Transcript Living with Dementia in a licensed Continuing Care

Living with Dementia in a
Continuing Care Retirement
Community
Pilgrim Place Forum
Thursday, January 12th at 11:00 am
Presented by
Sue Fairley and Sharon Berry
Pilgrim Place - January 19, 2011
Forum on Health Services
Excerpts from AAHSA meeting presentation in 2010 by
Westminster Place, Presbyterian Homes Evanston Il.
Aging happens, and not always in the way
we expect.
 Aging in place is sometimes overrated. By
living at Pilgrim Place, you have options
that others do not.
 People adapt best when there is a good
fit between their abilities and the
demands of their environment.
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“Take Aways” from Today
We are aware of the challenges in being a
caregiver 24/7.
 We need to partner with you to determine
compassionate solutions for you and your
loved one. Please don’t shut us out, we are
here to help.
 Maintaining the status quo and doing
nothing when individuals are struggling at
their current level of care, is not an option.
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Health Services Advisory Group
2012 Mandate
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Top Priority in 2012 will be to investigate
options for secured memory care under
the RCFE license or the LTC/SNF license
and the financial feasibility for each option.
What is Dementia ?
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Dementia is a general term for a decline in mental
ability severe enough to interfere with daily life. Memory
loss is an example. Alzheimer's is the most common type of
dementia.
Dementia is not a specific disease. It's an overall term
that describes a wide range of symptoms associated with
a decline in memory or other thinking skills severe enough to
reduce a person's ability to perform everyday activities.
Alzheimer's disease accounts for 60 to 80 percent of cases.
Vascular dementia, which occurs after a stroke, is the second
most common dementia type. But there are many other
conditions that can cause symptoms of dementia, including some
that are reversible, such as thyroid problems and vitamin
deficiencies.
Dementia is often incorrectly referred to as "senility" or "senile
dementia," which reflects the formerly widespread but incorrect
belief that serious mental decline is a normal part of aging.
Types of Dementia
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Alzheimer’s disease
Vascular dementia
Dementia with Lewy bodies
Mixed dementia
Parkinson’s disease
Frontotemporal lobar degeneration
Creutzfeldt-Jakob disease
Normal pressure hydrocephalus
Huntington’s disease
Wernicke-Korsakoff Syndrome
Reversible Dementia
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UTI (Urinary Tract Infections)
Anesthesia
Medication
Alcohol
Brain injury
Sleep deprivation
Dehydration
Malnutrition
Vitamin imbalance
Infections
10 Early Signs of Dementia
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Memory changes that disrupt daily life.
Challenges in planning or solving problems.
Difficulty completing familiar tasks at home, work or at
leisure.
Confusion with time or place.
Trouble understanding visual images and spatial
relationships.
New problems with words in speaking or writing.
Misplacing things and losing the ability to retrace steps.
Decreased or poor judgment.
Withdrawal from work or social activities.
Changes in mood.
Mild Cognitive Impairment(MCI)
Mild cognitive impairment (MCI) a condition in
which a person has problems with memory,
language, or another mental function severe
enough to be noticeable to other people and
to show up on tests, but not serious enough to
interfere with daily life.
 Because the problems do not interfere with
daily activities, the person does not meet
criteria for being diagnosed with dementia.
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CCRC Contractual Obligations
and Legal Liability
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The purpose of the Care and Residence
Agreement is to provide a statement of the
services that Pilgrim Place will provide to you
at the Community, and the legal obligations
that Pilgrim Place will be assuming. This
Agreement also sets forth your obligations to
Pilgrim Place, both financial and non- financial
Care and Residence Agreement
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Administration shall determine, in consultation with the clinical staff
at the Community and you, and/or your legal representative, if any,
or your family member(s), and your personal physician, when a level
of care change is appropriate.
If assisted living services are appropriate but space is unavailable at
Pitzer Lodge, or the Health Services Center, Pilgrim Place shall
assist you in arranging for your care on a fee-for-service basis,
either in your home or at an alternate site off the premises of the
Community until something appropriate becomes available.
The limit for you to be “bed bound” in your home is14 days by
regulation. During this time we will discuss with you your
condition and whether it is a chronic condition where Hospice
services may be appropriate or whether it is more appropriate for
your needs to be met either in Pitzer Lodge or the Health Services
Center depending on the prognosis of your condition.
Statutory Grounds for Transfer
Statutory Grounds for Transfer. Pilgrim Place may, at its discretion, transfer you if it
determines that any of the following grounds exists:
◦ You become non-ambulatory as this term is defined in Section 13131 of the
California Health and Safety Code, which provides that you are unable to leave
your Unit without the assistance of another person during an emergency and
your Unit is not -13- 1592548.8 approved by the State Fire Marshal for use by
non-ambulatory residents (that is, residents who depend on mechanical aids such
as crutches, walkers or wheelchairs, and residents who are unable, or likely to be
unable, to respond physically or mentally to oral instructions relating to
a fire danger);
◦ You develop a physical or mental condition that endangers your health,
safety, or well-being or that of another person;
◦ Your condition or needs require that you be transferred to an assisted living
care or skilled nursing because the level of care required by you exceeds
that which may be lawfully provided in your home; or
◦ Your condition or needs require that you be transferred to a nursing facility,
hospital, or other facility, and Pilgrim Place has no facilities available to provide
that level of care at the Community.
