Yoga and Advanced Aging, Part 4: Teaching in Assisted Living, Skilled Nursing, and Memory Care Spaces

“It’s your birthright to live into your entire body.” Matthew Sanford

Part 4: Grounding, Rhythm, and Movement

In Part One of this series we explored the atmospheric challenges of teaching in Senior Care spaces and focused on being creative and looking for hints of connection. In Part Two we discussed the importance of creating a welcoming community that can heal and transform by encouraging students to bring their stories into the space. We also looked at a few movements we might avoid with this population. Part Three was all about breathing and the body’s brilliance in using the breath as a problem-solving mechanism. We considered shifting our cueing in order to help students develop a more subtle relationship to the breath and body. In this fourth and final installment we will explore the grounding, rhythm, and movement.

Don’t Forget the Feet

I recently had a conversation with a yoga teacher who asked me to describe what it is I do. She said, “So, you get your students into parts of the shapes?” I replied, “I would argue there are no ‘parts of the shapes;’ you are either teaching a sensation of wholeness or you aren’t.” One of the things I frequently notice when observing Chair Yoga classes is that teachers often forgo mentioning the importance of how the feet and legs relate to spinal awareness and functional movement of the body.

“Chair yoga is not yoga from the waist up. Don’t forget the feet,” is something I preach in my workshops. The fact that many students with advanced aging sit for prolonged amounts of time, use wheelchairs, or need the assistance of walkers is all the more reason to cue them to use their legs to support their spines. By cueing through the feet and legs, not only are we building strength in the lower body and core, we are also getting more of the nervous system online.

We start the movement portion of my seated chair classes “walking in place.” As we move our legs, I ask students to walk their feet all the way out in front of their bodies and bring their awareness to how out of balance they just became from the waist up. We then walk our feet underneath our chairs and explore sensations from that position. I have them find the midpoint between those two extremes and ask them to notice the support the legs provide in this position. I cue them to firmly press down through their feet and use the strength of their legs to help them sit up a little taller. From there we explore how much effort we need to expend to maintain this posture. Efficient integration of our outer bodies leads to access into subtler spaces inside ourselves.

Rhythm is Powerful

Keeping the legs active in the posture above (aka Seated Mountain Pose), I ask my students to bring their awareness to their belly. Borrowing a cue I gleaned from renowned yoga therapy teacher Doug Keller, I playfully ask students to, “Imagine you’re putting on a ‘snug pair of pants.’ They've been in the dryer just a little too long. Button up those pants and keep them buttoned as you relax your ribs and breathe.” From there we begin to sway side-to-side, slowly creating circles, and rocking forward and back. All the while, I am cueing the feet, belly, and spine.

This sequence is the glue of my teaching and is my go-to transition. Knowing that rhythm is a powerful inroad to the nervous system, and swaying is usually accessible in some form or fashion for my students, I incorporate this sequence early and often. The repetition creates body memory and an anchor that students can return to if something we just attempted was difficult or challenging. In most cases, I will lose my students if I ask them to sit still in contemplation. So, we contemplate in movement.

Slow rhythmic movements are very calming and can be used as a grounding tool in chaotic environments. I had a student fall in class recently. We were all understandably concerned and dysregulated. While nurses and staff attended to the injured student, I led the students through a rocking and tapping sequence. We held our classmate in our hearts and extended our compassion to her. The energetic shift in the room was palpable within minutes. We were able to reset and continue with class as she received the medical care and attention she needed.

Functional Movements

Another way to incorporate rhythm is to gently move the joints. Shrugging the shoulders, wiggling the fingers, swinging the legs, lifting the heels and toes, shaking the head yes and no are all familiar access points into the body. When taught with mindful intention, these movements are great opportunities to create connection by layering in the breath and/or adding detailed focus.
Here are a few examples: 1) Shake out your hands, breathe in, and sigh it out, 2) Lift your shoulders up and breathe in, lower them down and breathe out, 3) Wiggle your fingers and then touch your fingertips with your thumbs, 4) Open your hands wide, now make a fist, open your hands wide and breathe in, breathe out as you make a fist.

