BY DEBRA WOOD, R.N. With millions of Americans e!eriencing dementia and the num"er gro#ing #ith an aging !o!ulation, researchers continue to see$ effecti%e !re%ention and treatment methods, #hile man& long-term care !ro%iders are !lacing more em!hasis on ho# "est to care for !eo!le #ith dementia. 'We(re hearing more from families regarding their concerns a"out the )ualit& of care and ser%ices a%aila"le for their lo%ed ones #ith dementia, not sur!rising gi%en the millions of !eo!le affected "& it and ho# costl& care is,* sa&s +ac$ie Pin$o#it,, -Ed, chair of CCA.- Ad%ancing Person-Centered .i%ing in Colts Nec$, N+, a national ad%ocac& organi,ation, #hich created the !erson-centered National Dementia /nitiati%e, and an instructor at Rutgers 0ni%ersit& 1chool of 1ocial Wor$, 2erontolog& Program. 3he 4567 Alzheimers Disease Facts and Figuresfrom the Al,heimer(s Association estimated 8.4 million Americans ha%e Al,heimer(s disease, a num"er !ro9ected to increase to :.6 million "& 4548 and 67.; million "& 4585. '3he "est !ractice is !erson-centered care,* re!orts Ruth Dre#, director of famil& and information ser%ices at the Al,heimer(s Association in Chicago. 'Care is focused on the indi%idual.* Person-centered care offers a humanistic and holistic a!!roach to caring for someone. /t incor!orates not onl& !h&sical considerations "ut also the !erson(s !s&chosocial and s!iritual #ell-"eing. '/t(s a multidimensional frame#or$, and it re)uires o#ners and a go%ernance "oard #anting to ma$e these changes,* sa&s Pin$o#it,. 3he Dementia /nitiati%e "rought together an e!ert !anel to determine "est !erson-centered !ractices and offer guidance. 3he initiati%e !roduced a consensus #hite !a!er, Dementia Care: The Quality Chasm. 'We #ant sta$eholders across research, !olic& and !ractice to use this !a!er as a call to action to collecti%el& address and ad%ance !erson-centered solutions,* Pin$o#it, adds. 3he document !resents a histor& of the !hiloso!h& for !erson-centered care as #ell as o!erational and !ersonali,ed !ractices for deli%ering care in this #a&. /t also offers recommendations to address "arriers and challenges to care. -an& .eadingAge mem"ers ha%e em"raced !erson-centered care and ha%e de%elo!ed inno%ati%e !rograms to ad%ance dementia care #ithin their organi,ations. Delivering Person-Centered Care 1#itching from an institutional focus to a resident or !erson-centered focus re)uires a change in organi,ational culture, often not an eas& tas$. 1taff must hone in on the things that im!ro%e the !erson #ith dementia(s )ualit& of life. '/t(s the right thing to do, and it ma$es caregi%ers( 9o"s more en9o&a"le and safer,* Dre# sa&s. Peo!le #ith dementia still ha%e a human desire to connect #ith other !eo!le and ha%e a sense of self, Dre# adds. Caregi%ers can use residents( life e!eriences as a $e& to connect. 'You ha%e to $no# the !erson and #ho the& trul& are, $no# their interests and %alues,* Pin$o#it, ad%ises. 'Don(t focus on #hat the& cannot do, "ut #hat the& en9o& and can do. /t(s a"out creating #arm, caring relationshi!s.* Once caregi%ers reall& $no# the !eo!le in their care as indi%iduals, the& learn #hat things the older adult finds comforting and u!setting, Dre# e!lains. /t also re)uires #atching for cues. <or instance, if someone shies a#a& from or a!!ears fearful of a thera!& dog that most !eo!le are fa#ning o%er, di%ert that !erson to a different acti%it&. .ong gone are the da&s of 'realit& orientation,* in #hich the !rofessional caregi%er #ould correct the dementia !atient and attem!t to reorient him or her to the caregi%er(s realit&. Rather than tr&ing to tell someone determined to 'go to #or$* that the& are no longer em!lo&ed, the "etter res!onse is to gi%e them a tas$ to do. The Community at Brookmeade Elfriede Russel (left) cuts the rug with Regan mith! "ew Day #rogram coordinator at The Ba#tist $ome at Brookmeade% Russel! once a #rofessional dancer in &ienna! thoroughly en'oys dancing to music from her #ast that (rings (ack wonderful memories% he en'oys the #hysical freedom she feels when dancing% '3hat #as a culture change,* sa&s =aren >o"el, administrator of 3he Ba!tist ?ome at 3he Communit& at Broo$meade in Rhine"ec$, NY. 