Pathways to the Past
by Sandra Stimson ADC, CALA, CDP
Executive Director,
Alternative Solutions in Long Term Care
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SANDRA STIMSON
Executive Director
Alternative Solutions in LTC
and
National Council of Certified
Dementia Practitioners
http://www.nccdp.org  
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ABOUT SANDRA

Sandra Stimson has
experience as a corporate
consultant, Corporate Trainer
and National Speaker. Her
experience is in long term
care, as Activity Director,
Director of Alzheimer's Units
and Assistant Administrator of a
550 bed long term care county
home.  She is Co-founder of
Pet Express Pet Therapy Club,
is a Life Replay Specialist.  
Sandra implements dementia
units nationwide.  Sandra has
written several books,
Volunteer Management
Essentials for Long Term Care
and Pet Express Pet Therapy
Program. Sandra has been a
facilitator for Alzheimer's
support groups and is the
Awards Chair for the NJ
Association of Activity
Professionals.  Sandra is the
Executive Director of
National
Council of Certified Dementia
Practitioners
http://www.nccdp.org  

Alternative Solutions in Long
Term Care offers resources for
health care professionals in
many areas of dementia care,
care plans, Snoezelen
products, dementia activity
calendars, adult day care
calendars, sensory calendars,
reminisce videos for dementia,
activity books, and dates to
remember, party supplies,
resources and links.
Each Norman
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Resident Rights and is
illustrated by a picture
depicting the "Resident
Right."
click here to purchase
resident rights prints
Creating Themed Boxes,
Memory Boxes and Themed Trunks

Creating Themed Boxes, Memory Boxes or Themed Trunks is a very important if not
essential component of dementia programming in the long term care setting. The
reminisce and sensory stimulation program may be conducted in a group setting or
provided to clients individually or as part of yourself recreation program.

There are many benefits to your clients when the program is implemented correctly.  It
is important that your staff is trained in reminiscing and sensory stimulation. The staff
should also understand the benefits of the program. If you don’t currently have a policy
and procedure for remising and sensory stimulation, it is recommended that policy and
procedure is developed and implemented.

Why is Reminiscing and Sensory Stimulation important? There are so many articles
and research solely devoted to this question. Some of the most common benefits cited
in the articles are:

For the resident there are many benefits:

  • Provides social stimulation
  • Improved quality of life
  • Sense of accomplishment
  • Replenishes the spirit
  • Encourages the resident to try
  • Opportunity to build new relationships
  • Exercises the brain
  • Provides cognitive stimulation
  • Pleasurable experience
  • Invokes all kinds of emotions from sad to happy
  • Relieves boredom
  • Encourages engagement of all participants
  • Enhancement of performance
  • Awareness of group members
  • Relive events from the past
  • Reduces stress and anxiety
  • Proactive self expression
  • Offers a creative out lit
  • Boost self esteem
  • Environmental awareness
  • Increase belonging
  • Increased communication
  • Improved self concept
  • Relaxation
  • Derive enjoyment and pleasure of leisure experience
  • Increased alertness
  • Stimulate the senses
  • Express individual identity
  • Alleviate depression
  • Involvement in meaningful, failure free, purposeful activity

There are many benefits to care staff as well:

  • Provide compassionate care
  • Understanding of the resident’s uniqueness and life history
  • Find links between past and possible present behaviors
  • Provide opportunities to form new relationships with their peers
  • Connect with the resident on a deeper level
  • Listening to their stories, demonstrates you care.

After attending a reminisce program, residents may be more apt to participate in
creative programs such as art, painting, drawing, poetry, storytelling, singing, music,
scrap booking or dancing.

How often should sensory programs be held? It is recommended that they be held at
least twice a week but obviously the benefits are so numerous that there could be a
program offered daily.
How long should the program last? The program should last about 45 minutes,
however if everyone is responding well continue with the program.
What time of day is good for this program? It is recommended that this program is
planned after lunch. This is a time when the residents are more relaxed and less
stressed. In the morning, just the act of getting dressed can be very stressful.
Additionally, many times the day room is also the dining room. When held in the
afternoon, you have the option of continuing a program with no time restraints because
of other functions.

