a holistic approach to increase engagement among staff, family, and residents in memory care
DESCRIPTION
Senior housing communities must take a proactive approach to minimize residents’ memory loss while enriching their lives. This session will examine the current state of memory care in a typical senior housing setting, how proactive engagement slows the progression of memory deterioration and how an integrated and holistic approach to memory care increases staff, resident and family satisfaction. Engaged family members are a key part of slowing the process of memory deterioration. Some family members may live close enough for regular visits, but many family members are geographically spread. Staff and administrators can engage with residents on a higher level by encouraging family members to submit stories, achievements, interests and other biographical information. Sarv Devaraj, Ph.D., Founder, CarexTech, Chair Professor of Management, University of Notre DameTRANSCRIPT
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S ar v Devara j , P h D
Fre d V. Duda Cha i r P ro fe sso r Un i ve r s i t y of Notre Dame
Founde r C arex Te c h , Inc .
s devara j@ nd . e du
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A HOLISTIC APPROACH TO INCREASE ENGAGEMENT AMONG STAFF, FAMILY, AND RESIDENTS
IN MEMORY CARE
…..AND WHY DOES IT MATTER?
Presented at ALFA 2015 National Conference Tampa, FL
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A LITTLE WARM-UP EXERCISE
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PROGRAM DESCRIPTION
Senior housing communit ies must take a proact ive approach to minimize res idents ’ memor y loss whi le enr ich ing thei r l i ves .
Th is sess ion wi l l examine :
1 . The cur rent s tate o f memor y care in a typ ica l sen ior hous ing set t ing , 2 . How proact ive engagement s lows the progress ion of memor y deter io rat ion 3 . How an in tegrated and ho l i s t i c approach to memor y care increases s taf f , res ident and
fami ly sat is fact ion .
Engaged fami ly member s are a key par t o f s lowing the process o f memor y deter io rat ion . Some fami ly member s may l i ve c lose enough for regu lar v is i ts , but many fami ly member s are geographica l l y spread .
Staf f and admin is t rator s can engage wi th res idents on a h igher leve l by encourag ing fami ly member s to submit s tor ies , ach ievements , in terests and other b iographica l in format ion .
Des igned for an in termediate - leve l aud ience .
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INTRODUCTION AND OUTLINE
Introduction “Give one, Get a Bunch”
Setting the Stage: Memory Care and Senior Living Engagement and the Triad: Family, Caregiver, Resident Contemporary Approaches STAR: An Approach to Memory
Care Technology to Empower the Human Touch Summary: Final Thoughts, Comments and Questions
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GIVE ONE - GET A BUNCH!
Index cards at your seat for sharing an INNOVATIVE ENGAGEMENT IDEA. This idea can be something you have implemented; or an idea that you would l ike to see implemented.
Af ter the talk I wi l l col lect the cards and in the next 10 days I wi l l compile them into a document and share ALL of the ideas with you via an email .
The next sl ide explains what you need to do to par t icipate.
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GIVE ONE - GET A BUNCH!
Side #1:
Your name* Your title* Your organization* Your phone* Your email*
( P le as e note t ha t t h i s i n fo rm at ion w i l l be inc lude d in t he docum e nt t ha t I s e nd you , s o anot he r pa r t i c ipant in te re s te d in your i de a can cont ac t you d i re c t l y. I f t h i s i n fo rm at ion i s m is s ing , you r i de a w i l l no t be inc lude d in t he l i s t and you won ’ t re ce i ve a copy o f t he docume nt . )
Side #2: A brief explanation of the INNOVATIVE ENGAGEMENT IDEA
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SETTING THE STAGE: MEMORY CARE AND SENIOR LIVING
According to the National Alzheimer’s Association, at least half of the residents in long-term care suffer from dementia.
From 2000 to 2010, there was a 68 percent increase in deaths from Alzheimer’s, while deaths from other major diseases, including heart disease, decreased.
Approximately 1 in 3 seniors will die from some form of dementia
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ONGOING CHALLENGES
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M E M O R Y C A R E C E R T I F I C AT I O N J O I N T C O M M I S S I O N I S S U E D C R I T E R I A FO R C E R T I F I C AT I O N W H I C H I N C L U D E S
“ E N G AG I N G M E A LT I M E , S O C I A L A N D R E C R E AT I O N A L E X P E R I E N C E S D E S I G N E D FO R R E S I D E N T S W I T H D E M E N T I A T H AT I N C L U D E FA M I L I E S A N D O P P O R T U N I T I E S FO R I N T E R G E N E R AT I O N A L AC T I V I T I E S ”
L I K E LY T O S E E M O R E E M P H A S I S AT S TAT E L E V E L FO R S K I L L E D C A R E , B U T A L S O AT LO W E R C A R E L E V E L S ( A L , E T C . ) E V E N I N U N L I C E N S E D M AY B E M O R E U N D E R S TA N D I N G O F T H E N E E D FO R D E S I G N I N G S P E C I F I C A L LY FO R D E M E N T I A
A S S I S T E D L I V I N G C O M M U N I T I E S - AV E R AG E AG E E N T E R I N G A L 8 5 A N D A B O U T 4 0 % H AV E S O M E M E A S U R A B L E M E M O R Y I M PA I R M E N T
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MEMORY CARE: A CONTINUUM
Cognitive Aging Dementia(s) Alzheimer’s
Clinical Dementia Rating (CDR) - 5 Stages
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AN ALZHEIMER’S EXPERIMENT: VIDEO
http://www.upworthy.com/he-was-fed-up-with-his-mom-so-he-tried-an-experiment-after-it -ended-he-started-sobbing?c=ufb2
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A VERY REAL AND PERSONAL ISSUE THAT AFFECTS ALL OF US
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ENGAGEMENT AS A STRATEGY
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Holleran Feb 2015 Insight Poll
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SOME EVIDENCE OF ENGAGEMENT
After Before
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THE MORE DIFFICULT QUESTIONS…
What do communities mean by engagement?