'We had to reassure staff that the& are not misleading the resident, "ut rather ste!!ing into his or her #orld.* 3he Ba!tist ?ome is in the !rocess of training all staff and %olunteers, using the Centers for -edicare @ -edicaid 1er%ices( ?and in ?and!rogram. 3he si sessions hel! #ith understanding dementia, !ro%ide resources to use #ith residents, ad%ise not ta$ing "eha%iors !ersonall&, and suggest #hen to !ull "ac$ and ho# to a!!roach residents and families. '/ #as gi%en tools to teach me ho# to ste! into that other !erson(s #orld, and that #as the most im!ortant !art of the trainingAho# to recei%e them #here the& are,* adds 1usanne Bernard, de%elo!ment director at 3he Communit& at Broo$meade. 3he use of anti!s&chotic medications also has fallen out of fa%or, after a De!artment of ?ealth and ?uman 1er%ices Office of /ns!ector 2eneral re!ort a"out at&!ical anti!s&chotic -edicare drug claims for !eo!le #ith dementia li%ing in nursing homes. 3he office found 6B !ercent of the residents had such claims, and ;7 !ercent #ere ordered 'off la"el.* /n res!onse, the Centers for -edicare @ -edicaid 1er%ices launched an initiati%e to reduce the use of those drugs. Ann -. =olano#s$i, PhD, RN, a nursing !rofessor at Penn 1tate 0ni%ersit& in 0ni%ersit& Par$, PA, led a grant-funded multidisci!linar& effort to create a !erson-centered tool"o for "eha%ioral health, #hich she e!ects #ill "e released this fall. 3he tool$it for nursing homes includes information a"out esta"lishing a nondrug focus throughout an organi,ation and offers suggestions of e%idence-"ased and cost-effecti%e methods other than medications to manage difficult "eha%iors. Recommendations include using music to calm !eo!le do#n and eercise !rograms to channel ecess energ& in !eo!le #ho #ander. )nnovative Dementia ervices Committee *ims to Disseminate Best Practices 'All our communities are seeing an increase of dementia in their residents, #hether in CCRCs or assisted li%ing. .eadingAge mem"ers are interested in )ualit& of life and care, and man& are loo$ing for guidance in ho# to "est a!!roach dementia. E%en communities #ith dementia !rograms are #ondering ho# to ma$e them "etter, ho# to find educational !rograms to hel! them.* 3hose are the #ords of =athleen Bla$e Curr&, chair of the ne# .eadingAge /nno%ati%e Dementia 1er%ices 1teering Committee. Curr& is %ice !resident, strateg& for dementia care for E-A, Elders"urg, -D. -ore * Person-Centered *##roach to Difficult Behaviors All "eha%iors are communication. When someone acts out of character it means the& are tr&ing to tell us something. 'We ha%e to loo$ at the #orld through their e&es and tr& to decode #hat the& are sa&ing,* Dre# sa&s. 'We start from the !remise that e%er&thing the& do has a meaning, then that hel!s us figure out the meaning and res!ond to #hat the& are tr&ing to sa&.* Dre# offers as an eam!le, a demure #oman #ho al#a&s dressed #ell "ut suddenl& started ta$ing off her clothes from the #aist do#n. 3he nurse suggested o"taining a urine sam!le, #hich indicated the #oman #ith dementia had an infection. Remo%ing her clothes #as an attem!t to relie%e the discomfort. Once treated, she $e!t her clothes on. 'Peo!le #ho cannot tal$ a"out their needs still ha%e needs,* Dre# re!orts. '3he& still are hungr&, thirst&, need to use the restroom, or are hot or cold. /f #e are good at figuring out #hat the& are tr&ing to sa&, #e gi%e much "etter care. And it(s a lot "etter caring for someone ha!!& and comforta"le. /t #or$s out #ell for e%er&"od&.