When he recalls the end stage of his grandmother's care, Greg A. Sachs, MD, a geriatrician at Indiana University's Center for Aging Research, recalls that there were few changes in the care of patients with end-stage dementia over the last 30 years (Boyles, 2009). According to Sabat (2009), the need to improve the lives of patients suffering from end-stage dementia; "constitutes a call to action that cannot and must not be ignored" (p. 1806). In this study, I will try to discover the changes I can make in the daily care routines of patients with cognitive impairment to reduce their stress levels. I propose that small changes in their routine 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 reduced cognitive abilities, such as that of patients diagnosed with mid-to-terminal Alzheimer's disease (Sabat, 2006). This study will be the first of several substudies aimed at examining opportunities for eliminating unnecessary stressors for these cognitively impaired patients, thereby reducing the stress levels of healthcare professionals caring for these patients. For further information and guidance, I will have patients' interactions with their caregivers videotaped just as Rogers and his colleagues did during his counseling sessions with clients (Gundrum, Lietaer, & Van Hees-Matthijssen, 1999). The aim of these shots will be to highlight areas in need of change and to direct attention to where further changes in care guidelines can be made. I expect that, through this study, we will be able to provide new instructions on how to better communicate… halfway through the paper… your study compared to the level of interaction that existed with these patients before this study began.1. Hypothesis: A reduction in patients' stress levels will allow patients to interact more with staff, family and friends. Null Hypothesis: Due to the patients' diagnosis of cognitive impairment, small changes in patients' stress levels will not make changes in the interactions patients have with staff, family and friends.2. Hypothesis: Making changes to the bathing ritual to increase respect for the patient's personal space and comfort will reduce anxiety in patients and increase their 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 bathroom routines.