The dreaded one to ones. Who should get a one to one? What should I do for the one to one. Why do I need to do them? Where should the one to ones be done? When should I do the one to ones? Lastly, how often do I provide them and how should I do one?
A one-to-one is basically an individualized activity. It is an activity that can be done between two people in a setting that doesn’t overstimulate or make the resident feel uncomfortable. It can be done in their room, common area in the facility, outside the facility or in the community. They are activities that focus on the specific interests, needs or skills of the resident you are visiting. You also want to make sure you take into consideration the current functioning level of the resident you are working with. Sometimes these visits are used to help a newly admitted resident acclimate to the facility and the staff. It can also help them build trust with the staff and give that extra attention that may help them come out of their rooms and get involved.
Normally the one-to-ones are a staff member with a resident. Notice it says a staff member and not activities. It is the responsibility of the entire facility to help provide one-to-ones. The first response most will say is “That’s not my job!” Maybe some examples would show how easy it is for all staff to participate in a one-to-one. Housekeeping cleans rooms and if the resident is present while the room is being cleaned, they can ask questions about pictures, keep sakes or items on display. They could help them take care of a plant in the room or maybe discuss what they are listening to on the radio or watching on TV. Nurse Aides spend most of their time providing care and they could be asking them about their family, favorite food, discussing the weather or how they celebrated holidays. They could also help encourage them to attend group activities. The maintenance man in one facility used to have a couple of the residents help him with repairs. They would hold his tools for him or help him complete the monthly building inspection.
There are several different reasons to do one-to-ones. Some examples are introverts, historic loners, depression, short term stays, limited mobility, hearing or vision impaired, feeling like they don’t belong, medical isolation, comatose, and vents. These are just some examples of reasons residents may not come out of their rooms or do not attend activities. However just because a resident falls under one of these categories doesn’t mean they need a one-to-one visit. We must look at the whole picture. What are they doing on their own? Example can include reading, putting puzzles together, puzzle books, watching TV or movies, listening to the radio or music, bird watching, people watching, has visitors several times a week or daily, ambulates through the facility, pursuing hobbies such as painting, sewing, crocheting, knitting, crafts, etc, talking on the phone, playing on the computer or iPad, games, writing letters, etc., and volunteering. You can have a resident that doesn’t attend group activities but is busy in their room all day long. Are they in isolation due to a medical diagnosis? Are they on a vent or in a coma? If so they will need more visits. Look at their functioning level, are they able to do things on their own independently or some things on their own? If so they will need less visits and maybe none at all. One facility had a resident that thought activities were a huge waste of time, however that same resident would help set up for the activities and then would come back later and help clean up. There are several tools out there to help gauge when a resident needs a one to one. The residents that will be your biggest concerns are those that cannot pursue independent activities without someone’s help. One example would be a resident that is in a coma. They will need that extra special attention to make sure they aren’t just left in the room with no stimulation. This would be the same with a resident that is in isolation for medical reasons.
One on ones should be resident specific. This is where the activity assessment comes in. You need know what their likes and dislikes are so the visits are meaningful. Most activities can be adapted for a one-to-one visit. Some examples of one to ones are exercise (going for a walk, balloon volleyball, kickball, catch, etc), trivia, reminiscing (pictures of family, places, scenery, animals, cars, etc), Music, Pet visits, newspaper, reading poems/jokes, magazines, playing games, massages, nail care, taking care of plants or even taking care of a doll baby. Remember that the one-to-ones need to be based on their assessed interests. The use of a doll baby can sometimes appear not age appropriate. One facility had a resident that had all kinds of behaviors, she was combative with care, disruptive in activities and wasn’t easily redirected. She did have Alzheimer’s. Activities interviewed the family and found out that she never had any children, but that she had taken care of the kids in her entire neighborhood. Her whole life had been around children. Newborns were her favorite and she spent a lot of time helping out new mothers. The activity director asked permission to try and doll baby that looked real. Family gave the approval, and a doll baby was purchased. Staff gave her the doll baby and her face lit up. She named the baby after the aides that took care of her. Staff brought in baby clothes they had, and activities bought her some diapers. She cleaned out her bottom drawer and put a blanket in it. This was the baby’s bed. She took care of her baby every day. Her behaviors slowly decreased until they completely disappeared. She was no longer combative with care or disruptive in activities.
When doing one-to-ones there are a few things to keep in mind.
1. The first thing is knowing your resident and why they isolated themselves. Making sure you know their past interests, especially if they have dementia.
2. Knowing when the best time to visit. Some people are night owls and others are early risers. Some worked the night shift and are used to being up all night and moving into a facility isn’t going to change that routine.
3. Always keep yourself at eye level when speaking with the resident you are visiting. Standing over someone can make them feel inferior and will make it much harder to build that rapport with them.
4. Go in prepared with whatever supplies may be needed for the visit.
5. Ensure you are not competing with the TV, radio or other outside interference. Be sure they can hear you, if they are hearing impaired, take a white erase board or pen and paper to communicate with.
6. The visit doesn’t always have to occur in their room. Try going outside or even to a different room in the facility.
7. Be mindful of body language. Maybe they aren’t feeling good or are falling asleep. Also be mindful of your body language – looking at the clock or your watch sends a message that you are in a hurry, not making eye contact, crossing your arms, leaning back in the chair or standing up instead of sitting down. Making eye contact shows you care.
8. Never get upset for having to repeat the same thing over and over. Make sure you answer the question with the same tone of voice every time. Be read to go over whatever they want to talk about. Be prepared to not use what you have planned. Sometime our conversation leads to something completely different and that is ok.
One-to-ones do not have to be a burden. Come up with a theme each month and then weekly questions that staff can use to interact with the Residents. Ask the administrator if you can be part of a staff meeting and demonstrate how one-to-ones work. Demonstrate how staff can help improve the quality of life for the residents by using one-to-ones. You can also use other residents to help with one-to-ones. Some facilities have welcoming committees that residents serve on. It is one thing to have a staff member welcoming a new resident, but if someone who lives in the facility comes and welcomes them, they have a more accurate picture of what it is like to live in that facility. Family members can also be used to help with one-to-ones. Families that have loved ones with dementia really struggle to have meaningful visits. This is an opportunity for activities to help families have meaningful experiences with their loved ones, by providing them with the tools they need to make their visits enjoyable.
Tammy Point NAAP West Regional Director