directing an alzheimer’s/dementia care unit
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
Directing an Directing an Alzheimer’s/Dementia Alzheimer’s/Dementia
Care UnitCare Unit
Funded by:Funded by:Indiana State Department of HealthIndiana State Department of Health
Co-sponsored by:Co-sponsored by:IAHSAIAHSA
IHCAIHCA
HOPEHOPE
Module 1:Module 1:Review of Dementia and Care Review of Dementia and Care
PracticesPracticesIn this section, we will cover:In this section, we will cover: Definition of dementia and Alzheimer’s diseaseDefinition of dementia and Alzheimer’s disease Alzheimer’s disease progressionAlzheimer’s disease progression Differences between dementia, depression, and Differences between dementia, depression, and
deliriumdelirium Importance of person centered care and its Importance of person centered care and its
implementationimplementation Importance of stress management with family Importance of stress management with family
and staffand staff
What is Dementia?What is Dementia? Dementia is a disease processDementia is a disease process
– Progressive decline in cognitive functionProgressive decline in cognitive function– Memory lossMemory loss
Over 170 irreversible dementiasOver 170 irreversible dementias– HIV, Vascular, Lewy Body, Parkinson’s, HIV, Vascular, Lewy Body, Parkinson’s,
Alzheimer’sAlzheimer’s Some forms are reversible (treatable)Some forms are reversible (treatable)
– Thyroid disorders, drug interactions, Thyroid disorders, drug interactions, dehydrationdehydration
Alzheimer’s DiseaseAlzheimer’s Disease Most common form of irreversible Most common form of irreversible
dementiadementia– Nearly 70% of all dementias are Alzheimer’sNearly 70% of all dementias are Alzheimer’s– Over 4.5 million Americans have Alzheimer’sOver 4.5 million Americans have Alzheimer’s– It is estimated that 60% of all nursing home It is estimated that 60% of all nursing home
residents have Alzheimer’s diseaseresidents have Alzheimer’s disease Alzheimer’s is not normal agingAlzheimer’s is not normal aging
– Learning new information make take longerLearning new information make take longer– May be difficult to filter out noiseMay be difficult to filter out noise
Brain ScanBrain Scan
StagesStagesEarlyEarly Needs Needs
remindersreminders Daily Daily
routines routines difficultdifficult
Concentrat-Concentrat-ion is ion is difficultdifficult
MiddleMiddle May need May need
hands on hands on carecare
May get lost May get lost easilyeasily
Changes in Changes in personalitypersonality
LateLate Severe Severe
confusionconfusion Needs hand Needs hand
on care for on care for most most personal personal carecare
May not May not recognize recognize self or self or familyfamily
Areas of the Brain AffectedAreas of the Brain AffectedCognitionCognition MemoryMemory LearningLearning LanguageLanguage Praxic Praxic
FunctionFunction Abstract Abstract
thinkingthinking Psycho-Psycho-
motor speedmotor speed
BehaviorBehavior Communi-Communi-
cationcation SafetySafety Personal Personal
care care deterioratesdeteriorates
Lapses in Lapses in clarityclarity
Hallucina-Hallucina-tions tions
DelusionsDelusions
EmotionEmotion Disregulated Disregulated DisorganizedDisorganized Apathy (loss Apathy (loss
of energy, of energy, willingness)willingness)
Lability Lability (moods (moods change)change)
Delirium, Depression, and Delirium, Depression, and DementiaDementia
DeliriumDelirium– Acute onset, can be treatedAcute onset, can be treated– Altered state of consciousnessAltered state of consciousness
DepressionDepression– Gradual onset, can be treatedGradual onset, can be treated– Look for signs, such as low self-esteemLook for signs, such as low self-esteem
DementiaDementia– Gradual onset, might be treatedGradual onset, might be treated– Memory loss and decline in cognitive functionMemory loss and decline in cognitive function
MedicationsMedications Cholinesterase Cholinesterase
InhibitorsInhibitors– CognexCognex– AriceptAricept– ExelonExelon– ReminylReminyl
Glutamate ReceptorsGlutamate Receptors– NamendaNamenda
Person Centered CarePerson Centered Care Person centered care is truly putting the Person centered care is truly putting the
