As the worshippers begin to gather for the weekly service, the Rev. Alex Treitler prepares the Communion table and arranges the hand-held chimes. Those gathered sit quietly in anticipation as Treitler walks around the room and greets each person individually.
Once the greetings are complete, the worship service begins with the song “Amazing Grace.” The small group sings confidently. The words are ensconced in their memories, and there is no need for hymnals or for words on a screen—even as the song moves into a second verse. Some worshippers even sing harmony, giving the popular hymn a full and abundant sound.
The song over, the group sits calmly, relaxed, waiting for the next element in the service.
While this scene is similar to other worship services held each week around the globe, the nine people who attended this specially designed sensory worship service have something else in common with each other. Each of them has dementia. They are residents of Emerald Crest by Augustana Care in Burnsville.
Theresa Klein was hired by Emerald Crest in 2000. As the cognitive clinical specialist, she was tasked with creating programs for residents with middle- to late-stage dementia.
“Dementia is kind of an umbrella term,” she said. “It’s a condition that encompasses a lot of symptoms. People mostly think of memory loss as the one. Usually that is the first sign for some of the diseases that cause dementia. That’s the first thing people notice. But by the time they actually notice that, it’s possible that dementia has been going on maybe a year or two before that.”
When people—or their families—decide it’s time to enter a facility like Emerald Crest, the dementia has already affected their ability to perform basic functions. They may not remember to shower, eat, take their medicine or any of a host of other daily tasks that run the gamut from minor to critical.
The typical resident at Emerald Crest by Augustana, according to Klein, is a woman in her mid 80s who is still able to walk, talk and participate in her own care. She just needs reminders.
A day rich in activity
An important part of the program at Emerald Crest is developing activities that encompass an entire day.
“From the moment they wake up to going to meals and breakfast, there are activities throughout the day from 8:30 a.m. to 8:00 p.m.,” Klein said. “Those activities include rest times, they include meal times and care, but they also include activities for them to engage in. We try to gear the activities not only to their interests but to what they can do. We want to set them up to succeed.”
People who are entering the middle stage of dementia can often sit in a traditional Bible study.
“But they need to have attention, and they need to be able to understand words,” she said. “That changes as someone goes through the different stages of dementia. Words start to lose their meaning, both in spoken word and in written word. But feelings and emotions are still there, and memories are still there. We find things that pull the memories out, things that they’ve done for many, many years.”
As an alternative to a 20-minute sermon or even a 10-minute lesson, staff at Emerald Care began to experiment with various sensory experiences: smell, taste, visual images and even sound effects.
Klein uses the example of Jesus’ birth. For those with dementia, simply hearing the story told verbally or reading it in Scripture no longer has a significant impact. But “telling” the story in a different way can provide a powerful moment of connecting with the truth of God’s story.
“We might bring in a Nativity scene, so we bring in props,” she said. “As we’re reading the story, we may kind of use the props to create the scene.”
That “scene” will include more than the sight of the Nativity scene. Stable sounds are mimicked. A handful of hay suggests the aroma of Jesus’ birthplace; touching is a reminder of the roughness of Jesus’ crib, if not softened by the cloth wrapped around Him.
Music and interaction
After the small worship group finishes singing “Amazing Grace,” Treitler tells a story, one that is familiar to his congregants. He doesn’t read from Scripture about how David defeated Goliath, however. Treitler asks people if they know the story, calling upon their memories and experiences.
While he begins to tell the story, he takes out a smooth stone, much like the one David could have used in his slingshot. He hands the rock to each person, allowing the feel of the stone to help tell the story: They get a sense of how much it weighs and how easy it might be to toss. All these efforts help pull out the memories, experiences and emotions from their past, giving them a richer and more fruitful worship experience.
“I always choose Bible stories that are familiar,” Treitler said. “It’s not a teaching moment; it’s a reminiscing moment. I will also choose a Bible story that connects with what I assume to be their life experience in some way. Having a sensory element is really important ….”
The worship element of the service includes more than just singing too. Treitler brings out several hand chimes. He shows how to play them and then hands out several, all tuned to a different note. Then the group sings again, the chimes making the experience richer, more complete.
More singing follows, and again the small congregation needs no hymnal or projected words; the memories begin to flood back. Communion is served, and those gathered become silent, calm.
And that calm is a positive effect of the sensory services.
Klein said they see less agitated behaviors before and after the services, agitation being a common occurrence with many dementia patients. The time spent communing together somehow bringing a sense of calm to their lives.
“Sometimes people who have been very agitated will be more peaceful after a service,” Treitler said. “I think that’s because of a connection with the religious practice but again spiritually, I think it’s a connection with something that is life for them and for people collectively.”
Lot of life left
People often believe a diagnosis of dementia is a death sentence. They think life will quickly diminish and decades left to live will become years—or less. Klein said that’s not necessarily the case, and they believe they can make those remaining years full.
“When someone’s diagnosed with dementia, they might be 10, 15, 20 years until that end stage,” Klein said. “There’s a whole lot of living that can happen. We try to help people live.”
ACTIONPOINT: For more information about Emerald Crest at Augustana Care, visit www.augustanacare.org.
— by Scott Noble