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BALANCED CARE

METHOD workbook

A Holistic Approach

to Healthy Longevity

Featuring Our Cognitive

Therapeutics Method

to Boost Brain Health!

2 / Balanced Care Method Workbook

Introduction to the

Balanced Care Method

The Balanced Care Method is a unique approach to care we implement at

Home Care Assistance designed to improve the quality of life for our clients.

This workbook provides specific ways you can incorporate these approaches

to care as a Home Care Assistance caregiver.

The Balanced Care Method

is based on studies of the extraordinarily

long-lived elders in the Okinawa region

of Japan; life spans of over 100 years are

not unusual in Okinawa. Perhaps even

more astounding than their longevity is

the quality of health these elders enjoy;

people in their 70s, 80s and beyond

enjoy excellent physical health, mental

acuity, independence and inner calm.

Studies have found that genetic factors

only account for about one third of the

Okinawan elders’ extraordinary health

and long lifespans. The other two-thirds

can be attributed to the lifestyle factors

which comprise our Balanced Care

Method approach to care.

Components of the Balanced Care

Method Training include:

• Healthy Diet

• Physical Activity

• Cognitive Engagement

• Social Ties

• Calmness and Purpose


Table of Contents

Healthy Diet 4

Physical Activity 18

Cognitive Engagement 21

Social Ties 62

Calmness & Purpose 65

Etiquette 67

Daily Checklist 69

Quiz 70


Healthy Diet

A major factor that contributes to the

extraordinary health enjoyed by Okinawan

elders is their distinct diet. It is plantbased,

low in fat and animal-based

protein and high in fiber, omega-3 fatty

acids and flavonoids. It includes low to

moderate alcohol intake, plenty of fruits

and vegetables and very low levels of

saturated fat and sodium. The twenty

percent of animal-based calories the

Okinawans do consume come mostly

from cold-water fish or stewed meats

from which the fat has been rendered.

In addition, the fats they eat – fish, soy

products, and cold-pressed canola oil

– are largely monounsaturated (which

helps to lower “bad” cholesterol) and rich

in omega-3 fatty acids.

Thus, the Balanced Care Method

promotes a varied diet rich in vegetables

and fruits, whole grains and other complex

carbohydrates, lean proteins, flavonoid

and omega-3-rich foods, and low in

saturated fats, refined sugars, processed

foods and alcohol. There is room in this

diet profile for most people’s favorite

foods, at least in moderation. Similar to

the Okinawan practice of hara hachibu,

which means eating until only 80% full,

the Balanced Care Method promotes a

5 / Balanced Care Method Workbook Healthy Diet

moderate to low-calorie diet to help achieve

or maintain a healthy body mass index. For

older, less active people, this is often 1,500

– 2,000 calories per day. Maintaining small

portions with a focus on whole foods (fruits,

vegetables, soy and grains), low-fat foods

and an avoidance of processed foods will

help keep caloric intake low.

The Modified MyPyramid for Older Adults

shown below is a good guide to follow

to create a balanced, nutritious diet

for older adults. This picture shows the

dietary guidelines that will help promote

health and vitality:

• Whole, enriched, and fortified grains and

cereals such as brown rice and 100%

whole wheat bread

• Bright-colored vegetables such as

carrots and broccoli

• Deep-colored fruit such as berries and

melon

• Low- and non-fat dairy products such

as active culture yogurt and low-lactose

milk

• Beans and nuts, fish, poultry, lean meats

and omega-3 eggs

• Liquid vegetable oils



Dietary Program Overview:

Enjoy Daily

• Vegetables

• Fruits

• Whole grains (whole wheat bread, brown

rice, oatmeal, corn meal, etc.)

• Omega-3-rich foods (cold water fish like

tuna, salmon and mackerel; walnuts, dark

greens, eggs)

• Green tea

• Water

Enjoy in Moderation

• Low-fat milk products

• Lean meats

• Fruit juices

Limit

• Cheese and full-fat milk products

• Sugar

• Refined grains (white bread, white rice, etc.)

• Processed or fatty meats

• Sodas

• Alcohol

We will now look more closely at each of

the elements of the Balanced Care Method

dietary program.

Vegetable & Fruits

The most important part of the Balanced

Care Method diet is keeping consumption

of vegetables and fruits high. Ideally, clients

should have multiple servings of vegetables

and at least 1 serving of fruit every day. A

serving of vegetables is usually about 1 cup

of chopped, sliced, or mashed vegetables,

except for leafy greens like lettuce which

are 2 cups per serving. Often the amount of

vegetables served at a restaurant or even

at home counts as 2, 3, or even 4 servings. A

serving of fruit is also about 1 cup chopped or

1 whole fruit, as long as that fruit is relatively

small. Many apples sold at stores today are so

large they count as 2 or even 3 servings each!

Vegetables and fruits are vital for a healthy

diet because they contain vitamins, minerals

and antioxidants. Equally important, they

contain natural fiber, which promotes healthy

digestion and helps people feel full and

satisfied longer. For this reason, vegetables

and fruits make excellent snacks; they satisfy

the body’s craving for food while providing a

low-calorie sense of fullness.

Variety is important, but not all fruits and

vegetables are created equal. Some contain

more nutrients and health benefits than

others and should be worked into the diet

more frequently:

• Dark, leafy greens (kale, spinach, chard)

• Sweet potatoes

• Cabbage and related vegetables

(broccoli, cauliflower)

• Crunchy, raw vegetables of all kinds

• Tomatoes

• Berries

• Apricots

• Melons


Whole Grains & Carbohydrates

Vegetables and fruits do provide our bodies

with carbohydrates, but another good

source of this important dietary component

are whole grains. Carbohydrates, both

complex and not (fruits and veggies), should

make up a large portion of your client’s diet.

Whole grain breads (whole wheat, rye),

oatmeal and brown rice are several easy,

familiar ways to add whole grains to any

diet. Whole grains, as opposed to refined

grains, contain a wider range of nutrients

and fiber. Limit intake of refined grains like

white bread and white rice as they have

zero nutritional value.

Nutritional whole grains to incorporate into

the diet:

• Oatmeal

• Brown rice

• Barley

• Corn meal (cornbread, tortillas, baked

tortilla chips)

• Buckwheat (kashi, soba noodles, groats)

Soy-Based Foods

Along with being an excellent source of

low-fat protein, soy contains high levels

of flavonoids, which help protect against

cancer and heart disease. 2 to 4 servings

each day of flavonoid-rich foods are

recommended to help maintain bone

density, muscle mass and protect against

disease. Flavonoids are found in a range

of foods, but are most concentrated in soy

products such as tofu, edamame and soy

milk. Other flavonoid-rich foods include:

• Ground flax seed

• Dark greens

• Onions

• Sprouts

• Cranberries

• Apples

• Strawberries

• Grapes

• Apricots

• Green and black teas

Soy-based foods may be new to you or

your client. Here are some ways to easily

incorporate them into the diet:

• Add “silken” tofu to smoothies or pureed

soups

• Try soy beans (often sold as “edamame”) as

a snack

• Use soy beans in place of beans or peas in

favorite recipes

• Serve sweetened and/or flavored soy milk in

place of milk

• Try baked tofu over regular tofu; it’s firmer,

more flavorful and more appealing to

many people


Omega-3-Rich Foods

Omega-3 is an essential fatty acid that has

been shown to support heart health and

brain function. 1 to 3 servings a day is advised.

Some omega-3 rich foods to include in

the diet:

• Cold-water, fatty fish

– Salmon

– Tuna

– Mackerel

• Walnuts

• Dark, leafy greens

– Spinach

– Swiss chard

– Kale

– Mustard, turnip, beet,

and collard greens

• Flaxseeds and chia seeds (can sprinkle on

yogurt or salad)

• Omega-3 enriched eggs – Look for

“pastured” or “cage-free” versions

Tea & Water

Plenty of fresh water is good for everyone

and a much better thirst-quencher than

juice. The Balanced Care Method also

encourages drinking several cups of tea

daily. Black tea is fine, but the healthier

option is a decaffeinated jasmine, green

or herbal tea. Try fresh ginger, chamomile

and peppermint teas for a soothing effect,

adding a bit of honey or lemon juice for

more flavor.

It is very important to make sure your client

is drinking enough fluids; according to the

Mayo Clinic, men and women should consume

at least 8 glasses of water a day to avoid

dehydration. More may be necessary if your

client takes medications that have diuretic

or laxative effects. Dehydration can result in

very serious consequences and should be

monitored closely.

Symptoms can include:

• Fatigue

• Headache

• Dry mouth

• Little or no urination

• Muscle weakness

• Dizziness or light headedness

• Confusion and forgetfulness

• Deep rapid breathing or an increased

heart rate

Here are several suggestions to ensure your

client consumes the adequate amount of

fluids each day:

• Encourage your client to drink before he or

she feels thirsty

• Help keep him or her hydrated by having

water or tea nearby for sipping throughout

the day

• Serve water or tea before serving food at

meals

• Foods such as soups and raw fruits and

vegetables are also an excellent ways to

stay hydrated

Coffee

Many people enjoy a cup of coffee in the

morning before or with their breakfast. While

some believe that coffee is not good for you,

recent studies suggest that moderate coffee

consumption can help stave off Alzheimer’s


and dementia. As long as no doctor’s order

prevents it, a few cups of coffee a day are fine.