PERSON firstPERSON first CharacteristicsCharacteristics
– Behaviors are a desire to communicateBehaviors are a desire to communicate– We must maintain and uphold the value of the We must maintain and uphold the value of the
personperson– Promote positive healthPromote positive health– All action is meaningfulAll action is meaningful
Person Centered Care, Cont.Person Centered Care, Cont. Core psychological needs must be met Core psychological needs must be met
to provide quality careto provide quality care– LoveLove– InclusionInclusion– AttachmentAttachment– IdentityIdentity– OccupationOccupation– ComfortComfort
Implementing Implementing Person Centered CarePerson Centered Care
RecognitionRecognition NegotiationNegotiation Collaboration/Collaboration/FacilitationFacilitation
PlayPlay TimalationTimalation CelebrationCelebration
RelaxationRelaxation ValidationValidation HoldingHolding
Person Centered Care Person Centered Care and Familiesand Families
Know what families are looking forKnow what families are looking for– Kindness and respectKindness and respect– Looks are importantLooks are important– The extrasThe extras
Be sensitive to the emotions family Be sensitive to the emotions family members may be experiencingmembers may be experiencing
Module 2:Module 2:Administrative PracticesAdministrative Practices
In this section, we will cover:In this section, we will cover: The role of the unit manager and its The role of the unit manager and its
responsibilitiesresponsibilities Review of human resources practicesReview of human resources practices Philosophy of carePhilosophy of care Admission/discharge requirementsAdmission/discharge requirements Policies and procedures of a special Policies and procedures of a special
care unitcare unit
Role of the Unit ManagerRole of the Unit Manager Identify your commitmentIdentify your commitment
– Become dementia-capableBecome dementia-capable Know the disease processKnow the disease process Know types of supports for familiesKnow types of supports for families Be willing to provide services for those with Be willing to provide services for those with
dementiadementia EvaluateEvaluate
– Evaluate for effectiveness of careEvaluate for effectiveness of care Quality indicatorsQuality indicators CommunicationCommunication
Empowerment!Empowerment! Challenge the processChallenge the process Inspire and share visionInspire and share vision Enable others to actEnable others to act Model the wayModel the way Encourage the heartEncourage the heart
Ownership and LeadershipOwnership and Leadership
ChallengeChallenge InspireInspire EnableEnable
ModelModel EncourageEncourage EmpowerEmpower
Philosophy of CarePhilosophy of Care Create mission statement and purposeCreate mission statement and purpose Approach to careApproach to care What’s “special” about special care?What’s “special” about special care? Communicate the messageCommunicate the message
Characteristics of Characteristics of Good Dementia WorkersGood Dementia Workers
CompassionCompassion Respect and Respect and honorhonor
DependabilityDependability
FairnessFairness HonestyHonesty IntegrityIntegrity
SupportiveSupportive Appreciation of Appreciation of teamworkteamwork
FlexibilityFlexibility
CreativityCreativity Sense of funSense of fun EnergeticEnergetic
WarmthWarmth Sense of Sense of humorhumor
Unconditional Unconditional positive regardpositive regard
Skills of Good Dementia Skills of Good Dementia WorkersWorkers
AssessmentAssessment EnergyEnergy
Problem solvingProblem solving Dementia-capable Dementia-capable communicationcommunication
ObservationalObservational RespectfulRespectful
Conflict resolutionConflict resolution PrioritizingPrioritizing
Hiring Staff with KnackHiring Staff with Knack Ask current staff for recommendations Ask current staff for recommendations
and to participate in processand to participate in process Look for nontraditional candidatesLook for nontraditional candidates Walk candidate around unitWalk candidate around unit Can the candidate have fun?Can the candidate have fun? Share your philosophyShare your philosophy Ask for storiesAsk for stories
From: Best Friends Staff. Bell and Troxel.From: Best Friends Staff. Bell and Troxel.
