Feeding the person is usually done while the person is in a vertical position and seated in a chair. However, their attention is directed toward the food with little or no attention directed to maintaining their sense of balance. After being fed, they usually go to sleep because they are worn out. The time being fed does not seem to meet the need to be in a vertical position because the signs of distress still appear.

Prevent malnutrition, dehydration and choking by feeding a pureed diet, with thickening liquids. Total assistance is required.

The person will assist with rolling to ease placement of bedpan and holding their arm over the bed rail for perineal care.

Full assistance is required for cleaning perineal area, changing incontinence pads and managing clothing.

Caregivers need to schedule toileting 30 minutes after meals and every 2 hours.

ACL 1.6

A sponge bath maybe given and hair is washed in bed.

ACL 1.8

Caregivers may provide physical guidance and verbal directives to hold up body parts, hold arm over the bed rail and roll body to cooperate with bathing.

When a tilt-in-space shower / commode chair with head support is used, the person will also cooperate by holding still.

To preserve their dignity for daytime wear and for caregiver ease, modify the person's customary clothing to open / fasten down the back.

ACL 1.6

The person will assist with dressing by rolling, holding their arm over bed rail, and following the direction to "hold still."

ACL 1.8

Caregivers may provide physical guidance to roll from side to side, initiate "bridging" to hold up buttocks for a few seconds to cooperate with donning lower extremity garments.

The person is dependent on others for all of their self-care activities.

Caregivers will need to assist with all activities of daily living and ensure that an adequate level of care is provided.

The person may cooperate with swallowing pureed food, holding a trunk position or lifting a body part if the caregiver waits 20 seconds.

Things that produce sounds vary. Everyday objects can produce a sound. It can vary in volume and pitch. If the person has a favorite instrument see if a relative will bring it in if it is portable. Find recordings of their favorite familiar music. Keep beats and rhythms simple. Other sounds that capture attention are things like bike bells.

They may respond to simple instructions like "hold still" now.

Taste preference is also very individualized. You may have siblings with very similar backgrounds who have very different food preferences. This preference can also occur in people with a cognitive disability. Give them a variety of tastes to awaken their senses. Of course, adhere to swallowing precautions. Some strong taste experiences are salty, sour, sweet and bitter.

A person's sense of smell may diminish as their cognition drops. The smell will have to be very strong in order to gain their attention. Mustard, garlic, lemon, perfumes and various herbs and spices produce strong distinct smells.

Primary contrasting colors are noticed in ACL1 High when their vision is intact. A PDF of a yellow smiley face is available here: https://acdmweb.com/downloads.

Busier pictures maybe ignored as the information is not processed.