T105 Dementia Staging - IHCA › files › Education › Convention › Session...Dementia Facts and...

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Dementia Staging

Quality Implications for Patients and Providers

Making a difference in the lives of those we serve

Today’s Presenter


Corrie Dyson, MS, CCC‐SLPClinical Excellence Coordinator

Hedgehog Ambassador

CPI Certified Instructor of Dementia Capable Care Foundations and Behaviors Courses

Certified Dementia Care Specialist

[email protected]

1‐800‐804‐9961

Dementia Facts and Figures

• Alzheimer’s Disease is the 6th leading cause of death in the US

• 1 in 3 people will either have Dementia, or will serve as a caregiver for a person with Dementia in their lifetime

• 1 in 3 Seniors dies with Alzheimer’s or another Dementia

• 5.7 Million Americans are currently living with Alzheimer’s Disease

• This number is expected to rise to nearly 14 million by 2050

• 1 in 10 people age 65, and older, and 1 in 3 over 85 has ADRD

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What is Dementia?

• Dementia: The loss of mental capacity of such severity as to interfere with a person’s daily functioning

• Dementia is not a disease itself, but a group of symptoms which may accompany other diseases or conditions

• Examples of these symptoms include:

Memory Loss Communication and Language changes

Impaired ability to focus and pay attention Decreased judgment and reasoning

Impaired visual perception Impaired ability to recognize and solve problems

Difficulty sequencing through daily tasks Changes in behavior

Types of DementiaReversible Irreversible

Normal Pressure Hydrocephalus Alzheimer’s Disease

Neoplasms/Tumors Vascular Dementia

Metabolic Disorders Lewy Body Dementia

Delirium Frontotemporal Dementia (including Pick’s Disease and Primary Progressive Aphasia) LATE DementiaDrug Overdose/Alcohol Abuse

Medication Interactions Dementias related to Neurodegenerative Diseases and/or conditions, i.e.:• ALS• Huntington’s Disease• Parkinson’s Disease• Down’s Syndrome• Creutzfeldt-Jakob Disease• AIDS

Head Trauma/ TBI/ CVA (to some degree)

High Fever

Various InfectionsSleep Deprivation

DepressionInflammation

Heart DiseaseExtreme Stress

Common Risk Factors for residents with Dementia• Falls/Injury

• Unmanaged Pain

• Weight Loss/Dehydration

• Aspiration &/or Pneumonia

• Skin Breakdown and Wounds

• Contractures or ROM Declines

• Inappropriate use of Chemical &/or Physical Restraints

• Communication Breakdowns

• Social Isolation

• Responsive Behaviors

• Decreased Functional Mobility

“ Individually we are one drop. Together we are an ocean”

~Ryunosuke Satoro

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Benefits of a Formal Dementia Program

Patients

Family Members

Staff

Surveyors

Cost

Health

Satisfaction

Safety

Formal Dementia Program Implementation: Where do we begin?1. Begins with community staff, patient, and caregiver education regarding risk and reward

through implementation and the entire community is involved and invested in driving this development.

2. Requires the community as a team to have understanding of risk factors and external key features for patient identification. Clinician remains “expert” in identification.

3. Requires standardized procedures in place, accountability for implementation, and explanations for deviations

4. Clinician is required to provide ongoing communication and interaction to keep focus and attention on issue. This would include activities, educational information sessions, flyers and status updates

5. Requires hands on operational oversight for proper execution and accountability in the case of lapses

6. Includes a Paradigm Shift in the way we view and even talk about Dementia. Focus changes from focusing on disabilities, to focusing on remaining ABILITIES, and from a reactive approach, to a PROACTIVE approach.

Program Implementation Process

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Dementia Risk‐Based Screen

• Has resident had a recent change in living setting?

• Is resident taking a new (or new dosage of) psychotropic medication?

• Has resident had a recent or previously unaddressed decline in participation in Activities?

• Has resident had a recent increased need for help with his/her ADLs?

• Is resident exhibiting new or increased behaviors (aggression, refusal of care, wandering, etc.)

• Has resident had a new or previously unaddressed decline in communication (Expressive or Receptive)

• Is resident using a physical restraint?

• Does resident have new/worsening pressure ulcers?

• Has the resident had recent falls?

• Is the resident on a restorative program? (New/Changed/Previously Unaddressed?)

• Other Risks

Cognitive‐Based Leveling: Tracking Residents over Time• There is no one tool that can accurately assess all

aspects of function related to Dementia. A successful formal Dementia program should require at least 3 distinct assessments for dementia staging

• This allows the team to customize a plan of care to meet the needs of the residents while educating staff on appropriate care approaches and remaining abilities at each stage

• Assessments include: Global Deterioration Scale, Functional Assessment Staging Tool, Allen Cognitive Levels, and Routine Task Inventory‐Expanded, in addition to the therapists’ Skilled Observation of the resident’s remaining abilities

CFS CognitiveScale

BIMS Score CPS Score

Cognitively Intact 13‐15

Mildly Impaired 8‐12 0‐2

Moderately Impaired

0‐7 3‐4

Severely Impaired 5‐6

“The disease might hide the person underneath, but there’s still a person in there who needs your love & attention.”

