Workbook - Home Care Assistance Montreal

The Balanced Care Method™ Workbook

Home Care Assistance’s holistic approach to healthy longevityfeaturing our Cognitive Therapeutics Method™ to boost brain health!

The Balanced Care Method™

1BalancedCareMethod.com

Table of Contents

Introduction.............................................................................................P. 3

1. Healthy Diet........................................................................................P. 4

2. Physical Activity...................................................................................P. 21

3. Cognitive Engagement.......................................................................P. 25

4. Social Ties...........................................................................................P. 69

5. Calmness & Purpose...........................................................................P. 72

6. Etiquette.............................................................................................P. 74

7. Daily Checklist....................................................................................P. 75

8. Quiz.....................................................................................................P. 76

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Introduction

The Balanced Care Method™ and Cognitive Therapeutics Method™ are two unique approaches to care weimplement at Home Care Assistance designed to improve the quality of life for our clients. This workbookprovides specific ways you can incorporate these approaches to care as a Home Care Assistance caregiver.

The Balanced Care Method™ is based on studies of the extraordinarily long-lived elders in theOkinawa region of Japan; life spans of over 100 years are not unusual in Okinawa. Perhaps even moreastounding than their longevity is the quality of health these elders enjoy; people in their 70s, 80s andbeyond enjoy excellent physical health, mental acuity, independence and inner calm. Studies have foundthat genetic factors only account for about one third of the Okinawan elders’ extraordinary health andlong lifespans. The other two-thirds can be attributed to the lifestyle factors which comprise our BalancedCare Method™ approach to care.:

Components of the Balanced Care Method Training include:

• Healthy Diet• Physical Activity• Cognitive Engagement• Social Ties• Calmness and Purpose

The Cognitive Therapeutics Method™ goes hand in hand with the Balanced Care Method™

and is a research-based activities program designed to keep aging minds engaged. Studies have shownthat participating in meaningful cognitive activities alongside making healthy lifestyle choices can boostcognitive resilience. The Cognitive Therapeutics Method™ was developed by a team of researchers ledby a neuropsychologist at Home Care Assistance, and targets the following five cognitive domains:

Executive Functioning includes cognitive abilities such as reasoning,problem solving, judgement and thought flexibility.

Attention refers to the ability to focus on a specific piece of informationfor a long period of time while ignoring competing distractions.

Language refers to the ability to execute verbal functions, includingspontaneous speech, speech repetition, speech comprehension,naming, reading and writing.

Visual-Spatial Perception involves the ability to accurately perceivean object’s physical location and understand the relationships between objects.

Memory refers to the ability to retain information and utilize it later.

As part of our mission to change the way the world ages, it’s important that our caregivers and employeesare trained in both of these Methods. Doing so ensures we are providing clients with the exceptional carethey deserve, thereby enabling them to live happier, healthier lives at home.

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1. Healthy Diet

A major factor that contributes to the extraordinary health enjoyed by Okinawan eldersis their distinct diet. It is plant-based, low in fat and animal-based protein and high infiber, omega-3 fatty acids and flavonoids. It includes low to moderate alcohol intake,plenty of fruits and vegetables and very low levels of saturated fat and sodium. Thetwenty percent of animal-based calories the Okinawans do consume come mostly fromcold-water fish or stewed meats from which the fat has been rendered. In addition, thefats they eat – fish, soy products, and cold-pressed canola oil – are largely monounsaturated(which helps to lower “bad” cholesterol) and rich in omega-3 fatty acids.

Thus, the Balanced Care Method promotes a varied diet rich in vegetables and fruits,whole grains and other complex carbohydrates, lean proteins, flavonoid and omega-3-rich foods, and low in saturated fats, refined sugars, processed foods and alcohol. Thereis room in this diet profile for most people’s favorite foods, at least in moderation.Similar to the Okinawan practice of hara hachibu, which means eating until only 80% full, the Balanced Care Method promotes a moderate to low-calorie diet to help achieve ormaintain a healthy body mass index. For older, less active people, this is often 1,500 – 2,000calories per day. Maintaining small portions with a focus on whole foods (fruits, vegetables,soy and grains), low-fat foods and an avoidance of processed foods will help keepcaloric intake low.

The Modified MyPyramid for Older Adults shown below is a good guide to follow tocreate a balanced, nutritious diet for older adults. This picture shows the dietary guidelines that will help promote health and vitality:

• Whole, enriched, and fortified grains and cereals suchas brown rice and 100% whole wheat bread

• Bright-colored vegetables such as carrots and broccoli

• Deep-colored fruit such as berries and melon

• Low- and non-fat dairy products such as active culture yogurt and low-lactose milk

• Beans and nuts, fish, poultry, lean meats and omega-3 eggs

• Liquid vegetable oils

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Enjoy Daily

VegetablesFruitsWhole grains (whole wheat bread, brown rice, oatmeal, corn meal, etc.)Omega-3-rich foods (cold water fish like tuna, salmon and mackerel; walnuts, dark greens, eggs)Green tea Water

Enjoy in Moderation

Low-fat milk productsLean meatsFruit juices

Limit

Cheese and full-fat milk productsSugarRefined grains (white bread, white rice, etc.)Processed or fatty meatsSodasAlcohol

We will now look more closely at each of the elements of the Balanced Care Method dietary program.

The Balanced Care Method™

Dietary Program Overview:

1. Healthy Diet

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1. Healthy Diet

Vegetable & Fruits

The most important part of the Balanced Care Method diet is keeping consumption ofvegetables and fruits high. Ideally, clients should have multiple servings of vegetables and at least 1 serving of fruit every day. A serving of vegetables is usually about 1 cup ofchopped, sliced, or mashed vegetables, except for leafy greens like lettuce which are 2 cups per serving. Often the amount of vegetables served at a restaurant or even athome counts as 2, 3, or even 4 servings. A serving of fruit is also about 1 cup chopped or1 whole fruit, as long as that fruit is relatively small. Many apples sold at stores today areso large they count as 2 or even 3 servings each!

Vegetables and fruits are vital for a healthy diet because they contain vitamins, mineralsand antioxidants. Equally important, they contain natural fiber, which promotes healthydigestion and helps people feel full and satisfied longer. For this reason, vegetables andfruits make excellent snacks; they satisfy the body’s craving for food while providing a low-calorie sense of fullness.

Variety is important, but not all fruits and vegetables are created equal. Some contain morenutrients and health benefits than others and should be worked into the diet more frequently:

• Dark, leafy greens (kale, spinach, chard)• Sweet potatoes• Cabbage & related vegetables (broccoli, cauliflower)• Crunchy, raw vegetables of all kinds• Tomatoes• Berries• Apricots• Melons

Whole Grains & Carbohydrates

Vegetables and fruits do provide our bodies with carbohydrates, but another goodsource of this important dietary component are whole grains. Carbohydrates, both complex and not (fruits and veggies), should make up a large portion of your client’s diet.

Whole grain breads (whole wheat, rye), oatmeal and brown rice are several easy, familiarways to add whole grains to any diet. Whole grains, as opposed to refined grains, contain a wider range of nutrients and fiber. Limit intake of refined grains like whitebread and white rice as they have zero nutritional value.

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1. Healthy Diet

Nutritional whole grains to incorporate into the diet:

• Oatmeal• Brown rice • Barley • Corn meal (cornbread, tortillas, baked tortilla chips)• Buckwheat (kashi, soba noodles, groats)

Soy-Based Foods

Along with being an excellent source of low-fat protein, soy contains high levels offlavonoids, which help protect against cancer and heart disease. 2 to 4 servings each dayof flavonoid-rich foods are recommended to help maintain bone density, muscle massand protect against disease. Flavonoids are found in a range of foods, but are most concentrated in soy products such as tofu, edamame and soy milk. Other flavonoid-richfoods include:

• Ground flax seed• Dark greens• Onions• Sprouts• Cranberries• Apples• Strawberries• Grapes• Apricots• Green and black teas

Soy-based foods may be new to you or your client. Here are some ways to easily incorporate them into the diet:

• Add “silken” tofu to smoothies or pureed soups• Try soy beans (often sold as “edamame”) as a snack• Use soy beans in place of beans or peas in favorite recipes• Serve sweetened and/or flavored soy milk in place of milk• Try baked tofu over regular tofu; it’s firmer, more flavorful and more appealing to many people

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1. Healthy Diet

Omega-3-Rich Foods

Omega-3 is an essential fatty acid that has been shown to support heart health and brainfunction. 1 to 3 servings a day is advised.

Some omega-3 rich foods to include in the diet:

• Cold-water, fatty fishSalmonTunaMackerel

• Walnuts• Dark, leafy greens

SpinachSwiss chardKaleMustard, turnip, beet, and collard greens

• Flaxseeds and chia seeds (can sprinkle on yogurt or salad)• Omega-3 enriched eggs

Look for “pastured” or “cage-free” versions

Tea & Water

Plenty of fresh water is good for everyone and a much better thirst-quencher than juice. The Balanced Care Method also encourages drinking several cups of tea daily. Black tea is fine, but the healthier option is a decaffeinated jasmine, green or herbal tea. Try fresh ginger, chamomile and peppermint teas for a soothing effect, adding a bit of honey orlemon juice for more flavor.

