DELIVERING HIGH QUALITY PERSON CENTERED

DEMENTIA CARE

DEBI BUZANOWSKI MA, CDP, CAADCT

EXECUTIVE DIRECTOR

MARJORIE DOYLE ROCKWELL CENTER

EDDY ALZHEIMER’S SERVICES

WHAT ARE WE TALKING ABOUT?

To begin with we have to have a working definition

of what we are talking about-

-What is Dementia?

-What is person centered care?

DEFINING DEMENTIA

Dementia

• A general term for a cluster of symptoms effecting intellectual functioning-

• The symptoms include problems with:

•Memory

• Judgment

• Language

• Decision-Making

• Many different conditions may cause dementia.

• Dementia is NOT a stand alone disease/condition.

Thought

or

Cognition

Memory

Language

Abstraction

Perception

Reasoning

Attention

Judgment

Organization

IMPORTANT ELEMENTS OF THOUGHT

BRAIN CHANGES IMPACTING CARE

• Memory centers are being destroyed-

• short term memories not forming or staying only briefly

• Forgetting they just ate/thinking they already ate

• Asking questions repeatedly

• Not understanding the passage of time

• Long Term Memories remain longer but may become less clear or defined

• Telling stories over and over but details are left out in each telling

BRAIN CHANGES IMPACTING CARE

• Frontal Lobe damage means the brain’s control center is being

effected

• Loss of attention- need cueing and reminder to focus on eating

• Crude/inappropriate language and behaviors are demonstrated – do not take it

personally

• Poor judgment and decision making- eating food when it is too hot

• Difficulty following directions

BRAIN CHANGES IMPACTING CARE

•When the Temporal lobe is damaged language issues develop

• Difficulty finding the right word- appears like the word is on the tip of the

tongue

• Not able to remember what an object is called- may point or gesture

instead of speak

• May eventually stop talking or speak in word salad- need to interpret

what is said and read tone and body language

KNOWING THIS HOW DO WE PROVIDE QUALITY CARE?

• With all these brain changes how then do we translate this into quality care?

• True Person Centered-Care

• Positive Strategies that Support Change

• Education, Education, Education!!!

PERSON CENTERED CARE

• What does person centered care mean for memory care?

• To see the person as a unique individual

• To respect remaining skills and abilities

• To support them to be successful and maintain independence

• To help them meet their needs for attachment, inclusion, identity, occupation, and comfort.

• To support them as a member of a community

• What decisions are they making for themselves?

• Does your staff support a person centered culture?

• Are you sure??

BARRIERS TO PERSON CENTERED CARE

• Lack of consistent staff

• Lack of meaningful activities

• Not understanding behaviors as communication

• Physical problems

• Not knowing our resident as a person

PERSON CENTERED CARE- RELATIONSHIP BUILDINGWHO ARE WE CARING FOR?

• Person Centered Care

• Who is our resident- what do we know about them?

• Learning personal triggers and talking points

• Intervention- Profile Cards

• Lists fast facts

• Talking points

• History Books

• Family Completes

PERSON CENTERED CARE- RELATIONSHIP BUILDING

• Resident based engagement opportunities

• Build programs related to resident interests

• Gardening

• Cooking

• Hunting/Fishing

• Special Dinners

• Small group opportunities

• Staff share their interests, vacations, hobbies etc.

PERSON CENTERED CARE-DAILY ROUTINES• Natural Wake-Up vs. Set Wake-Up

• More natural

• Prevents daytime sleepiness

• Bathing

• What is the bathing process in your facility?

• Do they HAVE TO get showers?

• So many ways to wash someone…

• Mealtimes

• Set mealtimes

• Substitutions

• Medications

• How many times are they getting meds?

• How many meds…

PERSON CENTERED CARE- SUPPORTING DECISION MAKING

•Residents DO NOT HAVE TO DO ANYTHING!

•They can make choices and decisions that we don’t agree

with, so we must support them-

• Does your staff know how to support them?

• Does everyone support resident decision making?

• …Are you sure??

EDUCATION, EDUCATION, EDUCATION• To truly have high quality person centered care, the care staff has to understand

dementia and what person centered care is and be empowered to carry it out!

• Knowledge is POWER!

• Staff can NEVER have enough Alzheimer’s and dementia education!

• Educated staff is more proactive in their approaches to our dementia residents rather

than reactive.

• What is your education plan?

• How many hours of dementia education are you providing?

• Does your staff think it’s enough?

• Who is doing the education?

EDUCATION, EDUCATION, EDUCATION• A High Quality Person Centered Dementia Care education should cover:

• Person Centered Dementia Care

• Biology of Dementia

• Communication Skills Training

• Environmental Assessment

• Resident Engagement

• Dementia Sensitivity

• Supporting Resident Decision Making

• Staff should receive additional training on a variety of topics of their choosing:

• Hoarding, Wandering and Paranoid Behaviors

• Enhancing the Mealtime Experience

• Challenges of Personal Care with Dementia Residents

• Intimacy and Sexuality

• Each of these educational sessions not only provides educational information but suggest non-

pharmacological interventions that could be used with our residents.

COMMUNICATION TRAINING TO ENHANCE QUALITY

• Communication Skills

• Eye Level-No Standing Over

• Slow down

• Simple Statements- 7 words or less

• Avoiding Questions

• Interventions

• Communication skill coaches

• Peer to peer coaching

• Simple statement cards

THERAPEUTIC FIBBING-ENTERING THEIR WORLD

• It can-

• Reduce anxiety/ Keeps them calm

• Keeps them in a positive frame of mind

• Prevents arguing and confrontation

• The Yes/No debate

• De-escalate a situation

• Prevent aggression

• Make them feel safe and secure

• Reassure them

PERSON CENTERED ENGAGEMENT

• Engaging Dementia Residents

• Engagement does not have to be in a large group or for 30 minutes

• Dementia residents still have strengths

• What are they and how do we use them?

• Interventions

• Therapeutic art/music groups

• Strength based tools

• Resident led activities

• Connection Centers

CONNECTION CENTERS-PERSON CENTERED ENGAGEMENT

• Strength-based tool kits that provide opportunities for our residents with dementia to exercise

the parts of their brain that are still healthy.

• These centers are offered at small tables allowing residents to participate individually or in a

group.

• The materials used in the centers feature a large variety of authentic props.

• The centers are used to help staff connect residents with other residents, reminisce, and

engage residents in meaningful activities.

• Staff function as a facilitators and not leaders when using the Connection Centers with the

residents.

• Used during change of shift, during the night- anytime that residents need something to

engage them.

CONNECTION CENTERS-PERSON CENTERED ENGAGEMENT • There are items to sort, fold, look at, reminisce with, manipulate and use their

cognitive skills with:

• Office Supplies

• Gardening

• Baking Supplies

• Baby clothes/pictures

• Jewelry

• Cat/Dog pictures

• Button Sorting

• Cards

• Word games/puzzles

• Coupon cutting

SAFETY ISN’T A VIRTUE…RISK TAKING

• Our first thought in the morning isn’t “I hope I’m safe today” why is it always

our first thought with our residents?

• We cannot always be afraid of the what ifs…

• Open discussions with families lead to the best person centered outcomes

IMPLEMENTING QUALITY PROGRAMMING

• Buy In!!!

• Program Champions

• Manager Modeling

• Involving staff in every discipline to enact change

• Education is Key

• Ask staff what they need/want to know

• Anticipate and embrace change and new ideas!

• If money were no object exercise…

QUESTIONS?

Debi Buzanowski

518-238-4160

debi.buzanowski@sphp.com