~Jamie Calandriello

Cognitive‐Based Leveling:The Cognitive Disabilities Model (CDM)

• Developed by Claudia Allen, OTR

• The Levels focus on FUNCTIONAL cognition, and describe a measure of cognitive functional abilities and deficits

• Designed to provide residents with appropriate activities and goals, in order to set them up for success 24 hours/day, 7 days/week, whether in a community or at home.

• Used to provide a comprehensive plan to guide caregivers through each level.

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Cognitive‐Based Leveling:The Warchol Best Abilities Model • Created by Kim Warchol, OT

• Developed to work in tandem with an optimized physical environment to improve health, safety, level of functional independence, and quality of life.

• Based on 3 theories:

• Allen Cognitive Disabilities Model

• Reisberg’s Theory of Retrogenesis

• Kitwood’s Person‐Centered Care Approach

• Focuses on:

• Simplifying a resident’s world

• Gaining their trust

• Providing exceptional person‐centered, stage‐specific care

Cognitive‐Based Leveling: Stages of Dementia

Level 1:End Stage

Level 2: Late Stage

Level 3: Middle Stage

Level 4: Early Stage

Level 5: Mild Cognitive Impairment

Level 6: Normal Cognitive

Cognitive‐Based Leveling:Level 1: Automatic Actions ‐ End Stage

• Primary Remaining Abilities:

• Minimal response(s) to sensory stimulation provided to all 5 senses (provided by caregiver)

• Attends to subliminal sensory cues

• Swallow

• Vocalize

• Move limbs through partial Range of Motion (ROM)

• Time is useful in increments of SECONDS

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Cognitive‐Based LevelingLevel 1: End Stage• Communication Approaches to facilitate BATF:

• Provide meaningful sensory stimulation to promote vocalizations, movement, and interactions

• Provide stimuli directly in front of the person to capture attention

• Gain the person’s trust and agreement

• Reduce distractions

Cognitive‐Based Leveling:Level 1: Automatic Actions ‐End Stage

• Movement Information:

• Automatic spontaneous motor actions

• Not able to imitate others’ actions

• Purpose of movement is to achieve arousal or prevent discomfort

Cognitive‐Based Leveling:Level 1: Reflexive Responses ‐ End Stage

Level 1 - Modes1.8 May perceive one word to communicate; Supplies 50% of effort to

sit; Improved ability to assist in bed mobility and sitting

1.6 Spontaneous movements to prevent discomfort; AAROM of UEs; Sits in secure support (25%); Responds to tactile cues

1.4 Turns head to track a moving cue (visual, auditory); May turn head to track stimuli; swallows with modified diet; AAROM of the neck

1.2Responds to stimuli provided to all 5 senses; positive response to pleasant stimuli (olfactory); nonverbal arousal to voice and facial expression

1.0 Withdrawal from stimuli; best response from noxious stimuli

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Cognitive‐Based Leveling:Level 2: Postural Actions ‐ Late Stage• Primary Remaining Abilities:

• Gross motor movements against gravity

• Mobility: may sit, stand, walk (unsteady)

• Simple communication (Expressive & Receptive)

• Possible self‐feeding/drinking

• Time is useful in increments of MINUTES

• Able to approximate imitation of others’ actions

Cognitive‐Based Leveling:Level 2: Postural Actions ‐ Late Stage• ADL & Communication Approaches to facilitate BATF:

• Wait for a response (may be 10‐20 seconds)

• Use verbal, visual, and tactile cueing to gain attention and assist in processing directions

• Allow to self‐feed with finger foods, when able

• Allow resident to assist as much as possible during ADLs, to avoid agitation

• Provide frequent cueing to maintain attention to meals/tasks/activities

• Provide verbal and tactile cues for simple directions.

