Schedules, Routines, and Transitioning Tasks, Oh My!
by Julie Gala, MA CCC-SLP,
Senior Director of Clinical Success and PAC Certified Independent Trainer
It’s 7:50 in the morning and I’m making my second cup of coffee when I hear a ping from my computer in the other room indicating a new alert. I hastily make my way to the device to see what caused the triggering sound. I look at the screen and see that I have a meeting that starts in 10 minutes. My hair has been brushed but I’m still in my pajamas, which is not acceptable attire for a Zoom meeting. Swiftly, I change my outfit, check my makeup, and continue preparing myself for the day. Anxiety creeping in due to the time limitations to complete this task and transition to another.
A stressful situation has pressurized my normal, Sapphire demeanor, into a Diamond state of mind. I’m sure we have all had those mornings, some more than others. In this case, having an auditory cue alerted me to my next daily activity when I had not completed my prior task in a timely fashion. Could I have set myself up for better success? Of course! Instead of depending on that auditory cue I should have first accessed my visual cue by checking my schedule in advance.
Since I am typically a Sapphire, I was able to smoothly transition tasks from making my cup of coffee to completing my morning routine, albeit with some stress. People Living with Dementia (PLwD) may not be able to effectively transition from one task to another without a schedule, visual cue, auditory cue, or a combination of any. As dementia progresses fluidly from each state to the next, so do the cerebral impairments governing cognitive function. In the example I provided, a Sapphire can return to normal once the stress has passed, but not all PLwD in other states may respond the same. Let’s look at how other GEMS may respond to lack of schedules, routines, or sudden changes in task transitions and what we can do to support people in each state.
Diamonds are rigid, inflexible, and often use old routines and habits. They can usually follow simple prompted schedules. Care partners can optimize successful transitions between tasks by providing highlighted schedules, personalizing their room, and offering way-finding signs to the next activity. Verbal cues such as invitations to the next task, permission to enter their space, or giving a new activity before removing the current activity (think substitution, not subtraction), can be helpful for participation of PLwD in the daily routine and reduce their anxiety and stress.
Emeralds may start to feel the need to be on the go, having a job or task that needs to be completed. Once they are finished with a task, they enjoy moving on to the next activity fairly quickly. Care partners should anticipate Emeralds’ needs to transition between multiple tasks throughout the day and prepare several activities that can be performed. Emeralds may not be able to follow a written schedule as well as a Diamond, but showing or modeling the task before expecting the carryover from the PLwD can lead to a more successful outcome and reduce potential distress. Ultimately, care partners need to go with the flow, and not force the task.
The mid to late-stage dementia GEMS States consist of Amber, Ruby, and Pearl. In these GEMS States, PLwD may be dependent on their care partners to transition from one task to another, including their daily care needs. It can become easy to tell them what to do and what comes next, but care partners should take the time to slowly transition from one task to another by modeling each activity that is expected. Showing while providing auditory cues can greatly improve the person’s understanding of the task required while increasing participation and reducing the risk of refusing assistance.
It’s important for all care partners to understand what state their PLwD may present to ensure the optimal support system is in place for successful transitions between tasks when a schedule may or may not be an appropriate support. For myself, I’m going to make sure I view my schedule first thing in the morning so I can truly enjoy my second cup of coffee with sugar, not stress.