Directing an Alzheimer’s/Dementia Care Unit Funded by: Indiana State Department of Health Co-sponsored by: IAHSA IHCA HOPE.
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Directing an Alzheimer’s/Dementia Care Unit Funded by: Indiana State Department of Health Co-sponsored by: IAHSA IHCA HOPE Module 1: Review of Dementia and Care Practices In this section, we will cover: Definition of dementia and Alzheimer’s disease Alzheimer’s disease progression Differences between dementia, depression, and delirium Importance of person centered care and its implementation Importance of stress management with family and staff What is Dementia? Dementia is a disease process – Progressive decline in cognitive function – Memory loss Over 170 irreversible dementias – HIV, Vascular, Lewy Body, Parkinson’s, Alzheimer’s Some forms are reversible (treatable) – Thyroid disorders, drug interactions, dehydration Alzheimer’s Disease Most common form of irreversible dementia – Nearly 70% of all dementias are Alzheimer’s – Over 4.5 million Americans have Alzheimer’s – It is estimated that 60% of all nursing home residents have Alzheimer’s disease Alzheimer’s is not normal aging – Learning new information make take longer – May be difficult to filter out noise Brain Scan Stages Early Needs reminders Daily routines difficult Concentration is difficult Middle May need hands on care May get lost easily Changes in personality Late Severe confusion Needs hand on care for most personal care May not recognize self or family Areas of the Brain Affected Cognition Behavior Memory Learning Language Praxic Function Abstract thinking Lapses in clarity Psychomotor speed Hallucinations Delusions Communication Safety Personal care deteriorates Emotion Disregulated Disorganized Apathy (loss of energy, willingness) Lability (moods change) Delirium, Depression, and Dementia Delirium – Acute onset, can be treated – Altered state of consciousness Depression – Gradual onset, can be treated – Look for signs, such as low self-esteem Dementia – Gradual onset, might be treated – Memory loss and decline in cognitive function Medications Cholinesterase Inhibitors – – – – Cognex Aricept Exelon Reminyl Glutamate Receptors – Namenda Person Centered Care Person centered care is truly putting the PERSON first Characteristics – Behaviors are a desire to communicate – We must maintain and uphold the value of the person – Promote positive health – All action is meaningful Person Centered Care, Cont. Core psychological needs must be met to provide quality care – – – – – – Love Inclusion Attachment Identity Occupation Comfort Implementing Person Centered Care Recognition Negotiation Collaboration/ Facilitation Play Timalation Celebration Relaxation Validation Holding Person Centered Care and Families Know what families are looking for – Kindness and respect – Looks are important – The extras Be sensitive to the emotions family members may be experiencing Module 2: Administrative Practices In this section, we will cover: The role of the unit manager and its responsibilities Review of human resources practices Philosophy of care Admission/discharge requirements Policies and procedures of a special care unit Role of the Unit Manager Identify your commitment – Become dementia-capable Know the disease process Know types of supports for families Be willing to provide services for those with dementia Evaluate – Evaluate for effectiveness of care Quality indicators Communication Empowerment! Challenge the process Inspire and share vision Enable others to act Model the way Encourage the heart Ownership and Leadership Challenge Inspire Enable Model Encourage Empower Philosophy of Care Create mission statement and purpose Approach to care What’s “special” about special care? Communicate the message Characteristics of Good Dementia Workers Compassion Fairness Supportive Creativity Warmth Respect and honor Honesty Dependability Appreciation of teamwork Sense of fun Flexibility Sense of humor Unconditional positive regard Integrity Energetic Skills of Good Dementia Workers Assessment Energy Problem solving Dementia-capable communication Observational Respectful Conflict resolution Prioritizing Hiring Staff with Knack Ask current staff for recommendations and to participate in process Look for nontraditional candidates Walk candidate around unit Can the candidate have fun? Share your philosophy Ask for stories From: Best Friends Staff. Bell and Troxel. Orientation Normal aging vs. dementia Dementia process and progression Communication techniques Behaviors and approach Philosophy, policies, procedures Admission/discharge criteria How to work with families Stress reduction techniques Stress! Stress can lead to poor quality care, quality of life, and abuse and neglect Signs of stress – – – – – Too little or too much sleep, nightmares Fatigue Headaches, backaches, joint pain Diarrhea/constipation Frequent accidents Assessments Medical Functional Emotional Social Cognitive Behavioral Special needs Special interests Talents Habits Interventions Ascertain validity of diagnoses Level of functioning Preferences Family wishes Advanced directives Religion Care Plans Focus on individual needs Flexibility to enable a person to live the life he or she would want Emphasis on resident’s own sources of self-esteem and pleasure Regular reevaluation Build in specific objectives and strategies Immediate Problem Analysis Task – Too complicated, too many steps, not modified, unfamiliar Environment – Too large, too much clutter, excessive stimulation, no clues, poor sensory, unstructured, unfamiliar Physical health – Medications, impaired vision/hearing, acute illness, chronic illness, dehydration, constipation, depression, fatigue, physical discomfort Miscommunication The 