What is the basis of engagement?
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CONSEQUENCES
I f engaging experiences DON”T take place in residential care, more elderly wi l l progress to advanced stages of dementia requir ing more costly care.
Study showed 2/3 of AL residents had Dementia and 1/3 had psychiatr ic disorders such as depression, anxiety or psychosis.
Tip of the iceberg ?
This also leads to the conclusion that ALL residents need engaging experiences to slow progression of dementia and give good quality of l i fe.
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THE TRIAD: FAMILY, CAREGIVER, RESIDENT
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PUTTING ENGAGEMENT TO WORK
Life Stories of Residents Activities Trigger Events Memorable Moments Media: Pictures, Music, Video Conversations
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LIFE STORIES OF RESIDENTS
Captureing richly detailed stories can help in several ways:
Design resident-centric activities Use trigger events in providing care Empower Reminiscing Validation
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ACTIVITIES
● Engage residents’ intellectual, emotional and thought-process aspects and preferably all day long, not just during “activity hour”
● Adjust level of support provided for the activities ● Several activities should be based on Life Stories of residents ● Keep a log of participation and engagement and correlate to
well -being; what works for one person might not for the other ● BALANCED: Life enrichment activites focused on one of more
aspects - Physical, Social, Cognitive, Spiritual
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TRIGGER EVENTS
Trigger events are memorable incidents that can bring a quantum change in a resident’s behavior when discussed with him
Often times these are deeply buried in the minds and psyche of the resident
Family can provide a details about these
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MEMORABLE MOMENTS
One of the best ways to make yourself happy in the present is
to recall happy times from the past. Photos are a great
memory-prompt, and because we tend to take photos of
happy occasions, they weight our memories to the good. Gretchen Rubin
Media: Pictures, Music, Video
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CONVERSATIONS
A conversation is like a...
- a good friend
- a cognitive exercise
- a social boost
- a secure feeling
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CONTEMPORARY APPROACHES: QUICK REVIEW
Music and Memory Care
Validation Therapy
Habituation Therapy
DICE Model
Best Friends
The Eden Alternative 22
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MUSIC AND MEMORY CARE
Music, at its essence, is what gives us memories. And the longer a song has existed in our lives, the more memories we have of it . Stev ie Wonder
Alive Inside! https://www.youtube.com/watch?v=8HLEr-zP3fc
https://www.youtube.com/watch?v=U8TsAh-zYFI
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musicandmemory.org
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VALIDATION THERAPY
Naomi Feil ’s pathbreaking ef forts - is a method of communicating with disoriented seniors - based on empathy and enhances dignity - 3 basic pieces
- classifying behavior into 4 progressive stages (malorientation, time confusion, repetitive motion, and vegetation)
- based on empathy and respects/values seniors without judgment
- includes specific techniques geared to the individual
Video: Gladys Wilson and Naomi Fell ht tps ://www.youtube.com/watch?v=CrZXz10FcVM&noredirect=1
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vfvalidation.org
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HABILITATION THERAPY
The therapy is designed “to promote a positive emotion in a person with dementia, focusing on their strengths and minimizing l imitations,”
Communication. Words, body language and nonverbal communication become increasingly important.
The physical environment. “We really think about and talk about the importance of, the influence of, the physical environment.”
The approach to personal care—“really keeping the person with dementia in the middle and the focus in terms of our approach to care.”
Purposeful and meaningful engagement throughout the day—“giving the person with dementia a sense of purpose and belonging.”
Behavior as communication. When speaking is difficult, behavior becomes the way to communicate. Caregivers use a “behavior log” of sorts to identify behaviors and internal or external triggers to behaviors that need to be responded to.
Audience participation - Case studies
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Aging in Action, Volume 26, Number 24, Fall 2011
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DICE MODEL
Based on research from University of Michigan and Johns Hopkins University
Describe
Investigate
Create
Evaluate
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Journal of the American Geriatrics Society, April 2014 by Kales, Gitlin and Lyketsos
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BEST FRIENDS
● Viriginia Bell and David Troxel ● Staff member who empathizes with their situation,
remains loving and positive, and is dedicated to helping the person feel safe, secure and valued
● Person with dementia needs a friend (a best friend)
● Conceptual overlap with Validation approaches
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bestfriendsapporach.com
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THE EDEN ALTERNATIVE
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www.edenalt.org
Addresses 3 states of human condition: Loneliness, Boredom, and Helplessness
7 Primary Domains of Well-Being: Identity, Growth, Autonomy, Security, Connectedness, Meaning, Joy
Care Partner Teams work in collaborative partnership
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A LIFO MODEL (LAST IN FIRST OUT)
Memories are last in, first out..