Movement Across the Midline

Moving across the midline is a staple of my sequencing; the midline is an imaginary line down the center of the body that divides it into left and right. This type of movement stimulates both hemispheres of the brain, but for students with a stroke history, coordinating movement across the midline can be challenging. Choosing an accessible pace and teaching with patience encourages students to problem solve.

Here’s an example: Cross your arms and take your opposite hand to your opposite leg, slide your bottom arm out and place it on top, once you start moving keep moving. You may notice that one arm is easier to move than the other, that’s okay, go as slow as you need to. Notice your breath. Breathe out and take a gentle breath in and a slow breath out.

I usually shy away from using left/right cues. Left/right discrimination is one of the things that students with age-related cognitive decline and dementia struggle with. When I do cue lefts and rights, I start a sequence on a specific side and see how the class responds. If I feel like they’re able to follow those instructions fairly well, I will keep using left and right language as a cognitive exercise. If I find the class is having a hard time, I get creative with my approach.


Let’s take a look at a few different ways you could cue a sequence that requires bilateral coordination. 1) Lift your right arm up toward the ceiling, now lift your left leg; or 2) Lift one arm up toward the ceiling, now lift your opposite leg; or 3) Let your hands rest on your legs, take one arm up toward the ceiling, now lift the leg that you’re touching.

The sequence we just explored in the last paragraph requires students to move in multiple planes at once, i.e., across the midline and in the upper and lower body. You may have noticed that I cued movement in the upper body first, then the lower body. This allows the students find precision on one side before they cross the midline and add on. My pace is usually slow and deliberate. I might eventually layer in the breath or ask them to lift the legs and arms at the same time once they have settled in to the sequence. If students are having a difficult time managing a task, let them move without expectation of outcome. Sometimes things work, sometimes they don’t. Non-attachment and going with the flow are necessary when working with this population.

I thank you for reading this series, and encourage you to connect with your students, find your unique voice, and get creative as you share yoga with this population. Things that may not look like “yoga” can be incorporated into your classes when practiced in the spirit of unity and connection. Feel free to reach out to me at carey@careysimsyoga.com if you have any questions and I hope to see you again soon on the Accessible Yoga Blog.

This post was edited by Patrice Priya Wagner, co-editor of Accessible Yoga blog and member of the Board of Directors.

CLICK HERE TO VIEW THE ORIGINAL CONTENT


Yoga and Advanced Aging, Part 3: Reconsidering the Breath

Part Three: Reconsidering the Breath

Many of us have discovered that connecting with our breath is where the rubber meets the road in our practice. But some of the breath techniques we find effective in the general population may not always apply to adaptive and senior students. In this article we will rethink how we cue the breath and explore the challenges our students may be facing when we ask them to breathe in certain ways.

How many times have we been encouraged to take a deep breath in a yoga class? Probably more than we can count. But for some students with advanced aging, a “deep” breath can feel invasive and even violent. I often kid that handing out a cough drop or a cup of water counts as an assist in my classes because breath work inevitably ignites a coughing spell.

I have found that replacing the word “deep” with “gentle” allows for a full inhale, but invites softness into the breathing experience. Students are less likely to overexert, grip, and become tense. Example: “Take a gentle breath in and a slow breath out.”

I also give students the freedom to breathe from their nose and/or mouth. Usually most students inhale through the nose and exhale through the mouth, but not always. As teachers, we must constantly ask what we are trying to achieve with a particular cue or technique and allow ourselves to be creative in achieving that goal. Connection to the breath is what matters to me; I don’t get dogmatic about methods.

