RCFE ADMINISTRATOR INITIAL CERTIFICATION PROGRAM

Transcription

1 RCFE ADMINISTRATOR INITIAL CERTIFICATION PROGRAM Day 6 DAY 6 1) Dementia Care Definitions Types/causes Managing behavioral challenges Medications Regulatory requirements Staff training Medications in dementia care Caring for the physical needs of residents with dementia Monitoring for changes in condition 2) Final Preparations for the State Exam 2 ABOUT YOUR INSTRUCTOR Name Background Years with CCG An interesting fact 3

2 Pre-test Pretest Pre-Test PRE TEST 4 Which of the following are possible causes of dementia? a) Alzheimer s disease b) Strokes c) Parkinson s disease d) All of the above 5 Mild cognitive impairment is not addressed in the RCFE dementia care regulations. a) True b) False 6

3 Effective approaches to managing behaviors in persons with dementia can include: a) Identifying and eliminating triggers b) Prescribing heavy doses of psychotropic medications c) Changing caregivers every day to keep them fresh d) All of the above 7 Under new RCFE laws, all RCFE staff must receiving training on dementia. a) True b) False 8 Which of the following medications carry a black box warning related to the danger of their use in persons with dementia? a) Antidepressants b) Antianxiety medications c) Antipsychotic medications d) Anxiolytics 9

4 Introduction to Dementia Care INTRODUCTION TO DEMENTIA CARE % Of all residents in assisted living have Alzheimer s disease or another form of dementia 12

5 Alzheimer's disease is the sixth leading cause of death in the United States. More than 5 million Americans are living with the disease. 1 in 3 seniors dies with Alzheimer's or another dementia. In 2012, 15.4 million caregivers provided more than 17.5 billion hours of unpaid care valued at $216 billion. Nearly 15% of caregivers for people with Alzheimer's or another dementia are longdistance caregivers. In 2013, Alzheimer's will cost the nation $203 billion. This number is expected to rise to $1.2 trillion by Source: Alzheimer s Association, 13 WHAT IS DEMENTIA? Not a specific disease A general term Majority due to Alzheimer s 2 nd most common is Vascular dementia Source: Alzheimer s Association, 14 DEMENTIA Alzheimer s Disease Frontotemporal Mixed Dementia Vascular Dementia Lewy Body Parkinson s Disease 15

6 SYMPTOMS OF DEMENTIA At least two: Memory Communication and language Ability to focus and pay attention Reasoning and judgment Visual perception 16 CAUSES OF DEMENTIA #1: Alzheimer s disease #2: Vascular dementia Many other causes 17 ALZHEIMER S DISEASE Symptoms: Difficulty remembering Apathy and depression Impaired judgment Disorientation Confusion Behavior changes Difficulty speaking Source: Alzheimer s Association 18

7 ALZHEIMER S DISEASE Brain changes: Deposits of protein Twisted strands of protein Nerve cell damage Source: Alzheimer s Association 19 ALZHEIMER S DISEASE 20 ALZHEIMER S DISEASE Source: Alzheimer s Association 21

8 STAGES Stage 1 Stage 2 Stage 3 No impairment The person does not experience any memory problems. An interview with a medical professional does not show any evidence of symptoms of dementia. Very mild cognitive decline The person may feel as if he or she is having memory lapses forgetting familiar words or the location of everyday objects. But no symptoms of dementia can be detected during a medical examination or by friends, family or co-workers. Mild cognitive decline Friends, family or co-workers begin to notice difficulties. During a detailed medical interview, doctors may be able to detect problems in memory or concentration. Source: Alzheimer s Association 22 STAGES Stage 4 Stage 5 Stage 6 Moderate cognitive decline At this point, a careful medical interview should be able to detect clear-cut symptoms in several areas: forgetfulness of recent events, greater difficulty performing complex tasks, such as planning dinner. Moderately severe cognitive decline Gaps in memory and thinking are noticeable, and individuals begin to need help with day-to-day activities. Severe cognitive decline Memory continues to worsen, personality changes may take place and individuals need extensive help with daily activities. Source: Alzheimer s Association 23 STAGES Stage 7 Very severe cognitive decline In the final stage of this disease, individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement. Source: Alzheimer s Association 24

