Thursday, January 31, 2013

The article below is from the January 25, 2013 edition of the Globe and Mail (Ottawa / Quebec Edition) and was written by Tralee Pearce. Photographs by Fred Lum. 

A new school of thought 

on dementia

Montessori principles aim to reduce anxiety and provide meaningful activity for adults with cognitive diseases

‘Find the story and see the person’ 

As more Canadian families grapple with the heartache of dementia, a new program offers hope by applying the simple principles of Montessori education to elder care.

A retired cardiologist sits at a table at Toronto’s L’Chaim Retirement Home, sorting through cardiograms. He’s not volunteering his time helping others, however. Unbeknownst to him, he’s working at keeping what memories he has.
Therese Holtzman makes cookies at Dementia Support Dov & Zipora Burstein Senior Centre in Toronto. L’Chaim is using the Montessori Method for Dementia program, a novel approach to combat dementia that has been rolling out in day centres and nursing homes across the country over the last few years. Taking the principles of the Montessori method created for children in the 1970s and applying them to adults suffering from a range of cognitive diseases, the program is seen as a ray of hope in what is often a heartbreaking reality. More than half a million Canadians are currently affected by dementia, and with an aging population, it is poised to become an even greater concern.
The program’s relatively simple approach is part of its appeal. As in the case of the doctor, the Montessori Method gets people to do tasks that feel familiar, along with brain-boosting games, discussion groups and a physical environment that’s designed to both reassure and stimulate. And it seems to help.
At the Dementia Support Dov & Zipora Burstein Senior Centre, the first day centre of its kind in the Greater Toronto Area, Miriam Greenberg is working at rolling out cookie dough. It’s obvious she’s done this many times before. Her manicured hands move the rolling pin very slowly to smooth out each segment to its edge, pressing any cracks that have formed back together.
In other settings, this petite 87-year-old and the three other women at the table would likely have been seen primarily as dementia patients who need constant care. Here, at the new seniors’ day centre Greenberg attends three times a week, she’s seen as a woman who might have enjoyed baking earlier in her life and who might enjoy it today, too. “I used to bake a lot,” she says as she sprinkles a nut mixture over the dough. “Grandma’s cookies,” she adds, her voice trailing off as she quietly lists the first few ingredients.
The Montessori Method for Dementia is the brain child of Gail Elliot, a retired McMaster University gerontologist who now runs a business training caregivers and consulting with public and private institutions. She was inspired by the work of an American psychologist, Cameron Camp, who in the late 1990s seized upon the idea that by finding the person behind the dementia, caregivers can find clues about how to strengthen their brain function – or at least slow the decline. “Find the story and see the person: Who is that person today and how can we bring that person out?” says Elliot. “Memories aren’t all gone. Let’s find out what still exists and capitalize on it and enhance the quality of life.”
While Elliot resists seeing too many parallels between young children and people with dementia so as not to infantilize anyone, she does think the Montessori brand may help the idea click for many.
“It’s so basic,” she says. “When you’re doing something with your child, you’re thinking what are the needs of this child? What does he like to do, what is he able to do? You don’t challenge him to do too much because he’ll be frustrated and gives up. But you make it a little harder than what he can do so he can improve.”
Others who work in the field see Montessori-based methods as having good potential for providing stimulation and engagement.
Habib Chaudhury, a professor and graduate program chair in the department of gerontology at Simon Fraser University, says more research is needed but there is “some evidence that the method reduces anxiety and provides meaningful activity for people with dementia.”
He says another factor he sees as beneficial is that the method relies heavily on the sensory environment, and the five senses, which is “very important in dementia experience.”
At the centre, it’s hard not to notice another major Montessori principle in play, that of the “prepared environment.” Large, legible signs fill the walls. There’s a huge calendar, reminding people what day it is. At the self-serve coffee and tea table everything down to the sugar bowl is labelled. While the exits are cleverly camouflaged by tromp l’oeil paintings of furniture – to avoid the common behaviour of many dementia patients to “exit-seek” – everything else is well labelled, including the bathrooms and the kitchen cupboards.
“Nothing is left to their memory to guess,” says Deborah Rothenberg, the director of operations, as we tour the centre. “It’s a safe place.”
Tables are prepped with adult versions of daycare activities like sorting, puzzles and games. Song books and stories are printed only on the right-hand page, with a “Please turn the page” note on every lower righthand corner. Where children might play with cute animal images, the activities here play to the crowd. There’s a basket of towels to fold and one holding socks to match. If there were men here today, they might be pointed in the direction of a bin filled with Home Depot tubing and plumbing connects – adult Lego if you will.
“Nothing is babyish,” she says. Except, that is, for one of the small rooms flanking the centre’s large open space filled with baby dolls and clothes. Rothenberg is careful to point out that this room is therapeutic for very low-functioning dementia clients, who can find cuddling dolls and dressing them comforting – the seven women here today are considered highfunctioning and would be insulted to be asked to play with dolls.
In addition to helping seniors spend a meaningful, enjoyable day, Elliot says the program can also curb many of the behaviours associated with dementia, such as patients grabbing at staff, repeatedly asking the same questions, wandering and screaming, which can be common in facilities without more resources.
“I’d like to transform the way we care for people with dementia.”
Greenberg’s daughter, Fern Kutnowski, says the difference in her mother, in the past four months she’s been attending the $59-a-day program, has been astounding. She had been on a decline health-wise and spent most of her time sitting in a chair looking out the window. Now, she’s more likely to engage in conversation with her daughter and doesn’t need to be nagged to get active. Although she was resistant to go at first, “She feels good at the end of the day. She’ll come home and say ‘I worked very hard today.’”
And, yes, baking may have played a role. “My mother was an amazing baker. We all used to ask for ‘Safta’s (grandmother’s) cookies.”
Greenberg, who has suffered from dementia for more than seven years, lived in an apartment with home-care help, but now lives in a seniors’ home. Kutnowski says she is functioning well and is engaged in life.