It is very important to make sure your client is drinking enough fluids; according to the MayoClinic, men and women should consume at least 8 glasses of water a day to avoid dehydration.More may be necessary if your client takes medications that have diuretic or laxative effects.Dehydration can result in very serious consequences and should be monitored closely.

Symptoms can include:

• Fatigue• Headache• Dry mouth• Little or no urination• Muscle weakness• Dizziness or light headedness• Confusion and forgetfulness• Deep rapid breathing or an increased heart rate

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1. Healthy Diet

Here are several suggestions to ensure your client consumes the adequate amount of fluidseach day:

• Encourage your client to drink before he or she feels thirsty• Help keep him or her hydrated by having water or tea nearby for sipping throughout the day

• Serve water or tea before serving food at meals• Foods such as soups and raw fruits and vegetables are also an excellent ways to stay hydrated

Coffee

Many people enjoy a cup of coffee in the morning before or with their breakfast. While some believe that coffee is not good for you, recent studies suggest that moderate coffee consumption can help stave offAlzheimer’s and dementia. As long as no doctor’s order prevents it, a few cups of coffee a day are fine.

Note: If your client has trouble sleeping, it may be wise to limit coffee consumption to themorning hours (before lunch).

Dairy & Meat

The North American diet is largely made up of animal products. While meat and dairy docontain protein and minerals, they also contain saturated fat, which can threaten hearthealth when consumed in large quantities.

Meat and dairy do not need to be purged from diets completely, but most people will enjoybetter digestion and overall health if they limit their consumption.

Try to keep meat consumption to a few times a week, if possible. Also observe a true servingsize, which is 4 ounces of meat (about the size of a deck of cards). When choosing meat:

• Look for lean meats such as chicken, turkey and tenderloin cuts• Minimize processed meats like hot dogs and chicken nuggets• Cook meat in a way that renders its fat: roasting, baking or stewing is better than frying

Try to substitute extra-virgin olive oil for butter whenever you can; most times your clientwon’t know the difference. Full-fat or “whole” milk products contain a lot of saturated fatand should be limited. Low-fat or skim versions, however, are excellent sources of protein,calcium and vitamin D.

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1. Healthy Diet

In addition, unsweetened or Greek yogurts with live cultures and probiotics are healthy alternatives to more full-fat dairy products. They contain “good” bacteria that aid in digestion and promote overall health.

Salt

We all need some salt in our diets to maintain proper body function, but most individualsconsume too much. So much in fact, that many older adults are on low-salt diets due to high blood pressure, heart disease, stroke and osteoporosis.

To add flavor to foods without using as much salt, try these easy tips:

• A squirt of lemon juice before serving can highlight flavors much like salt does• Fresh herbs add flavor to salads, roast meats and cooked vegetable dishes• Use low-fat, reduced sodium stock or broth for cooking and added flavor to the food without salt

Sweets & Sugar

As people get older they tend to develop more of a sweet tooth. Though other tastes fade,many seniors retain the ability to taste sweet things, and therefore crave them. Refined sugarand other sweets should have a very limited role in the diet in order to avoid blood sugarspikes, stress on the pancreas and empty calories. A piece of fruit is a much healthier way toend a meal while still satisfying the craving for something sweet; applesauce, dried fruits andlow-fat yogurt with fresh fruit are all good options.

Not all sweeteners are created equally. Levels of processing and how our bodies handlesweeteners means some are easier on our systems than others.

Preferred SweetenersHoneyAgave

Sweeteners to AvoidWhite sugarCorn syrup and foods containing high fructose corn syrup

Alcohol

Some studies suggest that red wine, in moderation, can have beneficial effects on hearthealth; red wine contains antioxidants, which are thought to help prevent heart disease by increasing levels of “good” cholesterol and protecting against artery damage. However,doctors are wary about encouraging anyone to start drinking alcohol as overconsumptioncan have negative effects on the mind and body. Bottom line: Alcohol should be consumedin moderation, if at all.

1. Healthy Diet

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Salmon – Contains omega-3 fatty acids that fight artery deposits of LDL cholesterol.

Walnuts and other nuts – Cholesterol-free and high in heart healthy unsaturated fat including omega-3s, certain nuts have been shown to reduce the risk of heart disease.

Carrots – Contain vitamin A and antioxidants. The beta-carotene helps prevent macular degeneration, the leading cause of blindness as we age.

Eggs – A superior source of protein, eggs include all the essential amino acids the humanbody requires for good health.

Flaxseeds – Evidence suggests that these seeds can reduce the risks of heart disease, cancer and stroke.

Blueberries – Loaded with vitamins B-6, B-12 and C, along with folic acid and potassium.

Dark chocolate – With a high cocoa percentage (60% or more) this treat is full of antioxidants.

Jicama– Has probiotic properties to boost healthy bacteria in the stomach and aid in digestion. It is also high in vitamin C which helps fight wrinkles.

Chia – These tiny seeds are excellent sources of fiber, calcium, iron and omega-3s.

Sprouts – These germinating seeds (e.g. bean, alfalfa, broccoli) can be eaten raw or cookedand can come from different beans. Broccoli sprouts contain about 50 times more of theanti-cancer agent, sulforaphane, than their fully mature stalks.

Black Garlic – This sweet garlic has cholesterol lowering properties and nearly double the antioxidants compared to a regular raw bulb of garlic.

Kelp – Packed with vitamin K and calcium, certain studies have shown that it can help decrease women's risk of developing breast cancer.

Barley–This grain contains lignans, which help fight cancer and lower cholesterol, and niacin,which helps keep skin and hair healthy.

Nutritional Yeast – Loaded with protein and vitamin B, this yeast helps keep energy levelshigh and stress levels low.

Try to incorporate one or more

of these Super Foods into

the client’s diet on a daily basis:

Recipes from our Comfort Foods

Cookbook: A Healthy Twist on

Classic Favorites

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1. Healthy Diet

While the amount of food we consume tends to decrease as we age, the quality andnutritional value become more essential; after all, eating properly is pivotal to our lifespanand health-span. Over the years, our clients and caregivers have shared countless recipeswith us – recipes that inspired good food and fond memories. With the input of nutritionists,we adapted these favorite recipes to meet our Balanced Care guidelines. By introducinghealthier ingredients and cooking methods to the kitchen, we’re making sure that all of ourfavorite foods are also great sources of nutrition at any age, but in particular for older adults.

We would like to share some of the recipes from our Comfort Foods Cookbook: A HealthyTwist on Classic Favorites with you. For a complete list of recipes, request a copy of ourcookbook from your local office.

Breakfast

Mixed Berry Almond SmoothieCan be served with a slice of whole wheat toastServes 1

This refreshing blend of berries, yogurt, and almond milk gets a vitamin C boost from orange juice, with a flavor that’s simply delicious. It’s easy to make and perfect for breakfast on the go or an afternoon pick me up.

½ cup mixed berries (fresh or frozen)½ cup almond milk¼ cup plain low-fat or nonfat yogurt¼ cup calcium-fortified orange juice

DirectionsCombine and blend all the ingredients until frothy and smooth. Pour into glasses and serve.

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1. Healthy Diet

Lunch

Three-Bean ChiliCan be served with cornbread and a small saladServes 3-4

This recipe makes a hearty batch of vegetarian chili. Freeze leftovers in individual servingsto make reheating quick and easy for a healthy lunch or hassle free dinner.

2 carrots, peeled and finely chopped1 can (14-oz.) chopped tomatoes (no salt added)1 can (14-oz.) crushed tomatoes3 cans (14-oz. each) pinto, kidney, white and/or black beans, rinsed and drained1 cup frozen whole-kernel corn1 red bell pepper, chopped (optional)1 zucchini, chopped (optional)1 ½ Tbsp. rice vinegar4 cups of water

Directions1. Put carrots, tomatoes, beans, corn, red pepper and zucchini into a large pot with 4 cupsof water. Bring to a boil. Cover, reduce heat, and simmer until carrots are tender, about 25 minutes. Add salt and pepper to taste.

2. Stir in vinegar. Top with fresh cilantro and nonfat yogurt, if you like.

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1. Healthy Diet

Dinner

Tuscan Rosemary ChickenCan be served with a whole grain roll and steamed asparagusServes 2

This one-pot dinner is easy to make. Any leftovers can be reheated a day or two later forlunch or dinner, or frozen and reheated at a later time.