9 VASCULAR DEMENTIA Symptoms: Impaired judgment Occurs because of brain injuries Location of injury determines losses Source: Alzheimer s Association 25 VASCULAR DEMENTIA: BRAIN CHANGES Imaging can often detect problems Used to exclude Alzheimer s diagnosis in past No longer valid as we understand brain better Source: Alzheimer s Association 26 WHAT DOES DEMENTIA FEEL LIKE? 1. Divide into small groups 2. Each person take a sheet of paper and draw three columns, labeling them like this: How would you FEEL? What would you DO? What have you LOST? 3. Listen to the instructor read aloud. Note first: How would you feel? List everything that comes to mind. Then, think, If I felt that way, what would I do? In the third column, write down what you have lost in that situation. SHARE and DISCUSS 27

10 Regulatory Requirements for Dementia REGULATORY Care REQUIREMENTS FOR DEMENTIA CARE 28 DIG IN! You have just completed an exercise to better understand the experience of the person with dementia. Now dig into the regulations (87705, 87706, 87707). Which of these SUPPORT the PERSON with dementia? Why? 29 CARE OF PERSONS WITH DEMENTIA Applicability Mild Cognitive Impairment Fire clearance Training Adequate staffing Medical assessments and appraisals Safety modifications Personal grooming and hygiene items Wrist bands and egress alert devices Exit alarms Delayed egress Locked doors Applicable Regulations

11 ADVERTISING DEMENTIA SPECIAL CARE Plan of operations Philosophy Assessments Admission procedures Activity programming Staff qualifications Staff training Physical environment Changes in condition Success indicators Admission agreement Advertisements Applicable Regulations TRAINING REQUIREMENTS IF ADVERTISING 6 hours of orientation Various methods 8 hours inservice training Require topics Documentation Trainer requirements Applicable Regulations CAREGIVER ORIENTATION TRAINING 40 hours total 20 hours before working independently 20 hours within first 4 weeks 33

12 2016 CAREGIVER ONGOING TRAINING 20 hours annually 8 hours dementia 4 hours postural supports, hospice 34 Care of Persons with Dementia CARE OF PERSONS WITH DEMENTIA 35 UNDERSTANDING THE PERSON S EXPERIENCE Pick one of the following roles and spend the next few minutes acting this out. Once your instructor calls Time share your feelings about the experience. You feel restless and cannot sit still. You re tired but can t stop moving. Drift around the room, rummaging in other people s handbags, making noises or trying to take other people s things. Imagine you re looking for something and you don t know what. Put your head down and think about things that make you feel sad. Don t respond if someone approaches you. Do a repetitive task from your chair like tapping or rocking. Don t stop. You need to leave here and go home right now. Focus your mind on a situation that might happen at home that would worry you if you don t get there now. 36

13 BEHAVIOR MANAGEMENT Can be biggest challenge Established techniques Behaviors are managed Expect some behaviors 37 TOP 5 TIPS 1. Don t take it personal 2. Remain patient 3. Explore pain as a trigger 4. Don't argue 5. Try to work through it Source: Alzheimer s Association 38 BEHAVIOR MANAGEMENT Step 1: Is it a problem? Step 2: What is the problem? Step 3: Who, when and where? Step 4: Why? Step 5: How will you manage it? Step 6: Reassessment 39

14 STEP 1: IS THE BEHAVIOR A PROBLEM? Negatively affects the resident or others = Yes Does not negatively affect the resident or others = No 40 STEP 2: WHAT IS THE PROBLEM? Identify the problem 41 STEP 3: WHO, WHEN, AND WHERE? Identify who, when, where Identify triggers Consider time, residents or staff, specific places or situations 42

15 STEP 4: WHY? Why the problem behavior occurs Could be symptom of dementia 43 STEP 5: HOW WILL YOU MANAGE THE BEHAVIOR? Team effort All members can contribute Managed, not resolved 44 STEP 6: REASSESSMENT Regularly reassess Is it getting better? Has it become worse? Should management solution be updated? Establish regular time frame 45

16 COMMON TRIGGERS Pain Frustration Demoralizing or infantilizing approach Misunderstanding a request Fatigue Communication barriers Inability to perform a task Inability to express needs Rapid change in the environment 46 Behavior Tips BEHAVIOR TIPS 47 48

17 AGGRESSION AND ANGER Identify the immediate cause Rule out pain Focus on feelings Don't get upset Limit distractions Try a relaxing activity Shift the focus Decrease danger Avoid using restraint Source: Alzheimer s Association 49 SLEEP ISSUES AND SUNDOWNING Keep the home well lit Make a comfortable sleep environment Maintain a schedule Avoid stimulants and big dinners Plan more active days Try to identify triggers Source: Alzheimer s Association 50 WANDERING Carry out daily activities Identify the most likely times Reassure the person Ensure all basic needs are met Avoid busy places Place locks out of sight Camouflage doors Use devices to signal egress Provide supervision Keep car keys out of sight Source: Alzheimer s Association 51

