This article is a follow-on to Part 1, not surprisingly, and may make more sense if you read Part 1 first.  Each person with Alzheimer’s is different, so it is important to customize activities for the person you care for.  Most of us who are assisting a Person with Alzheimer’s (PWA) search for meaningful activities to keep our loved one as active as possible.  Here are a few things that have been helpful for my husband Charles.

First of all, I had to manage my own fear and frustration when I would offer suggestions or carefully plan activities, only to have Charles reject them.  Because he was always a hard-working, busy man, it tore at my heart to see him sitting aimlessly, staring into space.  I had to learn to let my expectations go, and to understand that there are times when he is lost in his own world, and that is okay.

Here are a few things that he enjoys at home now, in the late-moderate stage of Alzheimer’s:

• Watching the birds.  I have a couple of bird-feeders positioned where he can see them from the living room, and we are both entertained by the variety of feathered friends who come to visit.  Even the antics of thieving squirrels are fun to watch!
• Listening to music.  The Pandora app on our Smart TV is a godsend.  You can set up a channel by era or artist, and for a small monthly fee, it plays commercial-free.
• Watching nature shows.  There is an endless assortment of gorgeously photographed nature shows on Netflix (I really like most of the BBC shows).  Charles can’t operate a remote control any more, but he truly appreciates the natural beauty in these shows.  There is no need to follow a plot line or to remember characters (a bear is just a bear, after all), so these work very well for people with memory loss.
• Folding washcloths.  It’s hard to come up with chores that a person with limited memory and mobility can do, but everyone likes to feel useful.  We go through a lot of washcloths, so my praise and appreciation for his folding (which he does meticulously, if slowly) is genuine.  Find a household chore that is within the person’s capability range, and pile on the positive feedback.
• Using a coloring app on an iPad.  Charles (who used to be a computer guy) can no longer operate his iPad independently, but I set up the Colorfy app and gave him a stylus.  All he has to do is to touch a color and then touch the area he would like to color.  He needs assistance to do this, but it is instantly rewarding, and easier for him than coloring with pens or pencils, which his tremor made very difficult.  Some folks with dementia might enjoy the sensation of using colored pencils or crayons, however.  Any sort of art activity that works for the individual is a great choice.
• Looking at photographs together.  He can no longer identify family members or even his younger self, but when I tell him who is in the picture and explain who that person is, he enjoys it.  The key is not to quiz the PWA – “Do you know who this is?”  You don’t want them to feel inadequate.
• Looking at art books or magazines with colorful photographs, such as National Geographic.  Charles can no longer read, but he will page through these books and magazines with pleasure.
• Dangling a toy for the cat.  This is a two-minute project, but it is good for the cat and good for a few laughs.
• Doing special jigsaw puzzles (which I buy on amazon.com).  There is a beautiful line of puzzles for people with dementia (Keeping Busy).  The pieces are color-coded and bagged in small groups.  I confess that after buying a few of the lovely but pricey puzzles, I began to create my own.  I found that Cobble Hill had the same or similar puzzles (35-piece puzzles with a hard cardboard backing tray on which to assemble the pieces).  I divided the puzzle into about 7 areas (5 pieces each), and used a colored marker on the back of the pieces to indicate which group belonged together.  Each color group of pieces goes into a small ziplock bag.  Then I used the same color maker to outline the places where the pieces go on the backing tray.  Charles needs a little help to get started, and I only give him one color-coded group of pieces at a time, but this works great, at less than half the cost of the pre-made sets.  Hints: Use a solid-color contrasting tablecloth under the puzzle pieces to make it easier for the PWA to see them.  If the person is having a tough time, hand them a piece at a time, facing the way it needs to be for the puzzle, and remind them, “This goes in the green area,” indicating where that is.

Routine is helpful and important for many people with Alzheimer’s and other dementias.  A typical day at home might go something like this:

• I get up and prepare our breakfasts.  I return and awaken Charles (who is dozing lightly at this point), get him washed and changed, and set him up with breakfast.  He can still feed himself, but cannot prepare food or clear his dishes.
• Bathroom break.  Many people with Alzheimer’s are unaware that they need to use the toilet.  Rather than ask, I simply say, “Let’s go to the bathroom, now that you’ve had your breakfast.”
• Listening to music and watching the birds.  Since I work from home, I get Charles set up and check on him periodically.
• I might give him a basket of washcloths to fold before lunch a couple of times a week – giving him plenty of time, and not expecting him to do anything else like talk to me or watch a show, because he needs to concentrate.
• Lunch, which we eat together.  I confess I often put the TV on during meals (something I used to abhor), because he can’t really carry on a conversation and I hate eating in silence.
• Bathroom break.
• Nature shows, which I set up and he watches while I work.  Each one lasts about 45-60 minutes, so that is a reminder to get up, talk to him, check to see if he needs anything, and put on another.  He might nap while watching – that’s certainly ok!
• Jigsaw puzzle or coloring on the iPad, which we do together.
• Bathroom break.
• Supper together.
• True confession time:  I’m usually tired enough after supper that we watch a couple of TV shows together.  He can’t really follow the plot, but he enjoys some of the familiar characters.  I used to pause the shows and explain what was happening, but this is no longer helpful.  I often choose talent shows or something similar because we both enjoy them and there is no real plot to follow.
• If I look at Facebook or play an online word game, I’ll describe what I am doing and help him to feel included in my activity.
• Time to wash up and get ready for bed, with lots of assistance!

There are many online suggestions of more demanding activities for people earlier in the disease process, such as cooking or gardening.  Since the two of us do quite a few things out and about (see Part 1 of this blog post), these quiet days are relaxing for Charles and productive for me.  If you are caring for someone who needs in-the-room supervision or has more challenging behaviors, of course you will have to make major modifications to these suggestions.

One of the most useful things to do in planning activities is to check your expectations.  Talk to members of your caregiver support group, a healthcare provider, or a trusted friend or family member.  Most of all, observe your loved one to see if you are expecting too much or too little.  One woman I know complained bitterly that her husband was not helping her with chores in the house and yard, and spent most of his time on the couch napping.  It turns out that he was entering the final stages of Alzheimer’s, was nearly 90 years old, and had multiple medical problems.  Expecting him to leap off of the couch and offer to water the garden was completely outside of the realm of reality.

When the person you care for is your partner, it is even more challenging to maintain realistic expectations.  We used to share the chores and help each other all the time.  Charles was always willing to lend me a hand, do the physically difficult tasks, and work alongside me in the house as well as doing massive amounts of yard work.  In truth, it’s hard not to feel sorry for myself sometimes when I am doing everything that needs to be done, from mowing the lawn to hauling out the trash, and he is sitting in the living room looking at a magazine.  I have to remind myself that he would do much more if he could.  Right now, he is unsteady on his feet, can’t follow verbal instructions, and is unable to plan and process tasks; therefore, it makes no sense to expect him to offer meaningful help (with the exception of those beautifully folded washcloths!).

Now, I have to derive my satisfaction from making sure that he is engaged in life to the extent possible, and that he is comfortable and satisfied with the “now” in which he exists.  His needs change from day to day, week to week, and month to month, so I have to change my expectations and strategies to match.  Most important, I have to remember to do so with a smile and a kiss, so that we both have a good day.