Leading an Alzheimer s/dementia Care Unit

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Bridget Robbins
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1 Leading an Alzheimer s/dementia Care Unit Review of Dementia and Care Practices In this section, we will cover: Definition of dementia and Alzheimer s disease Alzheimer s disease progression Importance of person centered care and its implementation Discussion of Administrative Practices in Dementia Care Unit Reviewing regulatory standards Importance of stress management with family and staff What is Dementia? Dementia is a disease process Progressive decline in cognitive function Memory loss Over 170 irreversible dementias HIV, Vascular, Lewy Body, Parkinson s, Alzheimer s Some forms are reversible (treatable) Thyroid disorders, drug interactions, dehydration 1

Alzheimer s Disease Most common form of irreversible dementia Nearly 70% of all dementias are Alzheimer s Over 5 million Americans have Alzheimer s It

longer May be difficult to filter out noise Brain Scan Early Needs reminders Daily routines difficult Concentration is difficult Stages Middle May need

2 Alzheimer s Disease Most common form of irreversible dementia Nearly 70% of all dementias are Alzheimer s Over 5 million Americans have Alzheimer s It is estimated that 60% of all nursing facility residents have Alzheimer s disease Alzheimer s is not normal aging Learning new information make take longer May be difficult to filter out noise Brain Scan Early Needs reminders Daily routines difficult Concentration is difficult Stages Middle May need hands on care May get lost easily Changes in personality Late Severe confusion Needs hand on care for most personal care May not recognize self or family 2

3 Areas of the Brain Affected Cognition Memory Learning Language Praxic Function Abstract thinking Psychomotor speed Behavior Communication Safety Personal care deteriorates Lapses in clarity Hallucinations Delusions Emotion Disregulated Disorganized Apathy (loss of energy, willingness) Lability (moods change) Medications Tacrine (Cognex ) a cholinesterase inhibitor available by prescription since 1993 (it is rarely prescribed today because of associated side effects, including possible liver damage.) Treats mild to moderate Alzheimer s. Donepezil (Aricept ) a cholinesterase inhibitor available by prescription since Treats mild to moderate Alzheimer s. Rivastigmine (Exelon ) a cholinesterase inhibitor available by prescription since Treats mild to moderate Alzheimer s. Galantamine (Reminyl ) a cholinesterase inhibitor available by prescription since Treats mild to moderate Alzheimer s. Memantine (Namenda ) approved by the FDA on Oct. 17, Forest Laboratories, memantine s U.S. developer, was granted FDA-approval to sell memantine under the brand name Namenda. Treats more severe symptoms. Delirium Delirium, Depression, and Dementia Acute onset, can be treated Altered state of consciousness Depression Gradual onset, can be treated Look for signs, such as low self-esteem Dementia Gradual onset, might be treated Memory loss and decline in cognitive function 3

4 Person Centered Care Person centered care is truly putting the PERSON first Characteristics Behaviors are a desire to communicate We must maintain and uphold the value of the person Promote positive health All action is meaningful Person Centered Care, Cont. Core psychological needs must be met to provide quality care Love Inclusion Attachment Identity Occupation Comfort Implementing Person Centered Care Recognition Negotiation Collaboration/ Facilitation Play Timalation Celebration Relaxation Validation Holding 4

5 Person Centered Care and Families Know what families are looking for Kindness and respect First Impressions The extras Be sensitive to the emotions family members may be experiencing Administrative Practices In this section, we will cover: The role of the unit manager and its responsibilities Review of human resources practices Philosophy of care Admission/discharge requirements Policies and procedures of a special care unit Role of the Unit Manager Identify your commitment Become dementia-capable Evaluate Know the disease process Know types of supports for families Be willing to provide services for those with dementia Evaluate for effectiveness of care Quality indicators Communication 5

6 Ownership and Leadership Challenge Inspire Enable Model Encourage Empower Empowerment! Challenge the process Inspire and share vision Enable others to act Model the way Encourage the heart Philosophy of Care Create mission statement and purpose Approach to care What s special about special care? Communicate the message 6

7 Hiring Staff with Knack Ask current staff for recommendations and to participate in process Look for nontraditional candidates Walk candidate around unit Can the candidate have fun? Share your philosophy Ask for stories From: Best Friends Staff. Bell and Troxel. Characteristics of Good Dementia Workers Compassion Respect and Dependability honor Fairness Honesty Integrity Supportive Appreciation of Flexibility teamwork Creativity Sense of fun Energetic Warmth Sense of humor Unconditional positive regard Skills of Good Dementia Workers Assessment Energy Problem solving Observational Conflict resolution Dementia-capable communication Respectful Prioritizing 7

8 Orientation of Staff Normal aging vs. dementia Dementia process and progression Communication techniques Behaviors and approach Philosophy, policies, procedures Admission/discharge criteria How to work with families Stress reduction techniques Constructive Feedback 1. Address it as soon as possible 2. Talk in private 3. Be specific and objective 4. Explain how it should be done differently 5. Allow a reaction 6. Be affirming Review Reward Reassure Recognize Remedy Re-model The 6 R s 8

