1. It Pays to Work With Dementia Clients: Functional, Reimbursable Therapy Lynette Carlson, Mark Mizuko & Jolene Hyppa Martin Department of Communication Sciences and Disorders University of Minnesota-Duluth

2. Rationale for SLP Service By 2050, 22% of US population will be >65yo Approximately 15% of people >65yo are affected by dementia. Dementia affects communication and leads to problems meeting basic needs. SLPs play a primary role in helping people with communication disorders secondary to dementia (ASHA Position, 2005)

3. Roles of SLP in working with people with dementia (ASHA Position, 2005) Identification Assessement Intervention Counseling Collaboration Case management Education Advocacy Research

4. Universal Needs (Luceros, 1991) Maslow’s (1943) Fundamental Human Needs Constant guidance and direction Safe environment Structured environment Consistent caregivers Low stress environment –Appropriate Stimulation Redundant Cuing More Time – 72% more time Simplification Five Fundamental Human Needs (Maslow, 1943)

5. Distress Behaviors Ways we fulfill needs Communication Self-sufficiency Both of these skills deteriorate with dementia  increase in behaviors Distress behaviors

6. Distress Behaviors & Communication Cohen-Mansfield Agitation Inventory (CMAI)

7. ICF

8. Participation As dementia progresses, independent and appropriate communication activity decreases. As SLPs, we can help create supported activity which allows for increased and meaningful participation in life

9. Cognitive-Communication Engagement Engagement in constructive, meaningful activities or with objects that have positive associations creates a possibility for enhancing a resident’s level of daily functioning as well as preventing the problem behaviors often associated with dementia. Additionally, engagement promotes enjoyment and quality of life. Often, it is difficult to find the objects or activities that are appropriate for persons with dementia.

10. Example of Assessment for Measures of Distress Physical Restraints 7/3023% Stage 5.8-6.24/7 57% Stage 6.4-6.62/729% Stage 6.8-7.01/714% Gender (Overall 70% Female) Male4/757% Female 3/742% Non-English Speaking 2/729% Male Occupations Blue Collar3/475% May be indicative of following: –Agitation -> message of distress –Stress –Needs are not being met Review data according: –“Transition Stages” Inappropriate programming Stage 6: self stimulatory wanders, looking for people –Gender: Males (High) Facilities Setup for females Every male for every 10 females – hen pecked –Non-English Speaking (High) Communication problems – unable to communicate needs –Occupations (outdoor High) Try to go outdoors (farmers, laborers, sales persons, truck drivers)

11. Traditional Service Model Assess and diagnose Set goals for improved communication Submit for insurance approval Insurance payment For demonstrated Gains in communication Demonstrate gains in independent communication Provide service to improve skill

12. Concern of Service Access Traditional Reimbursement is driven by demonstrated gains in independent communication. SLPs tend to serve individuals with communication disorders in mild to moderate stages of dementia, who can readily demonstrate increased communication independence. Individuals with low moderate to severe stages of dementia may be underserved, partly due to barriers in reimbursement. As a result, negative communication behaviors are not sufficiently addressed.

13. Cost-Effective Service Provision: Consultation Proposition: Reduction in negative interactions and increase in life participation leads to: Improved family satisfaction Improved staff satisfaction Decreased incidence reports Decreased reports of negative behavior Decreased or maintained psychopharmacological management

14. Cost-Effective Service Models Traditional reimbursement Paid Consultation by Outside SLP Consultation with In- House SLP

15. Example of Cost Baselines Pharmacological management for each of 9 clients with dementia: $479.59/month Average facility cost for a single incidence report: *$135.83 Excludes the medical expenses for injury.

16. References ASHA (2005). The Roles of Speech - Language Pathologists Working With Individuals W ith 1 Dementia - Based Communication Disorders : Position Statement 2 3 Ad Hoc Committee on Dementia. LC SLP / SLS 8 - 2005 Attachment. Cohen-Mansfield, J. (2000). "Theoretical frameworks for behavioral problems in dementia." Alzheimer's Care Quarterly, 1(4): 8-21. Luceros, M (1991). Programming for Dementia. Geriatric Resources. Maslow, A. (1943). A Theory of Human Motivation. Psychological Review, 50, 370-396.