“If she was healthy, she might think this was nonsense. But it’s working. She’s not the same person.”


It's spreading...Montessori with Elders. 
Imagine an Elders' Casa!

Saturday, January 26, 2013

Flower Arranging in an Adult Day Program - Exercises in Decision Making

Flower arranging (click flower arranging to see the work being done in one of my old classrooms) was one of my favorite lessons to present when I was a teacher.  I loved the coupling of flowers and mathematics. Watching a 4 year old hold a stem of flowers up to a vase and estimating just how much they should cut off so that it would fit the height of the vase silenced me as I viewed their deep concentration.

Every few weeks, the local florist donates a large, plastic tub of flowers to the Bridge. It is such a wonderful gift. In the fall, they brought in dozens of miniature sunflowers.  Yellow-mooned blossoms brought a glow to the place.

The last donation was a mixture of roses and carnations. There were dozens of each. One of the seniors enjoys breaking the large quantity of flowers down into smaller groups from which she makes floral arrangements. She makes many decisions as she goes along regarding color and height combinations, as well as how many to put in one vase or another. This senior does have dementia. She may or may not remember she did the work an hour afterwards, but the evidence of her work remains for days.

Her first independent decision was to sort the flowers by color. She slowly pulled them out of the various vases and then piled them on the table into color groups. 

Then she took five or six of one color of carnations and placed those into a vase. Next, she selected a handful of flowers of a different color. She then stood back and took a moment to decide on what to add and where.

In the foreground of the photo below you can see one of her first completed arrangements. But wait, just when I thought she was done with that arrangement, she picked a white rose from another vase and....

...inserted it into the bundle of pink and purple carnations as an accent point. She leaned back for a moment and smiled at her work.

She worked for more than an hour creating one arrangement after another.

Decision making: She divided, that's right; she used mathematical skills, the flowers into groups and then she created enough arrangements for each of the dining tables. Writing this now, I have this new thought on flower arranging, and I have written a lot about the subject over the years.  There are overlapping elements between flower arranging and spooning - they are both activities/work in which quantities are distributed.

Then she placed one vase on each table - again, distribution of quantity.

She returned to her work table and I watched as she began working silently on one last arrangement of flowers.

When it was finished, she cleaned up her table/work area, returned to her usual seat and began looking at one of her magazines. I left the floor, turned the corner and there it was. A lovely gift placed on my desk next to my computer. She had placed the vase of flowers there for me.

 Her quiet work reminded me of a quote by 
Anne Morrow Lindbergh:

Arranging a bowl of flowers
in the morning can give a sense
of quiet in a crowded day - 
like writing a poem 
or saying a prayer


Never underestimate the creative intelligence of an individual with dementia.

Tuesday, January 15, 2013

Poetry as an Act Within An Adult Day Center: "It's a great life if we don't weaken." - J.H.

There are moments at the Bridge that hold me still and in that stillness I dwell in the sacredness of what I am bearing witness to. Poetry is alive at the Bridge. Poetry as an act; as spoken words. It is heard most clearly between one activity and another. In the small space between breaking bread and bowling, soft words are spoken and, too, eyes peer out the window panes at the world at large.

Last week, one of our newest attendees, a woman in her mid-nineties, stood at one of the large windows and silently watched snow falling outside. She then asked in a quiet voice, "Does this always happen here?" Not waiting for an answer, she continued, "I have never seen anything like this before. It's wonderful."