11 W’s Who has the behavior? What is the specific behavior? Why does it need to be addressed? What happened just before? Where does it occur? What does the behavior mean? When does the behavior occur? What is the time, frequency? Who is around? What is the outcome? What is the DESIRED change? Transfer/Discharge Criteria Educate family during pre-admission and in care plan meetings Compare reassessment data to admission/discharge criteria Utilize RAI/MDS assessment data, RAPS, and care plan process Is the resident still compatible with the mission? Be consistent! Module 3: Educating Staff In this section, we will cover: Basic principles of adult education, including needs of adult learners Types of audiences within facility Techniques for assessing for types of educational needs Understand materials provided Explore and assess potential internal and external resources for educational services Basics of Adult Education Adults who attend educational opportunities have made a great effort to attend Adults have unique and individual needs The educator is the organizer, guiding learning Successful Learning Be prepared with extra information Make the program safe and interesting Make the learning goals clear, and stick to them Clarify the criteria of evaluation Promote self-empowerment Emphasize the felt needs of learners Provide a variety of learning techniques Alternative Methods of Teaching Cross train Bulletin or graffiti boards Articles or newsletters Mini in-services Group activities Orientation Audiences and Needs Families – Care plan, modeling, coaching, family handbook, family programs Resident councils – Understanding disease process, administrative practices, working with staff Specific staff groupings – Nursing, activities, night shift Techniques for Assessment Gather ideas – Observation, questionnaires, records, interviews, informal gatherings Determine needs – Organization, people, task Create – Objectives, content, techniques, organization, visual aids Educational Materials Overview of Dementia Person Centered Care Communication Strategies Understanding Behaviors Activities of Daily Living Family Dynamics Internal Resources Who is the best educator? – Not everyone is right for every subject Who has an interest in educating? What can each person contribute? – Line staff – Administrative – Managers External Resources Consultants Medical Directors Alzheimer’s Association Service agencies ESL Module 4: Regulatory Standards and Reducing Deficient Practices In this section, we will cover: Overview of commonly sited F-tags Key safety concerns and potential solutions Relationship between person centered care and resident rights Family needs and potential opportunities Potential situations leading to abuse and neglect Possible quality indicators F-Tags 154: Right to be informed 157: Notification of changes 164: Privacy and confidentiality 207: Equal access to quality care 221/222: Resident behavior and facility practices 223: Abuse 224/226: Staff treatment of residents 240: Quality of life 241: Dignity F-Tags, Cont. 242: Self-determination 243/244: Participation in resident and family groups 245: Participation in other activities 246: Accommodation of needs 280: Care plans 281/282: Professional standards of quality 309: Quality of Care 310: Activities of Daily Living F-tags, Cont. 323/324: Accidents 353: Nursing services 495: Competency 497: Regular in-service education 498: Proficiency of nurse aids Safety Concerns and Solutions Environmental implications of physiological changes – Vision, hearing, thermal regulation, tactile sensation, musculoskeletal, balance Security – People with dementia may not be able to judge unsafe conditions Physical supports Resident Rights—Bell and Troxel To be informed on one’s diagnosis To have appropriate ongoing medical care To be productive in work and play as long as possible To be treated like an adult, not a child To have expressed feelings taken seriously To be free of psychotropic medications if at all possible To life in a safe, structured and predictable environment To enjoy meaningful activities to fill each day Abuse and Neglect Willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm or pain, anguish, or deprivation by an individual of goods or services that are necessary to attain or maintain physical, mental, or psychosocial well being Physical Sexual Verbal Mental Family Feelings Denial Frustration Isolation Guilt Anger Loss/grief Letting go Conflict Resolution Denial can be healthy Educate in small doses Do not push to hard Encourage support groups Acknowledge Listen Feedback Privacy Internal Resources Staff members Library Administrator Family counsels Care plan meetings Alzheimer’s Association Helpline Family Education Support Groups Care Consultation Safe Return Strategies for Positive Relationships Show support – Family tours, communication processes – Validate emotions, develop realistic expectations, compliment, report good news Promote successful visits – Offer suggestions and support – Bring in family videos, pictures – Activities Quality Indicators Number and frequency of medication adverse effects Proportion of residents who are over-sedated Incidence of falls, fractures, and elopements Prevalence of restraints Incidence and prevalence of skin breakdown Incidence of symptomatic urinary tract infection Incidence of dehydration Use of futile or undesired treatments Moment by moment comfort of residents Comfort of caregiving staff Quality Indicators, Cont. Ability of staff to deal confidently with situations A coherence between values expressed in mission and actual practice Prevalence of agitated behaviors Prevalence of fecal impaction Prevalence of weight loss Incidence of decline in ROM Prevalence of little or no activity