Transcript What Make Our Special Care Unit Special?”

“What Makes Our
Special Care Unit Special ?”
Deer Lodge Centre
Dementia Care Unit
Maureen Chouinard, Manager of Resident Care
Arlis Decorte, Clinical Resource Nurse
Nancy Fiebelkorn, Social Worker
SCU – Tower, SCU-West
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47 beds on two units
Tower opened in 1988, West opened in 2006
Higher staff to resident ratio
Units address behaviours, care needs
Male or female; veterans or community
applications
Philosophy of Care
 Equal, individualized, respectful and safe care
 A person’s individuality is unique and does not
change because of cognitive impairment
 Staff are advocates
 A specialized environment is required for dementia
care
 Families have the right to be informed
Philosophy of Care (continued)
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Specialized skills and abilities are essential
Interdisciplinary team approach
End of life care
Upholding Resident’s Bill of Rights
Effective and efficient use of available resources
SCU Admission Criteria
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Age
Primary and secondary diagnoses
Environment
Behaviours
Risks
How to Access the Special Care
Unit at DLC
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WRHA Behavioral Panel
Contact the panel secretary at 940-3600
Access Office is at 490 Hargrave St.
Application should include an A/A form, a
Dependency Assessment Supplement and the
Behavioral Assessment Supplement.
 A brief summary of the resident/client will be
submitted along with behavior maps, recent
progress notes, consults and lab work.
Behavioural Panel
Purpose:
To facilitate the management of individuals with
challenging behaviors in the most appropriate care
setting.
Behavioural Panel
Guiding Principles:
 Behaviors are not being managed in their current
environments
 Existing resources already accessed
 Information meets panel criteria and standards
 Panel meets monthly
 Additional problem-solving may be required to
ensure placement in proper environment
Behavioural Panel
Who Sits on the Panel?
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Medical Director of the Rehab/Geriatrics Program
Director of the LTC Access Centre or designate
A representative from a PCH
A representative from the Geriatric Mental
Health Team
 A CNS for the WRHA long term care program
 Access Coordinators
 Health care professionals/family who have been
integral to managing the individual’s care needs
Preadmission Visits
 Purpose:
• Confirm the information provided by panel
• Meet needs of the applicant?
• Plan for any special needs or equipment
• Meet the applicant and family
 Completed by the Social Worker and Unit
Manager once accepted by Behaviour Panel
 Visit usually within one week, at applicant’s
current residence
The Interdisciplinary Approach
 The SCU at Deer Lodge Centre utilizes an
interdisciplinary approach to care.
 Weekly meetings
 Goal is to review each resident on a quarterly
basis.
 Post-admission and Annual conferences
 All members of the team are available to family
 Contact information provided
The Interdisciplinary Team
Consists of:
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The Resident and Family
Attending Physician and Consultant Psychiatrist
Manager of Resident Care
Clinical Resource Nurse
The Nursing Team-RNs, RPNs, HCAs
The Interdisciplinary Team
Consists of (continued) :
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Social Worker
Pharmacist
Physiotherapist
Occupational Therapist
Dietician
Recreation Facilitators
Spiritual Care
What Gives Us a
Sense of Well-being?
-The Bradford Dementia Group
Well-Being (continued)
What do we need to maintain a sense of
well-being?
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A sense of control
A sense of who we are
A feeling of safety and security
The ability to communicate with others
The feeling that we are socially included
Well-Being (continued)
 Having meaningful things to do
 Being taken seriously- do others respect and
recognize when we feel frustrated, angry, sad,
anxious, tired/exhausted, confused, lonely,
frightened?
Reactive Behaviours
 Reactive Behaviour- the way in which a person
responds to a specific set of conditions.
P.I.E.C.E.S. program
 All residents on the Special Care Unit have a
behavioural history which has made residing in a
regular personal care home setting difficult or
impossible.