What types of sensory programs should be offered. Sensory enrichment programs
have many forms such as;

  • Memory Boxes and Theme Boxes
  • Themed / Seasonal Murals
  • Laughter Kits
  • Themed Trunks
  • Sensory Gardens
  • Sensory Rooms
  • Create picture books
  • Time Slips
  • Music Programs
  • Interactive short plays with props to hold
  • Sensory Carts
  • Sculptures, Paintings

Very large fish tanks and water gardens
How to get started in creating themed boxes. It is recommended you meet with your
staff. Explain the program and provide the staff with some suggestions or themes. Ask
each staff member to create 4 theme boxes for a specific month that are seasonal and
related to the month. Give the staff a week to think about ideas and report back their
ideas at the next meeting.
Each staff member should create 4 themed boxes with 6 to 10 tactile items, as well as
at least one other item for the other senses. Provide the staff with plastic rectangle
Tupperware boxes and lids that can be purchased at the dollar store. Provide a black
magic marker to write the name of the theme on the container.  Provide funds for the
staff to purchase the items. They would only need a few dollars for each container. This
type of program involves all of your staff and utilizes one of the most unique traits found
in activity professionals and recreation therapists and that’s “creativity.”

Where to purchase the items: The items can be purchased at thrift shops, garage
sales, dollar stores and job lot stores. Place a sign in the staff lounge as well and
specifically list what items you are seeking for a specific month.

You can also solicit donations from families. Place a Want Ad column in your facility
newspaper and explain your new program and list the types of items you are seeking.
You might be surprised and have families who really want to get involved and might
even volunteer to present their own themed boxes.  When residents are discharged,
families might be interested in signing out a specific theme box to use at home;
especially if they saw positive feedback from their loved one when in the program. This
is a fantastic way to demonstrate your level of compassion and commitment to your
residents. Make a list of all the theme boxes you have available.   To see a sample letter
sent to families see
http://ezinearticles.com/?SOS-Success-Oriented-Sensory-Stimulation,-Kits-and-
Theme&...

One facility, also assigned themes to each department that were related to their
function. For example, dietary was asked to come up with two ideas. One was on items
used for cooking. Another was items used for washing dishes.  This was an excellent
way to get the whole building involved. It’s important that you give written detailed
instructions to the departments so that the department heads clearly understand what
the program is and how to design themed boxes. Provide an example, such as a theme
box called Baseball which would include a baseball, baseball diamond, uniform,
cleats, etc.

You could also put up a wish list in the employee lounge of specific items you are
seeking. For example, your theme might be “babies”. You could list, baby blanket, baby
lotion, baby power, new born diapers and clothes, pacifier, etc.

When creating the memory kits keep the following in mind:

Older people should be familiar with most or all of the items in the kits.
The objects need to be carefully selected so that they relate to specific ideas, events,
occasions or period of life.
The objects need to be age and experience appropriate and safe for older people to
use.  (Museum Victoria, 1995, pg 3)
To provide an interesting visual to your program, purchase an old trunk. Before
beginning your program, transfer the items into the old trunk. This will really peak their
curiosity rather than walking in with a plastic Tupper ware container. You can purchase
small old trunks at thrift shops, garage sales and antique shops. Be sure to clean the
trunk and make sure it’s safe and won’t close on any ones hands. Have your
maintenance department check your hinges.
Provide interesting theme names on the calendar for your theme boxes, such as a Day
at The Beach, Blue Sunday (Blue Colors) or Famous Sweethearts.

This article is intended for those residents in later states of dementia; however this
program could be adapted and called “Guess what’s In the Trunk”, and used with your
highest functioning resident’s. You would give clues until they guessed each item.