* Dre# also recommends slo#ing do#n and not tr&ing to mo%e too fast around !eo!le #ith dementia, #ho cannot !rocess things )uic$l&. '/f &ou ta$e a gentle calm #a& at their !ace, it hel!s them rela and "e at their "est,* Dre# ad%ises. 3raditionall& difficult times, such as meals and "athing, can im!ro%e #ith a !erson-centered a!!roach. Dre# recommends a !leasant, home& en%ironment for dining, to feed finger food and use color contrasting foods, offered one or t#o at a time. Rather than feeding the !erson, encourage the !erson to do as much as the& can for as long as the& can. 0se cuing or hand- o%er-hand techni)ues to assist rather than do for the !erson. Peo!le #ith dementia often ha%e issues #ith #ater. Warm the "athroom. One that loo$s li$e home can "e hel!ful as can tr&ing to $ee! to a former routine. Partiall& co%er the !erson #ith a to#el and offer a #ashcloth to hold o%er the face. Perha!s sing #ith a !erson #ho used to %ocali,e in the sho#er or offer a fa%orite coo$ie to someone food-moti%ated. '=no#ing the !erson and euding #armth can o%ercome a lot of difficulties,* Dre# sa&s. Program Em(races Person-Centered Care The Community at Brookmeade +annie Caragine (left) and *nne $um(ach #artici#ate in the art thera#y #rogram at The Ba#tist $ome at Brookmeade% Caragine was a #rofessional hair stylist and en'oys self-e,#ression% $um(ach is an artist and has en'oyed a lifelong love of art% *t *nne-s we(site! htt#.//www%anniesstories%com/! her grandson Ro( *ndren has lovingly #laced his "ana-s stories for all the world to en'oy% 3he Ba!tist ?ome esta"lished its Ne# Da& !rogram to !ro%ide creati%e acti%ities for residents of its s$illed nursing facilit&. 3he D&son <oundation !ro%ided a C65,555 grant. Residents can !artici!ate si da&s !er #ee$ in the morning, afternoon or "oth. A"out D8 !ercent of residents, at all functional le%els, !artici!ate in one or more sessions. Certified nursing assistants assigned to acti%ities greet !artici!ants as the& arri%e to ma$e coo$ies or !i,,a, create art#or$, eercise or reminisce a"out mo%ies. 'We tr& to do things that are the norm,* >o"el sa&s. '3his !attern and routine has decreased "eha%iors and decreased confusion. We ha%e residents #a$e u! in the morning e!ecting to go some#here.* Residents ma& thin$ the& are going to #or$ or to school. <amilies are encouraged to 9oin in, or sit or #al$ in the Court&ard, #here 3he Ba!tist ?ome has installed a mail"o stuffed #ith 'mail,* a clothesline, a gardening cart, shad& seating and a "us sto!Etrain station. When a resident sa&s he needs to catch a "us to #or$, a staff mem"er ta$es him to that '"us sto!.* 3he residents can !ic$ flo#ers and ma$e center!ieces. 3he facilit& also has esta"lished a #al$ing !rogram. '/t(s thin$ing out of the "o,* >o"el sa&s. 'E%er&"od& is different, and &ou ha%e to ha%e a num"er of resources in &our tool"o.* 1ome !atients ha%e come off medications. 3he facilit& does not use restraints. 3he -usic and -emor& !rogram allo#s residents to listen to familiar music on an iPod. 3he music tends to calm residents. /t also hel!s them "riefl& regain s$ills the& had lost to dementia. 3he effect lasts for a short time after the music is off, gi%ing families o!!ortunities to con%erse #ith lo%ed ones. "on#harmaceutical )ntervention )m#roves +unctioning Eli,a +ennings in .a$e#ood, O?, has introduced an inter%ention, called 1A/DO .earningF, #hich has reduced and re%ersed s&m!toms of cogniti%e im!airment, re!orts De"orah ?iller, Eli,a +ennings !resident and CEO. /t is the first 0.1. organi,ation to incor!orate the !rogram, #hich originated in +a!an. Eli,a +ennings e!anded the !rogram to all of its locations and #ill soon "ecome the onl& training center for the inter%ention in the 0nited 1tates. ?iller learned a"out the non!harmaceutical inter%ention and an o!!ortunit& to !artner #ith the =umon /nstitute for Education in +a!an on a research trial and did not hesitate to !artici!ate. Eli0a 1ennings *t Eli0a 1ennings! residents and staff are #ioneering the use of *)D2 3earning in the 4nited tates% '/ sa# this a!!roach could dri%e !erson-centered care to a greater degree than it eisted for us, e%en though #e had "een in%ol%ed #ith the !erson-centered care mo%ement for more than a decade,* ?iller sa&s. '3he research from +a!an demonstrated that 1A/DO .earning im!ro%es the s&m!toms of dementia.