Recalling his grandmother's end-of-life care, Greg A. Sachs, MD, a geriatrician at the Indiana University Center for Aging Research, recalls that there has been little change in the care of patients with terminal dementia over the past 30 years (Boyles, 2009). According to Sabat (2009), the need to improve the lives of patients with terminal dementia; “constitutes a call to action that cannot and should not be ignored” (p. 1806). In this study, I will seek to discover what changes I can make to the daily care routines of patients with cognitive impairment in order to decrease their stress levels. I propose that small changes in their routines will result in a reduction in these patients' stress levels and an improvement in their quality of life. This improvement will occur because increased stress diminishes the mental systems available for cognitive processes in patients with diminished cognition, such as in patients diagnosed with mid- to end-stage Alzheimer's disease (Sabat, 2006). This study will be the first of several sub-studies to examine opportunities for eliminating unnecessary stressors for these cognitively impaired patients, which will then reduce the stress levels of caregivers caring for these patients. For additional information and advice, I will videotape patients' interactions with their caregivers, just as Rogers and colleagues did during his counseling sessions with clients (Gundrum, Lietaer, & Van Hees-Matthijssen, 1999 ). The purpose of this filming will be to highlight areas requiring change and draw attention to areas where further changes in care guidelines can be made. I hope that through this study we will be able to provide new instructions on how to communicate better...... middle of article...... its study versus level of interaction with these patients that existed before the start of this study.1. Hypothesis: A reduction in patient stress levels will allow patients to interact more with staff, family, and friends. Null Hypothesis: Due to patients' cognitive impairment diagnosis, small changes in patients' stress levels will not result in any changes in the interactions patients have with staff, family, and friends.2. Hypothesis: Making modifications to the bathing ritual to increase respect for the patient's personal space and comfort will reduce patient anxiety and increase cooperation in the bathing ritual. Null Hypothesis: Due to the cognitive decline experienced by patients diagnosed with Alzheimer's disease, there will be no reduction in patients' anxiety levels due to changes in bathing habits.