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Directing an Alzheimers/Dementia Care Unit. Funded by: Indiana State Department of Health Co-sponsored by: IAHSAIHCAHOPE.

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Presentation on theme: "Directing an Alzheimers/Dementia Care Unit. Funded by: Indiana State Department of Health Co-sponsored by: IAHSAIHCAHOPE."— Presentation transcript:

1 Directing an Alzheimers/Dementia Care Unit

2 Funded by: Indiana State Department of Health Co-sponsored by: IAHSAIHCAHOPE

3 Module 1: Review of Dementia and Care Practices In this section, we will cover: Definition of dementia and Alzheimers disease Definition of dementia and Alzheimers disease Alzheimers disease progression Alzheimers disease progression Differences between dementia, depression, and delirium Differences between dementia, depression, and delirium Importance of person centered care and its implementation Importance of person centered care and its implementation Importance of stress management with family and staff Importance of stress management with family and staff

4 What is Dementia? Dementia is a disease process Dementia is a disease process – Progressive decline in cognitive function – Memory loss Over 170 irreversible dementias Over 170 irreversible dementias – HIV, Vascular, Lewy Body, Parkinsons, Alzheimers Some forms are reversible (treatable) Some forms are reversible (treatable) – Thyroid disorders, drug interactions, dehydration

5 Alzheimers Disease Most common form of irreversible dementia Most common form of irreversible dementia – Nearly 70% of all dementias are Alzheimers – Over 4.5 million Americans have Alzheimers – It is estimated that 60% of all nursing home residents have Alzheimers disease Alzheimers is not normal aging Alzheimers is not normal aging – Learning new information make take longer – May be difficult to filter out noise

6 Brain Scan

7 Stages Early Needs reminders Needs reminders Daily routines difficult Daily routines difficult Concentrat- ion is difficult Concentrat- ion is difficult Middle May need hands on care May need hands on care May get lost easily May get lost easily Changes in personality Changes in personality Late Severe confusion Severe confusion Needs hand on care for most personal care Needs hand on care for most personal care May not recognize self or family May not recognize self or family

8 Areas of the Brain Affected Cognition Memory Memory Learning Learning Language Language Praxic Function Praxic Function Abstract thinking Abstract thinking Psycho- motor speed Psycho- motor speedBehavior Communi- cation Communi- cation Safety Safety Personal care deteriorates Personal care deteriorates Lapses in clarity Lapses in clarity Hallucina- tions Hallucina- tions Delusions DelusionsEmotion Disregulated Disregulated Disorganized Disorganized Apathy (loss of energy, willingness) Apathy (loss of energy, willingness) Lability (moods change) Lability (moods change)

9 Delirium, Depression, and Dementia Delirium Delirium – Acute onset, can be treated – Altered state of consciousness Depression Depression – Gradual onset, can be treated – Look for signs, such as low self-esteem Dementia Dementia – Gradual onset, might be treated – Memory loss and decline in cognitive function

10 Medications Cholinesterase Inhibitors Cholinesterase Inhibitors – Cognex – Aricept – Exelon – Reminyl Glutamate Receptors Glutamate Receptors – Namenda

11 Person Centered Care Person centered care is truly putting the PERSON first Person centered care is truly putting the PERSON first Characteristics Characteristics – Behaviors are a desire to communicate – We must maintain and uphold the value of the person – Promote positive health – All action is meaningful

12 Person Centered Care, Cont. Core psychological needs must be met to provide quality care Core psychological needs must be met to provide quality care – Love – Inclusion – Attachment – Identity – Occupation – Comfort

13 Implementing Person Centered Care RecognitionNegotiationCollaboration/Facilitation PlayTimalationCelebration RelaxationValidationHolding

14 Person Centered Care and Families Know what families are looking for Know what families are looking for – Kindness and respect – Looks are important – The extras Be sensitive to the emotions family members may be experiencing Be sensitive to the emotions family members may be experiencing

15 Module 2: Administrative Practices In this section, we will cover: The role of the unit manager and its responsibilities The role of the unit manager and its responsibilities Review of human resources practices Review of human resources practices Philosophy of care Philosophy of care Admission/discharge requirements Admission/discharge requirements Policies and procedures of a special care unit Policies and procedures of a special care unit

16 Role of the Unit Manager Identify your commitment Identify your commitment – Become dementia-capable Know the disease process Know the disease process Know types of supports for families Know types of supports for families Be willing to provide services for those with dementia Be willing to provide services for those with dementia Evaluate Evaluate – Evaluate for effectiveness of care Quality indicators Quality indicators Communication Communication

17 Empowerment! Challenge the process Challenge the process Inspire and share vision Inspire and share vision Enable others to act Enable others to act Model the way Model the way Encourage the heart Encourage the heart

18 Ownership and Leadership ChallengeInspireEnable ModelEncourageEmpower

19 Philosophy of Care Create mission statement and purpose Create mission statement and purpose Approach to care Approach to care Whats special about special care? Whats special about special care? Communicate the message Communicate the message