So older memories are often the bridge
Talk to them using their name
Talk to them about their school days
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DISCUSSION OF THE APPROACHES
The research leads to specific types of interventions and life-enriching activities
that engage the resident.
Audience experiences ?
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GIVE ONE - GET A BUNCH!
Index cards at your seat for sharing an INNOVATIVE ENGAGEMENT IDEA. This idea can be something you have implemented; or an idea that you would like to see implemented.
After the talk, I will collect the cards and in the next 10 days I will compile them into a document and share ALL of the ideas with you via an email.
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STAR FRAMEWORK: HOLISTIC
Socialization
Trigger events
Activity balance
Reminiscence
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STAR FRAMEWORK:
Socialization Johns Hopkins research points to meaningful organized socia l act iv i t ies could stop,
and in males actual ly reverse , decl ines in vo lume in regions of the bra in vulnerable to dement ia .
Trigger events Ident i fy mental switches that can change behavior of res idents
Activity balance Studies shows that i t ' s the var iety of an e lder ly person's le isure and phys ical
act iv i t ies and not the intensi ty of the act iv i ty that may help reduce the r isk of dement ia , according to a new study.
Reminiscence Encouraging res idents to reminisce leads to posi t ive outcomes
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OPERATIONALIZING THE MODELS
Major Challenges:
Information
Caregiver
Documenting --- Analytics
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ENTER TECHNOLOGY: EMPOWERING THE HUMAN TOUCH IN MEMORY CARE
Bringing the Life Story of the resident to life
Capturing Music and Pictures
Monitoring Activities and Engagement
Bringing families/extended families into the equation
Cognitive assessments (e.g. MMSE)
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ACTIVIT Y ENGAGEMENT (GRAPHS)
So….here are ways that you could measure – once you’re capturing data
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ACTIVIT Y ENGAGEMENT (ANALY TICS)
Detecting a trend
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Ac#vity Type1 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Totals Ave/Mon
Social 12 23 11 14 12 13 14 15 16 14 12 14 170 14
Spiritual 6 5 9 6 5 4 5 8 5 4 5 6 68 6
Cogni9ve 15 15 15 15 18 1 8
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19 19 16 14 170 14
Physical 22 25 24 21 19 21 20 18 15 12 11 11 219 18
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ACTIVIT Y ANALY TICS
0
5
10
15
20
25
30
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Activity Trend
Social Spiritual Cognitive Physical
A picture tells the story
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USING TECHNOLOGY: SPECIFICALLY LIFE STORIES
Traditional: Interview with Mom
Technology Enabled: Contributions from family, extended family (with video, pictures, music!)
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MOM TELLS LIFE STORY (FROM INTERVIEW)
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I like cooking I enjoy music
LIFE STORY
I enjoy walking the garden sometimes
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ENGAGED FAMILY TELLS LIFE STORY
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Mom won the Best Pie contest in the State Fair 4 times in a row!
Daughter Suzie:
Son John:
She travelled all the way to Ireland to attend a Springsteen concert!
Niece Jane:
She used to write recipes for Good Housekeeping magazine and taught me everything I know about cooking
Grandchild Emily:
She was the lead singer for the Church choir
Daughter Amanda:
Grandma makes the best pumpkin spice cookies in the world!
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THE TRIAD: FAMILY, CAREGIVER, RESIDENT
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THE RESULTS
Family engagement enabled by technology - benefits the community, as well as the resident
Resident care more person-centered - better outcomes
Families are more connected - greater satisfaction and positive word of mouth
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THE MODEL
Rich Life Story STAR Better
Outcomes
-Enriched by family/friends -Enabled by technology
-Socialization -Trigger Events -Activity Balance -Reminisce
-Cognitive wellbeing -Activity Participation -MMSE -Moods
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SUMMARY
Put your final touches of - “Give one, Get a Bunch” Setting the Stage: Memory Care and Senior Living
Engagement The Triad - Family, Caregiver, Resident
Contemporary Approaches STAR: An Approach to Memory Care Technology to Empower the Human Touch
Summary: Final Thoughts, Comments and Questions 45
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IF I GET DEMENTIA.. .
If I get dementia, I want my fr iends and family to embrace my real ity. I f I
think my spouse is st i l l al ive, or i f I think we’re visit ing my parents for
dinner, let me bel ieve those things. I ’ l l be much happier for i t .
I f I get dementia, ask me to tel l you a story from my past.
I f I get dementia, make sure I always have my favorite music playing within
earshot.
I f I get dementia, remember that I am sti l l the person you know and love.
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Rachel Wonderlin’s blog
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SEEKING RESEARCH PARTNERS:
Sarv Devaraj, PhD Fred V. Duda Chair Professor
University of Notre Dame
Founder CarexTech, Inc.
Innovation Park at Notre Dame
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