Department of Social Services
Residential Care for the Elderly
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Licensee who accepts and retains residents with
“dementia” shall be responsible for ensuring the
following:
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“Non ambulatory” fire clearance for rooms or apartments used to
accommodate persons with dementia who are unable or unlikely
to respond to oral instructions relating to fire or other dangers or
to independently take appropriate action.
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Our response: When a resident with dementia lives with a spouse or
loved one who is the primary caregiver, we must, under the RCFE
regulations guarantee, that the person is never left alone due
to their inability to respond appropriately to an emergency.
This is an area where staff work with the caregiver to develop
an appropriate service plan to ensure the resident’s safety.
Department of Social Services
Residential Care for the Elderly
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Licensee who accepts and retains residents with
“dementia” shall be responsible for ensuring the
following:
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The Emergency Disaster Plan must address the safety of residents
with dementia.
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Our response: When a resident with dementia lives with a spouse or
loved one who is the primary caregiver, we must, under the regulation,
guarantee, that the person is never left alone due to their inability to
respond appropriately to an emergency. Our resident Area Captains
must also be aware of the residents in their area with
Dementia so that they can respond appropriately in case of a
real disaster: and if by chance the caregiver gets hurt and is
unable to assist the resident with dementia, the Captain is
aware of the need for assistance.
Department of Social Services
Residential Care for the Elderly
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Licensee who accepts and retains residents with
“dementia” shall be responsible for ensuring the
following:
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Night Supervision.
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Our response:When a resident with dementia lives with a spouse or
loved one who is the primary caregiver, we must, under the regulation,
guarantee, that the person is secure at night, in case they would
decide to exit the home. There should be some device in
place that would alert the caregiver who may be sleeping:
otherwise there would need to be someone awake and on
duty in the home if the resident is residing there. If exiting
presents a hazard to the resident, an auditory device or other
staff/caregiver alert feature to monitor exiting must be used.
Department of Social Services
Residential Care for the Elderly
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Licensee who accepts and retains residents
with “dementia” shall be responsible for
ensuring the following:
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Annual Assessment by staff including a Physician’s visit
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Our response: When a resident with dementia lives with a
spouse or loved one who is the primary caregiver, we must,
under the regulation, guarantee, that the person is
reassessed annually to determine if their needs
have changed. The service plan that determines the
care and supervision for the resident would then be
updated to include alterations or changes.
Department of Social Services
Residential Care for the Elderly
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Licensee who accepts and retains residents
with “dementia” shall be responsible for
ensuring the following:
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Activity Program
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Our response: When a resident with dementia lives with a
spouse or loved one who is the primary caregiver, we must,
under the regulation, guarantee that the person has
access to a program that addresses the needs and
abilities of the resident, including large motor
activities and perceptional and sensory stimulation.
This may be done in conjunction with the caregiver
and entered into the Service Plan for the resident.
Department of Social Services
Residential Care for the Elderly
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Licensee who accepts and retains resident s with
“dementia” shall be responsible for ensuring the following:
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Safety Modifications
Our response: When a resident with dementia lives with a spouse or loved one
who is the primary caregiver, we must, under the regulation, guarantee, that the
person does not have access to oven ranges, heaters, wood stoves, or
other heating devices.
 Another option: Install “kill switch” or unplug items that could be
dangerous. Knives, matches, firearms, tools and other items that
could constitute a danger to the resident must be inaccessible. Overthe-counter medication, nutritional supplements or vitamins, alcohol,
cigarettes, and toxic substances such as certain plants, gardening
supplies, cleaning supplies and disinfectants, must also be
inaccessible.
 What this means is that either the caregiver makes these items
inaccessible or has some way to monitor/supervise their loved one
with dementia.
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Department of Social Services
Residential Care for the Elderly
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Licensee who accepts and retains residents with
“dementia” shall be responsible for ensuring the
following:
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Safety Modifications
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Our response: When a resident with dementia lives with a spouse
or loved one who is the primary caregiver, we must, under the
regulation, guarantee that the person shall either be
supervised when outside the home, or be in an enclosed
area to protect the safety of the resident. GPS or other
tracking/identification items may be worn, provided the
item does not violate the resident’s rights.The resident
with dementia may never be left alone in a locked
home, as this is considered abuse and neglect of the
resident with dementia.
In the meantime…
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Caregiver Support Group will be
starting on Wednesday January 25 from
2-3pm in Napier/Brunger – led by Cathy
Brown, MSW.
Memory Support Group will also be
starting on Wednesday January 25th from
10-11am in Napier/Brunger – led by
Cathy Brown, MSW.
Clinical Team will be meeting with
residents and developing service plans in
cooperation with caregivers.
HSAG will be working on feasibility of
Memory Care Secured option.
Scholarships are available for residents
to attend the Enrichment Group at
HSC on Mondays, Wednesdays, and
Fridays.
Additional Resources for Brain
Fitness and Caregiver Support
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Dakim BrainFitness Software
Memory Trainer and Memory Matrix by Lumosity.com
(applications for iPhone and smart phones)
CogniFit.com
Coach Broyles’ Playbook for Alzheimer’s Caregivers – a practical
tips guide (www.alzheimersplaybook.com)
www.alz.org (Alzheimer’s Association)
24- hour Help Line: (800) 272-3900
Safe Return Program (http://www.medicalert.org/alzheimerssafereturn)
Questions???