* 1A/DO .earning consists of 75-minute thera!eutic sessions of sim!le reading, #riting and arithmetic fi%e da&s !er #ee$ for each !artici!ant, called a 'learner,* #ith a staff mem"er, called a 'su!!orter.* Residents !a& C685 !er month. Donations !ro%ide funding for Eli,a +ennings residents una"le to !a& for the !rogram. Each !erson is started at his or her indi%idual le%el and !rogresses. 3he learners com!lete the #or$sheets in a #a& in #hich the& are al#a&s successful. 3hrough a !henomenon $no#n as the transfer effect, the !refrontal corte stimulation causes im!ro%ements in other as!ects of the learner(s memor&, such as acti%ities of dail& li%ing or engagement #ith others. Partici!ants must continue in the !rogram for sustaina"le results. Each su!!orter #or$s #ith t#o learners. Although it sounds la"or-intensi%e, Eli,a +ennings has not needed to add staff. 3he trial, conducted at Eli,a +ennings in 4566 #ith 47 residents and 4B controls at a different in-net#or$ communit& during a si-month !eriod, found residents in the inter%ention grou! im!ro%ed on the mini-mental state eam, #hile the controls( !erformance declined. Additionall&, as a secondar& outcome, -D1 results sho#ed a B5 !ercent im!ro%ement in the inter%ention grou! and a :8 !ercent decline in the controls. -ood se%erit& im!ro%ed in the inter%ention cohort #hile the controls e!erienced a clear decline. '/t(s almost "e&ond "elief, until &ou see it,* ?iller sa&s. Eli,a +ennings is training all of its em!lo&ees in 1A/DO .earning, so the& could recogni,e su"tle im!ro%ements occurring in !artici!ating residents, such as a shado# of an e!ression on a learner(s face. 'Dail& #e see changes,* ?iller re!orts. '3he data su!!orts the da&-to-da& im!ro%ements, #hich "order on miraculous.* Residents ha%e regained continence, rest more comforta"l&, can use the tele!hone and communicate #ith famil& mem"ers, and are a"le to do more for themsel%es. ?iller antici!ates 1A/DO .earning could ha%e !rofound effects on health care costs. Care for !eo!le #ith dementia #ill cost C457 "illion this &ear, according to the Al,heimer(s Association fact "oo$. '/n +a!an, the& ha%e seen a reduction in the amount of care !eo!le need,* ?iller sa&s. '/t could reduce health care costs in the 0nited 1tates if 1A/DO .earning #as #idel& a%aila"le.* "ew *## timulates )nteraction! elf-E,#ression in Those 5ith Dementia C1E enior3ife C+E 1enior.ife of Chicago recentl& un%eiled a ne# iPad a!! that "uilds on its esta"lished Art in the -oment !rogram, a 9oint %enture "et#een C+E 1enior.ife and 3he Art /nstitute of Chicago. 3he Art in the -oment a!! #as made !ossi"le #ith funding from the Al,heimer(s <oundation of America and de%elo!ed "& 1ch#ar3ech Consulting ..C. 3he a!! dis!la&s selected #or$s of art found in 3he Art /nstitute(s collection to ser%e as a con%ersation !iece "et#een caregi%ers and indi%iduals #ith Al,heimerGs disease, stimulating interaction and encouraging self-e!ression. /t also offers #a&s for users to engage in art-ma$ing acti%ities on their o#n. -ore De(ra 5ood! R%"%! is a writer who lives in 2rlando! +3% Pre%ious 1tor& ?ome Net 1tor& 1hare on !rint 1hare on email 1hare on face"oo$ 1hare on t#itter 1hare on lin$edin -ore 1haring 1er%ices *dvertisements
1e!tem"er E Octo"er 4567 HO.0-E 7, N0-BER 8
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