OrientationOrientation Normal aging vs. dementiaNormal aging vs. dementia Dementia process and progressionDementia process and progression Communication techniquesCommunication techniques Behaviors and approachBehaviors and approach Philosophy, policies, proceduresPhilosophy, policies, procedures Admission/discharge criteriaAdmission/discharge criteria How to work with familiesHow to work with families Stress reduction techniquesStress reduction techniques
Stress!Stress! Stress can lead to poor quality care, Stress can lead to poor quality care,
quality of life, and abuse and neglectquality of life, and abuse and neglect Signs of stressSigns of stress
– Too little or too much sleep, nightmaresToo little or too much sleep, nightmares– FatigueFatigue– Headaches, backaches, joint painHeadaches, backaches, joint pain– Diarrhea/constipationDiarrhea/constipation– Frequent accidentsFrequent accidents
AssessmentsAssessmentsMedicalMedical FunctionalFunctional EmotionalEmotional
SocialSocial CognitiveCognitive BehavioralBehavioral
Special needsSpecial needs Special Special interestsinterests
HabitsHabits
InterventionsInterventions TalentsTalents ReligionReligion
Ascertain validity of diagnosesAscertain validity of diagnoses Level of functioningLevel of functioning PreferencesPreferences Family wishesFamily wishes Advanced directivesAdvanced directives
Care PlansCare Plans Focus on individual needsFocus on individual needs Flexibility to enable a person to live the Flexibility to enable a person to live the
life he or she would wantlife he or she would want Emphasis on resident’s own sources of Emphasis on resident’s own sources of
self-esteem and pleasureself-esteem and pleasure Regular reevaluationRegular reevaluation Build in specific objectives and Build in specific objectives and
strategiesstrategies
Immediate Problem AnalysisImmediate Problem Analysis TaskTask
– Too complicated, too many steps, not modified, Too complicated, too many steps, not modified, unfamiliarunfamiliar
EnvironmentEnvironment– Too large, too much clutter, excessive stimulation, no Too large, too much clutter, excessive stimulation, no
clues, poor sensory, unstructured, unfamiliarclues, poor sensory, unstructured, unfamiliar Physical healthPhysical health
– Medications, impaired vision/hearing, acute illness, Medications, impaired vision/hearing, acute illness, chronic illness, dehydration, constipation, depression, chronic illness, dehydration, constipation, depression, fatigue, physical discomfortfatigue, physical discomfort
MiscommunicationMiscommunication
The 11 W’sThe 11 W’s Who has the behavior?Who has the behavior? What is the specific behavior?What is the specific behavior? Why does it need to be addressed?Why does it need to be addressed? What happened just before?What happened just before? Where does it occur?Where does it occur? What does the behavior mean?What does the behavior mean? When does the behavior occur?When does the behavior occur? What is the time, frequency?What is the time, frequency? Who is around?Who is around? What is the outcome?What is the outcome? What is the DESIRED change?What is the DESIRED change?
Transfer/Discharge CriteriaTransfer/Discharge Criteria Educate family during pre-admission Educate family during pre-admission
and in care plan meetingsand in care plan meetings Compare reassessment data to Compare reassessment data to
admission/discharge criteriaadmission/discharge criteria Utilize RAI/MDS assessment data, RAPS, Utilize RAI/MDS assessment data, RAPS,
and care plan processand care plan process Is the resident still compatible with the Is the resident still compatible with the
mission?mission? Be consistent!Be consistent!
