The Pool Activity Level (PAL) Instrumental Tool1 is a framework designed to support individuals living with dementia. This article discusses how to support persons living with dementia in the mild stages of dementia, who are usually in the Planned stage of the PAL tool. Learn more about tailoring activities for your loved ones’ cognitive and functional abilities.
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What is the Planned Level
The Planned Level of the PAL tool describes those at the earliest stage of dementia. At this Level, persons living with dementia can still carry out well-rehearsed tasks and routines with structure and support, but they need prompts and environmental cues to stay on track.
For instance, they can go to the market or coffee shop to buy their daily meals. However, if there are changes to the shop, such as its location, they may face difficulty orienting themselves.
Below is an example of how to identify if your loved one is at the Planned Stage:
Level | Person Living with Dementia | Example (Getting Dressed) | Role of Caregiver |
|---|---|---|---|
Planned Level | Plan and carry out familiar tasks independently | Plans what to wear; selects own clothing from cupboard; dresses in correct order | Encourage autonomy with minimal guidance |
What should Caregivers Do?
The following shares how, as a caregiver, you can support your loved one living with dementia at the Planned Level:
1. Provide Structure and Routine
- Stick to a familiar schedule to reduce confusion and anxiety. Consider providing an activity schedule or timetable for your loved one to know what is expected throughout the day. Place it in an area visible and frequented by your loved one.
- Engage them in activities that follow established patterns, such as making a cup of Milo, folding laundry, or gardening.
- Use step-by-step instructions, repeating as needed. Provide 2-3 steps instruction, giving verbal promptings if required. For example, “Pour the powder in the cup” (pause) “Let’s add the water now.”
2. Use Environmental Cues
- Label cupboards and rooms with pictures and simple words.
- Keep commonly used items in consistent, visible places that are easy to reach, such as a low cabinet.
- Use visual aids or colour codes to indicate steps.
- For example, using matching colors on keys and the items they unlock.
3. Offer Guided Participation
- Let them initiate the activity, when possible, and try to join in as a collaborator rather than an instructor.
- Use verbal prompts, gestures, or demonstrations when they hesitate or forget what to do next.
- Encourage independence with supervision, intervening only when necessary.
- For example, if the person living with dementia has been regularly cooking, caregivers can make sure their loved one is within sight during that activity to ensure safety and intervention when required.
4. Choose Familiar and Purposeful Activities
- Select tasks they used to do regularly, such as setting up the table, sorting items, or simple craftwork such as knitting or sewing.
- Focus on the process of doing the activity, rather than completing it perfectly.
- Social activities like taking a walk in the park or sensory and creative activities like sing-along sessions and gardening are ideal.
5. Communicate Simply and Positively
- Speak slowly, clearly, and use simple, familiar words.
- Offer praise and encouragement, reinforcing their effort and participation.
- Avoid correcting or criticising — redirect gently if they are off track.
Use familiar words
”Its time to eat now”
”We can go soon”
Praise and encouragement
”That looks great, you are a good painter. Thank you for helping me”
Avoid correcting or criticising
”I like the design, why don’t we try a different method for the next one?’
6. Minimise Distractions
- Create a calm, clutter-free environment.
- Reduce distracting background noise and unnecessary sensory inputs such as glaring lights to help them focus.
Matching support to your loved one’s current cognitive abilities may preserve dignity, promote engagement, and reduce frustration or behavioural challenges for your loved ones. At the Planned Level, the goal is to empower them to continue participating in meaningful tasks/activities.
Activities for Planned Level
Such activities offer a sense of purpose and familiarity:
- Folding laundry (e.g. towels, clothes)
- Setting the table with guided prompts
- Sweeping or dusting
- Sorting items (e.g. cutlery, buttons, socks)
- Watering plants Making a simple sandwich or a wrap by helping to prepare ingredients
Such activities support self-expression and refine motor engagement:
- Colouring or painting within outlines
- Simple knitting or sewing tasks
- Making greeting cards with prepared materials
- Creating collage from magazines
- Decorating cookies or cupcakes
Music taps into preserved emotional memory:
- Singing along to familiar songs or listening to their favorite tunes
- Clapping or tapping to the rhythm of a song
- Playing with simple percussion instruments (e.g. tambourine, shakers)
- Scent matching with aromatics (e.g. coffee, cinnamon sticks, laksa leaves), essential oils or herbs.
Engage memory and identity:
- Looking through photo albums
- Matching games using familiar images
- Reminiscence storytelling (“Tell me about your/your children’s wedding day.”)
- Reading aloud (with large print newspaper articles, books or poems)
- Listening to short stories or radio plays/podcast
Promote movement and coordination:
- Guided walks in a garden or along the corridor
- Simple chair exercises with music
- Ball toss or bean bag games
- Dancing or swaying to familiar music (even when seated)
Foster connection and interaction:
- Playing Bingo or picture-based games with visual cues
- Participating in small social gatherings
- Participating in group sing-along sessions/Karaoke
- Participating in structured group craft sessions
Activities should be person-centered and adapted to their past interests, preferences, and current abilities. When supported appropriately, individuals at the Planned Level can still find joy, purpose, and connection through these daily experiences.
Conclusion
These activities provide your loved one living with dementia a sense of autonomy while playing to their strengths.
- Pool, J. (2022). How to support people living with dementia at the Planned level. CaringTimes. https://caring-times.co.uk/feature/how-to-support-people-living-with-dementia-at-the-planned-level/
- Pool, J. (2012). The Pool Activity Level (PAL) Instrument. Jessica Kingsley publishers, London. https://www.dailysparkle.co.uk/wp-content/uploads/2022/04/PAL-Guide-for-Activity-Provision.pdf