Note: If your client has trouble sleeping, it

may be wise to limit coffee consumption to

the morning hours (before lunch).

Dairy & Meat

The North American diet is largely made up

of animal products. While meat and dairy

do contain protein and minerals, they also

contain saturated fat, which can threaten

heart health when consumed in large

quantities.

Meat and dairy do not need to be purged

from diets completely, but most people will

enjoy better digestion and overall health if

they limit their consumption.

Try to keep meat consumption to a few

times a week, if possible. Also observe a

true serving size, which is 4 ounces of meat

(about the size of a deck of cards). When

choosing meat:

• Look for lean meats such as chicken, turkey

and tenderloin cuts

• Minimize processed meats like hot dogs

and chicken nuggets

• Cook meat in a way that renders its fat:

roasting, baking or stewing is better than

frying

Try to substitute extra-virgin olive oil for

butter whenever you can; most times your

client won’t know the difference. Full-fat

or “whole” milk products contain a lot of

saturated fat and should be limited. Lowfat

or skim versions, however, are excellent

sources of protein, calcium and vitamin D.

In addition, unsweetened or Greek yogurts

with live cultures and probiotics are healthy

alternatives to more full-fat dairy products.

They contain “good” bacteria that aid in

digestion and promote overall health.

Salt

We all need some salt in our diets to

maintain proper body function, but most

individuals consume too much. So much

in fact, that many older adults are on lowsalt

diets due to high blood pressure, heart

disease, stroke and osteoporosis.

To add flavor to foods without using as much

salt, try these easy tips:

• A squirt of lemon juice before serving can

highlight flavors much like salt does

• Fresh herbs add flavor to salads, roast

meats and cooked vegetable dishes

• Use low-fat, reduced sodium stock or broth

for cooking and added flavor to the food

without salt

Sweets & Sugar

As people get older they tend to develop

more of a sweet tooth. Though other tastes

fade, many seniors retain the ability to taste

sweet things, and therefore crave them.

Refined sugar and other sweets should have

a very limited role in the diet in order to avoid

blood sugar spikes, stress on the pancreas

and empty calories. A piece of fruit is a

much healthier way to end a meal while still

satisfying the craving for something sweet;

applesauce, dried fruits and low-fat yogurt

with fresh fruit are all good options.

Not all sweeteners are created equally.

Levels of processing and how our bodies

handle sweeteners means some are easier

on our systems than others.

Preferred Sweeteners: Honey and Agave

Sweeteners to Avoid: White sugar and Corn

syrup and foods containing high fructose

corn syrup


Alcohol

Some studies suggest that red wine, in

moderation, can have beneficial effects

on heart health; red wine contains

antioxidants, which are thought to help

prevent heart disease by increasing levels

of “good” cholesterol and protecting

against artery damage. However, doctors

are wary about encouraging anyone to

start drinking alcohol as overconsumption

can have negative effects on the mind

and body. Bottom line: Alcohol should be

consumed in moderation, if at all.

Try to incorporate one or more of

these Super Foods into the client’s

diet on a daily basis:

Salmon – Contains omega-3 fatty acids

that fight artery deposits of LDL cholesterol.

Walnuts and other nuts – Cholesterol-free

and high in heart healthy unsaturated fat

including omega-3s, certain nuts have been

shown to reduce the risk of heart disease.

Carrots – Contain vitamin A and

antioxidants. The beta-carotene helps

prevent macular degeneration, the leading

cause of blindness as we age.

Eggs – A superior source of protein, eggs

include all the essential amino acids the

human body requires for good health.

Flaxseeds – Evidence suggests that these

seeds can reduce the risks of heart disease,

cancer and stroke.

Blueberries – Loaded with vitamins B-6, B-12

and C, along with folic acid and potassium.

Dark chocolate – With a high cocoa

percentage (60% or more) this treat is full of

antioxidants.

Jicama– Has probiotic properties to boost

healthy bacteria in the stomach and aid in

digestion. It is also high in vitamin C which

helps fight wrinkles.

Chia – These tiny seeds are excellent

sources of fiber, calcium, iron and omega-3s.

Sprouts – These germinating seeds (e.g.

bean, alfalfa, broccoli) can be eaten raw

or cooked and can come from different

beans. Broccoli sprouts contain about

50 times more of the anti-cancer agent,

sulforaphane, than their fully mature stalks.

Black Garlic – This sweet garlic has

cholesterol lowering properties and nearly

double the antioxidants compared to a

regular raw bulb of garlic.

Kelp – Packed with vitamin K and calcium,

certain studies have shown that it can help

decrease women’s risk of developing breast

cancer.

Barley – This grain contains lignans, which

help fight cancer and lower cholesterol,

and niacin, which helps keep skin and hair

healthy.

Nutritional Yeast – Loaded with protein and

vitamin B, this yeast helps keep energy levels

high and stress levels low.


Recipes from our Comfort Foods Cookbook:

A Healthy Twist on Classic Favorites

While the amount of food we consume tends

to decrease as we age, the quality and

nutritional value become more essential;

after all, eating properly is pivotal to our

lifespan and health-span. Over the years,

our clients and caregivers have shared

countless recipes with us – recipes that

inspired good food and fond memories.

With the input of nutritionists, we adapted

these favorite recipes to meet our Balanced

Care guidelines. By introducing healthier

Breakfast

Mixed Berry Almond Smoothie

Can be served with a slice of whole wheat toast

Serves 1

This refreshing blend of berries, yogurt, and

almond milk gets a vitamin C boost from orange

juice, with a flavor that’s simply delicious. It’s easy

to make and perfect for breakfast on the go or

an afternoon pick me up.

• ½ cup mixed berries (fresh or frozen)

• ½ cup almond milk

• ¼ cup plain low-fat or nonfat yogurt

• ¼ cup calcium-fortified orange juice

Directions

Combine and blend all the ingredients until

frothy and smooth. Pour into glasses and serve.

ingredients and cooking methods to the

kitchen, we’re making sure that all of our

favorite foods are also great sources of

nutrition at any age, but in particular for

older adults.

We would like to share some of the recipes

from our Comfort Foods Cookbook: A

Healthy Twist on Classic Favorites with you.

For a complete list of recipes, request a copy

of our cookbook from your local office.

Lunch

Three-Bean Chili

Can be served with cornbread and a small salad

Serves 3-4

This recipe makes a hearty batch of

vegetarian chili. Freeze leftovers in individual

servings to make reheating quick and easy

for a healthy lunch or hassle free dinner.

• 2 carrots, peeled and finely chopped

• 1 can (14-oz.) chopped tomatoes (no salt added)

• 1 can (14-oz.) crushed tomatoes

• 3 cans (14-oz. each) pinto, kidney, white

and/or black beans, rinsed and drained

• 1 cup frozen whole-kernel corn

• 1 red bell pepper, chopped (optional)

• 1 zucchini, chopped (optional)

• 1 ½ Tbsp. rice vinegar

• 4 cups of water

Directions

1. Put carrots, tomatoes, beans, corn, red pepper

and zucchini into a large pot with 4 cups of

water. Bring to a boil. Cover, reduce heat,

and simmer until carrots are tender, about

25 minutes. Add salt and pepper to taste.

2. Stir in vinegar. Top with fresh cilantro and

nonfat yogurt, if you like.


Dinner

Tuscan Rosemary Chicken

Can be served with a whole grain roll and steamed

asparagus

Serves 2

This one-pot dinner is easy to make. Any

leftovers can be reheated a day or two later

for lunch or dinner, or frozen and reheated at a

later time.

• 1 boneless, skinless chicken breast (about 8

oz.), cut in half

• 1 Tbsp. olive oil

• 1 small zucchini, halved lengthwise and sliced

• ½ cup green beans, trimmed and cut into

½-inch lengths

• 1 cup low-sodium chicken or vegetable broth

• 1 tsp. minced fresh or ¼ tsp. dried rosemary

(optional)

• ¼ cup mashed white beans

• 1 cup halved cherry or grape tomatoes

Directions

1. In a large frying pan heat olive oil over

medium heat. Cook chicken, turning once,

until it is no longer pink in the center, about

10 minutes. When you cut into the chicken

the juices should run clear. Transfer chicken

to a platter and cover to keep warm.

2. Add zucchini, green beans, broth and

rosemary to the pan. Bring to a boil and then

reduce heat to a simmer. Cover and cook

until vegetables are tender, about 3 minutes.

3. Stir the mashed beans and tomatoes into

the sauce. Add the chicken breast back into

the pan to warm it up and serve.


Breakfast

Ham and Cheese Breakfast Casserole

Can be served with coffee or tea and a cup of fruit

Serves 4

This healthy version of the traditionally rich

ham and cheese breakfast casserole is

equally delightful with plenty of flavor, half

the calories and one-third the fat of the

original casserole.