Module 3:Module 3:Educating StaffEducating Staff
In this section, we will cover:In this section, we will cover: Basic principles of adult education, including Basic principles of adult education, including
needs of adult learnersneeds of adult learners Types of audiences within facilityTypes of audiences within facility Techniques for assessing for types of Techniques for assessing for types of
educational needseducational needs Understand materials providedUnderstand materials provided Explore and assess potential internal and Explore and assess potential internal and
external resources for educational servicesexternal resources for educational services
Basics of Adult EducationBasics of Adult Education Adults who attend educational Adults who attend educational
opportunities have made a great effort opportunities have made a great effort to attendto attend
Adults have unique and individual needsAdults have unique and individual needs The educator is the organizer, guiding The educator is the organizer, guiding
learninglearning
Successful LearningSuccessful Learning Be prepared with extra informationBe prepared with extra information Make the program safe and interestingMake the program safe and interesting Make the learning goals clear, and stick Make the learning goals clear, and stick
to themto them Clarify the criteria of evaluationClarify the criteria of evaluation Promote self-empowermentPromote self-empowerment Emphasize the felt needs of learnersEmphasize the felt needs of learners Provide a variety of learning techniquesProvide a variety of learning techniques
Alternative Methods of Alternative Methods of TeachingTeaching
Cross trainCross train Bulletin or graffiti Bulletin or graffiti boardsboards
Articles or newslettersArticles or newsletters Mini in-servicesMini in-services
Group activitiesGroup activities OrientationOrientation
Audiences and NeedsAudiences and Needs FamiliesFamilies
– Care plan, modeling, coaching, family Care plan, modeling, coaching, family handbook, family programshandbook, family programs
Resident councilsResident councils– Understanding disease process, administrative Understanding disease process, administrative
practices, working with staffpractices, working with staff Specific staff groupingsSpecific staff groupings
– Nursing, activities, night shiftNursing, activities, night shift
Techniques for AssessmentTechniques for Assessment Gather ideasGather ideas
– Observation, questionnaires, records, Observation, questionnaires, records, interviews, informal gatheringsinterviews, informal gatherings
Determine needs Determine needs – Organization, people, taskOrganization, people, task
CreateCreate– Objectives, content, techniques, organization, Objectives, content, techniques, organization,
visual aidsvisual aids
Educational MaterialsEducational Materials Overview of DementiaOverview of Dementia Person Centered CarePerson Centered Care Communication StrategiesCommunication Strategies Understanding BehaviorsUnderstanding Behaviors Activities of Daily LivingActivities of Daily Living Family DynamicsFamily Dynamics
Internal ResourcesInternal Resources Who is the best educator?Who is the best educator?
– Not everyone is right for every subjectNot everyone is right for every subject Who has an interest in educating?Who has an interest in educating? What can each person contribute?What can each person contribute?
– Line staffLine staff– AdministrativeAdministrative– ManagersManagers
External ResourcesExternal Resources ConsultantsConsultants Medical DirectorsMedical Directors Alzheimer’s AssociationAlzheimer’s Association Service agenciesService agencies ESLESL
Module 4:Module 4:Regulatory Standards and Reducing Regulatory Standards and Reducing
Deficient PracticesDeficient PracticesIn this section, we will cover:In this section, we will cover: Overview of commonly sited F-tagsOverview of commonly sited F-tags Key safety concerns and potential solutionsKey safety concerns and potential solutions Relationship between person centered care Relationship between person centered care
and resident rightsand resident rights Family needs and potential opportunitiesFamily needs and potential opportunities Potential situations leading to abuse and Potential situations leading to abuse and
neglectneglect Possible quality indicatorsPossible quality indicators
F-TagsF-Tags 154: Right to be informed154: Right to be informed 157: Notification of changes157: Notification of changes 164: Privacy and confidentiality164: Privacy and confidentiality 207: Equal access to quality care207: Equal access to quality care 221/222: Resident behavior and facility practices221/222: Resident behavior and facility practices 223: Abuse223: Abuse 224/226: Staff treatment of residents 224/226: Staff treatment of residents 240: Quality of life240: Quality of life 241: Dignity241: Dignity
F-Tags, Cont.F-Tags, Cont. 242: Self-determination242: Self-determination 243/244: Participation in resident and family 243/244: Participation in resident and family
