Program Structure

Duration

45 Minutes once a week

Participants in the Program

This is a program for very impaired "behavior problem" residents (usually with hostile defensive or withdrawn behavior, often referred to as the "biters, scratchers, screamers or kickers" by staff). The staff caring for these residents are usually stressed, and show it in their approaches to them. Participation is limited to residents with similar levels of functioning in order to promote a consistent environment, and to foster group ownership and cohesiveness. This ensures that the level of operation of the group is consistent with the participants' limited abilities. Higher functioning residents joining the group would most likely take over the program, and the targeted population would, once again, be excluded.

Group Size

6 to 8

Selection of Residents

The facilitator selects the members of the group on the basis of an informal interview with the resident, and with staff input on the resident's behavior and perceived needs. Participation is limited to residents with similar levels of social and cognitive functioning in order to promote a consistent environment.

Entrance Criteria

1. Resident experiences difficulty in adapting to facility routines or rules of social behavior.
2. Resident is capable of some socially appropriate response, even if only when approached in a friendly, undemanding manner.
3. Resident is believed able to participate in this group safely, and with some therapeutic benefit.

Exit Criteria

1. Resident's behavior does not indicate a benefit for him/her, or constitutes a significant disruption of the group, or a danger to self (swallowing difficulty, holding up hot tea cup)
2. Resident refuses to attend.

Staff and Equipment Required

1. One facilitator, one co-facilitator
2. Room with door that can be closed
3. Table with tablecloth and centerpiece

Program Content

1. The group meets 1x wk. for 45 minutes on the unit where most of the group members live.
2. The principal activity is always making, serving and drinking of tea, with all its attendant ritual and rules of conduct.
3. No other activity is ever introduced during the group.
4. The conversation and relationships revolve around this one purpose.
5. How it is done determines how effective it is in meeting its objectives.

Physical Environment for the Program

1. Room with a door that can be closed, free of distractions and interruptions.
2. A table set with a tablecloth and flowers or a centerpiece.
3. A tea service, including the teapot, creamer and sugar bowl, cups and saucers, teaspoons, napkins, hot water in a carafe or coffee/tea machine or a kettle to boil water on the stove if available, a container of tea bags, and a tray of assorted cookies or snacks are on a separate cart or counter. (All of these articles are important because their familiarity stimulates old patterns of behavior and social competency.)
4. The seating at the table is arranged according to residents' needs, and the likelihood of interacting positively or negatively with one another.

The Ritual is important. Regular, consistent and predictable cues help the resident with dementia become adapted to the program. It also promotes group connection and fosters a sense of control in residents.

Forms to Assist in Care Planning

1. Sample ID Care Plan (PDF, 9KB, 1pg.)
2. Goals on Care Plan for Individual Residents (PDF, 890KB, 2pg.)