Dementia: How does management approach/deal with residents? by Denise Fredericks (ASA)

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1 Dementia: How does management approach/deal with residents? by Denise Fredericks (ASA)

2 As an organisation, we are fully aware of the problems retirement villages are going through and empathize with you. However we cannot close our eyes to the way Alzheimer s/dementia patients are being treated at some villages. They still have rights as human beings and most cannot speak for themselves.

3 Dementia, a Growing Concern Worldwide 6 5 Dementia: 4 3 Series 1 Aids: 33 million Series 2 2 Series 3 1 = 0 Category Category Category Category million An Economic Crisis

4 Dementia worldwide

5 Dementia: A growing concern in SA Research UFS (2010) About 750, 000 South Africans are living with dementia (UK 850,000 (2014)) Urban black population higher than expected. Estimated 2.1% over 65yrs now 6%.

6 Worldwide costs of dementia in 2010

7 Average cost pp/pm for dementia care Details Price Frailcare R11,152,00 Pp sharing Medical waste removal R340,00 User articles (eg. nappies) R1000,00 Medical Aid R2700,00 Chemist surplus payments R1000,00 If not on AD meds (R400) Toiletries R250,00 TOTAL R17,542,00

8 Dementia: A public health priority? Dementia should be a public health priority and statistics be taken seriously as we are advancing on a dementia epidemic at an advanced pace. To address this, there are actions that can be taken: I. promote a dementia friendly society through education and awareness which will help to improve attitudes to, and understanding of, dementia; II. III. IV. make dementia a public health and social care priority everywhere. Government departments should assist; invest in health and social systems to improve care and services for people with dementia and their caregivers; and increase research on dementia.

9 ANYONE can get dementia! Each person is unique. Most people with dementia are/were highly intelligent. Give them the respect they deserve. Do not discriminate. Imagine living in a village for 20 yrs then to be told to move at age 85yrs!

10 How can management approach or deal with residents with AD?

11 Be prepared! Organize for regular memory screening tests Organize a multi-disciplinary team - network Assistance: Make a list of names and numbers eg Alzheimer s SA (helpline), Drs: GP, neurologist, Psychiatrist Social workers if there are no next of kin. Care agencies Family

12 Organize 1) Finance: (very important) Legal issues have to be addressed BEFORE midstage of AD. Who will be appointed Enduring/Conditional Power of Attorney/Curator bonis 2) Living Will (not legal in SA) mild stage. ALL residents should state what their preference would be in the event of them getting AD. 3) Reports (Life File): Medical, financial, personal. Keep filed. 4) Dates: Keep a diary/journal of appointments, events and family gatherings for the PWD (carer).

13 Plan ahead for CARE Everything practically possible to keep PWD independent for as long as possible.

14 Different kinds of Care Part-time/Day/Sleep-in carer mild stage (trained in dementia care) Home-based care Agencies (after moderate stage - end ) Nursing Home: a) Independent living b) Assisted living c) Frailcare

15 Different kinds of Care Day care for dementia patients Many residents have problem behaviour because they are bored or lonely (shared responsibility between villages) Music therapy Art therapy Pet therapy Exercise classes Craft classes Bridge, dominoes, card clubs Brain-stimulating games

16 Frailcare (specialized care) Build your own frailcare facility. Be sure to do proper research. Start a dementia unit in one of your cottages (Jeugland), fence it, have staff trained, build on it. Form partnerships with frailcare facilities in your area.

17 Possible Solutions! 1) Educate and create awareness to all staff and residents to reduce stigma against dementia. Alzheimers SA can help in this regard. 2) Village sister (half day): either one per village or shared between 2/3 villages. Checking meds Monitor progress PWD feels secure knowing someone cares

18 Possible solutions! Try to stay calm a diagnosis is upsetting to the patient as well as the family, just like any other illness. The patient thus needs lots of compassion and reassurance. Don t make rash decisions the progression of alzheimers is slow, you have time.

19 Possible solutions! Accumulate as much history of the person as possible as they revert back to their childhood. Many incidences can be avoided by knowing these facts. Embarrassing mealtimes can be avoided by giving the person softer foods or food cut into smaller portions.

20 DILEMMAS YOU COULD FACE Repetitive behaviour Confusion/Aggression Accusing others of stealing be aware of exploitation in this regard. Poor hygiene Continuous falls

21 DILEMMAS YOU COULD FACE Inappropriate dressing Immoral or sexually deviant behaviour Wandering/Lost/Going into other resident s houses Incapable of working with their finances.

22 Managing difficult behaviour Do not argue Do not reason Do not confront If they are wandering up and down, leave them alone they are not bothering anyone. Don t try to stop them, rather fall in step with them and after a few minutes ask whether they would like to go home. Be very careful what calming meds you give a PWD and how much.

23 Managing difficult behaviour If they are repeating themselves, try to change the subject/activity, tell them a story about your childhood. Go for a walk/tea. If they re walking around inappropriately dressed, do not draw their attention to it. Try to use humor to get them back to their room. Always try to find out what is triggering the difficult behaviour and what reaction works for you. Sometimes they tend to listen to certain people.

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