groupsgroups 245: Participation in other activities245: Participation in other activities 246: Accommodation of needs246: Accommodation of needs 280: Care plans280: Care plans 281/282: Professional standards of quality281/282: Professional standards of quality 309: Quality of Care309: Quality of Care 310: Activities of Daily Living310: Activities of Daily Living
F-tags, Cont.F-tags, Cont. 323/324: Accidents323/324: Accidents 353: Nursing services353: Nursing services 495: Competency495: Competency 497: Regular in-service education497: Regular in-service education 498: Proficiency of nurse aids498: Proficiency of nurse aids
Safety Concerns and SolutionsSafety Concerns and Solutions Environmental implications of Environmental implications of
physiological changesphysiological changes– Vision, hearing, thermal regulation, tactile Vision, hearing, thermal regulation, tactile
sensation, musculoskeletal, balancesensation, musculoskeletal, balance SecuritySecurity
– People with dementia may not be able to judge People with dementia may not be able to judge unsafe conditionsunsafe conditions
Physical supportsPhysical supports
Resident Rights—Bell and Resident Rights—Bell and TroxelTroxel
To be informed on one’s diagnosisTo be informed on one’s diagnosis To have appropriate ongoing medical careTo have appropriate ongoing medical care To be productive in work and play as long as To be productive in work and play as long as
possiblepossible To be treated like an adult, not a childTo be treated like an adult, not a child To have expressed feelings taken seriouslyTo have expressed feelings taken seriously To be free of psychotropic medications if at all To be free of psychotropic medications if at all
possiblepossible To life in a safe, structured and predictable To life in a safe, structured and predictable
environmentenvironment To enjoy meaningful activities to fill each dayTo enjoy meaningful activities to fill each day
Abuse and NeglectAbuse and Neglect Willful infliction of injury, Willful infliction of injury,
unreasonable unreasonable confinement, confinement, intimidation, or intimidation, or punishment with punishment with resulting physical harm resulting physical harm or pain, anguish, or or pain, anguish, or deprivation by an deprivation by an individual of goods or individual of goods or services that are services that are necessary to attain or necessary to attain or maintain physical, maintain physical, mental, or psychosocial mental, or psychosocial well beingwell being
PhysicalPhysical SexualSexual VerbalVerbal MentalMental
Family FeelingsFamily Feelings DenialDenial FrustrationFrustration IsolationIsolation GuiltGuilt AngerAnger Loss/griefLoss/grief Letting goLetting go
Conflict ResolutionConflict Resolution Denial can be healthyDenial can be healthy Educate in small dosesEducate in small doses Do not push to hardDo not push to hard Encourage support groupsEncourage support groups AcknowledgeAcknowledge ListenListen FeedbackFeedback PrivacyPrivacy
Internal ResourcesInternal Resources Staff membersStaff members LibraryLibrary AdministratorAdministrator Family counselsFamily counsels Care plan meetingsCare plan meetings
Alzheimer’s AssociationAlzheimer’s Association HelplineHelpline Family EducationFamily Education Support GroupsSupport Groups Care ConsultationCare Consultation Safe ReturnSafe Return
Strategies for Positive Strategies for Positive RelationshipsRelationships
Show supportShow support– Family tours, communication processesFamily tours, communication processes– Validate emotions, develop realistic Validate emotions, develop realistic
expectations, compliment, report good newsexpectations, compliment, report good news Promote successful visitsPromote successful visits
– Offer suggestions and supportOffer suggestions and support– Bring in family videos, picturesBring in family videos, pictures– ActivitiesActivities
Quality IndicatorsQuality Indicators Number and frequency of medication adverse effectsNumber and frequency of medication adverse effects Proportion of residents who are over-sedatedProportion of residents who are over-sedated Incidence of falls, fractures, and elopementsIncidence of falls, fractures, and elopements Prevalence of restraintsPrevalence of restraints Incidence and prevalence of skin breakdownIncidence and prevalence of skin breakdown Incidence of symptomatic urinary tract infectionIncidence of symptomatic urinary tract infection Incidence of dehydrationIncidence of dehydration Use of futile or undesired treatments Use of futile or undesired treatments Moment by moment comfort of residentsMoment by moment comfort of residents Comfort of caregiving staffComfort of caregiving staff
Quality Indicators, Cont.Quality Indicators, Cont. Ability of staff to deal confidently with situationsAbility of staff to deal confidently with situations A coherence between values expressed in A coherence between values expressed in
mission and actual practicemission and actual practice Prevalence of agitated behaviorsPrevalence of agitated behaviors Prevalence of fecal impactionPrevalence of fecal impaction Prevalence of weight lossPrevalence of weight loss Incidence of decline in ROMIncidence of decline in ROM Prevalence of little or no activityPrevalence of little or no activity