When teaching movement, consider the breath as a layer of experience. Matthew Sanford has a saying, “Prana follows consciousness more than it follows breath.” This is one of the cornerstones of my teaching. I come from a vinyasa background and this was initially hard to wrap my head around, but once I stopped leading with breath, I began to tangibly see the results in my students’ ability to connect with their bodies. Why would this be?


Students with advanced aging and/or dementia often struggle with left/right discrimination and moving in two directions at once. Managing these types of movements and coordinating breath at the same time is extremely challenging and often causes frustration. I know that linking breath with movement is powerful, but my solution is to explore movement first and layer in the breath after we have connected with the body.


A simple change in my cueing order creates the necessary rhythm, connection, and space for the breath to benefit rather than impede my students. For example, “Lift your arms up toward the ceiling and lower them back down by your sides. Do this a few times and notice how that feels. Now we are going to move with our breath. Breathe in and lift your arms up and breathe out and lower your arms down.” I don’t want my students to feel like they are doing something wrong and become frustrated. If that happens, they may quit participating or decide not to come to yoga the next time. I am not their Physical Therapist or Occupational Therapist— I want them to feel good during our time together.

Another way to teach breath awareness is by exploring function. When we understand the utility of a technique or pattern, we can shift our relationship to it both as teachers and practitioners. Take holding the breath for example. This is natural reaction to being over stimulated. It’s like the brain knows we need to hit pause and regroup for a second or two. The next time you are focusing really hard on a new or complicated task, observe your breathing. If you find that you are holding your breath, don’t admonish yourself; instead be amazed at your body’s brilliance at problem solving.


When I work with my senior students on a new sequence, I often ask them to check in and notice if they are holding their breath. We usually laugh and smile at this recognition. I tell them it’s okay, explain why it’s happening, and ask them to let their body catch up to the posture or movement. From there we breathe out slowly. We simply need to create space for the breath to sort itself out and trust that our bodies know what to do once we get out of the way.

As we just explored, holding the breath is a brilliant stabilizing mechanism for the mind, but I’ve witnessed many times that the body also intuitively supports the spine through breath suspension or retention. Think of an instance where you picked up something a little too heavy and grunted or held your breath for a second. Your body intuitively knew it needed stability and used a pause in the breath to create it. Understanding this function helps me appreciate why some students are breathing the way they are. For many of my students, a movement like lifting the arms overhead is strong. These students often instinctively hold the breath as a means to recruit strength. Recognizing this, I will work with what is naturally happening and layer in a slow exhalation as we lower the arms.

Elongating the breath has a similar stabilizing function to breath retention, but introduces the sensation of ease inside of effort. I may refine the last example further by asking students not to drop their chest as they lower their arms. As we continue we might focus on decelerating the downward momentum of our limbs as we exhale. Example: “Lift your arms up toward the ceiling, keep your chest lifted and slowly lower the arms down as you exhale.”

A friend of mine said something beautifully powerful to me recently. “Carey you are helping your students connect with their bodies before they leave them.” I never really thought of it that way, but it’s true. Many, if not most, of my students’ bodies are steadily declining. I have lost a lot of students over the past few years. This is all the more reason to let our time together become a place of playful exploration. My students don’t need to be concerned about getting things “right,” especially their breathing. Imperfections are welcome. 

This article is part of a series exploring the practical application of yoga in Assisted Living, Skilled Nursing, and Memory Care spaces. Carey shares some of the challenges he has encountered teaching in these environments and offer practical techniques that he has found useful in sharing yoga with this population.

This post was edited by Patrice Priya Wagner, co-editor of Accessible Yoga blog and member of the Board of Directors.