1 boneless, skinless chicken breast (about 8 oz.), cut in half1 Tbsp. olive oil1 small zucchini, halved lengthwise and sliced½ cup green beans, trimmed and cut into ½-inch lengths1 cup low-sodium chicken or vegetable broth1 tsp. minced fresh or ¼ tsp. dried rosemary (optional)¼ cup mashed white beans1 cup halved cherry or grape tomatoes

Directions1. In a large frying pan heat olive oil over medium heat. Cook chicken, turning once, until it is no longer pink in the center, about 10 minutes. When you cut into the chicken the juices should run clear. Transfer chicken to a platter and cover to keep warm.

2. Add zucchini, green beans, broth and rosemary to the pan. Bring to a boil and then reduce heat to a simmer. Cover and cook until vegetables are tender, about 3 minutes.

3. Stir the mashed beans and tomatoes into the sauce. Add the chicken breast back into the pan to warm it up and serve.

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1. Healthy Diet

Breakfast

Ham and Cheese Breakfast CasseroleCan be served with coffee or tea and a cup of fruitServes 4

This healthy version of the traditionally rich ham and cheese breakfast casserole is equallydelightful with plenty of flavor, half the calories and one-third the fat of the original casserole.

2 large eggs6 large egg whites1 cup nonfat milk2 Tbsp. Dijon mustard1 tsp. minced fresh or dry rosemary¼ tsp. freshly ground pepper5 cups chopped spinach4 cups whole-grain bread, crusts removed if desired, cut into 1-inch cubes (about ½pound, 4-6 slices)1 cup diced ham (5 ounces)½ cup chopped roasted red peppers¾ cup shredded reduced-fat Swiss cheese

Directions1. Preheat oven to 375°F. Coat a 7x11 inch glass baking dish or a 2-quart casserole with cooking spray.

2. Whisk eggs, egg whites and milk in a medium bowl. Add mustard, rosemary and pepper; whisk to combine. Toss spinach, bread, ham and roasted red peppers in a largebowl. Add the egg mixture and toss well to coat. Transfer to the prepared baking dish and push down to compact. Cover with foil.

3. Bake until the eggs have set, 40-45 minutes. Uncover, sprinkle with cheese and continuebaking until the eggs are puffed and golden on top, 15 to 20 minutes more. Let it cool for 15 to 20 minutes before serving.

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1. Healthy Diet

Lunch

Grape Walnut Chicken SaladCan be served with whole grain bread or crackers and shredded cabbage or cole slawtossed with a light dressingServes 1

This fresh salad is perfect when you want something light but flavorful.

2 Tbsp. thick Greek-style plain yogurt or nonfat plain yogurt½ tsp. lemon juiceFreshly ground black pepper½ cup shredded or chopped cooked chicken or turkey2 Tbsp. chopped walnuts1 small stalk celery, finely chopped¼ cup grapes, halved

Directions1. In a medium bowl, combine yogurt, lemon juice, and pepper to taste.2. Add chicken, walnuts, celery, and grapes and toss to combine thoroughly. Serve immediately or cover and chill until ready to eat.

Dinner

Miso-Glazed Salmon or Arctic CharCan be served with steamed broccoli or spinach and brown riceServes 1

This one dish supper is pretty quick to pull together and packed with flavor.

1 wild salmon or arctic char fillet (6 oz.)2 Tbsp. white or yellow miso1 tsp. rice vinegar1 tsp. fresh grated ginger½ tsp. toasted sesame oil

Directions1. Preheat broiler and place salmon on a baking sheet.2. In a small bowl, combine miso, vinegar, ginger, and sesame oil. Spread over the salmon.3. Broil until cooked through—it should flake easily when prodded with a fork, about 10 minutes.

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1. Healthy Diet

Breakfast

Whole Grain Blueberry PancakesCan be served with coffee, tea or Calcium-fortified orange juice and a slice of turkey baconServes 2

A sweet but healthy alternative to traditional blueberry pancakes.

1 cup whole wheat flour½ cup toasted wheat germ½ cup cornmeal1 Tbsp. light brown sugar1 Tbsp. baking powder½ tsp. salt1 egg 1/3 cup nonfat milk2 tsp. canola oil1 cup fresh blueberries

Directions1. In a large bowl, mix together flour, cornmeal, wheat germ,baking powder, brown sugar and salt.

2. In a small bowl, whisk together egg, milk and oil. Pour into dry mix and stir to combine. Add in blueberries.

3. Pour batter onto a heated non-stick griddle or frying pan, about ¼ cup per pancake, and cook until bubblesappear in the batter. Flip and cook until browned on thesecond side. Repeat with remaining batter. Top with light maple syrup and blueberries.

Lunch

Tuna SandwichCan be served with a small salad or cup of fruitServes 1

Tuna fish has many health advantages, promoting good cardiovascular health and providinga non-fatty source of protein. A tuna sandwich is one easy way to obtain the benefits ofthis nutritious food. Any extra can be stored in a plastic sealable container in the refrigeratorfor use within a week.

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1. Healthy Diet

6 oz. can of tuna¼ cup nonfat mayonnaise1/3 cup relish1/3 cup chopped red onion (optional)Freshly ground black pepperTwo slices of whole wheat bread

Directions1. Place tuna in a medium-sized mixing bowl.2. Add mayonnaise to the tuna along with the relish and black pepper to taste.3. Finely chop part of an onion and add it to the bowl, if desired.4. Stir the ingredients together and spread onto one of the slices of bread and place the other slice on top.

Dinner

Butternut Squash Stir-FryCan be served with brown rice and a small saladServes 3-4

This fun and colorful stir-fry makes a quick and delicious dinner. For extra protein, you canadd 4 oz. chopped firm tofu.

1 bag cubed squash1 head Swiss chard or kale, thick ribs removed1 Tbsp. olive oil2-inch piece ginger, peeled and finely diced1 Tbsp. white or yellow miso¼ cup chopped cilantro (optional)

Directions1. Chop chard or kale and set aside.2. In a large frying pan or pot, heat oil over medium-high heat. Add ginger and cook, stirring, until opaque and fragrant, about 30 seconds.

3. Add squash. Dissolve miso in ½ cup water and add to squash and ginger. Stir to combine. Add chard or kale, stir, cover, and cook, stirring occasionally, until squash is tender, about 15 minutes. If you are adding tofu, do so at this step. Add additional water if necessary to keep squash from sticking to the pan.

4. Add cilantro, if you like, and stir to combine.

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1. Healthy Diet

Breakfast

Cinnamon Apple OatmealCan be served with coffee, tea or Calcium-fortified orange juiceServes 1

Jazz up plain old oatmeal with some sugar and spice.

1 cup apple juice½ cup rolled oats1 small red apple, peeled and chopped1/8 tsp. ground cinnamon1 tsp. light brown sugar (optional)

Directions1. In a small sauce pan bring apple juice to a boil. Stir in oats, chopped apple and cinnamon. Adjust heatto maintain a steady simmer.

2. Cook until oats are tender, about 5 minutes. Serve hot andsprinkle with brown sugar for added sweetness if you like.

Lunch

Caesar Salad with SardinesCan be served with a cup of soupServes 1

A healthy take on a traditional favorite.

¼ head romaine lettuce, torn into bite-size pieces1 Tbsp. olive oil2 tsp. lemon juice1 tsp. white or yellow miso¼ tsp. freshly ground black pepper½ cup whole grain croutons1 (2 ounce) can sardine fillets, drained

Directions1. Put lettuce in a large bowl.2. Combine olive oil, lemon juice, miso and pepper in a jar. Cover tightly and shake vigorously.3. Pour dressing over lettuce and toss gently to coat lettuce leaves. Add croutons and toss again.4. Place on a serving plate and top with sardines. Serve immediately.

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1. Healthy Diet

Dinner

Pork Chops with Apple SauceCan be served with a small salad and sautéed spinachServes 1

When cooked, pork chops can sometimes be dry, so adding apple sauce to this dish canhelp increase the meat’s flavor.

½ cup nonfat milk½ tsp. salt1 (½ -inch-thick) pork chop (with or without bone)¾ cup fresh whole wheat bread crumbs, ground in a food processor¼ Tbsp. minced garlic½ tsp. fresh or dried rosemary½ tsp. fresh or dried thyme½ cup apple sauce1 Tbsp. canola oil

Directions1. Stir together milk and salt in a shallow 3-quart dish, add pork chops. Marinate, covered and chilled, turning over once, at least 1 hour.

2. Preheat oven to 200°F.3. Stir together bread crumbs, garlic, rosemary and thyme in a shallow bowl. Lift pork chopsfrom milk, letting excess drip off, and dredge in bread crumbs. Pat bread crumbs lightly to help them adhere.

4. Heat oil in a skillet over moderately high heat. Add pork chop and saute, turning over once, until golden brown, about 5 to 6 minutes.