How Do I Conduct the Program? It’s important to have not only visual items but
something to taste or smell related to your theme. For example, if you were going to
discuss a Picnic, you would not only have items in the picnic basket but also Ice Tea for
taste. To make this program even more unique, try incorporating music or a song
related to your theme. For example, if you were doing a day at the beach as your
sensory theme you could use a Beach Boys Song.
Prepare about 20 questions ahead of time related to the theme kit. Once you are
finished with the questions, place those questions back in the kit for the next therapist
or activity professional to use. Try to use what, where, when and why questions. If you
get a response, ask, “Tell me more.”
To begin this program, place the residents around a large table. Introduce the residents
to each other and to you the facilitator. Explain the theme you will be discussing. Begin
bringing the items out one by one and discussing what each item is. Have each
resident touch the items. Ask for input from each resident. Place each of these items on
the table. Each response will be different for each resident and their responses are
neither right nor wrong. The goal is to prompt a response, emotion or memory.

Knowing the residents strengths and past history may also be away of opening the
discussion. There are times when the group members may be shy. You could begin,
for example when using a “Teacher’s Kit”, sensory program, “Mr. Smith I heard you
were a great history teacher, what do you think of this text book.”

Give everyone an opportunity to respond. Remember, a dementia resident needs time
to process what you have just asked. Ask one question at a time and wait for a
response, even if the silence seems uncomfortable. If you do not get a response, thank
the resident for trying.
Some residents input may be a simple one word answer while others may give you
several sentences. However detailed or fleeting, all of their thoughts and input are to be
valued. (Coaten, 2001, pg 20)

Don’t rush the resident. Give the resident ample time to express themselves as they
are searching for their words. Be aware of their gestures, facial expressions and body
movements as these are non verbal cues to what they are trying to express.

If you have a white board, write down their responses and at the end of the session
incorporate their responses into a story. You could then publish your story in the facility
newsletter
Sometimes the reminiscing or tool kit may elicit an emotional response, such as sad or
tearfulness. This is not a bad thing as long as the resident is not a danger to himself or
others. It’s ok to ask the person why they are sad.  All feelings that are experienced
during a reminisce session are valid and important.

Next provide something to eat, drink or smell that is related to the theme. Be careful if
using liquid aroma therapy as the concentrated liquid should not be placed directly on
the skin.
In closing a reminisce group, try to use a song related to the theme as music can uplift
the spirit.

Always thank the participants for coming to the program. Explain what they will be doing
next.
This program may also be used “one on one” or incorporated into your room visits
program.
There are endless possibilities for themed boxes, memory boxes and memory trunks.
Kits could be developed based on holidays, colors, themes, resident’s interests,
cultures, hobbies, items from the past, work experience, pets, children, religions,
countries, horticulture, etc. See the link provided in this article for West Virginia Activity
Association and Nova Scotia Recreation Professionals Newsletters for specific
supplies. The kits that are developed should use all of their senses which includes;
Kinesthetic (Movement), Visual (Sight), Auditory (Sound), Tactile (Touch), Olfactory
(Smell) and Gustatory (Taste). As you develop your kits, try to keep this in mind when
collecting items.  Some kit ideas to consider are:

  • Life Roles Kits: Mother, Father, Daughter, Grandparent, Best Friend
  • Occupations: Priest, Nun, Teacher, Doctor, Nurse, Factory Worker
  • Men’s Kits
  • A Specific Era
  • Crazy Hats
  • Children’s Back Pack
  • Women’s Kits
  • Thanksgiving
  • Christmas
  • St Patrick’s Day
  • New Years Eve
  • A Day at the Beach
  • Baking
  • Tackle Box
  • Military
  • Spring Cleaning
  • Grocery Shopping
  • Farming
  • Cars and Trucks
  • Babies
  • Fishing
  • Railroad
  • Gambling
  • The Great Depression
  • Mail Men / Women
  • Factory Jobs
  • Regrets
  • Toys
  • Wedding
  • Halloween
  • Autumn
  • Graduation
  • Vacation
  • Tool Sheds
  • Garages
  • Sports (Baseball, Football, Soccer, etc)
  • Cheerleading
  • Happy
  • Colors (Green, Red, Purple, Black, White)
  • Office
  • Airline Tickets
  • Travel and Packing
  • Animals (Dogs, Cats, Horses, etc)
  • Gardening
  • Tea Time
  • Coffee
  • Facials
  • Back To School
  • Proms
  • Smells of winter
  • Smells of spring / summer
  • Things You Can Do With Peanut Butter
  • Bundling Up For the Cold Weather
  • School Days
  • Music Boxes
  • Kaleidoscope
  • Sensory Bottles-See http://www.recreationtherapy.com/tx/txsensor.htm