This woman, who will turn 100 in 4 years, lived almost her entire life in California. She recently relocated to Alaska to live with her daughter and her family. This winter was the first time she had experienced snow falling on an almost daily basis. It marveled her. She saw such great beauty in what so many here in Alaska think of as common. What resonated with me, while watching her, was how absolutely still she became while she viewed the snow falling. This stillness seamed together with her silent wonder was poetry.

Yesterday, I was sitting with a couple of seniors after our afternoon snack. I could hear two other women, both in their late eighties, talking at the table behind me. One of them was making a statement; a wisdom statement. This woman lived a childhood absent of toys and games. Her family worked picking fruit and harvesting vegetables on farms on the East Coast. She joined them in the field when she was eight years old. Her adult life hasn't been easy either. Yet, she has a strong belief in God and helps others whenever she can.

What I heard her say was this: "It's a great life if we don't weaken. You know what I mean? Do you understand? I'll say it again. It's a great life if we don't weaken. Yeah, because life is hard and you can get tired, but if you don't weaken you will see when you get older how great life really is. So, it's a great life if we don't weaken."

I came home last night, sat down at my kitchen table and said it over and over again as if it was a Buddhist koan or the first line in a prayer I was learning to recite. "It's a great life if we don't weaken."

Today, I invited a senior to work with the Montessori materials who hasn't before, but whom I spied peeking into a few of the small boxes that house some of those materials. First she did wood polishing. She did a wonderful job polishing the wooden cat.

After she was finished wood polishing, I asked her if she wanted to see what was in one of the boxes she has been peeking into. She quickly answered yes.

I brought a small box to the table and explained that it was used to identify singular and plural. I showed her how to lay out the cards and labels. I then asked her to carefully remove one item after another from the box and place each next to their matching label.

She opened the box lid, looked inside and joyfully exclaimed, "Look how small these things are!" She had been upset earlier about an incident she said she couldn't help but think about. It was the suicide of a school friend decades ago. "I cried and cried at his funeral. I just couldn't stop," she told each of the staff, and myself, repeatedly. I had chosen this time to introduce her to the singular and plural language material as a means of shifting her thoughts away from those about her friend's suicide. Too, as I noted above, I had observed that she was interested in the work.

She pulled one baby from the box and gleefully said, "Now this baby makes me happy! And look, there's it's twin." She pulled the second baby from the box and put both next to their matching labels. Then she pulled a very tiny man from the box. I had purchased it and several others like it in Upstate New York from an antique store that specialized in miniatures. "Wow, that is the smallest thing I have ever seen," she said. And then she did it. She held it up against her chest, leaned back and giggled. No, she didn't laugh. She giggled and her face lit up with joy.

I watched her, listened to the sound of her happiness and thought of all the glass blue birds my grandmother kept on windowsills at her home. Sitting there, I heard the poetry of birdsong in the giggle of an 85 year-old woman's voice.

Wednesday, January 9, 2013

Wood Polishing in an Adult Day Program

I prepared a wood polishing tray and placed it on the shelf in the back room a few months ago. I have been waiting for just the right moment to present it to a particular senior. This senior has done silver polishing and flower arranging, so I thought this would be the next work for her. I finally presented it today. But, I did not present it to the senior who I initially thought it would be perfect for, yet that doesn't mean I won't present it to her later. Instead, I invited the male client that recently worked with the Chinese Puzzle (my hybrid version of the constructive triangles) to do some work with me. However, this time I asked him to pick which work he wanted to use from the shelves completely independent of my suggestions. This was a goal my supervisor and I had discussed for this particular client.

We walked to the "Montessori" shelves in the backroom and I reviewed with him what each work was. He was drawn to the singular / plural work that he has done several times before and chose that. He did the work perfectly. He laid out the labels and then matched the objects to the labels. Before we knew it, he had completed the material. I asked him to carefully put away all of the objects/labels and to return the box to the shelf. He did.

Next, I asked if he was interested in doing a new work. I said I had put together a tray that might be appealing to him. He said he wanted to continue working with me and so we did. I invited him to come to the shelves with me to get the tray, the needed supplies and an apron. We brought everything back to the table that we had been working at and I placed a red, paper place mat in front of him to designate a working space.

After I helped him put on the apron, I asked him to remove the items from the tray and place them on the place mat. Next, I asked him to take some polishing cloths, cotton balls and q-tips from the containers holding them and to place them in various objects from the tray. Then, I poured some of the wood polish into a porcelain dish for him to use.

There were two wooden objects that I had recently purchased from the thrift store and made available for him to polish. When he saw the first he said, "I think that is a gazelle. Gazelles are from Africa." This statement immediately brought both vocabulary and geography to this practical life work. It was wonderful to hear his words.

He carefully used a q-tip to apply wood polish to the narrow areas of the wooden gazelle. Next he used a cotton ball to apply polish to the entire figure.

Lastly, he used a cloth to polish the wood.