• 2 large eggs

• 6 large egg whites

• 1 cup nonfat milk

• 2 Tbsp. Dijon mustard

• 1 tsp. minced fresh or dry rosemary

• ¼ tsp. freshly ground pepper

• 5 cups chopped spinach

• 4 cups whole-grain bread, crusts removed

if desired, cut into 1-inch cubes (about ½

pound, 4-6 slices)

• 1 cup diced ham (5 ounces)

• ½ cup chopped roasted red peppers

• ¾ cup shredded reduced-fat Swiss cheese

Directions

1. Preheat oven to 375°F. Coat a 7x11 inch

glass baking dish or a 2-quart casserole

with cooking spray.

2. Whisk eggs, egg whites and milk in a

medium bowl. Add mustard, rosemary

and pepper; whisk to combine. Toss

spinach, bread, ham and roasted red

peppers in a large bowl. Add the egg

mixture and toss well to coat. Transfer to

the prepared baking dish and push down

to compact. Cover with foil.

3. Bake until the eggs have set, 40-45

minutes. Uncover, sprinkle with cheese and

continue baking until the eggs are puffed

and golden on top, 15 to 20 minutes more.

Let it cool for 15 to 20 minutes before

serving.

Lunch

Grape Walnut Chicken Salad

Can be served with whole grain bread or crackers and

shredded cabbage or cole slaw tossed with a light dressing

Serves 1

This fresh salad is perfect when you want

something light but flavorful.

• 2 Tbsp. thick Greek-style plain yogurt or

nonfat plain yogurt

• ½ tsp. lemon juice

• Freshly ground black pepper

• ½ cup shredded or chopped cooked

chicken or turkey

• 2 Tbsp. chopped walnuts

• 1 small stalk celery, finely chopped

• ¼ cup grapes, halved

Directions

1. In a medium bowl, combine yogurt, lemon

juice, and pepper to taste.

2. Add chicken, walnuts, celery, and grapes

and toss to combine thoroughly. Serve

immediately or cover and chill until ready

to eat.


Dinner

Miso-Glazed Salmon or Arctic Char

Can be served with steamed broccoli or spinach and

brown rice

Serves 1

This one dish supper is pretty quick to pull

together and packed with flavor.

• 1 wild salmon or arctic char fillet (6 oz.)

• 2 Tbsp. white or yellow miso

• 1 tsp. rice vinegar

• 1 tsp. fresh grated ginger

• ½ tsp. toasted sesame oil

Directions

1. Preheat broiler and place salmon on a

baking sheet.

2. In a small bowl, combine miso, vinegar,

ginger, and sesame oil. Spread over the

salmon.

3. Broil until cooked through—it should flake

easily when prodded with a fork, about 10

minutes.

Breakfast

Whole Grain Blueberry Pancakes

Can be served with coffee, tea or Calcium-fortified orange

juice and a slice of turkey bacon

Serves 2

A sweet but healthy alternative to traditional

blueberry pancakes.

• 1 cup whole wheat flour

• ½ cup toasted wheat germ

• ½ cup cornmeal

• 1 Tbsp. light brown sugar

• 1 Tbsp. baking powder

• ½ tsp. salt

• 1 egg

• 1/3 cup nonfat milk

• 2 tsp. canola oil

• 1 cup fresh blueberries

Directions

1. In a large bowl, mix together flour, cornmeal,

wheat germ, baking powder, brown sugar

and salt.

2. In a small bowl, whisk together egg,

milk and oil. Pour into dry mix and stir to

combine. Add in blueberries.

3. Pour batter onto a heated non-stick

griddle or frying pan, about ¼ cup

per pancake, and cook until bubbles

appear in the batter. Flip and cook until

browned on the second side. Repeat with

remaining batter. Top with light maple

syrup and blueberries.


Lunch

Tuna Sandwich

Can be served with a small salad or cup of fruit

Serves 1

Tuna fish has many health advantages,

promoting good cardiovascular health and

providing a non-fatty source of protein. A

tuna sandwich is one easy way to obtain the

benefits of this nutritious food. Any extra can

be stored in a plastic sealable container in

the refrigerator for use within a week.

• 6 oz. can of tuna

• ¼ cup nonfat mayonnaise

• 1/3 cup relish

• 1/3 cup chopped red onion (optional)

• Freshly ground black pepper

• Two slices of whole wheat bread

Directions

1. Place tuna in a medium-sized mixing bowl.

2. Add mayonnaise to the tuna along with

the relish and black pepper to taste.

3. Finely chop part of an onion and add it to

the bowl, if desired.

4. Stir the ingredients together and spread

onto one of the slices of bread and place

the other slice on top.

Dinner

Butternut Squash Stir-Fry

Can be served with brown rice and a small salad

Serves 3-4

This fun and colorful stir-fry makes a quick

and delicious dinner. For extra protein, you

can add 4 oz. chopped firm tofu.

• 1 bag cubed squash

• 1 head Swiss chard or kale, thick ribs

removed


• 2-inch piece ginger, peeled and finely diced

• 1 Tbsp. white or yellow miso

• ¼ cup chopped cilantro (optional)

Directions

1. Chop chard or kale and set aside.

2. In a large frying pan or pot, heat oil over

medium-high heat. Add ginger and cook,

stirring, until opaque and fragrant, about

30 seconds.

3. Add squash. Dissolve miso in ½ cup water

and add to squash and ginger. Stir to

combine. Add chard or kale, stir, cover,

and cook, stirring occasionally, until

squash is tender, about 15 minutes. If you

are adding tofu, do so at this step. Add

additional water if necessary to keep

squash from sticking to the pan.

4. Add cilantro, if you like, and stir to combine.


Lunch

Caesar Salad with Sardines

Can be served with a cup of soup

Serves 1

A healthy take on a traditional favorite.

• ¼ head romaine lettuce, torn into bite-size

pieces


• 2 tsp. lemon juice

• 1 tsp. white or yellow miso

• ¼ tsp. freshly ground black pepper

• ½ cup whole grain croutons

• 1 (2 ounce) can sardine fillets, drained

Breakfast

Cinnamon Apple Oatmeal

Can be served with coffee, tea or Calcium-fortified

orange juice

Serves 1

Jazz up plain old oatmeal with some sugar

and spice.

• 1 cup apple juice

• ½ cup rolled oats

• 1 small red apple, peeled and chopped

• 1/8 tsp. ground cinnamon

• 1 tsp. light brown sugar (optional)

Directions

1. Put lettuce in a large bowl.

2. Combine olive oil, lemon juice, miso and

pepper in a jar. Cover tightly and shake

vigorously.

3. Pour dressing over lettuce and toss gently

to coat lettuce leaves. Add croutons and

toss again.

4. Place on a serving plate and top with

sardines. Serve immediately.

Directions

1. In a small sauce pan bring apple juice to

a boil. Stir in oats, chopped apple and

cinnamon. Adjust heat to maintain a

steady simmer.

2. Cook until oats are tender, about 5

minutes. Serve hot and sprinkle with brown

sugar for added sweetness if you like.


Dinner

Pork Chops with Apple Sauce

Can be served with a small salad and sautéed spinach

Serves 1

When cooked, pork chops can sometimes

be dry, so adding apple sauce to this dish

can help increase the meat’s flavor.

• ½ cup nonfat milk

• ½ tsp. salt

• 1 (½ -inch-thick) pork chop (with or without

bone)

• ¾ cup fresh whole wheat bread crumbs,

ground in a food processor

• ¼ Tbsp. minced garlic

• ½ tsp. fresh or dried rosemary

• ½ tsp. fresh or dried thyme

• ½ cup apple sauce

• 1 Tbsp. canola oil

Directions

1. Stir together milk and salt in a shallow

3-quart dish, add pork chops. Marinate,

covered and chilled, turning over once, at

least 1 hour.

2. Preheat oven to 200°F.

3. Stir together bread crumbs, garlic,

rosemary and thyme in a shallow bowl.

Lift pork chops from milk, letting excess

drip off, and dredge in bread crumbs.

Pat bread crumbs lightly to help them

adhere.

4. Heat oil in a skillet over moderately high

heat. Add pork chop and saute, turning

over once, until golden brown, about 5 to

6 minutes.

5. Serve pork chop topped with apple

sauce.


Physical Activity

Okinawan elders have lifelong routines of

moderate exercise and physical activity,

with the majority regularly practicing the

soft martial art of tai chi. They walk most

places they go and keep up daily tasks like

housework and gardening. These are all

low-impact and weight-bearing forms of

physical activity. Tai chi alone provides its

practitioners with aerobic, anaerobic and

flexibility fitness. Being physically fit helps

keep Okinawan elders lean and in shape.

They report that these physical activities

also give them a sense of calmness and

psychological wholeness.

Being as active as possible helps people

at all stages of life achieve and maintain

a healthy body mass, heart health and

engaged minds. For older adults, exercise

can help prevent the loss of muscle strength,

bone density and balance, and thereby

reduces the risk of falls. Researchers have

also found that patients who are more

physically fit have less brain-tissue atrophy.

The Balanced Care Method seeks to help

seniors start and maintain a healthy activity

level. Seniors still able to do small chores or

gardening should be encouraged to do so.

For seniors who are still mobile, walking a

little bit each day can help them maintain

19 / Balanced Care Method Workbook Physical Activity

this agility. It is recommended that seniors

exercise 4-5 times per week with the consent

and guidance of a physician. Consulting with

your client, his or her medical practitioner,

and his or her family or friends will help you

determine the appropriate level at which

your client can and should keep up his or her

previous activities.


