Montessori and Dementia: New Ways to Enhance Activity Programs

By Lara Belonogoff
What is Montessori?
In 1907, Maria Montessori, one of the first female physicians in Italy, began an experimental school where the students were considered unmanageable. One of her guiding ideas was to create a secured and ordered environment that was the antithesis of the slums the children roamed in during non-school hours. Her ideas caught on in Europe and eventually trawled across the Atlantic. Today in the US there are thousands of Montessori schools. In the last few years, an emerging trend in assisted living facilities is to apply some of these principles to structuring activities for dementia residents.

According to basic Montessori principals, learning will ensue as long as the environment is set up for it and is maintained. This “environment” includes the physical surroundings as well as the ambience created by group and internalized dynamics. Montessori-based classrooms often have the children immersed in a present and “centering” activity. The idea is to enhance their motor skills and memory—and push their minds from basic ideas into more complex or intangible ones, incorporating as many of their senses as possible. Another important aspect is that individuals are seen as a whole wherein emotional, mental, physical, social and spiritual needs and interests are intertwined conceptually. This idea also supports the concept of respecting others.

How Can Montessori Principles Be Used in Dementia Care?
These basic tenets translate into the assisted living environment, a type of long-term care setting, in a relatively seamless way. We’ve all seen or heard about lethargic dementia patients who are totally disconnected from themselves and their surroundings. This can happen even if they are not in the advanced stages. Digging into the Montessori treasure chest, activity directors work on creating familiar surroundings for dementia patients. Instead of activities taking place in a disordered room or having patients participating in activity with a shifting focus, the environment becomes nurturing and akin to a cocoon that can protect the individual from too much or the wrong kind of stimulus. As confidence and ability grows, he or she can push along the cocoon sides to create more room. Thus the dementia resident’s world gets bigger and safer to operate in.

Montessori-based activities eliminate judgment so that nothing is “right” or “wrong.” (In a previous post on caregiving, I pointed out an auxiliary and parallel trend, which is to stop “correcting” dementia patients when abnormal or inappropriate behavior occurs.) In the Montessori-based schema residents feel both worthy and successful; each attained goal can move into more complex activities. Obviously, dementia patients must still fight against the disease course, but the idea is that a person could retain more function if activities are relational to everyday needs. For example, an activity in which a row of zippers are closed could help foster keeping the ability to dress one’s self. Recreating ballistic movements like these is important when cognition and memory begins to fail.

Along with the move to create a smaller, more manageable world in which these individuals can thrive, the concept of respect is foremost. One facet of the Montessori philosophy has individuals with greater cognitive abilities teaching concepts to others. This is translated into the dementia community by having individuals with less impaired cognitive skills run specific activities. Although originally designed for schoolchildren, no one in this structure is “babied,” as patients in small groups all play a contributing role in an activity. This fosters a sense of worthiness. For example, one person could find items whereas another will then count them. These sorts of interactions fulfill the very human need to belong and contribute is factored into each activity.

Some of the Montessori principles have been integrated into care philosophies outside activity rooms—in an effort to keep the proverbial cocoon tightly closed. Montessori-trained staffers avoid anything that asks a resident to use their memory, and keeps in mind that invitation always triumphs over insistence and praise should be detailed and genuine. Some of these concepts seem like a reiteration of basic care philosophies, but thorough training helps staffers avoid any uncomfortable situations—and keeps residents content and immersed in the moment. Lucky for today’s caregivers a great deal of products, literature and training has brought this into the public focus. Sometimes the best ideas are the ones you already had—maybe they just needed some tweaking.