Click here to view the original post on the Accessible Yoga Blog

Yoga and Advanced Aging, Part 2: Teaching in Assisted Living, Skilled Nursing, and Memory Care Spaces

Part Two: Safety, Presence and Connection

Understanding your population and the challenges students are facing in their bodies is essential for yoga techniques to be effective. That said, you will never know enough about every condition and everybody in the room. It’s simply not feasible. I make certain generalizations when teaching group classes in senior care spaces that guide my sequencing and help to keep my students safe. Depending on policy, I may not be able to ask certain questions, and even if I can, students may not know exactly what they should or should not do. I assume (my mother said to never assume, but in this case, I believe it’s wise) that some, if not many, of my students have trauma, back pain, high blood pressure, glaucoma, vertigo, osteopenia and/or osteoporosis, arthritis, knee, hip, and shoulder injuries/replacements, some degree of hearing loss, early stage cognitive decline, and balance issues. This is my baseline and is by no means an exhaustive list. Many other students have a stroke history, limb loss, Parkinson’s disease, heart failure, Cerebral Palsy, COPD, Multiple Sclerosis, visual impairment, ataxia, and the list goes on and on. This amount of variance can be scary and daunting, but don’t fret. Do your research on contraindications, explore what’s possible, and trust the yoga.

In the two articles I have contributed to the Accessible Yoga Blog, I have defined yoga as connection. I believe safety, presence, and connection are the cornerstones of a healthy yoga practice. One of the first things I do is learn my students’ names. As we interact more, I become attentive to their stories. Where they are they from? What is their favorite sports team? What are their hobbies? Who are their families? What was their former profession? We connect on a human level first and from there we may talk about an injury or illness, but I let them lead that discussion. My students have led incredible lives and have a lot of amazing stories to tell. Many times they are simply aching to share, but no one will take the time to truly listen. My teacher, Matthew Sanford, has a saying that he repeats a lot in his trainings, “If three things happen in a yoga class, yoga is the third most important.” If I can’t connect with you as a human being, what value can I offer you as a yoga teacher? When the teacher/student relationship fosters safety, presence, and connection, the class has the potential to become a healing space. 

In addition to learning names and taking time to truly be with our students, what guidelines should we follow when practicing yoga with this population? We will explore teaching the breath, cueing, and sequencing in a future post, but in terms of asana and movement, I avoid forward folds with the head lower than the heart (glaucoma, high blood pressure, vertigo). I am also cautious when crossing the legs and flexing the hip(s) beyond 90 degrees (hip replacement). Many of my students are in a perpetual state of spinal flexion due to years or forward-leaning movement patterns, gravity, and adjusting to a new life with a walker or a wheelchair. Emphasizing the importance of using the legs to support posture can be a game changer. I remind students to press down through their feet to support their spines about as often as I ask them to breathe.

With prevalent forward-leaning posture in mind, I focus a part of class on spinal extension. For kyphotic students, postures with a “lifted chest” or “long spine” will require a good deal of effort. Exaggerated flexion of the spine and deep twists are not part of my sequencing for this population. I am not saying that we should abandon these movements altogether; I am simply suggesting that we encourage them subtly. We want students to gently engage the muscles around the spine without compromising its structural integrity. Example: You might teach spinal flexion by having students give themselves a hug and asking them to notice the breath in the back of their bodies. By teaching with an awareness of the inevitable presence of osteopenia and osteoporosis, we can help students move safely, avoid injury, and help to improve their bone health. Remember we are talking about teaching group classes and we want the class to be safe first and foremost. In a one-on-one setting I might be willing to explore more.

Accessible Yoga trainings instruct how to teach true all-levels classes with different body types practicing various forms of asanas together in a communal space. But for this population, I encourage you to teach from the same orientation. Even if there are students who can physically do more than others, all of my students practice from a chair. I do occasionally have students in beds and I accommodate them. In these environments, if one student is doing something that looks very different (i.e. a standing asana), other students can feel inadequate or attempt an unsafe movement, and to me, the risk is simply not worth it. I try to understand what my students can manage and set them up for success. Continuity leads to accessibility. As explored in the first installment of this series, teaching in Assisted Living, Skilled Nursing, and Memory Care Spaces requires creativity and adaptability. The relationship between your students and yourself is the yoga. Creating a community is the most versatile tool in your yoga toolbox.

