Today’s senior housing market is much different than it was 10 or 20 years ago. The acuity of nursing home residents has increased significantly. Some kind of dementia is expected in 60% or more of residents.  At the same time, assisted living is also seeing dramatic increases and many experts agree that providing good care for residents with dementia is the future for the assisted living industry.

Many challenges come with this opportunity: dementia residents can be disruptive, demanding and loud. But they can also be quiet, undemanding, and unassuming. In both cases, social engagement in meaningful activities is one of the critical elements of good dementia care. Activities help residents maintain their functional abilities and can enhance quality of life and provide many other benefits such as: opportunities for social network continuation, sensory stimulation, improved self-esteem, emotional support, and emotional memories. It also helps staff with existing responsibilities such as the management of adjustment period, social isolation and prevents behavioral symptoms

Based on the work of Jitka Zgola (Care That Works) and other experts in the field of dementia care, it is possible to identify three indispensable pillars for social engagement:

1. The Person

Starting with the person, social engagement can be built by taking into consideration a context with personal meaning, a sense of community, choices and fun.  The interactions should be designed “with” as opposed to “for” the resident. Ultimately, the resident’s preferences should always be taken into account even if he/she prefers solitude.

To achieve this, resident information gathering needs to be constant, expanded, and updated while staying aware of individual behavior triggers. Here are tools that can be used to achieve this:

1. Life Stories
2. Resident spotlights
3. Psycho-social history
4. Family Meeting (Prior to Move In) and continuous thereafter
5. Assessments
6. Service Plans
7. Design specific resident centered training

2. The Setting

This component is probably the one that is the most often overlooked: How does one create opportunities for social engagement in the setting? One must make the most of the environment and include its three core aspects:

1. Social – entire teams get involved in social exchanges. A good example of that is extending the activity to the dining experience
2. Physical – Program layout: rearrange a room to plan for easy get around, purposeful strolling; and create strategic environment when thinking about resident placement
3. Cultural – Values and traditions; celebrate backgrounds of resident groups and integrate them into the community life with cultural activities, competitions, “team” events

3. The Activity

The creation of structured and unstructured dementia based activities is a critical component to social engagement which also needs to take into account resident centered principles.   Here are the basics of Dementia Specific Programs:

1. Sensory Stimulation (Taste, Auditory, Tactile, Olfactory, Visual)
2. Life Work Activities (Work Related Tasks=Occupational)
3. Reminiscence (Long term memory)
4. Failure Free Programs (Physical, Music/Singing, Individualized Program Plans)

Based on the needs of the community, appropriate types of activities can then be put in place: Is there a great need for small or large groups? Do residents need more structure versus unstructured type of interactions?  One must never forget that social engagement is an umbrella concept for the various components of an individual’s social behavior and social structure: Network, support, activity, integration and participation.