Exercise Program Overview:

• Stretching

• Strength-building

• Aerobic

Ideally, all three types of activity will happen

on a daily basis.

Stretching

Stretching helps maintain flexibility and

joint function and is an activity that can be

adapted to all levels of mobility. The best

stretching program covers all major joints

(hips, shoulders, knees, elbows, neck and

spine) and is best done when the body is

warm, after another form of exercise or a

bath or shower.

Here are 8 easy stretches that can be done

sitting or standing:

Neck Stretches

With a straight spine and chin up for

good posture, tilt the head from side to

side – trying to touch each ear to each

shoulder. Hold each side for 30 to 60

seconds, breathing steadily and deeply.

Keep shoulders down, jaw relaxed, and

eyes looking forward. Repeat until you are

comfortable. Another stretch for the neck

involves bringing your chin to your chest as

close as possible and holding for 30 to 60

seconds. Breathe deeply and keep the jaw

relaxed throughout the stretch.

Shoulder Stretches

Maintaining good posture, roll your shoulders

forward several times and then reverse

direction and roll shoulders backwards several

times. Next, hold your arms down at your sides

with palms facing forward. Lift them up as you

inhale, keeping palms facing forward, as

high as you can. Lower them slowly as you

exhale. Repeat until you feel relaxed.

Torso Stretches

Reach right arm straight up and lean to the

left as far as you can. Repeat with your left

arm over your right side. Next, reach both

arms straight up and lean slowly to the right.

Slowly come back up and repeat on the left

side. Another effective way to stretch the

torso is to lie on your back on the floor with

your knees bent. Lower your knees, still bent,

to the right, reaching the floor if possible.

Repeat on the left side.

Arm, Wrist and Hand Stretches

Hold your arms out in front of you with your

palms up. Bend your elbows and try to touch

your shoulders without lifting your elbows

higher than your shoulders. You can also

do this one arm at a time. Next, hold your

wrists out in front of you and make a gentle

fist. Roll your hands clockwise several times,

and then roll them counterclockwise several

times.

Stretching Hips

Stand with the right side of your body next

to the back of a chair. Put your right hand on

the back of the chair and cross your left foot

in front of your right leg. Lift your left hand

as high up above your head as you can and

gently lean to the right. Hold for at least one

deep breath. Repeat on the left side.

20 / Balanced Care Method Workbook Physical Activity

Stretching Legs

Sitting in a chair, put your right leg out as

straight as you can with your heel on the

floor (your toes can be pointing up). Hold for

at least one deep breath. Repeat with the

left leg. Next, sit on the floor with your legs

straight out in front of you. For many people,

this position is already a good stretch. For

the more limber, bend forward, keeping a

flat back, as far as is comfortable. Hold for

at least one deep breath.

Stretching Ankles

Sitting in a chair with good posture, lift

up your right leg just high enough so

you can roll your foot. Roll your right foot

clockwise several times and then roll it

counterclockwise several times. Repeat with

the left foot.

Back Stretches

Sitting in a chair with good posture, put your

hands under your right knee and lift it up

towards your chest as far as you comfortably

can. Hold for at least one deep breath.

Release slowly. Repeat on the left side. Next,

lie on the floor with your knees bent and feet

flat on the floor. Pull your knees as far into

your chest as you can and hold it a full, deep

breath.

Aerobic

Walking is an excellent source of aerobic

exercise. Even short walks, taken regularly,

can be very beneficial to one’s physical

and mental health. Following these tips will

help your client stay mobile:

• Wear comfortable shoes with good

support and breathable socks

• Wear a hat, sunglasses and sunscreen

• Dress warmly and wear layers in cooler

weather

• Find even, flat places or paths to walk

• Follow a regular schedule for walking

• Mix up the route every now and again to

keep things fresh and interesting

Some activities older adults can do that are

low impact, but still provide a workout are:

• Gardening

• Light housework

• Dancing

• Golfing

• Swimming or aqua aerobics

Strength-Building

One of the best ways for seniors to maintain

their strength is to do as many tasks as they

can without assistance. Joining a gym is also

an option, especially one that caters to older

adults. Weight-bearing exercise, like walking,

is also important. Carrying light weights (1

pound in each hand, for example) intensifies

the workout without putting too much of

strain on the joints.


Cognitive Engagement

Studies have shown the benefits of staying

mentally engaged throughout life; an active

mind is a healthy mind. There are numerous

things that you as a caregiver can do to

promote brain health for your client. Below

are some fun cognitive exercises that you

can facilitate with your client. Evaluate and

select activities that are most appropriate

and enjoyable for your client.

Cognitive Engagement Overview:

Alphabet Soup (Language)

Suggest a category from the list below.

Starting with the letter “A”, come up with a

word within that category that starts with

each letter of the alphabet. It’s okay if you

don’t find an answer for each letter.

Sample Topic: Fruits

A - Apple

B - Banana

C - Coconut

Sample Topic: School Subjects

A - Algebra

B - Biology

C - Chemistry

D - Drama

22 / Balanced Care Method Workbook Cognitive Engagement

Choose a topic (travel, sports, state, countries, movies, books, female/male names) and write

related words that begin with each letter of the alphabet.

TOPIC:__________________________ TOPIC: __________________________ TOPIC: ________________________

A. _____________________________

B. _____________________________

C. _____________________________

D. _____________________________

E. _____________________________

F. _____________________________

G. _____________________________

H. _____________________________

I. _____________________________

J. _____________________________

K. _____________________________

L. _____________________________

M. _____________________________

N. _____________________________

O. _____________________________

P. _____________________________

Q. _____________________________

R. _____________________________

S. _____________________________

T. _____________________________

U. _____________________________

V. _____________________________

W. _____________________________

X. _____________________________

Y. _____________________________

Z. _____________________________

A. _____________________________

B. _____________________________

C. _____________________________

D. _____________________________

E. _____________________________

F. _____________________________

G. _____________________________

H. _____________________________

I. _____________________________

J. _____________________________

K. _____________________________

L. _____________________________

M. _____________________________

N. _____________________________

O. _____________________________

P. _____________________________

Q. _____________________________

R. _____________________________

S. _____________________________

T. _____________________________

U. _____________________________

V. _____________________________

W. _____________________________

X. _____________________________

Y. _____________________________

Z. _____________________________

A. _____________________________

B. _____________________________

C. _____________________________

D. _____________________________

E. _____________________________

F. _____________________________

G. _____________________________

H. _____________________________

I. _____________________________

J. _____________________________

K. _____________________________

L. _____________________________

M. _____________________________

N. _____________________________

O. _____________________________

P. _____________________________

Q. _____________________________

R. _____________________________

S. _____________________________

T. _____________________________

U. _____________________________

V. _____________________________

W. _____________________________

X. _____________________________

Y. _____________________________

Z. _____________________________


Categorical Scrambles (Language)

Each category has five word scrambles; four of them match the category and one of them

does not. Have the client first unscramble the words, then figure out which word does not belong

to the category.

Exercise 1 (Answer on page 25)

1. Colors

a. erd

b. elub

c. eerng

d. itghl

e. lackb

2. Numbers

a. neo

b. ivef

c. xsi

d. wot

e. ewf

3. Emotions

a. unr

b. adm

c. hppay

d. sda

e. ladg

4. Pets

a. atc

b. odg

c. ishf

d. msoue

e. lantp

5. Temperatures

a. olcd

b. raf

c. oolc

d. toh

e. rmwa

6. Animals

a. ofx

b. tac

c. dgo

d. ishf

e. gru

7. Senses

a. itsgh

b. ufn

c. outch

d. atest

e. emsll

8. Drinks

a. uttber

b. odas

c. ilmk

d. atrew

e. uijce



1. Movie Genres

a. tnoaci

b. ytafasn

c. decoym

d. nrocema

e. rcasy

2. Book Genres

a. hbuplsi

b. epoyrt

c. goaphbiyr

d. otfnci

e. mrcie

3. Natural Disasters

a. zrdazilb

b. dmuih

c. erqaekutah

d. lancovo

e. airunehrc

4. Types of Food

a. neicxma

b. hait

c. taialni

d. cenishe

e. coahtcoel

5. Fruit

a. plape

b. daomnl

c. nabnaa

d. aerp

e. aegnor

6. Desserts

a. eip

b. keca

c. cbcroli

d. okioce

e. erbwnoi

7. Jewelry

a. katjetc

b. gnir

c. acbretle

d. knlceeac

e. rairneg

8. Transportation

a. rca

b. abto

c. lapen

d. ikte

e. cyeclib



1. Food

a. mburgaher

b. cilahenad

c. ckesanpa

d. dwiashcn

e. kcacilot

2. Gems

a. iaondmd

b. eayhtstm

c. phiapsre

d. laticps

e. raeldme

3. Sea Creatures

a. usinatm

b. osertlb

c. ifhasasrt

d. enamoen

e. yifslehlj

4. Clothing

a. aithrsestw

b. baenahdb

c. orseturs

d. uesblo

e. setrwea

5. Tools

a. ewhncr

b. acltandiesck

c. wsdivcere

d. amherm

e. wbcoarr

6. States

a. ykkcunet

b. gcmiahni

c. acanda

d. eniutccocn

e. ynesiaplvna

7. Types of Meat

a. neosvin

b. uyekrt

c. eicnhkc

d. rctihakeo

e. ubfloaf

8. Technology

a. rimror

b. evelsnitoi

c. certupom

d. erorfreagrit

e. ethlonpel


Answers to Exercise 1

(The word that is in capital letters is the answer that does not belong to

the category.)

