PreSchool in Alzheimer's Care Center
by Diane Guthrie

Sitting around a table in the dining room at The Hampton in Tumwater, Washington, preschoolers, their teachers, and Alzheimer’s residents paint with watercolor.  Rano, a student, says, “Excuse me,” to get some attention.  “Paint me a purple horse,” Rano says to resident Sally D.  Sally’s painting looks very much like Rano’s.  There are several brush stokes of different colors of paint – no recognizable forms.  Kara Lawrence, the preschool assistant, paints a purple horse for Rano.

Kristina Christenson, Preschool Supervisor, who has worked with elderly residents of care facilities and preschool students, says, “When they watercolor, they are of the same mind.”  

Christene Fujiwara, Administrator of The Hampton Alzheimer’s Special Care Center for the past five years, works to make the facility more home-like.  Like many other administrators, she brings in pets. But as far as she knows, she is unique in operating a preschool in a stand-alone Alzheimer’s unit. “We’re ahead of our time,” Fujiwara says.

“The preschool doesn’t have to be a money maker,” she says.  “It’s here to give more life to the residents.”  Conversely, there are many benefits for the preschoolers. Children, who are not always able to be around their grandparents or great grandparents, can participate in The Hampton intergenerational activities.  The building has security in place to prevent residents and students from exiting the facility without an escort.  A nurse is always on duty. Lots of eyes are on residents, students and staff.  When Fujiwara meets with family members of both prospective students and residents she stresses these benefits.

The mother of preschooler Brandon drives up to the outside of The Hampton at 7:45 am.  She enters four digits on a keypad to electronically unlock the door of the facility.  After Brandon’s mom signs him in and says her goodbyes, he follows his teacher out of the preschool room. “Hello Sally,” Brandon says to a resident.  He holds on to her walker as they walk together to the dining room to get something to eat.

One joint activity between the residents and students is music and games. Residents make a circle around the students. Songs play from a boom box and the children move within the circle singing and making motions to nursery rhymes like “Itsy Bitsy Spider,” “Farmer in the Dell,” and “Hokey Pokey.”  The preschool teacher tells the students to be careful when they swing out too close to the encircling residents.

Arlene R., a resident, follows the “Hokey Pokey” rhyme instruction of “you put your left hand in” and sings along.  “They’re jumping up and down and they’re tickled pink,” says Ruby C., another resident.  Margaret T., a resident in her 80s who looks 60, says, “I don’t do much with the children.  I like to watch them.  I don’t even know how old I am.”

Both young and old need to expend energy.  The Hampton has an indoor and outdoor circular walking route.  Alzheimer’s sufferers find comfort in performing repetitive actions like walking.  Students benefit too.  Lawrence holds a student’s hand and quickly walks with him.  “He likes to throw his fits so we take a walk,” she says.

Preschool staff presents options to a student to redirect them to another choice when they exhibit undesirable behavior rather than just saying, “No.”  They see caregivers doing this with the Alzheimer’s residents too.

During a two-hour spa activity Dotty Davis-Walsh, Life Enrichment Director, has residents soak their hands in a see-through plastic container of warm, soapy water.  Rocks and shells lie on the bottom to encourage exploration and longer soaking.  Parents of a preschooler use a similar method of placing bath toys in a bathtub to encourage children to extend their soaking time.

The spa activity is disturbed when Bill W., a resident, enters the room. “Get these people out of here,” he says.  He thinks that the table that they are sitting around is his. Davis-Walsh asks a caregiver to direct him out and tell him that she needs five minutes to clear the table.

Davis-Walsh uses redirection to interrupt unwanted behavior.  Sometimes she emulates what a parent might do–offer food to entice a change of behavior.  She keeps three dozen donut holes – chocolate and glazed – on hand.  “If you promise coffee and donuts you better deliver,” she says.

For the noon meal, the preschoolers eat first at the child-sized table. They are served the same food that the residents are.  While they are eating, residents get seated and a nurse dispenses medication to them prior to their meal.

Caregivers offer to help residents that are unable to cut their food.  Several residents wear towel-sized bibs. “This is called a shirt-saver and I’ve got it on,” says Arlene, pointing at her bib.

When residents get up to leave their table, those that use walkers search for theirs.  Arlene attempts to take another person’s walker.  Diana Warren, a caregiver, intervenes. “This is Juanita’s.  Yours is green; hers is blue.”  Warren playfully refers to the walkers as automobiles. Arlene’s is new and fancy and she calls it a “Cadillac.”  To a resident nearby she refers to his as a “Ford truck.”

In the early afternoon, the preschoolers sleep on mats on the floor of their room.  The room has windows on three sides so during naptime, shades are pulled down to darken it.  The rest of the time, the shades are up and people can observe the children through the windows.  Residents notice when the children are gone.  During the week the Preschool had off for the Christmas holiday, residents kept asking caregivers where the children were.

Afternoon activities include playing with Play-Doh. One resident sits at the table with the students but doesn’t appear to notice them. She is in the late stages of Alzheimer’s and has limited physical movement.  “We don’t give Play-Doh to residents, especially if it’s cut with a cookie cutter. They might eat it,” Lawrence says.  “A child under two and one-half might do that too.” Rano, rolling out and cutting her dough, says, “I’m making lunch – strawberry vanilla,” and laughs. A resident wanders in looking out of sorts.  “Are we being noisy?” Lawrence says.  “It’s a fun noise though.”

Preschoolers deliver mail to the residents late in the afternoon.  Morgan happily hands the envelope to a resident but doesn’t want to stick around while Lawrence helps them open the mail and read it.

Lawrence hands Jason an envelope to give to Sally. “She’s a pistol.  That’s why they get along so well.  They don’t see her as an old lady,” she says. “You’re my favorite kids in the world,” Sally says.  Jason hands the envelope to Sally.  “Can I give you a kiss,” she says. “No,” Jason says.  The caregiver suggests that Sally blow him a kiss.


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