Reactive Behaviours (continued)
Reactive behaviours may include:
 Restlessness
Calling out
 Wandering
Hoarding
 Resistance to Care
Agitation
 Anxiety
Aggression
 Withdrawal
 Inappropriate Sexual Behaviour
Reactive Behaviours (continued)
Staff are encouraged and trained to monitor and
document reactive behaviour:
 Antecedents (Triggers)
 Behaviours
 Interventions
 Consequences
Reactive Behaviours (continued)
Reactive Behaviours (continued)
Key Elements of Care
Alzheimer’s Australia, 2003
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Assessment
Individualized Care
Interdisciplinary Team Approach
Programming
Relationships
Key Elements of Care (continued)
Key Elements of Care (continued)
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Communication Skills
Physical Environment
Flexibility in Routines and Practices
Staff Training and Education
Communication
 Communication with persons who are cognitively
impaired may be difficult and frustrating at times
for both you and them
 Remember that behaviour is a form of
communication for residents that have impaired
expressive ability
Communication
Areas to focus on include:
 Approach in a gentle manner and identify yourself
by name
 Maintain eye contact
 Provide gentle direction
 Do not make an issue of a mistake, they happen
 Avoid asking facts
Communication
Areas to focus on include (continued):
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Reduction of distractions and background noise
Reorientation may not work
Appropriate touch
Items and illustrations to convey messages
Visiting
 May be difficult for families/caregivers – We, by
nature, need something from our visits
• Love
• Reassurance
• Support returned to us
• Ease of guilt
• Confirmation of our decisions
• To feel that a connection remains
Visiting (continued)
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Goals of Visiting
Who should Visit
When to Visit
Where to Visit
What to do when you Visit
Why Visiting may be difficult
Saying goodbye after your Visit
When younger family members Visit
Caregiver Support Group
 Informal group for families/friends that meet once
a month
 Connections for them, connections for us
 Share questions and information about SCU
 Supportive and safe environment
 Luncheons
Case Study
79 year-old gentleman residing on a general medical
hospital ward.
 dx of Alzheimer’s/Parkinson’s disease.
 hx of resistance and aggression during care,
occasionally towards co-residents.
 Poor response to psychotropics - oversedationminimal effect on behaviour.
Case Study
Care Plan in General Hospital Setting
 6 staff to provide care
 Resident to be restrained on bed utilizing 4 staff,
2 staff to prepare and provide care.
 Broda with lap table for meals and rest periods.
 Current Rx
• Carbamazepine 200mg bid
• Trazodone 75 mg od 18:00
Case Study
Care Plan on SCU - Goals
 Gain the resident’s trust.
 Create a “resident-friendly” care plan.
 Involve resident and family in care planningcreate an environment where resident and family
have decision-making authority.
 Ensure Consistency/reliability.
Case Study
Care Plan on SCU - Interventions
 ADL Care
 Broda chair and table for meals.
 “Bath-in-a-bag” products - no tub baths, no
showers
 Incontinent product-pullup/brief/overnight
 Monitoring behaviour on unit
 Plan all care - Scheduled………..CONSISTENT
Case Study
Care Plan on SCU (continued)
 Initially provide 4 staff for care and safety
 “Normalized care”, bathroom routine
 When resident requires care, approach and “be
with” resident
 Reapproach after a “break period”, invite him to
attend his room with you, or simply walk to room
with him.
 If care required more urgently, need to be more
“matter of fact”
Case Study
Care Plan on SCU (continued)
 Adjustment to medication following admission
 Trazodone Rx on revised care plan:
07:00 - 25 mg.
12:00 - 50 mg.
17:00 - 50 mg.
Case Study
Care Plan on SCU - Outcomes
 2-3 staff to provide care, dependant on mood (do not provide care alone)
 Aggression with co-residents
 Broda chair/table for meals
 ADL/Bathing
 Ongoing staff education
 The challenge of CONSISTENCY
End of Life Care
 Advance Care Plan/Health Care Directive
 Care planning around a progressive illness
 What is Comfort Care and its focus?
• Pain
• Difficulty Swallowing
• Lack of Appetite
• Labored Breathing
• Skin Breakdown
• Loving Presence
When the Resident No Longer
Requires SCU
 Resident no longer requires the specialized
programs of our unit.
 Social Worker prepares the family
 Move to another unit in DLC or another facility
Barriers to Discharge
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Long Wait Lists
History of reactive behavior
Families reluctance to move
Concerns of receiving facility
• Small unit vs large unit
• Treatment unit vs long-term care unit
Conclusion
What Have We Learned?
 The value of the unit staff
 Admissions – need to try new things
 Environmental challenges
• Closed-in vs. open spaces, Wall protection,
Decoration
 Low stimulus is a great idea but……
 Require a balance between environment and
pharmacological treatment