Course content – PFLEGE-16
The modules of this course – work through them in order.
7. Module 6 · Everyday life & daily structure
7.1. In depth: the right level and who provides what
Finding the right level, and who provides what
Meaningful activities
| Area | Example |
|---|---|
| Everyday tasks | Folding laundry, laying the table, garden |
| Exercise/music | Walk, seated dance, singing |
| Reminiscence/senses | Old photos, music, tactile stimuli |
| Sociability/animals | Being together, animal visits |
The power of music
A particularly impressive example of the effect of meaningful activity is music. Music – especially familiar songs from youth/earlier life – often reaches people with dementia in an astonishing way, even in advanced stages. The reason: musical memory and emotional memory (Module 1) are often preserved for a long time, even when almost everything else has been lost. People who hardly speak any more can sometimes still sing along to every verse of their favourite song; people who seem apathetic blossom when they hear familiar music; restless people become calm with soothing music. Music can awaken memories and feelings, bring joy and liveliness, enable connection and communication (where words fail), and calm or activate. That is why music is a valuable, simple and effective means of dementia care: singing together, playing their favourite music (the life history helps to find it!), music as a calming aid in restlessness, as joy in everyday life, as connection. Studies and experience show the positive effects of music on wellbeing, mood, restlessness and even communication in dementia. For care, this is encouraging: with something as simple as familiar music, a great deal of joy, calm and connection can be given. It is worth knowing the favourite music of every person with dementia (life history!) and using it deliberately – as joy, as calming, as a bridge to the person. Music is a fine example of the fact that dementia care does not consist only of ‘care tasks’ but of enabling joy, connection and liveliness – right to the end.
The power of music symbolises the whole organisation of everyday life: with the right offers, suited to the person’s life history, the lives of people with dementia can be enriched and their wellbeing strengthened – often with simple means and great effect.
The right level of challenge
The original text asks for activities that are enjoyable and successful, without pressure and without overload. In practice the hardest part is finding the right level. An activity that is too easy feels childish and leads to boredom. One that is too hard leads to frustration, shame or anger. Figure 6.2 shows three zones. They are a thinking aid based on general professional experience, and they are not measured values.
Two practical rules follow from Figure 6.2. First, always leave a way out. If the person walks away, that is a clear answer, and you respect it. Second, make the task look like what it is. A folded towel that is later used, a laid table that is really eaten from or a seedling that is really planted gives a sense of purpose. Tasks that look like “busywork” are noticed, even in advanced dementia.
Choice, privacy and the limits of “activation”
Activity is not a duty. Some people have always preferred their own company, a book or a window. A person who does not join the singing may still be content, and forcing participation can become another form of pressure. Offer, invite, repeat, and accept a refusal on the day. Ask whether the person is bored, lonely or simply calm. These need different responses. Also pay attention to how activities are presented. Words such as “group”, “therapy” and “programme” can put people off, while “come and help me” is often welcomed.
The evidence for single interventions is varied. Music, exercise and reminiscence are widely used and valued, and the original text rightly stresses the effect of music on wellbeing. At the same time, responses differ strongly between people, and no activity works for everyone. This course therefore treats these approaches as good general practice and as invitations to try, observe and adapt, and not as guaranteed treatments. For stage-specific details of cognition and speech, see Modules 1 and 2.
In Germany: who is responsible for activities?
- Section 43b of the Social Code Book XI (SGB XI), the law on social long-term care insurance, gives people in need of care in residential care facilities a right to additional care and activation, in addition to the basic care they need (Bundesministerium der Justiz, n.d.-d).
- Section 53b SGB XI instructs the national association of the care insurance funds to set guidelines on the qualifications and duties of the zusätzliche Betreuungskräfte (additional care assistants) who provide this support in residential facilities, with the approval of the Federal Ministry of Health (Bundesministerium der Justiz, n.d.-e). The paragraph speaks of residential facilities, so this entitlement does not automatically cover home care.
- Section 2 SGB XI aims at a life that is as independent and self-determined as possible and in keeping with human dignity (Bundesministerium der Justiz, n.d.-a). Activation is therefore meant to support the person’s own wishes and abilities.
The details, such as how many hours and which tasks, are set out in the guidelines and in your organisation’s own procedures. This course does not give them. Care assistants, nurses, occupational therapists and relatives usually share the work, so agree in the team who does what and note what works in the care plan.