Debbie Hommel's A.D. Tips
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by Debbie Hommel, BA, ACC, CTRS, Executive Director of DH Special Services
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Executive Director
DH Special Services
About Debbie

Debbie Hommel, BA, ACC,
CTRS, is the Executive
Director of DH Special
Services. She is a Certified
Activity Consultant on State
and National level, with over
twenty-seven years of
experience in providing direct
care and consultation to long
term care, medical day care,
assisted living, and ICF/MR
facilities throughout New
Jersey, New York, Maryland,
and Pennsylvania. She is an
experienced trainer and
workshop presenter,
conducting a variety of
seminars throughout the
Tri-State area for the Activity
Professional, Administrator,
and allied healthcare
professional. Debbie Hommel
is an active member of Activity
Professional Associations on
State and National levels. She
is ACC certified through the
NCCAP. She is a founding
member of the New Jersey
Activity Professionals'
Association, serving terms as
Vice President and President.
She received the Weidner
Lifetime Achievement Award
in 1994 and the Monmouth &
Ocean County Activity
Professionals Life
Achievement Award in 1999.
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in Long Term Care Settings

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Making Sense of Sensory
by Debbie Hommel, ACC/MC/EDU, CTRS

Working with the very cognitively impaired and frail resident is a challenging task for
many activity professionals.  Without proper training, the wrong approach can be
implemented creating stress not only for the resident but for the staff conducting the
approach.  Understanding the limitations as well as the strengths of the very impaired
resident is a crucial first step toward success.  

What is sensory stimulation?  It is simply an approach that stimulates any of the five
senses.  Sensory stimulation can be integrated into routine programs (such as
cooking, reminiscing or crafts) or can be a separate program unto itself.

What are the five senses?   
 Vision - considered the most important sense as we gather the majority of information
this way.
 Hearing - considered the second most important sense,
 Touch - the easiest sense to stimulation and can be the most comforting
 Taste - can bring the most pleasure and enjoyment
  Smell - the more emotional of the senses as certain aromas provoke a basic gut
reaction and related memory

Consider the Limitations:  The very cognitively impaired resident has a low threshold for
stimulation.  Offering multiple cues in quick succession is not good practice and can
over stimulate the resident.    

Strengths: The very cognitively impaired resident can still experience life emotionally.  
When presenting sensory cues, a basic emotional response is what can be hoped for.  
Pleasure, enjoyment, comfort, simple recognition of a familiar cue can have therapeutic
benefits for the very impaired elder.

Here are some helpful hints when conducting sensory stimulation:
* Prior to starting the process, verbally greet the resident and let them know what is
about to happen.  Even if the resident is very cognitively impaired, they should be
informed of the program about to occur.  It can be introduced in friendly terms, such as
spending some time to remember some pleasant memories.  A tactile greeting can
accompany the verbal greeting.

*When presenting the sensory cues, present one cue at a time, allowing time for
absorption and response.  Simple verbal cues should accompany the presentation of
the sensory cues, to explain and reinforce what is happening.

*When talking about the cues presented, ask is the cue reminds them of anything.  
Refrain from asking questions where there is a right or wrong answer or where they
have to correctly identify a cue.    Even though unable to verbally speak, much
communication can be shared through eye contact and facial expressions. Respond to
these as positive responses to verbal cuing.

*Consider the amount of cues and stimulation being presented at one time.  Music can
be used as a compliment to the sensory experience or it can act as extraneous over-
stimulation for the very impaired.  In some cases, quiet is the best compliment to

*When using touch, latex gloves are not required.  What makes a sensory experience a
quality of life interaction is the human-to-human touch.  To maintain infection control,
using an antiseptic foam or gel in between sessions is acceptable.  

* Be respectful and speak in an adult manner.  Maintaining a calm, soothing,
conversational tone is most effective.  

*Expect a response, even when one may not be forthcoming.  Being aware of small
responses, such as increased eye blinking, increased body movement, ceasing of
body movement, tensing or relaxing of body/facial expressions (to name a few) is

*Let them know you enjoy being with them.  Finding a personal style of conducting
sensory makes the process more satisfying and eventually more successful with the

*Continually analyze stimulation levels to avoid over stimulation.  We need to create a
balance of active stimulation and passive stimulation.  For very low functioning
residents, five minutes of active stimulation can be a long period of time.  Be intuitive of
the resident's response and if it seems they have had enough, don't be afraid to stop.  

*One must never forget that each resident is an individual and our approach should be
based on the needs and interest of the person.

“I want all my senses engaged.   Let me absorb the world's variety and uniqueness.”

~ Maya Angelou