5. Serve pork chop topped with apple sauce.

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2. Physical Activity

Okinawan elders have lifelong routines of moderate exercise and physical activity, with the majority regularly practicing the soft martial art of tai chi. They walk most places theygo and keep up daily tasks like housework and gardening. These are all low-impact andweight-bearing forms of physical activity. Tai chi alone provides its practitioners with aerobic, anaerobic and flexibility fitness. Being physically fit helps keep Okinawan elderslean and in shape. They report that these physical activities also give them a sense ofcalmness and psychological wholeness.

Being as active as possible helps people at all stages of life achieve and maintain a healthybody mass, heart health and engaged minds. For older adults, exercise can help preventthe loss of muscle strength, bone density and balance, and thereby reduces the risk of falls.Researchers have also found that patients who are more physically fit have less brain-tissueatrophy. The Balanced Care Method seeks to help seniors start and maintain a healthy activity level. Seniors still able to do small chores or gardening should be encouraged todo so. For seniors who are still mobile, walking a little bit each day can help them maintainthis agility. It is recommended that seniors exercise 4-5 times per week with the consentand guidance of a physician. Consulting with your client, his or her medical practitioner,and his or her family or friends will help you determine the appropriate level at which yourclient can and should keep up his or her previous activities.

The Balanced Care Method™ Exercise Program Overview:

Stretching Strength-buildingAerobic

Ideally, all three types of activity will happen on a daily basis.

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Stretching

Stretching helps maintain flexibility and joint function and is an activity that can beadapted to all levels of mobility. The best stretching program covers all major joints (hips,shoulders, knees, elbows, neck adn spine) and is best done when the body is warm, afteranother form of exercise or a bath or shower.

Here are 8 easy stretches that can be done sitting or standing:

Neck Stretches

With a straight spine and chin up for good posture, tilt the head from side to side – tryingto touch each ear to each shoulder. Hold each side for 30 to 60 seconds, breathing steadilyand deeply. Keep shoulders down, jaw relaxed, and eyes looking forward. Repeat until youare comfortable. Another stretch for the neck involves bringing your chin to your chest asclose as possible and holding for 30 to 60 seconds. Breathe deeply and keep the jaw relaxed throughout the stretch.

Shoulder Stretches

Maintaining good posture, roll your shoulders forward several times and then reverse direction and roll shoulders backwards several times. Next, hold your arms down at yoursides with palms facing forward. Lift them up as you inhale, keeping palms facing forward,as high as you can. Lower them slowly as you exhale. Repeat until you feel relaxed.

Torso Stretches

Reach right arm straight up and lean to the left as far asyou can. Repeat with your left arm over your right side. Next, reach both arms straight up and lean slowly to the right. Slowly come back up and repeat on the left side. Another effective way to stretch the torso is to lie on your back on the floor with your knees bent. Lower your knees, still bent, to the right, reaching the floor if possible. Repeat on the left side.


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Arm, Wrist and Hand Stretches

Hold your arms out in front of you with your palms up. Bend your elbows and try to touchyour shoulders without lifting your elbows higher than your shoulders. You can also do thisone arm at a time. Next, hold your wrists out in front of you and make a gentle fist. Rollyour hands clockwise several times, and then roll them counterclockwise several times.

Stretching Hips

Stand with the right side of your body next to the back of a chair. Put your right hand onthe back of the chair and cross your left foot in front of your right leg. Lift your left hand as high up above your head as you can and gently lean to the right. Hold for at least onedeep breath. Repeat on the left side.

Stretching Legs

Sitting in a chair, put your right leg out as straight as you can with your heel on the floor(your toes can be pointing up). Hold for at least one deep breath. Repeat with the left leg.Next, sit on the floor with your legs straight out in front of you. For many people, this positionis already a good stretch. For the more limber, bend forward, keeping a flat back, as far asis comfortable. Hold for at least one deep breath.

Stretching Ankles

Sitting in a chair with good posture, lift up your right leg just high enough so you can rollyour foot. Roll your right foot clockwise several times and then roll it counterclockwise several times. Repeat with the left foot.

Back Stretches

Sitting in a chair with good posture, put your hands under your right knee and lift it up towards your chest as far as you comfortably can. Hold for at least one deep breath. Releaseslowly. Repeat on the left side. Next, lie on the floor with your knees bent and feet flat onthe floor. Pull your knees as far into your chest as you can and hold it a full, deep breath.

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Strength-Building

One of the best ways for seniors to maintain their strength is to do as many tasks as theycan without assistance. Joining a gym is also an option, especially one that caters to olderadults. Weight-bearing exercise, like walking, is also important. Carrying light weights (1 pound in each hand, for example) intensifies the workout without putting too much ofstrain on the joints.

Aerobic

Walking is an excellent source of aerobic exercise. Even short walks, taken regularly, canbe very beneficial to one’s physical and mental health. Following these tips will help yourclient stay mobile:

• Wear comfortable shoes with good support and breathable socks• Wear a hat, sunglasses and sunscreen • Dress warmly and wear layers in cooler weather• Find even, flat places or paths to walk• Follow a regular schedule for walking• Mix up the route every now and again to keep things fresh and interesting

Some activities older adults can do that are low impact, but still provide a workout are:

• Gardening• Light housework• Dancing• Golfing• Swimming or aqua aerobics

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3. Cognitive Engagement

Home Care Assistance developed the Cognitive Therapeutics Method™ as an extension of the Balanced Care Method™. Studies have shown the positive correlation between cognitive stimulation and client engagement. Evaluate and select the activities that aremost appropriate for your client. The activities as seen below are activities offered throughthe Cognitive Therapeutics Method program and are fun, enjoyable activities to stimulatethe five domains of the brain.

The Cognitive Therapeutics Method™ Cognitive EngagementProgram Overview:

Alphabet Soup (Language)

Suggest a category from the list below. Starting with the letter "A", come up with a wordwithin that category that starts with each letter of the alphabet. It’s okay if you don’t find an answer for each letter.

Sample Topic: FruitsA - Apple B - BananaC - Coconut

Sample Topic: School SubjectsA - AlgebraB - BiologyC - ChemistryD - Drama

C

Topic: ____________________

A. _________________________

B. _________________________

C. _________________________

D. _________________________

E. _________________________

F. _________________________

G. _________________________

H. _________________________

I. _________________________

J. _________________________

K. _________________________

L. _________________________

M. _________________________

N. _________________________

O. _________________________

P. _________________________

Q. _________________________

R. _________________________

S. _________________________

T. _________________________

U. _________________________

V. _________________________

W. _________________________

X. _________________________

Y. _________________________

Z. _________________________

Topic: ____________________

A. _________________________

B. _________________________

C. _________________________

D. _________________________

E. _________________________

F. _________________________

G. _________________________

H. _________________________

I. _________________________

J. _________________________

K. _________________________

L. _________________________

M. _________________________

N. _________________________

O. _________________________

P. _________________________

Q. _________________________

R. _________________________

S. _________________________

T. _________________________

U. _________________________

V. _________________________

W. _________________________

X. _________________________

Y. _________________________

Z. _________________________

Topic: ____________________

A. _________________________

B. _________________________

C. _________________________

D. _________________________

E. _________________________

F. _________________________

G. _________________________

H. _________________________

I. _________________________

J. _________________________

K. _________________________

L. _________________________

M. _________________________

N. _________________________

O. _________________________

P. _________________________

Q. _________________________

R. _________________________

S. _________________________

T. _________________________

U. _________________________

V. _________________________

W. _________________________

X. _________________________

Y. _________________________

Z. _________________________

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Choose a topic (travel, sports, state, countries, movies, books, female/male names) andwrite related words that begin with each letter of the alphabet.

27


Categorical Scrambles (Language)

Each category has five word scrambles; four of them match the category and one ofthem does not. Have the client first unscramble the words, then figure out which worddoes not belong to the category.

Exercise 1 (Answer on page 30)

1. Colorsa. erdb. elubc. eerngd. itghle. lackb

2. Numbersa. neob. ivefc. xsid. wote. ewf

3. Emotionsa. unrb. admc. hppayd. sdae. ladg

4. Petsa. atcb. odgc. ishfd. msouee. lantp

5. Temperaturesa. olcdb. rafc. oolcd. tohe. rmwa

6. Animalsa. ofxb. tacc. dgod. ishfe. gru

7. Sensesa. itsghb. ufnc. outchd. ateste. emsll

8. Drinksa. uttberb. odasc. ilmkd. atrewe. uijce

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1. Movie Genresa. tnoacib. ytafasnc. decoymd. nrocemae. rcasy

2. Book Genresa. hbuplsib. epoyrtc. goaphbiyrd. otfncie. mrcie

3. Natural Disastersa. zrdazilbb. dmuihc. erqaekutahd. lancovoe. airunehrc

4. Types of Fooda. neicxmab. haitc. taialnid. cenishee. coahtcoel

5. Fruita. plapeb. daomnlc. nabnaad. aerpe. aegnor

6. Dessertsa. eipb. kecac. cbcrolid. okiocee. erbwnoi

7. Jewelrya. katjetcb. gnirc. acbretled. knlceeace. rairneg

8. Transportationa. rcab. abtoc. lapend. iktee. cyeclib

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1. Fooda. mburgaherb. cilahenadc. ckesanpad. dwiashcne. kcacilot

2. Gemsa. iaondmdb. eayhtstmc. phiapsred. laticpse. raeldme

3. Sea Creaturesa. usinatmb. osertlbc. ifhasasrtd. enamoene. yifslehlj

4. Clothinga. aithrsestwb. baenahdbc. orsetursd. uesbloe. setrwea

5. Toolsa. ewhncrb. acltandiesckc. wsdivcered. amherme. wbcoarr

6. Statesa. ykkcunetb. gcmiahnic. acandad. eniutccocne. ynesiaplvna

7. Types of Meata. neosvinb. uyekrtc. eicnhkcd. rctihakeoe. ubfloaf

8. Technologya. rimrorb. evelsnitoic. certupomd. erorfreagrite. ethlonpel

30


Answers to Exercise 1 (The word that is in capital letters is the answer that does not belong to the category.)