20 Characteristics of Good Dementia Workers Compassion Respect and honor Dependability FairnessHonestyIntegrity Supportive Appreciation of teamwork Flexibility Creativity Sense of fun Energetic Warmth Sense of humor Unconditional positive regard

21 Skills of Good Dementia Workers AssessmentEnergy Problem solving Dementia-capable communication ObservationalRespectful Conflict resolution Prioritizing

22 Hiring Staff with Knack Ask current staff for recommendations and to participate in process Ask current staff for recommendations and to participate in process Look for nontraditional candidates Look for nontraditional candidates Walk candidate around unit Walk candidate around unit Can the candidate have fun? Can the candidate have fun? Share your philosophy Share your philosophy Ask for stories Ask for stories From: Best Friends Staff. Bell and Troxel.

23 Orientation Normal aging vs. dementia Normal aging vs. dementia Dementia process and progression Dementia process and progression Communication techniques Communication techniques Behaviors and approach Behaviors and approach Philosophy, policies, procedures Philosophy, policies, procedures Admission/discharge criteria Admission/discharge criteria How to work with families How to work with families Stress reduction techniques Stress reduction techniques

24 Stress! Stress can lead to poor quality care, quality of life, and abuse and neglect Stress can lead to poor quality care, quality of life, and abuse and neglect Signs of stress Signs of stress – Too little or too much sleep, nightmares – Fatigue – Headaches, backaches, joint pain – Diarrhea/constipation – Frequent accidents

25 Assessments MedicalFunctionalEmotional SocialCognitiveBehavioral Special needs Special interests Habits InterventionsTalentsReligion Ascertain validity of diagnoses Ascertain validity of diagnoses Level of functioning Level of functioning Preferences Preferences Family wishes Family wishes Advanced directives Advanced directives

26 Care Plans Focus on individual needs Focus on individual needs Flexibility to enable a person to live the life he or she would want Flexibility to enable a person to live the life he or she would want Emphasis on residents own sources of self-esteem and pleasure Emphasis on residents own sources of self-esteem and pleasure Regular reevaluation Regular reevaluation Build in specific objectives and strategies Build in specific objectives and strategies

27 Immediate Problem Analysis Task Task – Too complicated, too many steps, not modified, unfamiliar Environment Environment – Too large, too much clutter, excessive stimulation, no clues, poor sensory, unstructured, unfamiliar Physical health Physical health – Medications, impaired vision/hearing, acute illness, chronic illness, dehydration, constipation, depression, fatigue, physical discomfort Miscommunication Miscommunication

28 The 11 Ws 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?

29 Transfer/Discharge Criteria Educate family during pre-admission and in care plan meetings Educate family during pre-admission and in care plan meetings Compare reassessment data to admission/discharge criteria Compare reassessment data to admission/discharge criteria Utilize RAI/MDS assessment data, RAPS, and care plan process Utilize RAI/MDS assessment data, RAPS, and care plan process Is the resident still compatible with the mission? Is the resident still compatible with the mission? Be consistent! Be consistent!

30 Module 3: Educating Staff In this section, we will cover: Basic principles of adult education, including needs of adult learners Basic principles of adult education, including needs of adult learners Types of audiences within facility Types of audiences within facility Techniques for assessing for types of educational needs Techniques for assessing for types of educational needs Understand materials provided Understand materials provided Explore and assess potential internal and external resources for educational services Explore and assess potential internal and external resources for educational services

31 Basics of Adult Education Adults who attend educational opportunities have made a great effort to attend Adults who attend educational opportunities have made a great effort to attend Adults have unique and individual needs Adults have unique and individual needs The educator is the organizer, guiding learning The educator is the organizer, guiding learning

32 Successful Learning Be prepared with extra information Be prepared with extra information Make the program safe and interesting Make the program safe and interesting Make the learning goals clear, and stick to them Make the learning goals clear, and stick to them Clarify the criteria of evaluation Clarify the criteria of evaluation Promote self-empowerment Promote self-empowerment Emphasize the felt needs of learners Emphasize the felt needs of learners Provide a variety of learning techniques Provide a variety of learning techniques

33 Alternative Methods of Teaching Cross train Bulletin or graffiti boards Articles or newsletters Mini in-services Group activities Orientation

34 Audiences and Needs Families Families – Care plan, modeling, coaching, family handbook, family programs Resident councils Resident councils – Understanding disease process, administrative practices, working with staff Specific staff groupings Specific staff groupings – Nursing, activities, night shift

35 Techniques for Assessment Gather ideas Gather ideas – Observation, questionnaires, records, interviews, informal gatherings Determine needs Determine needs – Organization, people, task Create Create – Objectives, content, techniques, organization, visual aids

36 Educational Materials Overview of Dementia Overview of Dementia Person Centered Care Person Centered Care Communication Strategies Communication Strategies Understanding Behaviors Understanding Behaviors Activities of Daily Living Activities of Daily Living Family Dynamics Family Dynamics

