Gerry, those are good! And number 3: I would say, best to have NO choices. Left to choose between wearing his navy blue vs. his gray sweatpants he could take an hour to decide. The idea of personal control over their environment is sound but choices in LBD don't work very well, at least in our situation.

I found that with my dad, in situations where I used to involve him in decision making, for his own dignity I'll say something like "We're going to take a little walk outside, is that ok with you?" rather than "do you want to go back to your room or outside?" If he doesn't want to go, he'll shake his fists and say something really nasty, and if he does, he'll answer "that'll be ok". That way he feels like he has some input, but I haven't given him confusing choices that he's not capable of making. (even with little things like that, or what color shirt to wear, etc.)

There is a book that I've mentioned before called Caregivers: Drowning in a Sea of Cognitive Challenges by Delaune Pollard, AccOT. In the middle of it is the most useful tool I've found (outside of this forum). It uses the Allen scale and likens each stage to a child's age, with the abilities and state of mind very similar to a child's at each stage of development. This has helped me tremendously in understanding my mother as her cognitive abilities slowly fail. It might also help professional caregivers understand their LBD, and other dementia, patients.

Also, providing in-services and materials to staff at SNF and ALF and wherever might be a great activity for "A Week to Remember" in October. There are educational materials available to volunteers. Check the home page.

Kate