1. Colorsa. redb. bluec. greend. LIGHTe. black

2. Numbersa. oneb. fivec. sixd. twoe. FEW

3. Emotionsa. RUNb.madc. happyd. sade. glad

4. Petsa. catb. dogc. fishd. mousee. PLANT

5. Temperaturesa. coldb. FARc. coold. hote. warm

6. Animalsa. foxb. catc. dogd. fishe. RUG

7. Sensesa. sightb. FUNc. touchd. tastee. smell

8. Drinksa. BUTTERb. sodac. milkd. watere. juice

31


Answers to Exercise 2

1. Movie Genresa. actionb. fantasyc. comedyd. romancee. SCARY

2. Book Genresa. PUBLISHb. poetryc. biographyd. fictione. crime

3. Natural Disastersa. blizzardb. HUMIDc. earthquaked. volcanoe. hurricane

4. Types of Fooda. Mexicanb. Thaic. Italiand. Chinesee. CHOCOLATE

5. Fruita. appleb. ALMONDc. bananad. peare. orange

6. Dessertsa. pieb. cakec. BROCCOLId. cookiee. brownie

7. Jewelrya. JACKETb. Ringc. Braceletd. Necklacee. Earring

8. Transportationa. carb. boatc. planed. KITEe. bicycle

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Answers to Exercise 3

1. Fooda. hamburgerb. enchiladac. pancakesd. sandwiche. COCKTAIL

2. Gemsa. diamondb. amethystc. sapphired. PLASTICe. emerald

3. Sea Creaturesa. TSUNAMIb. lobsterc. starfishd. anemonee. jellyfish

4. Clothinga. sweatshirtb. HEADBANDc. trousersd. blousee. sweater

5. Toolsa. wrenchb. CANDLESTICKc. screwdriverd. hammere. crowbar

6. Statesa. Kentuckyb. Michiganc. CANADAd. Connecticute. Pennsylvania

7. Types of Meata. venisonb. turkeyc. chickend. ARTICHOKEe. buffalo

8. Technologya. MIRRORb. televisionc. computerd. refrigeratore. telephone

33


Affinities (Language, Executive Function)Ask the client to determine the word/category to which the two words belong.

Example: Q: Fords and Pontiacs are ___________________ A: Cars

Exercise 1 (Answers in page 35)

1. Fords and Pontiacs are _______________________________________

2. Roses and Marigolds are ________________________________________

3. Sparrows and Finches are _______________________________________

4. Boston and Bangor are _______________________________________

5. Romeo and Juliet are _________________________________________

6. Maytag and Whirlpool are _______________________________________

7. Harvard and Yale are ____________________________________________

8. Camels and Winstons are _______________________________________

9. T-Bone and Porterhouse are ____________________________________

10. Valentino and Gable were __________________________________

11. Frank Sinatra and Judy Garland were _____________________________

12. Squash and Cucumbers are ____________________________________

13. Coke and Pepsi are ____________________________________________

14. Roosevelt and Eisenhower were __________________________________

15. Flannel and Satin are _______________________________________

16. Apples and Bananas are _______________________________________

17. Trout and Bass are ____________________________________________

18. Pines and Maples are _______________________________________

19. Vermont and Maine are _______________________________________

20. Wheaties and Cheerios are __________________________________

21. Collies and Poodles are _______________________________________

22. Texaco and Mobil are _________________________________________

23. Tide and Gain are ____________________________________________

34


Exercise 2 (Answers on page 36)

1. Vermont and Missouri are ______________________________________

2. Neptune and Mercury are ______________________________________

3. Copper are Lead are _________________________________________

4. Feta are Gouda are _____________________________________________

5. Yen and Rupee are ____________________________________________

6. Serenity and Apprehension are ________________________________

7. Gray and Violet are ____________________________________________

8. Tea and Coffee are ____________________________________________

9. Tsunami and Hurricane are ___________________________________

10. Taj Mahal and Stonehenge are __________________________________

11. Casa Blanca and The Shawshank Redemption are ________________

12. Trouser and Cardigan are ______________________________________

13. Ferry and Tram are ____________________________________________

14. Wrench and Screwdriver are ___________________________________

15. Mobile Phone and Laptop are __________________________________

16. Shark and Salmon are _________________________________________

17. Frida Kahlo and Georgia O’Keeffe are ___________________________

18. Jackie Robinson and Willie Mays were ________________________

19. Magic Johnson and Michael Jordan were ____________________________

20. Red Maple are Weeping Willow are ____________________________

21. Seattle and Tokyo are _______________________________________

35


Answers to Affinities Exercise 1

1. Fords and Pontiacs are (Cars)

2. Roses and Marigolds are (Flowers)

3. Sparrows and Finches are (Birds)

4. Boston and Bangor are (Cities)

5. Romeo and Juliet are (Lovers)

6. Maytag and Whirlpool are (Appliances)

7. Harvard and Yale are (Universities)

8. Camels and Winstons are (Cigarettes)

9. T-Bone and Porterhouse are (Steaks)

10. Valentino and Gable were (Actors)

11. Frank Sinatra and Judy Garland were (Singers)

12. Squash and Cucumbers are (Vegetables)

13. Coke and Pepsi are (Soft drinks)

14. Roosevelt and Eisenhower were (Presidents)

15. Flannel and Satin are (Fabrics)

16. Apples and Bananas are (Fruits)

17. Trout and Bass are (Fish)

18. Pines and Maples are (Trees)

19. Vermont and Maine are (States)

20. Wheaties and Cheerios are (Cereal)

21. Collies and Poodles are (Dogs)

22. Texaco and Mobil are (Gas companies)

23. Tide and Gain are (Laundry Detergent)

36



1. Vermont and Missouri are (States)

2. Neptune and Mercury are (Planets)

3. Copper are Lead are (Materials)

4. Feta are Gouda are (Cheese)

5. Yen and Rupee are (Currency)

6. Serenity and Apprehension are (Emotions)

7. Gray and Violet are (Colors)

8. Tea and Coffee are (Drinks)

9. Tsunami and Hurricane are (Natural Disasters)

10. Taj Mahal and Stonehenge are (Monuments)

11. Casa Blanca and The Shawshank Redemption are (Movies)

12. Trouser and Cardigan are (Clothing)

13. Ferry and Tram are (Transportation)

14. Wrench and Screwdriver are (Tools)

15. Mobile Phone and Laptop are (Technology)

16. Shark and Salmon are (Fish)

17. Frida Kahlo and Georgia O’Keeffe are (Artists)

18. Jackie Robinson and Willie Mays were (Baseball Players)

19. Magic Johnson and Michael Jordan were (Basketball Players)

20. Red Maple are Weeping Willow are (Trees)

21. Seattle and Tokyo are (Cities)

37


Block Tapping (Attention)

For this activity, tap the shapes on each page with your finger in an order you can remember,then ask the client to watch and try to copy you. Explain to client that you will tap shapes inorder; the client should watch first and then repeat the pattern. Start with two tap sequencesand work your way up. If the client gets the order wrong, try again until he or she gets it right.

Exercise 1

38


Exercise 2

39


Exercise 3

40


Exercise 4

41


Exercise 5

42


Antonyms (Language)

An antonym is a word opposite in meaning to another (e.g., bad and good). Have the clientdetermine the anonym for the words below. The first letter of each answer is provided. Thenumber of spaces indicates the number of letters in the word. If the client has trouble figuringout what the antonym is, feel free to provide hints such as the next letter.

Example: Above – B____ ____ ____ ____ A: Below

Exercise 1 (Answers on page 44) Find the antonym for the provided word; the first letter is provided.