1. Colors

a. red

b. blue

c. green

d. LIGHT

e. black

2. Numbers

a. one

b. five

c. six

d. two

e. FEW

3. Emotions

a. RUN

b. mad

c. happy

d. sad

e. glad

4. Pets

a. cat

b. dog

c. fish

d. mouse

e. PLANT

5. Temperatures

a. cold

b. FAR

c. cool

d. hot

e. warm

6. Animals

a. fox

b. cat

c. dog

d. fish

e. RUG

7. Senses

a. sight

b. FUN

c. touch

d. taste

e. smell

8. Drinks

a. BUTTER

b. soda

c. milk

d. water

e. juice



1. Movie Genres

a. action

b. fantasy

c. comedy

d. romance

e. SCARY

2. Book Genres

a. PUBLISH

b. poetry

c. biography

d. fiction

e. crime

3. Natural Disasters

a. blizzard

b. HUMID

c. earthquake

d. volcano

e. hurricane

4. Types of Food

a. Mexican

b. Thai

c. Italian

d. Chinese

e. CHOCOLATE

5. Fruit

a. apple

b. ALMOND

c. banana

d. pear

e. orange

6. Desserts

a. pie

b. cake

c. BROCCOLI

d. cookie

e. brownie

7. Jewelry

a. JACKET

b. Ring

c. Bracelet

d. Necklace

e. Earring

8. Transportation

a. car

b. boat

c. plane

d. KITE

e. bicycle



1. Food

a. hamburger

b. enchilada

c. pancakes

d. sandwich

e. COCKTAIL

2. Gems

a. diamond

b. amethyst

c. sapphire

d. PLASTIC

e. emerald

3. Sea Creatures

a. TSUNAMI

b. lobster

c. starfish

d. anemone

e. jellyfish

4. Clothing

a. sweatshirt

b. HEADBAND

c. trousers

d. blouse

e. sweater

5. Tools

a. wrench

b. CANDLESTICK

c. screwdriver

d. hammer

e. crowbar

6. States

a. Kentucky

b. Michigan

c. CANADA

d. Connecticut

e. Pennsylvania

7. Types of Meat

a. venison

b. turkey

c. chicken

d. ARTICHOKE

e. buffalo

8. Technology

a. MIRROR

b. television

c. computer

d. refrigerator

e. telephone


Affinities (Language, Executive Function)

Ask the client to determine the word/category to which the two words

belong.

Example:

Q: Fords and Pontiacs are ___________________ A: Cars

Exercise 1 (Answers in page 30)

1. Fords and Pontiacs are_____________________________________________________

2. Roses and Marigolds are___________________________________________________

3. Sparrows and Finches are__________________________________________________

4. Boston and Bangor are____________________________________________________

5. Romeo and Juliet are______________________________________________________

6. Maytag and Whirlpool are__________________________________________________

7. Harvard and Yale are______________________________________________________

8. Camels and Winstons are__________________________________________________

9. T-Bone and Porterhouse are________________________________________________

10. Valentino and Gable were__________________________________________________

11. Frank Sinatra and Judy Garland were________________________________________

12. Squash and Cucumbers are________________________________________________

13. Coke and Pepsi are________________________________________________________

14. Roosevelt and Eisenhower were_____________________________________________

15. Flannel and Satin are______________________________________________________

16. Apples and Bananas are___________________________________________________

17. Trout and Bass are________________________________________________________

18. Pines and Maples are______________________________________________________

19. Vermont and Maine are____________________________________________________

20. Wheaties and Cheerios are_________________________________________________

21. Collies and Poodles are____________________________________________________

22. Texaco and Mobil are______________________________________________________

23. Tide and Gain are_________________________________________________________


Exercise 2 (Answers on page 31)

1. Vermont and Missouri are____________________________________________________

2. Neptune and Mercury are___________________________________________________

3. Copper are Lead are_______________________________________________________

4. Feta are Gouda are________________________________________________________

5. Yen and Rupee are_________________________________________________________

6. Serenity and Apprehension are_______________________________________________

7. Gray and Violet are_________________________________________________________

8. Tea and Coffee are_________________________________________________________

9. Tsunami and Hurricane are__________________________________________________

10. Taj Mahal and Stonehenge are______________________________________________

11. Casa Blanca and The Shawshank Redemption are_____________________________

12. Trouser and Cardigan are___________________________________________________

13. Ferry and Tram are_________________________________________________________

14. Wrench and Screwdriver are_________________________________________________

15. Mobile Phone and Laptop are_______________________________________________

16. Shark and Salmon are______________________________________________________

17. Frida Kahlo and Georgia O’Keeffe are_________________________________________

18. Jackie Robinson and Willie Mays were________________________________________

19. Magic Johnson and Michael Jordan were_____________________________________

20. Red Maple are Weeping Willow are___________________________________________

21. Seattle and Tokyo are______________________________________________________


Answers to Affinities Exercise 1

1. Fords and Pontiacs are (Cars)

2. Roses and Marigolds are (Flowers)

3. Sparrows and Finches are (Birds)

4. Boston and Bangor are (Cities)

5. Romeo and Juliet are (Lovers)

6. Maytag and Whirlpool are (Appliances)

7. Harvard and Yale are (Universities)

8. Camels and Winstons are (Cigarettes)

9. T-Bone and Porterhouse are (Steaks)

10. Valentino and Gable were (Actors)

11. Frank Sinatra and Judy Garland were (Singers)

12. Squash and Cucumbers are (Vegetables)

13. Coke and Pepsi are (Soft drinks)

14. Roosevelt and Eisenhower were (Presidents)

15. Flannel and Satin are (Fabrics)

16. Apples and Bananas are (Fruits)

17. Trout and Bass are (Fish)

18. Pines and Maples are (Trees)

19. Vermont and Maine are (States)

20. Wheaties and Cheerios are (Cereal)

21. Collies and Poodles are (Dogs)

22. Texaco and Mobil are (Gas companies)

23. Tide and Gain are (Laundry Detergent)


Answers to Affinities Exercise 2

1. Vermont and Missouri are (States)

2. Neptune and Mercury are (Planets)

3. Copper are Lead are (Materials)

4. Feta are Gouda are (Cheese)

5. Yen and Rupee are (Currency)

6. Serenity and Apprehension are (Emotions)

7. Gray and Violet are (Colors)

8. Tea and Coffee are (Drinks)

9. Tsunami and Hurricane are (Natural Disasters)

10. Taj Mahal and Stonehenge are (Monuments)

11. Casa Blanca and The Shawshank Redemption are (Movies)

12. Trouser and Cardigan are (Clothing)

13. Ferry and Tram are (Transportation)

14. Wrench and Screwdriver are (Tools)

15. Mobile Phone and Laptop are (Technology)

16. Shark and Salmon are (Fish)

17. Frida Kahlo and Georgia O’Keeffe are (Artists)

18. Jackie Robinson and Willie Mays were (Baseball Players)

19. Magic Johnson and Michael Jordan were (Basketball Players)

20. Red Maple are Weeping Willow are (Trees)

21. Seattle and Tokyo are (Cities)


Block Tapping (Attention)

For this activity, tap the shapes on each page with your finger in an order you can

remember, then ask the client to watch and try to copy you. Explain to client that you will

tap shapes in order; the client should watch first and then repeat the pattern. Start with

two tap sequences and work your way up. If the client gets the order wrong, try again

until he or she gets it right.

Exercise 1


Exercise 2


Exercise 3


Exercise 4


Exercise 5


Antonyms (Language)

An antonym is a word opposite in meaning to another (e.g., bad and good). Have the

client determine the antonym for the words below. The first letter of each answer is provided.

The number of spaces indicates the number of letters in the word. If the client has

trouble figuring out what the antonym is, feel free to provide hints such as the next letter.

Example:

Above – B____ ____ ____ ____

A: Below


Find the antonym for the provided word; the first letter is provided.

1. Above – B E L O W

2. Answer – Q __ __ __ __ __ __

3. Back – F __ __ __ __

4. Better – W __ __ __ __

5. Cause – E __ __ __ __ __

6. Clean – D __ __ __ __

7. Close – O __ __ __

8. Cruel – K __ __ __

9. Dusk – D __ __ __

10. Deep – S __ __ __ __ __ __

11. Defense – O __ __ __ __ __ __

12. Deposit – W __ __ __ __ __ __ __

13. Empty – F __ __ __

14. Entrance – E __ __ __

15. Frail – S __ __ __ __ __

16. Fresh – S __ __ __ __

17. Flood – D __ __ __ __ __ __

18. Hard – S __ __ __

19. Harsh – M __ __ __

20. Help – H __ __ __ __ __

21. Hot – C __ __ __

22. Hurt – H __ __ __

23. In – O __ __

24. Keep – L __ __ __



Find the antonym for the below word. The first letter is provided.

