is not about creating rituals where ‘one size fits all'. Instead, there is a need for openness to the unique differences, preferences and possibilities that emerge through close contact with the individual. It is a process that evolves over time, starting with one or two small rituals and building on these, one by one. Rituals are the little things we need to say and do, in the same way, every time, every day. What sets rituals apart from chores is our tone of voice and the way we add opportunities to boost self-esteem and make the person feel extra special. For example: When you add smell to a ritual - Give Eric the aftershave to hold and smell for himself, saying, ‘Doesn't that smell fantastic?' Then after you dab scent on him, with enthusiasm, repeat, ‘Now you smell fantastic too.' Once you receive positive feedback from Eric - confirming this ritual really works for him, you can then add it to the enriching rituals you use together every day. By adding special phrases, words and unique touches - repeated every day - rituals turn the mundane into personalised, meaningful experiences. The bond and positive effects on all in your care will make these extra efforts so worthwhile and may actually even save you time. The following morning rituals were created for people who have moderate to severe dementia and who are incontinent. They are meant as guides that you can pick from and adjust to the unique needs of your loved one, or your special residents, clients or patients.
Morning rituals The best way to begin a successful morning ritual is to greet the person with a beaming smile. Say that you'll open the curtains so the person can see the new day. The person may or may not like you going into their cupboard or drawers, so we suggest that you assist the person straight onto the toilet. Once seated, you can help to remove any pads or disposable pants, while constantly reassuring that you are going to get some FRESH ones. We've found it works best to use the word FRESH rather than clean or dry. Wet or soiled pants are likely to cause stress. If you add: ‘Nothing is a problem for us,' the person will often think if it is not a problem for you then it ceases to be a problem for them too. You can now suggest ‘a little sit' and ‘squeeeeeeeze'. You may make a bit of loving fun by showing a squeeze using your whole face and body. The person is most likely to laugh and copy you. If it is safe to leave the person unattended, you can use this chance to pick out clothes for the day. When it comes to ‘toilet activity' our experience is that using expressive language such as a ‘squeeeeeeeze' and calling a spade a spade, such as talking about making a ‘wee' instead of urinating, works far better with the person in the middle to late stage of dementia. Some people may find using this language challenging or even demeaning, however, this approach has been proven to work, over and over, and the person responds in a positive way and is not offended. Isn't what works what really matters? Next, bring out two choices of clothing and use these exact words: "Today, is it your blue shirt/blouse or your green shirt/blouse?" Ask the question while you hold the two choices out in front, one in each hand. Then move the hand with the garment in question as you ask about that particular piece of clothing. This offer of choice helps the person to stay in control and have their self-esteem boosted. Once a choice is made, you can then repeat this little ritual with skirts or trousers or whatever the appropriate garments. Before supporting the person in getting dressed, suggest that you will wash their bottom with a warm face washer to freshen them up. Afterwards, if cream is necessary, give the person the jar to hold and enjoy smelling the lovely lavender scent etc. You could then say, ‘You have the softest, freshest bottom in the southern/northern hemisphere.' This will quite likely bring a laugh. Help the person to sit down again on the toilet and assist in putting on disposable pants, trousers or skirt, socks and shoes, and then hand them bra or singlet and shirt etc, one at a time, in the right order. Most often the person will prefer to do as much independently as possible. This gives you a chance to make the bed; once again, only if it is safe to leave the person unattended.
Sometimes
people with dementia do not like you to strip the bed or remove their washing,
so it is easier to do so during mealtimes or when they are busy getting
dressed. Rather than saying the bed is wet or clothes are dirty, as this can
cause offence and embarrassment, try using the explanation that, ‘Today is
‘big wash day.' Of course, the above are only guidelines and suggestions to explore in developing rituals best suited to the person for whom you care or to your individual residents. Expect the unexpected; don't take it personally. Bad tempers and outbursts last only for a short time. The most embarrassing and challenging moments will no doubt give the most laughs when you look back on them ‘fondly'. Be creative, and try, try, try again. Be ready to laugh together at the silliest things. Think ritual, not routine, and then joyful moments and easier, more meaningful experiences will ensue for both you and all those in your care. Further reading - Click topic
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