The Activity Director should provide an in-service to the CNA’s and explain how they are
used as well as conducting a program.  This will help the CNA to be more comfortable
with reminiscing and memory kits.

Once you have developed the sensory kits, they can be used as a last minute program
by the nursing assistants should your activity staff not be available due to illness.
Another sensory program is creating a very large mural that the residents would work
on daily until the mural is completed.  Start by going to your local newspaper and ask for
a donation of print paper. They generally will donate this but may ask for a small fee.
Place the paper on the entire wall. Most cities have a teacher store. Purchase a pretty
border and place the border around the paper. Be sure to use adult themes. At the
teacher stores you can purchase adult coloring books. The internet has endless
possibilities for pictures to down load.

Create a mural based on the season. For example, a February mural might depict a
winter forest scene which would have ever greens, pine trees, snow, cardinals, deer,
pine cones, winter berry bushes. Begin by finding pictures of ever green trees and
copying onto transparency and blowing up the picture on your over head projector. ACE
Moore Store sells projectors in their art department. Now trace the picture onto the large
mural paper. Each day, provide a picture for the residents to paint and cut the picture out
and glue onto the mural.  Try to use actual sizes of the item you are painting. Again the
ideas are endless, from a day at the beach, to picnics, state fairs, oceans, marinas,
flower garden, farming, etc.  The residents will take a lot of pride in creating this
gorgeous mural. Again, be careful that the mural is not child like.  The mural will provide
hours of discussion, reminiscing and enjoyment.

“Someone with dementia they may only give you a small piece of themselves-all there
is, and is enough at that moment.  That small piece is precious and may become a
strand or thread woven into your life as well. The fragments may, like the creation of a
mosaic, gradually be pieced together and something new is created (Coaten, 2001 pg
21)”.


Resources: Scroll down to see the free resources!

Sensory Enrichment Book available at www.activitytherapy.com

Wakeup Book (sensory tool kits) available at www.activitytherapy.com

Wilfred Gordon McDonald and Partridge available at www.activitytherapy.com

Therapeutic Recreation Directory
www.recreationtherapy.com/tx/txsensor.htm

Free: Reminiscing Handbook
http://www.bensoc.org.au/uploads/documents/reminiscing-handbook-jan2006.pdf

Free Download Choosing Activities to Fit the Day. See Reminisce section. http://www.
alz.org/cleveland/documents/Family_Members_Activities.pdf

Free Download Sensory Theme Ideas by Month- www.eldersong.erols.com

Free Newsletters Archives: Nova Scotia Recreation Professionals in Health http://www.
nsrph.com/downloads/newsletters/RPH_Newslettervol33.pdf

Association for Therapeutic Humor Great ideas and articles
http://www.aath.org/

National Library Service for the Blind Resource List
http://www.wnydf.bfn.org/library/parents.text

Flag House Special (senior) Populations

Memory Magic
www.memorymagic.com

Family Fun www.familyfun.com

Elderbooks 1800 909 2673

Eldergames 1800 637 2604

Alzheimer’s Disease Center
www.everydayhealth.com

Reminiscence Magazine –no web site but can be found on line with address and
located in Milwaukee WI

Geriatric Resources 1 800 539 0390

Bi Fokal Production Kits are free through your local library

Ideas from: West Virginia Activity Professional Association Winter Letter
http://www.
wvapa.org/newsletter/jan2005WinterEditionNewsletter.doc

Sensory Training
http://www.sensorytraining.com/aboutST-AuditoryIntegartionTraining.htm

Sensory Stimulation by Susan Fowler available on Amazon
-END