Pathways to the Past
by Sandra Stimson ADC, CALA, CDP
Executive Director,
Alternative Solutions in Long Term Care
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Executive Director
Alternative Solutions in LTC
National Council of Certified
Dementia Practitioners  
Providing Internet Resources
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in Long Term Care Settings

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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
Council of Certified Dementia

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.
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is paired with
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Resident Rights and is
illustrated by a picture
depicting the "Resident
click here to purchase
resident rights prints
Pick Your Staff Carefully for
Dementia Units
By Sandra Stimson CALA, ADC, CDP
National Council of Certified Dementia Practitioners
Alternative Solutions in Long Term Care

It is important to pick and choose the staff to work on the dementia unit. The staff the
Activity Director selects to work on the dementia units should possess the following

  • Able to work as a team
  • Able to think independently
  • Self Directed
  • Open Minded
  • Creative
  • Kind
  • Patient

Additionally and most important is to select staff who have several years experience
working with dementia clients. Often times, new employees with little or no training are
hired for the dementia unit.  The Activity Director should recruit seasoned, experienced
and trained staff to work on the dementia unit. Seasoned and experienced staff will
provide dynamic calendars, independent activities, appropriate programs, innovative
activities, family involvement, and alternatives for lower functioning residents. They
possess the knowledge necessary to adapt activity programs. Additionally, they are
able to motivate the CNA’s to participate in the activity program.

Inexperienced activity professionals lack the education, life experience, knowledge and
confidence to work in this key role.  Activity Directors should place new employees with
little or lack formal activity training with their highest functioning residents. High
functioning or independent residents will help guide a new employee and will also
vocalize suggestions and concerns.  

The activity assistant should have the opportunity to work with the person leaving the
unit. If this is not possible, the Activity Director should devote one full week and work
side by side with the assistant. This is important as the existing employee can offer
valuable information regarding:

  • Introduction to residents
  • Resident routines
  • Resident preferences
  • Level of functioning
  • Level of Cognition
  • Introduction to staff
  • Unit schedule and routine
  • Location of supplies
  • Documentation
  • Elopement protocol and emergency preparedness
  • Safety concerns
  • Snack times

The new employee should be given one day to read the Dementia Unit policy and
procedure. Additionally the new employee should be provided with the Federal and
state regulations as well as any specific regulations regarding the Alzheimer’s
dementia unit. There may be specific regulations that pertain to pets and volunteers
and those should be provided as well. If you’re a nursing home or adult day care,
provide the assistant with Dementia Care Plan Book.

The new employee after attending the facility general orientation should receive a job
specific orientation and a dementia unit orientation.  

The new employee should be given the schedule for breaks and lunch.  Often times,
the activity assistant is required to assist at meal times. This needs to be clearly
explained.  The activity assistant should receive proper training regarding special diets,
transferring from wheel chair to chair, transporting, van protocol, toxic plants and
precautions for aroma therapy, pet therapy protocol, feeding procedures and pain in-
service. Additionally, the staff should receive extensive dementia education before
beginning the job or within 7 days of placement.

Not investing in an appropriate activity assistant may have negative consequences.

  • Within the community facility reputation affected
  • Poor survey outcomes
  • Increased family complaints
  • Increased staff complaints
  • Destruction to day rooms that are not adequately supervised

Activity Assistants with little or no training provide:

  • Inappropriate activities
  • Activities that are too difficult
  • Demeaning activities
  • Too much down time between activities

Negative consequences for residents are:

  • Inappropriate activities
  • Demeaning activities
  • Lower self esteem
  • Increased Boredom
  • Increased agitation and restlessness
  • Increased verbal out bursts
  • Lower functioning residents completely left out of programs with no alternatives
  • Lost residents during outside trips
  • Accidents or incidents during activity programs

For the first 30 days, the Activity Director should be observing, monitoring and evaluating
the morning and afternoon programs. Some of the areas to look at are:

  • Appropriateness of program
  • Supplies and preparation for the program
  • Can everyone participate in the program
  • Those who can not participate what else is offered
  • Nursing assistants participating in the program
  • Employee Adjustment
  • Attitude of employee
  • Safety issues

At the end of each day, the director should meet with the employee to go over
observations, concerns and recommendations as well as seeking feed back from the

The Director should also send the assistant to seminars and conferences specific to
dementia topics.  Any available resource specific to dementia should also be provided.
There are many resources, web sites, magazines and organizations that offer free
resources. Insure that part of the activity budget is spent on supplies for the dementia
unit, such as reminisce products, relaxation videos, exercise props and music supplies
such as CD’s, bells, maracas and drums. Provide petty cash so the Assistant is able to
pick up creative things to sort and fold at the thrift shops and dollar stores. Begin a
notebook for the assistant and place articles and activity suggestions specific to
dementia.  This will be a valuable resource for the Activity Assistant.  

Compliment often and provide positive feed back as the assistant needs to hear it.   

The Director can avoid burnout and negative attitude if appropriate time is given for
selection of employees and proper training is provided. This can only be a “win win”
investment for the activity department, facility, family and most important the residents.  

See for activity props, dementia care plans, sensory programs
for low functioning residents and tons of books and resources.  

See for information on Certified Dementia Practitioner, Certified
Dementia Unit Manager (Dementia Unit Supervisors only) and Train the Trainer.