37 Internal Resources Who is the best educator? Who is the best educator? – Not 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 staff – Administrative – Managers

38 External Resources Consultants Consultants Medical Directors Medical Directors Alzheimers Association Alzheimers Association Service agencies Service agencies ESL ESL

39 Module 4: Regulatory Standards and Reducing Deficient Practices In this section, we will cover: Overview of commonly sited F-tags Overview of commonly sited F-tags Key safety concerns and potential solutions Key safety concerns and potential solutions Relationship between person centered care and resident rights Relationship between person centered care and resident rights Family needs and potential opportunities Family needs and potential opportunities Potential situations leading to abuse and neglect Potential situations leading to abuse and neglect Possible quality indicators Possible quality indicators

40 F-Tags 154: Right to be informed 154: Right to be informed 157: Notification of changes 157: Notification of changes 164: Privacy and confidentiality 164: Privacy and confidentiality 207: Equal access to quality care 207: Equal access to quality care 221/222: Resident behavior and facility practices 221/222: Resident behavior and facility practices 223: Abuse 223: Abuse 224/226: Staff treatment of residents 224/226: Staff treatment of residents 240: Quality of life 240: Quality of life 241: Dignity 241: Dignity

41 F-Tags, Cont. 242: Self-determination 242: Self-determination 243/244: Participation in resident and family groups 243/244: Participation in resident and family groups 245: Participation in other activities 245: Participation in other activities 246: Accommodation of needs 246: Accommodation of needs 280: Care plans 280: Care plans 281/282: Professional standards of quality 281/282: Professional standards of quality 309: Quality of Care 309: Quality of Care 310: Activities of Daily Living 310: Activities of Daily Living

42 F-tags, Cont. 323/324: Accidents 323/324: Accidents 353: Nursing services 353: Nursing services 495: Competency 495: Competency 497: Regular in-service education 497: Regular in-service education 498: Proficiency of nurse aids 498: Proficiency of nurse aids

43 Safety Concerns and Solutions Environmental implications of physiological changes Environmental implications of physiological changes – Vision, hearing, thermal regulation, tactile sensation, musculoskeletal, balance Security Security – People with dementia may not be able to judge unsafe conditions Physical supports Physical supports

44 Resident RightsBell and Troxel To be informed on ones diagnosis To be informed on ones diagnosis To have appropriate ongoing medical care To have appropriate ongoing medical care To be productive in work and play as long as possible To be productive in work and play as long as possible To be treated like an adult, not a child To be treated like an adult, not a child To have expressed feelings taken seriously To have expressed feelings taken seriously To be free of psychotropic medications if at all possible To be free of psychotropic medications if at all possible To life in a safe, structured and predictable environment To life in a safe, structured and predictable environment To enjoy meaningful activities to fill each day To enjoy meaningful activities to fill each day

45 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 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 Physical Sexual Sexual Verbal Verbal Mental Mental

46 Family Feelings Denial Denial Frustration Frustration Isolation Isolation Guilt Guilt Anger Anger Loss/grief Loss/grief Letting go Letting go

47 Conflict Resolution Denial can be healthy Denial can be healthy Educate in small doses Educate in small doses Do not push to hard Do not push to hard Encourage support groups Encourage support groups Acknowledge Acknowledge Listen Listen Feedback Feedback Privacy Privacy

48 Internal Resources Staff members Staff members Library Library Administrator Administrator Family counsels Family counsels Care plan meetings Care plan meetings

49 Alzheimers Association Helpline Helpline Family Education Family Education Support Groups Support Groups Care Consultation Care Consultation Safe Return Safe Return

50 Strategies for Positive Relationships Show support Show support – Family tours, communication processes – Validate emotions, develop realistic expectations, compliment, report good news Promote successful visits Promote successful visits – Offer suggestions and support – Bring in family videos, pictures – Activities

51 Quality Indicators Number and frequency of medication adverse effects Number and frequency of medication adverse effects Proportion of residents who are over-sedated Proportion of residents who are over-sedated Incidence of falls, fractures, and elopements Incidence of falls, fractures, and elopements Prevalence of restraints Prevalence of restraints Incidence and prevalence of skin breakdown Incidence and prevalence of skin breakdown Incidence of symptomatic urinary tract infection Incidence of symptomatic urinary tract infection Incidence of dehydration Incidence of dehydration Use of futile or undesired treatments Use of futile or undesired treatments Moment by moment comfort of residents Moment by moment comfort of residents Comfort of caregiving staff Comfort of caregiving staff

52 Quality Indicators, Cont. Ability of staff to deal confidently with situations Ability of staff to deal confidently with situations A coherence between values expressed in mission and actual practice A coherence between values expressed in mission and actual practice Prevalence of agitated behaviors Prevalence of agitated behaviors Prevalence of fecal impaction Prevalence of fecal impaction Prevalence of weight loss Prevalence of weight loss Incidence of decline in ROM Incidence of decline in ROM Prevalence of little or no activity Prevalence of little or no activity


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