He commented, "The wood is much darker and it looks more like a real gazelle now." I smiled at him and simply agreed.

I carefully removed the gazelle from the paper place mat and moved it towards the back of the table. I then showed him the small, wooden cat. "I think that is a Siamese cat. I never had a cat. But my friend had a cat that they called JD." He had just distinguished a particular type of cat from just any cat and given the name of that type of cat. Next, he associated the cat to a personal memory. He used the materials in the same order as he had with the gazelle. He was careful with his movements and was very focused on the work that he was doing.

When he finished polishing the cat, he admired his work and then said he was done. He is very direct about when he feels he has completed something and wants to move on. Exercises were going on in the other room and someone had called out his name asking if he were going to come and join them. Exercises are good for him and so off he went. I said I would make sure that all of the materials were returned to the shelf and did so.


I have one last thing to write about today and that is that there is a growing curiosity from other seniors about the Montessori materials on the shelves. Today, for the second time, a senior who has not used any of the practical life materials, asked to look at the boxes and to see what was inside them. She commented on how beautiful all of the objects were. She especially liked the little pitcher I had put on the leaf washing tray. I feel a momentum growing for all of the Montessori materials that is independent of me. The seniors are starting to ask, "What's that and how do you use it? May I use it too?"

Tuesday, January 8, 2013

Constructive Triangles in an Adult Day Program. Well, kind of...

Sometimes you just have to take a leap of confidence in the Montessori method and the lessons one is so familiar with. I am very limited in regards to the Montessori materials that I have to work with at The Bridge. I would love a gently used binomial and trinomial cube or the small or large hexagon box, but I don't have them...yet. Montessorians around the world have been doing for decades, I modified another material in order to present a work that I felt would be stimulating for and serve the needs of one of the seniors at The Bridge who does not have dementia. Instead, he has other medical issues that require that he be supervised and that he be in a setting that would also provide him social interactions.

I had bought a Chinese Puzzle at a church rummage sale to give as a gift for a fellow Montessori teacher thinking she might like to use it as an extension for constructive triangles. I never had the opportunity to give it to her, so it has been sitting on a shelf in my apartment for a year and a half.

I recently had a wonderful conversation with the head of a Montessori school in British Columbia. We talked at length about how paralyzed a teacher can become if what is in her album is not on her shelf. Maybe a material is broken or has been promised to be order under the next year's budget.  Should the teacher move ahead with the lessons skipping over say the multiplication board and presenting the division board, if there is no multiplication board? Multiplication can be presented with the bead box and other materials besides the board. At a refresher course years ago in Florida, the keynote speaker stated clearly, "Follow the child, not your albums."

The person I wanted to present the constructive triangles to isn't a child. They are an adult. The lessons are already modified to fit the needs of an adult. So...I had this beautiful Chinese Puzzle that kept whispering to me, "Susan, use me at The Bridge in place of the constructive triangles. I am such a beautiful material. I am small and delicate and I invite curiosity." Finally, I decided that it would be perfect for this particular senior.

It was mid-morning when he arrived. I waited for him to get settled. I then approached him and invited him to work with me. He immediately agreed to. I directed him to a table in the back. I picked the puzzle up off my desk and joined him.

Before I revealed what I was holding in my lap, I told him that I had something very beautiful and delicate that I wanted to share with him. I paused for a deliberate minute and then placed it on the table in front of him. I asked him to carefully open it. He did so with precise movements. He pulled the enclosed material out from the decorative cover and placed it on the table.

I then leaned towards him and said, "There are triangles and squares inside and we can make things with them." He smiled and then carefully opened the package. He studied the yellow, wooden material for a minute.

I asked him to take one piece out at a time. He did and immediately he started piecing the shapes together to create something.

After he  made one thing, he made another and then another. He was very pleased with his third construction calling it a rabbit.

The hand loves to engage and this action engages the mind. Maria Montessori wrote, “The hands are the instruments of man’s intelligence.” She also wrote, “We found individual activity is the one factor that stimulates and produces development.” The child's mind is not the only mind that needs stimulation for development. The need for mental development spans a lifetime.

Monday, January 7, 2013

Exciting AMI International Congress News!!

i am delighted to share my recent news! Glenn Goodfellow, AMI International Congress 2013 Administrator/ Montessori Institute NW has named me as the volunteer press / media agent for the Congress. This is the first time the AMI International Congress is being held in the United States. It is going to be held in Portland, Oregon, July 31 - August 3, 2013. It is open to the entire community - teachers, social workers, homeschoolers, educators and philosophers, writers and researchers, artists and more. Please email me if you have any questions about the Congress or have story ideas. I will post here later this week my Congress email, until then feel free to contact me via I have much writing to do! I am enormously excited to be a part of the Congress and to be working with Glenn and so many others.