This post was edited by Patrice Priya Wagner, co-editor of Accessible Yoga blog and member of the Board of Directors.

To view the original post on the Accessible Yoga Blog Click Here!

We Are All Connected: Carey Sims

“Even though I’m not a young person, I’m a fairly young teacher – I’ve only been teaching a few years. Right after I graduated from yoga teacher training, I received a phone call from a friend asking me to take over several chair yoga classes at a senior center. When I was called to do that, even though it was something that was sort of on my radar, it wasn’t immediately on it! My friend reassured me saying, ‘you have the perfect disposition for this’ and I was thinking, ‘oh crap I better get on YouTube, and I better get some books, and call my yoga-teacher friends for some guidance!’

So, one group was assisted living, so, what does yoga look like for them? I hadn’t seen it. I hadn’t ever done chair yoga other than maybe sitting down and moving my arms back and forth. I didn’t know what I had gotten myself into. The second class was an Alzheimer’s group, and that was completely nerve-wracking and scary thinking how I was going to interact with these students. I just did a lot of research on my own leading up to my first class, and I found it really cool doing that. I was just diving all in to this exploratory phase.

The Alzheimer’s class was pretty cool because there was a lot of me realizing that these people are still out doing life. I wasn’t going to break them, and it’s enough just to be playful and be able to bring that in. With this population, what’s important is, what we always talk about in yoga – connection: to your own story, connection to the people around you, and just like this conversation we’re having. That’s all that matters. Whether or not things or conversations register with my students, we’re making a connection and that’s what’s so important.

I’ve learned, if there are multiple things that happen in a yoga class, yoga is the least important. It’s about the interpersonal connection and that’s all yoga is about for me. Also, it’s important that it helps people interact with their body in a way that’s non-judgmental.

I teach a back care class too. Students often come in with some sort of pain, disgust, or frustration with their body. They come to just move without needing to fix anything, or needing to get something perfect without the thought that they must to push past something. Their ability to simply move their body is a gift; to connect with their breath, and have awareness without judgment.

Yoga’s never really been about the postures, it’s about connections. Whether it’s interpersonal or intrapersonal – we are all connected. If yoga means ‘union’ and it’s an intense link, what are we linking? Not only just with our intention and story, but with the space around us. It’s in a room when I’m working with a group of seniors and they’re in a community, and somebody laughs because they all realize that it doesn’t have it be perfect. That right there creates a playful connection with everyone around feeling safe and seen. It’s just the perfect thing.

The connection isn’t just about the student feeling connected – I’m definitely getting as much as I’m giving. I don’t feel drained when I teach; I feel privileged.

Connection is also about my practice as a teacher- being more than just on that 3×5 piece of rubber. I’ll ask, ‘Where can I take this out in the world?’ And with everything that’s going on in today’s world, if we don’t sit around and hold space for people to have difference, then we aren’t doing the work. The work isn’t for me to change anything; the work is for me to sit with you and allow you to speak.

I know we’re not all going to end up in this Kumbaya moment where we see eye-to-eye, but to feel safe enough to speak and be heard is all we want as human beings. I believe we all want somebody to see us – not just that you’re here, but to see us and to be able to put out what we feel and believe without being shot down for it.

We all need to move, we all need to breathe, and we all get stressed no matter how young or old we are. We all have a story. I wrecked a motorcycle in my 20’s and it led me to yoga. There are important connections to that event and story that I’ve embodied in my existence, but it’s not the only way I define myself. When people hurt, or they tweak their shoulder, and you get them to sit with that discomfort in the same way they can sit with the comfort, surprising things can happen. It’s in the exploration that even in that space where their body doesn’t feel good, to see and be open to that, ‘this is just your body doing its best’.