1. Above – B E L O W

2. Answer – Q __ __ __ __ __ __

3. Back – F __ __ __ __

4. Better – W __ __ __ __

5. Cause – E __ __ __ __ __

6. Clean – D __ __ __ __

7. Close – O __ __ __

8. Cruel – K __ __ __

9. Dusk – D __ __ __

10. Deep – S __ __ __ __ __ __

11. Defense – O __ __ __ __ __ __

12. Deposit – W __ __ __ __ __ __ __

13. Empty – F __ __ __

14. Entrance – E __ __ __

15. Frail – S __ __ __ __ __

16. Fresh – S __ __ __ __

17. Flood – D __ __ __ __ __ __

18. Hard – S __ __ __

19. Harsh – M __ __ __

20. Help – H __ __ __ __ __

21. Hot – C __ __ __

22. Hurt – H __ __ __

23. In – O __ __

24. Keep – L __ __ __

43


Exercise 2 (Answers on page 45)Find the antonym for the below word. The first letter is provided.

1. Wise – F __ __ __ __ __ __

2. Alert – T __ __ __ __

3. Repair – D __ __ __ __ __

4. Straighten – B __ __ __

5. Strength – W __ __ __ __ __ __ __

6. Save – S __ __ __ __

7. Vanish – A __ __ __ __ __

8. Vice – V __ __ __ __ __

9. Vital – T __ __ __ __ __ __

10. Merit – F __ __ __ __

11. Modern – A __ __ __ __ __ __

12. Neglect – C __ __ __

13. Particular – G __ __ __ __ __ __

14. Prosecute – D __ __ __ __ __

15. Proper – I __ __ __ __ __ __ __

16. Rapid – S __ __ __ __

17. Rare – C __ __ __ __ __

18. Expose – C __ __ __ __ __ __

19. Flexible – R __ __ __ __

20. Foreign – L __ __ __ __

21. Just – U __ __ __ __ __

22. Freedom – C __ __ __ __ __ __ __ __

23. Juvenile – M __ __ __ __ __

24. Lack – E __ __ __ __ __

44



1. Above – B __ __ __ __

2. Answer – Q __ __ __ __ __ __

3. Back – F __ __ __ __

4. Better – W __ __ __ __

5. Cause – E __ __ __ __ __

6. Clean – D __ __ __ __

7. Close – O __ __ __

8. Cruel – K __ __ __

9. Dusk – D __ __ __

10. Deep – S __ __ __ __ __ __

11. Defense – O __ __ __ __ __ __

12. Deposit – W __ __ __ __ __ __ __

13. Empty – F __ __ __

14. Entrance – E __ __ __

15. Frail – S __ __ __ __ __

16. Fresh – S __ __ __ __

17. Flood – D __ __ __ __ __ __

18. Hard – S __ __ __

19. Harsh – M __ __ __

20. Help – H __ __ __ __ __

21. Hot – C __ __ __

22. Hurt – H __ __ __

23. In – O __ __

24. Keep – L __ __ __

Below

Question

Front/Forth

Worse

Effect

Dirty

Open

Kind

Dawn

Shallow

Offense

Withdraw

Full

Exit

Strong

Stale

Drought

Soft

Mild

Hinder

Cold

Heal

Out

Lose

45



1. Wise – F __ __ __ __ __ __

2. Alert – T __ __ __ __

3. Repair – D __ __ __ __ __

4. Straighten – B __ __ __

5. Strength – W __ __ __ __ __ __ __

6. Save – S __ __ __ __

7. Vanish – A __ __ __ __ __

8. Vice – V __ __ __ __ __

9. Vital – T __ __ __ __ __ __

10. Merit – F __ __ __ __

11. Modern – A __ __ __ __ __ __

12. Neglect – C __ __ __

13. Particular – G __ __ __ __ __ __

14. Prosecute – D __ __ __ __ __

15. Proper – I __ __ __ __ __ __ __

16. Rapid – S __ __ __ __

17. Rare – C __ __ __ __ __

18. Expose – C __ __ __ __ __ __

19. Flexible – R __ __ __ __

20. Foreign – L __ __ __ __

21. Just – U __ __ __ __ __

22. Freedom – C __ __ __ __ __ __ __ __

23. Juvenile – M __ __ __ __ __

24. Lack – E __ __ __ __ __

Foolish

Tired

Damage

Bend

Weakness

Spend

Appear

Virtue

Trivial

Fault

Ancient

Care

General

Defend

Improper

Slow

Common

Conceal

Rigid

Local

Unfair

Captivity

Mature

Excess

46



1. A penny for your _________________

2. _________________ makes the heart grow fonder

3. Actions speak _________________ than words

4. To add _________________ to the fire

5. To _________________ insult to injury

6. A little _________________ told me

7. All in a _________________ work

8. _________________ of someone’s eye

9. Armed to the _________________

10. At each other’s _________________

11. The _________________ of both worlds

12. Ball-_________________ figure

13. To bark up the _________________ tree

14. To be up to no _________________

15. To beat _________________ the bush

16. Big fish in a _________________ sea

17. To bite the _________________ that feeds you

18. Costs an arm and a _________________

19. A clean _________________ of health

20. To come away _________________ handed

21. Come to _________________ of it

22. A cut above the _________________

23. To _________________ a hard bargain

24. A dream come _________________

Idiom Completion (Language and Memory)

An idiom is a common saying or phrase that does not have a literal meaning. This activity is bestfor clients with mild to moderate dementia as it focuses on stimulating the memory domain ofthe brain. The object is to come up with the missing word to complete the idiom.

47



1. Pull the _________________ over other people’s eyes

2. To pass the _________________

3. A _________________ of cake

4. To play something by _________________

5. To play it _________________

6. To _________________ a fast one

7. To push one's _________________

8. To put up a _________________ fight

9. As quiet as a _________________

10. _________________ and dirty

11. To _________________ one’s brain

12. To rain _________________ and dogs

13. To read _________________ the lines

14. To rock the _________________

15. To rub someone the _________________ way

16. Safe and _________________

17. To save money for a _________________ day

18. To see the _________________ on the wall

19. Speak of the _________________!

20. Strong as an _________________

21. Take it or _________________ it

22. To take something/someone for _________________

23. To take something with a grain of _________________

24. _________________ in cheek

48


Answers to Idiom Completion

Exercise 1

1. A penny for your thoughts

2. Absence makes the heart grow fonder

3. Actions speak louder than words

4. To add fuel to the fire

5. To add insult to injury

6. A little bird told me

7. All in a day’s work

8. Apple of someone’s eye

9. Armed to the teeth

10. At each other’s throats

11. The best of both worlds

12. Ball-park figure

13. To bark up the wrong tree

14. To be up to no good

Exercise 2

1. Pull the wool over other people’s eyes

2. To pass the buck

3. A piece of cake

4. To play something by ear

5. To play it safe

6. To pull a fast one

7. To push one’s luck

8. To put up a good fight

9. As quiet as a mouse

10. Quick and dirty

11. To rack one’s brain

12. To rain cats and dogs

13. To read between the lines

14. To rock the boat

15. To beat around the bush

16. Big fish in a little sea

17. To bite the hand that feeds you

18. Costs an arm and a leg

19. A clean bill of health

20. To come away empty handed

21. Come to think of it

22. A cut above the rest

23. To drive a hard bargain

24. A dream come true

15. To rub someone the wrong way

16. Safe and sound

17. To save money for a rainy day

18. To see the writing on the wall

19. Speak of the devil!

20. Strong as an ox

21. Take it or leave it

22. To take something/someone for granted

23. To take something with a grain of salt

24. Tongue in cheek

49


How Many Squares? (Visual-Spatial)

This activity involves counting the number of squares that are in each of the below designs.

Have the client count how many squares they can find within the design. Keep in mind that

rectangles do not count as squares.


50



51



52



53



54


Answers to How Many Squares?

1. 5 Squares

2. 14 Squares

3. 14 Squares

4. 9 Squares

5. 11 Squares

55


Visual Puzzles (Visual-Spatial)

Shown below are line drawings that have been taken apart and rotated. Ask the client toidentify the original object.

1

1 (Answer on page 61)

56


2


3


57


4


5


58


6

7



59


8

9



60


10


61


Visual Puzzles (Visual-Spatial) Answers

1. Beach ball

2. Tennis racket

3. Guitar

4. Wrench

5. Umbrella

6. Hamburger

7. Dress shirt

8. Cat

9. Bicycle

10. Feather

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The Cognitive Therapeutics Method™ program also involves engaging in activities not oriented around cognitive tasks. These activities may include: social engagement, sensorystimulation, recreation, stress management or light physical exercises, all of which promotebrain function.

Flower Arranging

Materials:• Different types of fresh flowers or different types of fake flowers trimmed into individual stems

• Styrofoam block• Small glass or plastic container (use ribbon or string to decorate)• Note card

Separate the bunches of flowers on a table so that it is easy to select individual stems (If fresh flowers, trim stems first to length of vase and remove any thorns). Encourage yourclient to do as much of the selection and arrangement as they are able. Have client selectwhere to place the bouquet around his/her home. You can also write a note together fromthe client to the recipient of the flowers. This is a great activity to do while playing calmingmusic in the background.

