Stacking and the Need for In-service Training
(The last track of the DVD contains slide(s) illustrating implementation of this activity.)

Block Stacking is just what it sounds like. You get a set of objects, and you encourage the resident to stack them. If your Marie is more alert, you might encourage her to stack the items in order with the largest object on the bottom ending with the smallest on the top, as illustrated to the left. Obviously, the resident is limited by his or her range of motion as to how high he or she can stack the objects. Some objects you might consider having the residents stack include: ice cream tubs, whipped cream tubs, butter containers, children's blocks, etc. If you want to make the stacking items more visually pleasing, you might lightly spray paint the empty food containers various colors. However, by leaving the labels visible, this could lead to a reality orientation or reminiscence discussion, if the resident has a high level of alertness. If you want to make the children's stacking blocks less child-like, you might consider spray painting over the illustrations, or perhaps you can find a set that is in solid colors.

However, if the goal is merely to stack, and you are working with a disoriented resident, I have found that the resident may be distracted by the labels and try to pull them off, look for food inside, etc. Or, if there is a picture of a cat on the children's stacking blocks, the resident may look inside the block expecting to find an animal. Thus, I recommend spray-painting your non-solid colored stacking items, if stacking is your goal. Craft stores have spray paint that you can use specifically for plastic, or try Krylon spray paint in several thin layers, drying between each layer to avoid 17b

peeling.

Words Distract
I find that a crucial key in implementing stacking, with a resident of the ability level for which stacking is appropriate, is that too much verbalization distracts them from the task. Therefore, if you consider yourself a talkative person, you may find the approach of limiting verbalizations challenging for you. I strongly recommend that once you evaluate stacking as appropriate for a particular resident, and you are walking towards them to do the activity, that you mentally envision zipping a zipper closed across your mouth. I found with some Activity Directors with whom I have consulted, that the ability to limit a continuous flow of chatter with a disoriented resident was a major challenge for them. So, if you consider yourself a "Chatty Cathy," consider the string in your neck is broken for the few moments that you are working with disoriented residents who become distracted by verbalizations.

Here are the steps in approaching your Marie with Block Stacking:
1. Introduce yourself by saying something like, "Hi Marie, (getting eye contact) my name is Cathy. I have some items for you to stack today. (Assessing her attention span) Would you like to stack some blocks to exercise your hand?" (Assessing your Marie’s verbal and nonverbal reaction)
2. Take the largest block or container and place it on the work surface in front of her with a slow motion, usually not saying anything, if you feel that she will be distracted by a bunch of chatter, as explained above. Of course, this varies for each resident.
3. Then, slowly take, in an exaggerated motion, the second item, and place it on top of the first.
4. Then say, "You try." Offer her a block, and assess if she has the mental ability to take it out of your hand, which indicates a major learning capability. Ideally, she would take the block out of your hand, and you would make an open-palmed gesture towards the top of the stack to see if she has the capability to observe and learn.
5. If the resident does not take the block from your hand, decide based upon her eye contact and attention to the stack whether demonstrating stacking the third block would be beneficial. Now the stack is about as tall as she can reach with stiff arms.
6. Say "Let's try un-stacking." Un-stacking is more difficult than stacking. So, usually you end up un-stacking without the resident’s assistance. Then, place the un-stacked items as far out of the visual range of the resident as possible, because they may be distracting to her.
7. Repeat steps 2, 3, 4 and 5. However, when you offer the resident the item to stack, if she doesn't take it, and is receptive to you touching her, you might cup your hand around hers and with total physical assistance; help her to stack the third block. Then, if she can reach that high, offer her the fourth. Of course, any attempt by the resident at doing anything appropriate regarding the stacking is reinforced by saying something like, "Good, great, you did a good job!"

Sorry, No Magic!
Obviously, the above seven steps need to be adapted based on the capabilities and limitations of each resident and perhaps altered each time you work with that resident.

Let's talk about change for a minute. You change from day to day, and your residents change from day to day. So, Block Stacking may have worked well at 10:30 in the morning, but may not work at all at 2:00 in the afternoon. For this reason…

It helps to have an expansive dynamic view of activities for each resident.
Stop the habit of being frustrated by having a stagnant, "one-stop-shopping" mentality,
always looking for THE Magic Activity…
that will keep a resident happily involved for an infinite period of time.

I know the above sentence sounds ridiculously obvious, but so many Activity Directors I have consulted with, or attendees at seminars tend to say, "I tried XYZ, they did it once or twice and wouldn't do it again." I agree that it is frustrating to evaluate, moment-by-moment, the activity needs of a resident that changes minute-by-minute. One minute he or she is alert and can do something, and the next minute the activity is seemingly totally inappropriate because they have "blanked out" mentally. I have been an activity director too, and have thought to myself, "Gee, if I could just find an activity that would work for an extended period of time. But as we all know, we are working in a health care facility with residents whose health is oftentimes declining each day. So what worked yesterday doesn't work today. That is why I put the above sentence in a box and in bold, to draw it to your attention regarding having an "expansive dynamic view" of Activities" rather than a “stagnant view” looking for the Magic Activity that will keep them eternally busy. Sorry, no magic, but if you find some Magic Activity Fairy Dust, sell it on eBay and make a fortune. Oh well, back to the real world. J

Need for In-service Training
If you receive negative feedback from staff members who are upset regarding the fact that you are encouraging residents to use children's toys, you might decide to give an In-service Training. This Training Session might state something along the lines that "I need to have an activity program that focuses in on the abilities that the residents actually have, rather than what we wish they had." From time to time, staff, families or volunteers express opposition towards providing dolls, stuffed animals (as mentioned in an earlier section) and stacking blocks for our residents who are in their 80’s or 90’s. I have found that staff who are not supportive of the use of an idea that provides the resident with a successful experience may be projecting their own feelings about themselves. These feelings maybe coming from their thoughts that may sound something like, "When I get to be 80 or 90, I don’t want to be so disoriented as to only be able to play with children's stacking blocks!" Thus, you might mention this understandable discomfort in a general way in your In-service. Your In-service Training might include the following three parts:
Part 1: You might start by explaining that the basic concept behind some one-to-one activities is merely to provide the residents with a successful experience to improve the quality of that resident's life.
Part 2: With the resident who is severely physically and mentally impaired, (you might mention a few resident names at this point in your In-service Training) simple projects like Block Stacking need to be provided to provide them with a feeling of success.
Part 3: Invite an open discussion regarding what other activities might be tried with the resident given the resident's specific limitations in attention span, hand coordination and so on. In short, in Part 3, you are "putting the ball back into the trainee’s court." You are asking, in so many words, "If you don't like Block Stacking because 80-year-old Marie is manipulating a child's toy, can you come up with a better activity in light of Marie's physical and mental capabilities and limitations that is not childlike?" You might point out that, one Alzheimer’s reference book describes the progression of Alzheimer's as bringing the person backwards through the stages of development, ending with the resident in a fetal position.

Culture Change Implementation: Place Block Stacking in labeled Activity Project Bag left in resident’s room for CNA, volunteer, etc. use.

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