18 SEXUAL BEHAVIOR CHALLENGES Ensure safety Resident rights Ability to consent Communicate with family Relocate 52 Medications in Dementia Care MEDICATIONS IN DEMENTIA CARE 53 54

19 WHY WORRY ABOUT OVERUSE? Resident rights Chemical restraints Side effects and adverse reactions Quality of life Increased fall risk Increased risk of mortality (off-label antipsychotics 55 THREE CATEGORIES OF MEDICATIONS Treat the disease Aricept Namenda Etc Manage symptoms Psychotropic medications Antidepressants Anticonvulsants Etc Common medications Heart medications Pain medications Insulin Etc 56 MEDICATIONS FOR MEMORY LOSS FDA approved two types Cholinesterase inhibitors Memantine (Namenda) Cannot stop damage Help lessen symptoms Source: 57

20 CHOLINESTERASE INHIBITORS Early to moderate stages Prevent breakdown of acetylcholine Delay worsening of symptoms Generally well tolerated Includes Aricept, Exelon and Razadyne 58 MEMANTINE (NAMENDA) Moderate to severe stages Improves memory, attention, reasoning, language Often used in combination Can cause side effects 59 Psychotropic Medications PSYCHOTROPIC MEDICATIONS 60

21 DIFFERENT NAMES Psychoactive Psychotropic Psychiatric Psychotherapeutic Psychopharmaceutical 61 PSYCHOTROPIC MEDICATIONS Change brain function Includes drugs for mental illness and recreational drugs Alter neurotransmitters 62 63

22 CLASSES OF PSYCHOTROPIC DRUGS Class Antidepressants Use Major depression, anxiety, eating disorders Antipsychotics Psychosis, schizophrenia, mania Anxiolytics (antianxiety) Mood stabilizers Stimulants Depressants Anxiety disorders Bipolar depression ADHD Sedatives, anesthesia 64 USE OF PSYCHOTROPICS Grown in the last two decades 77% of mental health cases include drugs $2.8 billion in 1987 to $18 billion in WHY HAS USE GROWN? Gains in effectiveness Insurance coverage Direct advertising Convenience 66

23 ANTIPSYCHOTICS Conventional Antipsychotics: available since the 1950s; used to treat schizophrenia Atypical Antipsychotics: Used since 1990s; more commonly used today. 67 ANTIPSYCHOTIC SIDE EFFECTS Drowsiness Dizziness Blurred vision Rapid heartbeat Sensitivity to the sun Skin rashes Menstrual problems Weight gain (atypicals) 68 ANTIPSYCHOTIC SIDE EFFECTS Traditional antipsychotics: Rigidity Persistent muscle spasms Tremors Restlessness Tardive dyskinesia 69

24 Reducing the Use of Psychotropic REDUCING THE Medications USE OF PSYCHOTROPIC MEDICATIONS 70 ANTIPSYCHOTICS AND DEMENTIA May help those with psychosis Mostly misused for challenging behaviors Don t address root cause BLACK BOX WARNING Warning: Increased Mortality in Elderly Patients with Dementia-Related Psychosis. Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. [Name of Antipsychotic] is not approved for the treatment of patients with dementia related psychosis.

25 NCAL QUALITY INITIATIVE Reduce off-label use by 15% Maintain rates at or below 5 percent All communities will implement use of at least one tool QUALITY OUTCOMES Improves performance Decreases side effects Source: National Center for Assisted Living, Caring for Physical Needs CARING FOR PHYSICAL NEEDS 75

26 ASSISTING WITH ACTIVITIES OF DAILY LIVING Encourage independence Go at resident s pace Simple instructions Prompt/cue 76 DISEASE PROGRESSION Needs will change and deepen Late-stage Alzheimer s needs Source:

27 FOOD AND FLUIDS Comfortable upright position Adapt foods Encourage selffeeding Assist with feeding Encourage fluids Monitor weight Source: 79 BOWEL AND BLADDER FUNCTION Set toileting schedule Limit liquids before bed Use incontinence products Monitor bowel movements Source: 80 DELIRIUM An acute confusional state Disruptions in thinking and behavior Likely in persons with dementia Can easily go unrecognized 81

28 PAIN Communicating pain becomes difficult Seek medical attention as soon as possible Look for physical signs Pay attention to nonverbal signs Watch for changes in behavior Source: 82 State Exam Review and Prep STATE EXAM REVIEW AND PREP 83 Much Success to You! MUCH SUCCESS TO YOU! 84

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