Bean Bag Toss

Materials: • Bean bags• Colored paper or colored plates

Have the client sit comfortably in a chair or stand. Line four plates in front of the client with the first plate closest (first base) followed by the second (second base) and third (third base) and fourth (home plate) or in a baseball diamond pattern. Clients can throwthe bag at any of the bases. The goal is to have the bag land on or touching the plate.

Balloon Games

Balloon games are a fun way to get exercise with clients, including those who are wheelchair or bed bound. Blow up a balloon and volley, by hitting the balloon back and forth. Put on upbeat music to add a festive feel. Add a plastic fly swatter to bat theballoon for an added challenge.

63


Magazine or Photo Scrapbooking/Reminiscing

Materials:• Magazines or scanned family photos (never scrapbook with original family photos)• Safety scissors• Tape or glue• Colored paper• Photo box or binder with 3 hole punched plastic sheet protectors• Extras: stamps and stamp-pad, colored pens or pencils

Magazine scrapbooking: Clients can cut (use safety scissors, not sharp kitchen sheers)out pictures they like, or to make it more challenging, choose a theme like: transportation,outdoors, women’s clothing, food.

Photo scrapbooking: Cut out each photo (use copies not originals) and have the clientselect a color background. Talk with the client about the photos and write details you discuss, such as a description of the picture. Encourage the client to participate in gluingor taping the photo into the scrapbook.

Social Reminiscing

Explore childhood and young adult memories; happy events from the past. Example questions are provided below, but if you feel like the conversation is lacking in substance,you can ask questions of your own. You might ask, “How did your husband/wife propose?”or “How long were you engaged?” Keep it light and avoid any topics that you think maydistress the client. If the client starts to get distressed, steer the conversation to a differenttopic. You might share your own brief anecdotes, but remember the purpose is to engageyour client in his/her own history. The following are potential topics and suggested questions.

64


Vacations:

1. What is your favorite type of vacation (beach, camping, hiking, safari,etc.)?

2. What is your most memorable vacation? Were you with your family, friends or

were you alone?

3. What is your favorite holiday? What is your favorite holiday memory?

4. When you were a young adult, did you like to travel or spend vacations at home?

Favorite Games:

1. What was your favorite childhood game?

2. Do you have any fond memories of a particular game you used to play that

you remember from your childhood?

3. Did you prefer board games, card games or other types of games (Ex. Hide

and Seek)?

4. Are you competitive? What do you like about playing games?

First Pet:

1. What was your first pet? Dog? Cat? Fish?

2. What was his/her name? How did you pick the name?

3. What memories do you have of your first pet?

4. Did you have other pets? What kind? Did your pets travel with you? What made

your pet unique?

School Days:

1. Where did you go to grammar school? High school? College?

2. What are your fondest memories of your school days?

3. Do you remember any of your teachers? Did you have a favorite teacher?

Why was he/she your favorite?

4. Did you stay in touch with your friends from your school days?

65


Holidays:

1. What was your favorite holiday growing up? Why?

2. If you could relive one holiday memory, which one would it be? Why is it so special?

3. Did you celebrate holidays with extended family? What did you do?

4. Did you travel anywhere special for particular holidays? With who? Where?

How did holiday celebrations change throughout your life?

Political Events:

1. Where were you when you learned that President Kennedy was assassinated?

2. What do you remember about the fall of the Berlin Wall?

3. What were the most memorable events during the Civil Rights Movement?

4. When your hear: “Once small step for man,one giant leap for mankind,”

what memories come to mind?

Childhood:

1. What do you remember most about your childhood? Where did you grow up?

2. Did you have a large family? Brothers? Sisters? What about your extended family?

3. If you could relive one memory of your childhood, what would it be? Why?

4. What did you used to love to do when you were a child?

Adolescence:

1. What do you remember most about your adolescence?

2. What was the most significant change from childhood to adolescence for you?

3. What did you do for fun? Who were your friends?

4. Adolescence can be a challenging time. What was most challenging for you?

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Music:

1. What was your favorite kind of music growing up? Has it changed?

2. Do you have any of your old albums? Who were your favorite artists?

3. Did you ever go to a concert? Who did you see? Who would you have liked to see?

4. What were your favorite times to listen to music? In the car? In the morning?

During a dinner party?

Dance:

1. Do you like to dance? Did you always like to dance? What is your favorite kind

of dance?

2. Did you go to your high school prom? What do you remember about it?

Who did you go with?

3. Where did you like to dance? At a party? On stage?

4. Do you have any particularly fond memories of an experience when you were

dancing?

Car:

1. Do you remember your first car? What was it?

2. What was one exciting memory about the first time you learned to drive?

What were some of the challenges?

3. Where did you used to drive? What other cars have you owned?

4. What was your favorite thing about being able to drive? Least favorite?

Job:

1. What was your first job? How long did you work there?

2. Did you ever work at a restaurant or in retail? What was it like? What other types

of jobs did you have?

3. What was your favorite job? What did you like about it?

4. What is one good memory you have about a job you had?

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Hand Massage

You will need: • Lotion• Towel• Pillow• Soft music CD

A hand massage is a great way to provide soothing interaction with clients. The purposeof this massage is to provide a relaxing touch, not a medical treatment. Massaging movements should have very minimal pressure as seniors’ skin is very frail. Always checkwith the Staffing Manager or Client Care Manager before giving a client massage as they may have health conditions such as arthritis or wounds that would make it an uncomfortable experience.

Have the client sit comfortably in a chair. Place a towel and pillow under their arm so theyare comfortable. Always ask client throughout the massage if they are comfortable.

• If your client is able to communicate verbally: “Hand massage helps some people with relaxation and I thought that you might enjoy one.” If your client agrees, be sure to let them know that they should tell you to stop immediately if anything feels uncomfortable.

• If your client has advanced dementia and is unable to communicate verbally: Sit facing them and take their hand in your hand. Hold their hand a minute before starting the massage. “ [Client Name], I’d like to give you a hand massage to help you feel nice and relaxed. I’m going to put some lotion on your hand.” Look for any non-verbal cuesthat your client is uncomfortable.

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Music

Questions to determine music preferences include:1. What type of music do you like ( e.g. Jazz, Swing, Big Band, Country, Gospel, Classic,Rock, Religious)?

2. Who are your favorite singers? Popular singers/groups include: Frank Sinatra, Dean Martin,Louis Armstrong, Doris Day, Nat King Cole, Glenn Campbell, Andrews Sisters.

3. Do you currently or did you used to play a musical instrument?

Using Music with Clients:Music can be played throughout the day. Some particular times you may want to play it may be:

• While preparing for and during bathing. Playing a client’s favorite music can help put them in a more positive mood and can distract from any discomforts they have with bathing.

• To spark socialization. Listen to music together, sing-along, ask a question like: what does this song make you think of?

• When your client is agitated: Putting on relaxing, soothing, familiar music can help ease the anxiety or frustrations they are feeling.

• While preparing for bed: Relaxing, soothing music can help signal that it is time to get ready for bed.

• While getting ready to go out: Upbeat music with a strong beat can help awaken clients and prepare them for outings.

4. Social Ties

Social ties – our connections to other people – keep us healthy. They provide emotionalsupport, make us feel connected, reduce depression, sadness, and loneliness and helplimit stress levels. Conversation between caregivers and seniors, then, is essential to an active and healthy relationship.

Many people find their social ties become fewer as they age; friends and family membersmove or pass away, and a lack of independence can hinder the ability to go on social outings. Yet such ties are important for our mental and physical well-being. If your client isvery social, facilitate that. If your client seems to be pulling away from people or becomingmore isolated, encourage him or her to maintain his or her sociability.

The Balanced Care Method™ Social Connection Overview:

• Stimulate conversation• Daily phone calls or emails• Visiting with friends or family• Senior center visits

Conversation

Spend at least one hour per day conversing with your client. Try one of these conversationstarters to get to know your client better and find things to talk about:

• What did you do for your 21st birthday? 40th?• Where did you go to school?• What was your favorite subject in school?• Did you ever take dance lessons?• Have you ever traveled to or lived in another country?• If you could visit any place in the world, where would it be?• What’s your favorite song?• What’s the strangest thing you’ve ever eaten?• What’s your favorite movie?• What’s the best costume you’ve ever worn?

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4. Social Ties

Reading a newspaper or magazine out loud can also stimulate conversation. Choose astory that interests both of you and discuss it together.

Written and Oral Communication

Just one phone call a day can help people feel connected to those they care about. Makea list of the people your client has fairly regular contact with and, working with them andyour client, draw up a schedule for phone calls. Many people tend to make phone calls tofamily on the weekends; a bit of scheduling can help spread the phone calls out over thecourse of the week.