Our bodies sew us back together and keep us doing life. It’s pretty amazing to reframe it that way, and look at it like, ‘wow, this is my body working as hard as it can, and keeping it all together.’ I try to teach my students to see it from this view, and to let some of the crap go, and be in this non-judgmental activity with the body.

When I wrecked my motorcycle, I just pushed through it and did all the things. I was imbalanced and I recklessly powered through life. It wasn’t ‘till I got to my late 30’s that I was like, ‘wow; I’m hurting a lot. This sucks!’ I needed to find a way to interact with my body that wasn’t just slamming right into my pain. It’s kinda cool, cause I’m 48, and my practice is a bit more clunky than it used to be. I’m getting less and less into the deep shapes, but my body feels so much better.

I think as humans we believe that we aren’t feeling anything unless we feel it in the most intense way. That’s why we normally don’t pay attention to the small things. That was the thing for me – to interact with my body in a way that was serving me. I’m the one in class who’s always using a chair or blocks and always trying things to constantly switch up my relationship to my practice and relationship with my body. Those are the things that I encourage in my teaching, and it’s what my body teaches me in my own practice.”

This article first appeared on The Self Stories. Click HERE to view the original content.

Alzheimer’s Disease and Yoga by Carey Sims – August 21, 2018


I teach Chair Yoga to seniors. Students of different shapes, sizes, and mobility levels come to class with their canes, walkers, and wheelchairs. Some are blind and others hard of hearing, but many have a less visible disability—Alzheimer’s disease. I smile, learn their names, and listen to their stories. Presence is my first and most important tool as a yoga teacher.

Aging is a slow path towards disability. Attempting to walk this path with grace is nothing less than an act of extreme bravery. For someone with Alzheimer’s, this path leads to an abyss of unknowing. Imagine someone is randomly editing your life’s story. The loss of context leads to loss of meaning. Memories lose texture. Experiences lose their weight. The current Self recedes and new personalities arise.

This is unsettling and extremely frustrating not only for the individual, but also for family members. In a society that privileges youth and autonomy, aging coupled with mental illness strips away dignity. The losses feel cruel. Alzheimer’s ruptures time; it isolates.

I am wary of using “Yoga for …” with anything. This language sounds prescriptive and curative, and let’s be clear: Yoga will not cure Alzheimer’s. I wish this were the case, but it’s not. So what does Yoga offer someone with Alzheimer’s? I believe the answer is simple: Yoga equals connection. In a world where context is unraveling, finding company within a group and connection within your body is for healing the soul. As a yoga teacher, I want people to experience connection, even if it’s temporary, because the body remembers when the mind cannot.

My classes are a community where we explore what’s possible and find humor in seemingly easy tasks that prove a challenge. We begin practice by grounding our feet and aligning our spines. In many cases the alignment isn’t very precise, but I want students to feel the sense of relief and integration that grounding offers. We layer in rhythmic movement by gently swaying side-to-side, moving in circles, and rocking forward and back. I return to some form of grounding and rhythm in between almost every sequence. Class is a dance of accessible movements and shapes with a focus on moving across the midline and in two planes at once. My objective is to access the body, calm the nervous system, and stimulate the brain.

Linking breath with movement is powerful, but it can be difficult for students with Alzheimer’s. Knowing this, I rarely lead with the breath. My students struggle with left/right discrimination and moving in two directions at once. Managing these types of movements and coordinating breath at the same time is extremely challenging and often causes frustration. We explore movement first and layer in the breath after we have connected with the body. A simple change in my cueing order creates the necessary rhythm, connection, and space for the breath to benefit rather than impede my students.

As our time together winds down, we place our hands over our hearts, honoring what the heart represents—a space of love, strength, courage, and compassion. I smile and bow, saying, “Thank you for joining me. I honor you.” Yoga equals connection.

This post was edited by Nina Zolotow, co-editor of the Accessible Yoga Blog and Editor in Chief of Yoga for Healthy Aging.

This context first appeared on Accessible Yoga. Click HERE to view the original content.