1. Wise – F __ __ __ __ __ __

2. Alert – T __ __ __ __

3. Repair – D __ __ __ __ __

4. Straighten – B __ __ __

5. Strength – W __ __ __ __ __ __ __

6. Save – S __ __ __ __

7. Vanish – A __ __ __ __ __

8. Vice – V __ __ __ __ __

9. Vital – T __ __ __ __ __ __

10. Merit – F __ __ __ __

15. Proper – I __ __ __ __ __ __ __

16. Rapid – S __ __ __ __

17. Rare – C __ __ __ __ __

18. Expose – C __ __ __ __ __ __

19. Flexible – R __ __ __ __

20. Foreign – L __ __ __ __

21. Just – U __ __ __ __ __

22. Freedom – C __ __ __ __ __ __ __ __

23. Juvenile – M __ __ __ __ __

24. Lack – E __ __ __ __ __

11. Modern – A __ __ __ __ __ __

12. Neglect – C __ __ __

13. Particular – G __ __ __ __ __ __

14. Prosecute – D __ __ __ __ __


Answers to Antonyms Exercise 1

1. Above – B __ __ __ __

2. Answer – Q __ __ __ __ __ __

3. Back – F __ __ __ __

4. Better – W __ __ __ __

5. Cause – E __ __ __ __ __

6. Clean – D __ __ __ __

7. Close – O __ __ __

8. Cruel – K __ __ __

9. Dusk – D __ __ __

10. Deep – S __ __ __ __ __ __

11. Defense – O __ __ __ __ __ __

12. Deposit – W __ __ __ __ __ __ __

13. Empty – F __ __ __

14. Entrance – E __ __ __

15. Frail – S __ __ __ __ __

16. Fresh – S __ __ __ __

17. Flood – D __ __ __ __ __ __

18. Hard – S __ __ __

19. Harsh – M __ __ __

20. Help – H __ __ __ __ __

21. Hot – C __ __ __

22. Hurt – H __ __ __

23. In – O __ __

24. Keep – L __ __ __

Below

Question

Front/Forth

Worse

Effect

Dirty

Open

Kind

Dawn

Shallow

Offense

Withdraw

Full

Exit

Strong

Stale

Drought

Soft

Mild

Hinder

Cold

Heal

Out

Lose


Answers to Antonyms Exercise 2

1. Wise – F __ __ __ __ __ __

2. Alert – T __ __ __ __

3. Repair – D __ __ __ __ __

4. Straighten – B __ __ __

5. Strength – W __ __ __ __ __ __ __

6. Save – S __ __ __ __

7. Vanish – A __ __ __ __ __

8. Vice – V __ __ __ __ __

9. Vital – T __ __ __ __ __ __

10. Merit – F __ __ __ __

11. Modern – A __ __ __ __ __ __

12. Neglect – C __ __ __

13. Particular – G __ __ __ __ __ __

14. Prosecute – D __ __ __ __ __

15. Proper – I __ __ __ __ __ __ __

16. Rapid – S __ __ __ __

17. Rare – C __ __ __ __ __

18. Expose – C __ __ __ __ __ __

19. Flexible – R __ __ __ __

20. Foreign – L __ __ __ __

21. Just – U __ __ __ __ __

22. Freedom – C __ __ __ __ __ __ __ __

23. Juvenile – M __ __ __ __ __

24. Lack – E __ __ __ __ __

Foolish

Tired

Damage

Bend

Weakness

Spend

Appear

Virtue

Trivial

Fault

Ancient

Care

General

Defend

Improper

Slow

Common

Conceal

Rigid

Local

Unfair

Captivity

Mature

Excess


Idiom Completion (Language and Memory)

An idiom is a common saying or phrase that does not have a literal meaning. This activity

is best for clients with mild to moderate dementia as it focuses on stimulating the memory

domain of the brain. The object is to come up with the missing word to complete the idiom.


1. A penny for your _________________

2. _________________ makes the heart grow fonder

3. Actions speak _________________ than words

4. To add _________________ to the fire

5. To _________________ insult to injury

6. A little _________________ told me

7. All in a _________________ work

8. _________________ of someone’s eye

9. Armed to the _________________

10. At each other’s _________________

11. The _________________ of both worlds

12. Ball-_________________ figure

13. To bark up the _________________ tree

14. To be up to no _________________

15. To beat _________________ the bush

16. Big fish in a _________________ sea

17. To bite the _________________ that feeds you

18. Costs an arm and a _________________

19. A clean _________________ of health

20. To come away _________________ handed

21. Come to _________________ of it

22. A cut above the _________________

23. To _________________ a hard bargain

24. A dream come _________________



1. Pull the _________________ over other people’s eyes

2. To pass the _________________

3. A _________________ of cake

4. To play something by _________________

5. To play it _________________

6. To _________________ a fast one

7. To push one’s _________________

8. To put up a _________________ fight

9. As quiet as a _________________

10. _________________ and dirty

11. To _________________ one’s brain

12. To rain _________________ and dogs

13. To read _________________ the lines

14. To rock the _________________

15. To rub someone the _________________ way

16. Safe and _________________

17. To save money for a _________________ day

18. To see the _________________ on the wall

19. Speak of the _________________!

20. Strong as an _________________

21. Take it or _________________ it

22. To take something/someone for _________________

23. To take something with a grain of _________________

24. _________________ in cheek


Answers to Idiom Completion

Exercise 1

1. A penny for your thoughts

2. Absence makes the heart grow fonder

3. Actions speak louder than words

4. To add fuel to the fire

5. To add insult to injury

6. A little bird told me

7. All in a day’s work

8. Apple of someone’s eye

9. Armed to the teeth

10. At each other’s throats

11. The best of both worlds

12. Ball-park figure

13. To bark up the wrong tree

14. To be up to no good

15. To beat around the bush

16. Big fish in a little sea

17. To bite the hand that feeds you

18. Costs an arm and a leg

19. A clean bill of health

20. To come away empty handed

21. Come to think of it

22. A cut above the rest

23. To drive a hard bargain

24. A dream come true

Exercise 2

1. Pull the wool over other people’s eyes

2. To pass the buck

3. A piece of cake

4. To play something by ear

5. To play it safe

6. To pull a fast one

7. To push one’s luck

8. To put up a good fight

9. As quiet as a mouse

10. Quick and dirty

11. To rack one’s brain

12. To rain cats and dogs

13. To read between the lines

14. To rock the boat

15. To rub someone the wrong way

16. Safe and sound

17. To save money for a rainy day

18. To see the writing on the wall

19. Speak of the devil!

20. Strong as an ox

21. Take it or leave it

22. To take something/someone for granted

23. To take something with a grain of salt

24. Tongue in cheek


How Many Squares? (Visual-Spatial)

This activity involves counting the number of squares that are in each of the below

designs. Have the client count how many squares they can find within the design.

Keep in mind that rectangles do not count as squares.











Answers to How Many Squares?

1. 5 Squares

2. 30 Squares

3. 14 Squares

4. 9 Squares

5. 11 Squares


Visual Puzzles (Visual-Spatial)

Shown below are line drawings that have been taken apart and rotated. Ask the client to

identify the original object.

1 (Answer on page 61)
















Visual Puzzles (Visual-Spatial) Answers

1. Beach ball

6. Hamburger

2. Tennis racket

7. Dress shirt

3. Guitar

8. Cat

4. Wrench

9. Bicycle

5. Umbrella

10. Feather


Activities not oriented around cognitive

tasks can also have a positive impact on

one’s brain functioning. These activities

may include: social engagement, sensory

stimulation, recreation, stress management

or light physical exercises.

Flower Arranging

Materials:

• Different types of fresh flowers or different

types of fake flowers trimmed into

individual stems

• Styrofoam block

• Small glass or plastic container (use ribbon

or string to decorate)

• Note card

Separate the bunches of flowers on a table

so that it is easy to select individual stems

(If fresh flowers, trim stems first to length of

vase and remove any thorns). Encourage

your client to do as much of the selection

and arrangement as they are able. Have

client select where to place the bouquet

around his/her home. You can also write a

note together from the client to the recipient

of the flowers. This is a great activity to

do while playing calming music in the

background.

Bean Bag Toss

Materials:

• Bean bags

• Colored paper or colored plates

Have the client sit comfortably in a chair or

stand. Line four plates in front of the client

with the first plate closest (first base) followed

by the second (second base) and third (third

base) and fourth (home plate) or in a baseball

diamond pattern. Clients can throw the bag

at any of the bases. The goal is to have the

bag land on or touching the plate.

Balloon Games

Balloon games are a fun way to get

exercise with clients, including those who are

wheelchair or bed bound. Blow up a balloon

and volley, by hitting the balloon back and

forth. Put on upbeat music to add a festive

feel. Add a plastic fly swatter to bat the

balloon for an added challenge.

Magazine or Photo Scrapbooking/

Reminiscing

Materials:

• Magazines or scanned family photos (never

scrapbook with original family photos)

• Safety scissors

• Tape or glue

• Colored paper

• Photo box or binder with 3 hole punched

plastic sheet protectors

• Extras: stamps and stamp-pad, colored

pens or pencils

Magazine scrapbooking: Clients can cut

(use safety scissors, not sharp kitchen

sheers) out pictures they like, or to make

it more challenging, choose a theme like:

transportation, outdoors, women’s clothing,

food.