9 Assessments Medical Functional Emotional Social Cognitive Behavioral Special needs Special Habits interests Interventions Talents Religion Ascertain validity of diagnoses Level of functioning Preferences Family wishes Advanced directives Care Plans Focus on individual needs Flexibility to enable a person to live the life he or she would want Emphasis on resident s own sources of self-esteem and pleasure Regular reevaluation Build in specific objectives and strategies Task Immediate Problem Analysis Too complicated, too many steps, not modified, unfamiliar Environment Too large, too much clutter, excessive stimulation, no clues, poor sensory, unstructured, unfamiliar Physical health Medications, impaired vision/hearing, acute illness, chronic illness, dehydration, constipation, depression, fatigue, physical discomfort Miscommunication 9

10 Who has the behavior? The 11 W s What is the specific behavior? Why does it need to be addressed? What happened just before? Where does it occur? What does the behavior mean? When does the behavior occur? What is the time, frequency? Who is around? What is the outcome? What is the DESIRED change? Transfer/Discharge Criteria Educate family during pre-admission and in care plan meetings Compare reassessment data to admission/discharge criteria Is the resident still compatible with the mission? Be consistent! Educating Staff In this section, we will cover: Basic principles of adult education, including needs of adult learners Types of audiences within facility Techniques for assessing for types of educational needs Understand materials provided Explore and assess potential internal and external resources for educational services 10

11 Basics of Adult Education Adults who attend educational opportunities have made a great effort to attend Adults have unique and individual needs The educator is the organizer, guiding learning Successful Learning Be prepared with extra information Make the program safe and interesting Make the learning goals clear, and stick to them Clarify the criteria of evaluation Promote self-empowerment Emphasize the felt needs of learners Provide a variety of learning techniques Alternative Methods of Teaching Cross train Bulletin or graffiti boards Articles or newsletters Mini in-services Group activities Orientation 11

12 Families Audiences and Needs Care plan, modeling, coaching, family handbook, family programs Resident councils Understanding disease process, administrative practices, working with staff Specific staff groupings Nursing, activities, night shift Educational Materials Overview of Dementia Person Centered Care Communication Strategies Understanding Behaviors Activities of Daily Living Family Dynamics Internal Resources Who is the best educator? Not everyone is right for every subject Who has an interest in educating? What can each person contribute? Line staff Administrative Managers 12

13 External Resources Consultants Medical Directors Alzheimer s Association Service agencies Area Agencies on Aging Regulatory Standards and Reducing Deficient Practices In this section, we will cover: Possible quality indicators Key safety concerns and potential solutions Relationship between person centered care and resident rights Family needs and potential opportunities Potential situations leading to abuse and neglect Quality Indicators Number and frequency of medication adverse effects Proportion of residents who are over-sedated Incidence of falls, fractures, and elopements Prevalence of restraints Incidence and prevalence of skin breakdown Incidence of symptomatic urinary tract infection Incidence of dehydration Use of futile or undesired treatments Moment by moment comfort of residents Comfort of caregiving staff 13

14 Quality Indicators, Cont. Ability of staff to deal confidently with situations A coherence between values expressed in mission and actual practice Prevalence of agitated behaviors Prevalence of fecal impaction Prevalence of weight loss Incidence of decline in ROM Prevalence of little or no activity Safety Concerns and Solutions Environmental implications of physiological changes Vision, hearing, thermal regulation, tactile sensation, gait and balance Security People with dementia may not be able to judge unsafe conditions Physical supports Resident Rights Bell and Troxel To be informed on one s diagnosis To have appropriate ongoing medical care To be productive in work and play as long as possible To be treated like an adult, not a child To have expressed feelings taken seriously To be free of psychotropic medications if at all possible To life in a safe, structured and predictable environment To enjoy meaningful activities to fill each day 14

15 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 Physical Sexual Verbal Mental Show support Strategies for Positive Relationships Family tours, communication processes Validate emotions, develop realistic expectations, compliment, report good news Promote successful visits Offer suggestions and support Bring in family videos, pictures Activities Denial Frustration Guilt Anger Worry Loss/grief Letting go Family Feelings 15

16 Stress! Stress can lead to poor quality care, quality of life, and abuse and neglect Signs of stress Too little or too much sleep, nightmares Fatigue Headaches, backaches, joint pain Diarrhea/constipation Frequent accidents Conflict Resolution Denial can be healthy Educate in small doses Do not push to hard Encourage support groups Acknowledge Listen Feedback Privacy Internal Resources Staff members Library Administrator Family counsels Care plan meetings 16

rights of individuals who receive in-home care services.

17 Alzheimer s Association Helpline Family Education Support Groups Care Consultation Safe Return LB 698 passes legislature, sent to Governor LB 698 would create the Home Care Consumer Bill of Rights and would seek to protect the rights of individuals who receive in-home care services. It would also provide for a memory care endorsement under the Health Care Facility Licensure Act (previously LB 708) for applicability to Alzheimer s special care units. Positive Attitude! 17

Dementia. Memory Evaluation Center Neurology

Dementia. Memory Evaluation Center Neurology Dementia Memory Evaluation Center Neurology Topics Overview of dementia Stages Medications Advanced planning What is Dementia? Dementia = significant global decline in cognitive function not due to medicine