Confusion often accompanies impaired alertness and mental fatigue.
Try to determine these predictable periods of increased alertness and schedule activities around these periods. From my experience, early in the morning and late in the afternoon are not good times for alertness. Find out which is the most effective for the individual patient and use this mode to accomplish tasks. Do not expect a patient's attentional capacities to remain constant every day as there are many factors which will affect this capacity. Say their name, touch them on the arm, etc., to make sure that they are looking at you and can hear your instructions.