Photo scrapbooking: Cut out each photo

(use copies not originals) and have the client

select a color background. Talk with the

client about the photos and write details you

discuss, such as a description of the picture.

Encourage the client to participate in gluing

or taping the photo into the scrapbook.


Social Reminiscing

Explore childhood and young adult

memories; happy events from the past.

Example questions are provided below, but

if you feel like the conversation is lacking

in substance, you can ask questions of

your own. You might ask, “How did your

husband/wife propose?” or “How long were

you engaged?” Keep it light and avoid any

topics that you think may distress the client.

If the client starts to get distressed, steer

the conversation to a different topic. You

might share your own brief anecdotes, but

remember the purpose is to engage your

client in his/her own history. The following are

potential topics and suggested questions.

Vacations:

1. What is your favorite type of vacation

(beach, camping, hiking, safari,etc.)?

2. What is your most memorable vacation?

Were you with your family, friends or were

you alone?

3. What is your favorite holiday? What is your

favorite holiday memory?

4. When you were a young adult, did you like

to travel or spend vacations at home?

Favorite Games:

1. What was your favorite childhood game?

2. Do you have any fond memories of a

particular game you used to play that you

remember from your childhood?

3. Did you prefer board games, card games or

other types of games (Ex. Hide and Seek)?

4. Are you competitive? What do you like

about playing games?

First Pet:

1. What was your first pet? Dog? Cat? Fish?

2. What was his/her name? How did you pick

the name?

3. What memories do you have of your first

pet?

4. Did you have other pets? What kind? Did

your pets travel with you? What made your

pet unique?

School Days:

1. Where did you go to grammar school?

High school? College?

2. What are your fondest memories of your

school days?

3. Do you remember any of your teachers?

Did you have a favorite teacher? Why was

he/she your favorite?

4. Did you stay in touch with your friends from

your school days?

Holidays:

1. What was your favorite holiday growing

up? Why?

2. If you could relive one holiday memory, which

one would it be? Why is it so special?

3. Did you celebrate holidays with extended

family? What did you do?

4. Did you travel anywhere special for

particular holidays? With who? Where?

How did holiday celebrations change

throughout your life?

Political Events:

1. Where were you when you learned that

President Kennedy was assassinated?

2. What do you remember about the fall of

the Berlin Wall?

3. What were the most memorable events

during the Civil Rights Movement?

4. When your hear: “Once small step for

man,one giant leap for mankind,” what

memories come to mind?


Childhood:

1. What do you remember most about your

childhood? Where did you grow up?

2. Did you have a large family? Brothers?

Sisters? What about your extended family?

3. If you could relive one memory of your

childhood, what would it be? Why?

4. What did you used to love to do when you

were a child?

Adolescence:

1. What do you remember most about your

adolescence?

2. What was the most significant change

from childhood to adolescence for you?

3. What did you do for fun? Who were your

friends?

4. Adolescence can be a challenging time.

What was most challenging for you?

Music:

1. What was your favorite kind of music

growing up? Has it changed?

2. Do you have any of your old albums? Who

were your favorite artists?

3. Did you ever go to a concert? Who did you

see? Who would you have liked to see?

4. What were your favorite times to listen to

music? In the car? In the morning? During a

dinner party?

Dance:

1. Do you like to dance? Did you always like

to dance? What is your favorite kind of

dance?

2. Did you go to your high school prom?

What do you remember about it? Who did

you go with?

3. Where did you like to dance? At a party?

On stage?

4. Do you have any particularly fond

memories of an experience when you were

dancing?

Car:

1. Do you remember your first car? What was

it?

2. What was one exciting memory about the

first time you learned to drive? What were

some of the challenges?

3. Where did you used to drive? What other

cars have you owned?

4. What was your favorite thing about being

able to drive? Least favorite?

Job:

1. What was your first job? How long did

you work there?

2. Did you ever work at a restaurant or in

retail? What was it like? What other types

of jobs did you have?

3. What was your favorite job? What did

you like about it?

4. What is one good memory you have

about a job you had?


Hand Massage

You will need:

• Lotion

• Towel

• Pillow

• Soft music CD

A hand massage is a great way to provide

soothing interaction with clients. The purpose

of this massage is to provide a relaxing

touch, not a medical treatment. Massaging

movements should have very minimal

pressure as seniors’ skin is very frail.

Always check with the Staffing Manager

or Client Care Manager before giving a

client massage as they may have health

conditions such as arthritis or wounds that

would make it an uncomfortable experience.

Have the client sit comfortably in a chair.

Place a towel and pillow under their arm

so they are comfortable. Always ask

client throughout the massage if they are

comfortable.

• If your client is able to communicate

verbally: “Hand massage helps some

people with relaxation and I thought that

you might enjoy one.” If your client agrees,

be sure to let them know that they should

tell you to stop immediately if anything

feels uncomfortable.

• If your client has advanced dementia and

is unable to communicate verbally: Sit

facing them and take their hand in your

hand. Hold their hand a minute before

starting the massage. “ [Client Name], I’d

like to give you a hand massage to help

you feel nice and relaxed. I’m going to

put some lotion on your hand.” Look for

any non-verbal cues that your client is

uncomfortable.

Music

Questions to determine music preferences

include:

1. What type of music do you like ( e.g.

Jazz, Swing, Big Band, Country, Gospel,

Classic, Rock, Religious)?

2. Who are your favorite singers? Popular

singers/groups include: Frank Sinatra, Dean

Martin, Louis Armstrong, Doris Day, Nat

King Cole, Glenn Campbell, Andrews

Sisters.

3. Do you currently or did you used to play

a musical instrument?

Using Music with Clients:

Music can be played throughout the day.

Some particular times you may want to play it

may be:

• While preparing for and during bathing.

Playing a client’s favorite music can help

put them in a more positive mood and can

distract from any discomforts they have

with bathing.

• To spark socialization. Listen to music

together, sing-along, ask a question like:

what does this song make you think of?

• When your client is agitated: Putting on

relaxing, soothing, familiar music can help

ease the anxiety or frustrations they are

feeling.

• While preparing for bed: Relaxing,

soothing music can help signal that it is

time to get ready for bed.

• While getting ready to go out: Upbeat

music with a strong beat can help awaken

clients and prepare them for outings.

62 / Balanced Care Method Workbook Social Ties

Social Ties

Social ties – our connections to other people

– keep us healthy. They provide emotional

support, make us feel connected, reduce

depression, sadness, and loneliness and

help limit stress levels. Conversation between

caregivers and seniors, then, is essential to an

active and healthy relationship.

Many people find their social ties become

fewer as they age; friends and family

members move or pass away, and a lack of

independence can hinder the ability to go

on social outings. Yet such ties are important

for our mental and physical well-being. If

your client is very social, facilitate that. If your

client seems to be pulling away from people

or becoming more isolated, encourage him

or her to maintain his or her sociability.

The Balanced Care Method Social

Connection Overview:

• Stimulate conversation

• Daily phone calls or emails

• Visiting with friends or family

• Senior center visits


Conversation

Spend at least one hour per day

conversing with your client. Try one of these

conversation starters to get to know your

client better and find things to talk about:

• What did you do for your 21st birthday?

40th?

• Where did you go to school?

• What was your favorite subject in school?

• Did you ever take dance lessons?

• Have you ever traveled to or lived in

another country?

• If you could visit any place in the world,

where would it be?

• What’s your favorite song?

• What’s the strangest thing you’ve ever

eaten?

• What’s your favorite movie?

• What’s the best costume you’ve ever

worn?

Reading a newspaper or magazine out loud

can also stimulate conversation. Choose a

story that interests both of you and discuss it

together.

Written and Oral Communication

Just one phone call a day can help people

feel connected to those they care about.

Make a list of the people your client has

fairly regular contact with and, working with

them and your client, draw up a schedule

for phone calls. Many people tend to make

phone calls to family on the weekends; a bit

of scheduling can help spread the phone

calls out over the course of the week.

Some older people enjoy writing letters to

friends and family members. Many seniors

may also find a great deal of satisfaction in

the tradition of sending cards for holidays.

Help your client maintain a list of people to

send cards to, shop for cards, and mail them

if this is important to him or her.

Email is another great, sometimes more

convenient way for seniors to stay in touch

– especially with younger family members.

Encourage your client to email with his or her

family and friends.

Skype and other video-enhanced web

communications are additional ways

for families to interact remotely – and

see growing grandchildren or greatgrandchildren

in action. Talk to your client’s

family about setting up a Skype or Google

Video Chat account.

Your client may enjoy engaging with others

– friends, family, or like-minded people – on

online gaming sites (i.e. Scrabble or bridge).

Some sites allow people to play in real-time

while others allow people to take their turns

at their convenience.

Visiting with Friends or Family

Visiting friends or family is, of course, the

best way to maintain social ties. You can

offer to pick up friends for a luncheon at the

client’s home and help prepare a meal for

them or hold an afternoon tea for neighbors.

Facilitate visits to family and friends’ houses

as well if at all possible. Some tips for making

visits successful:

• Plan the whole day, knowing how long

travel time is in particular

• Make sure your client is well-rested and

well-fed on visiting days

• Bring a snack and water

• Pack an extra jacket or sweater

• Keep visits to a length that doesn’t leave

your client overly tired


Community Outreach

If your client is mobile and this idea is

appealing to him or her, taking a seminar or

class at a local community center or college

can be a great way to meet people with

similar interests.