Some older people enjoy writing letters to friends and family members. Many seniors mayalso find a great deal of satisfaction in the tradition of sending cards for holidays. Helpyour client maintain a list of people to send cards to, shop for cards, and mail them if thisis important to him or her.

Email is another great, sometimes more convenient way for seniors to stay in touch – especially with younger family members. Encourage your client to email with his or herfamily and friends.

Skype and other video-enhanced web communications are additional ways for families to interact remotely – and see growing grandchildren or great-grandchildren in action.Talk to your client's family about setting up a Skype or Google Video Chat account.

Your client may enjoy engaging with others – friends, family, or like-minded people – ononline gaming sites (i.e. Scrabble or bridge). Some sites allow people to play in real-timewhile others allow people to take their turns at their convenience.

Visiting with Friends or Family

Visiting friends or family is, of course, the best way to maintain social ties. You can offer topick up friends for a luncheon at the client’s home and help prepare a meal for them orhold an afternoon tea for neighbors. Facilitate visits to family and friends’ houses as well if at all possible. Some tips for making visits successful:

• Plan the whole day, knowing how long travel time is in particular• Make sure your client is well-rested and well-fed on visiting days• Bring a snack and water• Pack an extra jacket or sweater• Keep visits to a length that doesn’t leave your client overly tired

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4. Social Ties

Community Outreach

If your client is mobile and this idea is appealing to him or her, taking a seminar or class at alocal community center or college can be a great way to meet people with similar interests.

Visits to senior centers or other community gatherings are a great way to add sociability to a daily or weekly schedule, according to your client’s mobility and energy level.

Worship services, arts and crafts, or book clubs can also be sources for maintaining socialties and helping build new ones.

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5. Calmness and Purpose

Okinawan elders’ inner calm and desire to remain productive into older age offer substantial stress relief, a sense of social connection and purpose, and allow them to continue playing an important role in their community. Most of these seniors practice aspirituality that combines the nature-revering aspects of Taoism, the communal respectemphasized by Confucianism and a native belief that celebrates women as connectors between past and present. To apply these principles to your own life, simply slow down,take a deep breath and become more involved with family, community and religion or spirituality.

The Balanced Care Method emphasizes calmness and bringing meaning and purpose toseniors’ lives by engaging them in their favorite topics, hobbies and activities. Older adultswith a calm and purposeful lifestyle are better equipped to avoid stress, disease andsymptoms of depression. As a caregiver, you provide companionship and act as a naturalpartner for the activities clients enjoy, allowing them to maintain their independence andquality of life. The more seniors can keep to their preferred activities and social networks, the more active, healthier and happier they will be. Fresh air, time in nature, sitting and enjoying a pretty view are all extraordinarily calming and stress-relieving for people of allages and can be particularly effective as people lose their physical and mental abilities torelieve stress in other ways.

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5. Calmness and Purpose

Purpose

Feeling useful is important for a sense of mental well-being. As people get older, a senseof purpose can often diminish, especially if the loss of physical or mental abilities hindersthem from participating in activities that used to fill their days. Each person interprets feeling “satisfied” or “productive” differently, so listen to and observe what matters most to your client.

Ways to keep purpose:

• Maintain hobbies or start new ones• Regular tasks – such as taking walks or doing light household chores• Write or record memories or family history• Activities– such as crafts, puzzle-solving and skill-based games• Community involvement – attend classes at a senior center or go to a place of worship

• Help client get involved in a volunteer activity (making quilts, writing letters)

Calmness

Including practices that keep stress levels low in your daily routine is important for overall health, and is particularly essential as we age and our ability to process and relieve stress decreases.

Ways to achieve calmness:

• Moments of focused, relaxed quiet • Prayer and worship– If your client has a place of worship, facilitate regular visits• Yoga– Yoga studios and classes are available in almost every city and plenty of towns. Many senior centers offer senior-specific classes

• Meditation is the practice of focusing thought. It can have enormous health benefits and an amazing ability to lower stress levels. If your client is interested, classes in meditation are offered at many senior and community centers, as well as many yoga studios

• Tai chi and qi gong–Some senior or community centers often offer senior-specific classes• Time in nature – Walks, bird-watching, or having a picnic are all engaging ways to spend time outdoors. Visiting the town garden or park near your client’s home is alsoa wonderful way to get fresh air and exercise

• Listening to favorite music

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6. Etiquette

Basic etiquette is the cornerstone to building a pleasant relationship with your client. Most importantly, address your client as he or she wishes to be addressed. Establish this inthe beginning of your relationship: would she like you to call her Mrs. Smith, or by her firstname? Avoid terms of endearment, such as “dearie” or “sweetheart.” While your intentionsmay be good, many seniors find these terms demeaning or insulting; they are inappropriate in a working relationship.

A vital part of your job is to maintain strict and absolute confidentiality regarding yourclient. You will be privy to many personal, private, and medical facts about your client. This information should not be shared with anyone. In general, you should not talk aboutyour client with anyone outside of the working relationship.

Clothing & Appearance

It is also important that you dress appropriately for your work. You should be wellgroomed with properly fitted, comfortable work clothes.

• Hair should be clean and worn short or pulled back• Jewelry should be minimal and not dangling• Clothes should be clean and fit properly –neither excessively baggy nor tight or clingy

Bodily Care

Different clients require different levels of physical care. The Balanced Care Method promotes independence, allowing clients to continue doing the activities within their abilities. This approach will help seniors maintain their strengths and privacy.

If your client requires help bathing and going to the bathroom, treat him or her with thedignity an adult deserves. Using babyish terms, cajoling, or otherwise treating him or heras a child is not appropriate.

• Use proper names for body parts• Let your client know what you are going to do before you start doing it

(“I'm going to lift your arm now, are you ready?”)• Allow them to do as much for themselves as they can• Avoid referring to any bodily care you provide when it is not in progress and do not, under any circumstances, refer to that care in front of other people

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7. Daily Checklist

Healthy diet• Several servings of whole grains• Several servings of fresh vegetables• 1 serving of fresh fruit• Omega-3-rich foods • Soy-based foods• At least 8 cups of water and/or green tea• Active culture yogurt or low-fat milk

Physical Activity• Basic stretches, as able• Any prescribed stretches• Strength building, as able• Aerobic exercise, as able

Cognitive Engagement• About an hour of cognitive and non-cognitive activities selected from workbook

Social Ties• Phone call or email to friend or family member • At least 1 hour of conversation• Visit to friend, group, or center as able

Purpose & Calmness• Hobbies or housework, as able• At least 1 calming activity

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8. Quiz

T F 1. A major factor that results in the extraordinary health enjoyed by Okinawan eldersis their distinct diet.

T F 2. There is no nutritional difference between various fruits and vegetables.

T F 3. Similar to the Okinawan practice of hara hachibu, which means eating until only80% full, the Balanced Care Method promotes moderate, low-calorie eating to helpachieve or maintain a healthy body mass index.

T F 4. Caffeine is harmful, so all tea and coffee should be avoided.

T F 5. The five cognitive domains are: Executive Functioning, Attention, Sensory, Memory and Langauge

T F 6. Executive functioning refers to the ability to accurately perceive an object’s physical location and understand the relationship between objects.

T F 7. It is recommended that seniors exercise 4-5 times per week with the consent andguidance of a physician.

T F 8. Stretching is best done when the body is warm, and is better to do after anothertype of exercise or after a bath or shower.

T F 9. Weight-bearing exercise, like walking, is also important for people of all ages.

T F 10. Visiting a museum and scent guessing are examples of activities that can boost memory and cognitive abilities.

T F 11. You should aim to spend at least one hour per day conversing with your client.

T F 12. Older adults with a calm and purposeful lifestyle are better equipped to avoid stress, disease and symptoms of depression.

T F 13. As a caregiver, you can provide companionship and act as a natural partner for the activities clients enjoy.

T F 14. As people get older, a sense of purpose can often diminish, especially if the loss ofphysical or mental abilities prevents them from doing the things they used to love to do.

T F 15. Watching television and sitting in isolation are good ways to promote calmness.

T F 16. You can call your client “dear” or “sweetie”.

T F 17. You can wear whatever you want to work because your client likely will not care or notice.

T F 18. When helping clients with hygiene, it’s important to let them do as much as theycan on their own and verbalize each step so they know what to expect if you willbe helping them.

T F 19. A vital part of your job is to maintain absolute confidentiality in your work and you should not speak about your client outside of work.

T F 20. You can make major changes to your client’s routine without consulting your supervisor.

Quiz Answers

1.T2. F3. T4. F5. F6. F7. T8. T9. T10. T

11. T12. T13. T14. T15. F16. F17. F18. T19. T20. F

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Our mission at Home Care Assistance is to change the way the world ages.We provideolder adults with quality care that enables them to live happier, healthier lives at home. Ourservices are distinguished by the caliber of our caregivers, the responsiveness of our staff andour expertise in daily care. We embrace a positive, balanced approach to aging centered on the evolving needs of older adults.

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