Visits to senior centers or other community

gatherings are a great way to add

sociability to a daily or weekly schedule,

according to your client’s mobility and

energy level.

Worship services, arts and crafts, or book

clubs can also be sources for maintaining

social ties and helping build new ones.


Calmness & Purpose

Okinawan elders’ inner calm and desire

to remain productive into older age offer

substantial stress relief, a sense of social

connection and purpose, and allow them to

continue playing an important role in their

community. Most of these seniors practice a

spirituality that combines the nature-revering

aspects of Taoism, the communal respect

emphasized by Confucianism and a native

belief that celebrates women as connectors

between past and present. To apply these

principles to your own life, simply slow down,

take a deep breath and become more

involved with family, community and religion

or spirituality.

The Balanced Care Method emphasizes

calmness and bringing meaning and

purpose to seniors’ lives by engaging them

in their favorite topics, hobbies and activities.

Older adults with a calm and purposeful

lifestyle are better equipped to avoid stress,

disease and symptoms of depression. As a

caregiver, you provide companionship and

act as a natural partner for the activities

clients enjoy, allowing them to maintain their

independence and quality of life. The more

66 / Balanced Care Method Workbook Calmness & Purpose

seniors can keep to their preferred activities

and social networks, the more active,

healthier and happier they will be. Fresh air,

time in nature, sitting and enjoying a pretty

view are all extraordinarily calming and

stress-relieving for people of all ages and

can be particularly effective as people lose

their physical and mental abilities to relieve

stress in other ways.

Purpose

Feeling useful is important for a sense of

mental well-being. As people get older,

a sense of purpose can often diminish,

especially if the loss of physical or mental

abilities hinders them from participating

in activities that used to fill their days.

Each person interprets feeling “satisfied”

or “productive” differently, so listen to and

observe what matters most to your client.

Ways to keep purpose:

• Maintain hobbies or start new ones

• Regular tasks – such as taking walks or

doing light household chores

• Write or record memories or family history

• Activities– such as crafts, puzzle-solving

and skill-based games

• Community involvement – attend classes

at a senior center or go to a place of

worship

• Help client get involved in a volunteer

activity (making quilts, writing letters)

Ways to achieve calmness:

• Moments of focused, relaxed quiet

• Prayer and worship– If your client has a

place of worship, facilitate regular visits

• Yoga– Yoga studios and classes are

available in almost every city and plenty

of towns.

• Many senior centers offer senior-specific

classes

• Meditation is the practice of focusing

thought. It can have enormous health

benefits and an amazing ability to lower

stress levels. If your client is interested,

classes in meditation are offered at many

senior and community centers, as well as

many yoga studios

• Tai chi and qi gong–Some senior or

community centers often offer seniorspecific

classes

• Time in nature – Walks, bird-watching,

or having a picnic are all engaging ways

to spend time outdoors. Visiting the town

garden or park near your client’s home is

also a wonderful way to get fresh air and

exercise

• Listening to favorite music

Calmness

Including practices that keep stress levels low

in your daily routine is important for overall

health, and is particularly essential as we

age and our ability to process and relieve

stress decreases.


Etiquette

Basic etiquette is the cornerstone to building

a pleasant relationship with your client.

Most importantly, address your client as he

or she wishes to be addressed. Establish

this in the beginning of your relationship:

would she like you to call her Mrs. Smith, or by

her first name? Avoid terms of endearment,

such as “dearie” or “sweetheart.” While your

intentions may be good, many seniors find

these terms demeaning or insulting; they are

inappropriate in a working relationship.

A vital part of your job is to maintain strict

and absolute confidentiality regarding your

client. You will be privy to many personal,

private, and medical facts about your client.

This information should not be shared with

anyone. In general, you should not talk about

your client with anyone outside of the working

relationship.

68 / Balanced Care Method Workbook Etiquette

Clothing & Appearance

It is also important that you dress

appropriately for your work. You should

be well groomed with properly fitted,

comfortable work clothes.

• Hair should be clean and worn short or

pulled back

• Jewelry should be minimal and not

dangling

• Clothes should be clean and fit properly

–neither excessively baggy nor tight or

clingy

Bodily Care

Different clients require different levels of

physical care. The Balanced Care Method

promotes independence, allowing clients to

continue doing the activities within their

abilities. This approach will help seniors

maintain their strengths and privacy.

If your client requires help bathing and going

to the bathroom, treat him or her with the

dignity an adult deserves. Using babyish

terms, cajoling, or otherwise treating him or

her as a child is not appropriate.

• Use proper names for body parts

• Let your client know what you are going to

do before you start doing it (“I’m going to

lift your arm now, are you ready?”)

• Allow them to do as much for themselves

as they can

• Avoid referring to any bodily care you

provide when it is not in progress and do

not, under any circumstances, refer to that

care in front of other people

69 / Balanced Care Method Workbook Daily Checklist

Daily Checklist

Healthy diet

Several servings of whole grains

Several servings of fresh vegetables

1 serving of fresh fruit

Omega-3-rich foods

Soy-based foods

At least 8 cups of water and/or green tea

Active culture yogurt or low-fat milk

Physical Activity

Basic stretches, as able

Any prescribed stretches

Strength building, as able

Aerobic exercise, as able

Cognitive Engagement

About an hour of cognitive and

non-cognitive activities selected from

workbook

Social Ties

Phone call or email to friend or family

member

At least 1 hour of conversation

Visit to friend, group, or center as able

Purpose & Calmness

Hobbies or housework, as able

At least 1 calming activity

70 / Balanced Care Method Workbook Quiz

Quiz

T F 1. A major factor that results in the extraordinary health enjoyed by Okinawan elders

is their distinct diet.

T F 2. There is no nutritional difference between various fruits and vegetables.

T F 3. Similar to the Okinawan practice of hara hachibu, which means eating until only

80% full, the Balanced Care Method promotes moderate, low-calorie eating to help

achieve or maintain a healthy body mass index.

T F 4. Caffeine is harmful, so all tea and coffee should be avoided.

T F 5. The five cognitive domains are: Executive Functioning, Attention, Sensory, Memory

and Language

T F 6. Executive functioning refers to the ability to accurately perceive an object’s physical

location and understand the relationship between objects.

T F 7. It is recommended that seniors exercise 4-5 times per week with the consent and

guidance of a physician.

T F 8. Stretching is best done when the body is warm, and is better to do after another

type of exercise or after a bath or shower.

T F 9. Weight-bearing exercise, like walking, is also important for people of all ages.

T F 10. Visiting a museum and scent guessing are examples of activities that can boost

memory and cognitive abilities.

T F 11. You should aim to spend at least one hour per day conversing with your client.

T F 12. Older adults with a calm and purposeful lifestyle are better equipped to avoid

stress, disease and symptoms of depression.

T F 13. As a caregiver, you can provide companionship and act as a natural partner for the

activities clients enjoy.

T F 14. As people get older, a sense of purpose can often diminish, especially if the loss of

physical or mental abilities prevents them from doing the things they used to love to do.

T F 15. Watching television and sitting in isolation are good ways to promote calmness.

T F 16. You can call your client “dear” or “sweetie”.

T F 17. You can wear whatever you want to work because your client likely will not care

or notice.

T F 18. When helping clients with hygiene, it’s important to let them do as much as they

can on their own and verbalize each step so they know what to expect if you will

be helping them.

T F 19. A vital part of your job is to maintain absolute confidentiality in your work and you

should not speak about your client outside of work.

T F 20. You can make major changes to your client’s routine without consulting your supervisor.

Quiz Answers

1.T 2. F 3. T 4. F 5. F 6. F 7. T 8. T 9. T 10. T

11. T 12. T 13. T 14. T 15. F 16. F 17. F 18. T 19. T 20. F

About

Home Care Assistance

At Home Care Assistance, we provide customized care to older adults so they can live

happier, healthier lives at home. We champion the needs of seniors with a positive,

empowering approach to aging that celebrates independence, dignity and quality of

life. Our caregivers receive exceptional training, support and resources to deliver an

unmatched care experience.

High Quality Care

We go above and beyond to deliver concierge-level care

for clients who want, and expect, the very best for their

aging loved ones.

Committed to Our Clients

We believe the best way to deliver exceptional care is

to focus on building long-term, trusting relationships

between caregivers, seniors and their families.

Elevated Quality of Life

Our Balanced Care Method emphasizes healthy

mind, body and spirit. We believe that with the proper

care, we can help older family members live happier,

healthier and more fulfilled lives.

Trusted Care Expertise

We are experts in all aspects of home care, from

family dynamics to nutrition, around-the-clock care to

dementia. And we train our caregivers accordingly.

Total Peace of Mind

We understand the trust you place in us, and do

everything possible to ensure that the home care

experience is worry-free for all concerned.

Connected in the Community

We are the trusted partner of reputable care

professionals in the communities we serve. We pride

ourselves on connecting our clients to the care solutions

they need - even if it’s outside our service offerings.

1-866-454-8346

HomeCareAssistance.com

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