• Decrease/Eliminate distractions, both internal & external


Cognitive‐Based Leveling:Level 2: Postural Actions ‐ Late Stage• Movement Information:

• Attends to proprioceptive cues

• Spontaneous motor actions are postural and often initiated to prevent discomfort

• Approximate imitation of others’ actions

• Purpose is to achieve comfort with desire to experience any movement

• Use of movement to affect the body

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Cognitive‐Based Leveling:Level 2: Postural Actions ‐ Late Stage

Level 2 - Modes2.8

Using grab bars; Has spontaneous reach; Able to use procedural memory & reminiscence to promote communication; Fails to recognize stability of objects used to correct balance

2.6Directed walking; Dependent for safety; May be confused by contrasting floor patterns; May initiate self-feeding if foods are in close proximity; Combines words with actions

2.4Walking is impulsive; May sit or lose balance suddenly; Avoids barriers above the knee; Uses one word to initiate communication; Capable of AROM; Mental energy focused on overcoming gravity

2.2 Righting reactions; Spontaneously stands; Drinks from a cup &/or eats finger foods placed in hand; May use single words

2.0 Can lean forward; Able to overcome gravity; Often recognizes loved ones; Delayed response to directions/stimulations

Cognitive‐Based Leveling:Level 3: Manual Actions ‐ Middle Stage


• Uses hands to pick up and manipulate familiar objects

• Attends to tactile cues

• Eye‐hand coordination

• Notices effects of actions on objects

• Follows one‐step directions with cueing.

• Sees 12‐14 inches, directly in front of them, with tunnel vision

• Time is useful within HALF HOURS

• Approximate 1‐minute attention span


• ADL and Communication Approaches to facilitate BATF:

• Use visual, verbal, and tactile cueing to gain attention & help to process directions

• Break Activities down into one‐step parts and cue to complete each step

• Use familiar objects to access procedural memories

• Allow resident as much independence as possible during the task, then check for thoroughness/completion

• Place objects within 14‐18 inches

• Provide hands‐on activities


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• Spontaneous motor actions are manual with imitation of another’s actions with objects

• Seek to engage their environment

• Purpose is to sustain interest through the experience of touching.


Level 3 - Modes3.8

Senses completion of activities by using all pieces/parts available; Can dress self with assistance; May need cues to complete tasks; may participate in practice to walk to new location.

3.6Notes results of actions on objects; Sorts objects into containers by shape/size/color; Uses pronouns; Uses simple phrases/sentences; Notes effects on objects; need cause/effect tasks

3.4 Can be sequenced through familiar activities, one step at a time; Sustains actions for appx 1 minute; Talks to self about actions;

3.2 Uses different grasp patterns for different objects; Clumsy grip; Speaks in short phrases; Easily distracted

3.0Spontaneous grasp/release with objects in immediate line of site; Names highly familiar objects; Uses verbs associated with objects; Walks with usteady gait; AROM exercises including opening/closing hands

Cognitive‐Based Leveling:Level 4: Goal‐Directed Activity ‐ Early Stage


• Goal‐directed in simple, familiar activities

• Thrives with schedules, routine, and structure

• Capable of some new learning with at least partial retention, provided repetition and cueing

• Some simple problem‐solving

• Attends to task, but only what is plainly seen

• Can follow 2‐3 step directions

• Able to socialize, but is socially egocentric

• Notices objects in plain sight (within arm’s reach)

• Time is useful in HOURS

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• ADL and Communication Approaches to Facilitate BATF:

• Set out and make visible, all supplies needed for tasks

• Provide assistance for solving problems

• Establish and maintain daily routines; be consistent with schedules


• Prioritize any new learning

• Avoid open‐ended questions. Provide choices with boundaries; choice of 2, or yes/no.

• Do not interrupt when they are attempting to tell you something.



• Modified Independence in Self‐Care and Mobility

• Goal‐directed

• Able to replicate actions and activities of others

• Spontaneous motor movements are goal‐directed


Level 4 - Modes4.8

Learns new steps (ROTE) and follows inflexibly; Uses lists to facilitate learning and activity completion; Uses lists/schedules to organize the passage of time; Scans environment and notes all visible cues.

4.6 Able to scan the environment; Independent with ADLs if safe and familiar; Requires assist with IADLs; May live alone with daily check-ins.

4.4Capable of some new learning with partial retention. May use Memory Book;Visual field of 3-4 feet; Oriented to a prescribed sequence of events; Aware of norms in language, customs, clothing; May learn new techniques with repetition

4.2Attends to differentiating features; May ID error & attempt to correct; Oriented to a goal; May be trained to locate calendar/locations; may learn familiar routines with striking visual cueing.

4.0 Sustains awareness of goal; Follows routines for simple self-care; Simple reading with impaired comprehension; Requires assist with IADLs

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Cognitive‐Based Leveling:Level 5: Mild Cognitive Impairment• Primary Remaining Abilities:

• Follows simple, written instructions

• Attends to related cues

• Possibility of employment (job coach)

• Understands primary (not secondary) effects of actions on objects

• May drive and perform child or adult‐care tasks

• Ability to learn through trial and error

• Time is useful in increments of WEEKS

Cognitive‐Based Leveling:Level 5: Mild Cognitive Impairment• ADL & Communication Approaches to Facilitate BATF:

• Provide Situation‐Specific Training

• Provide strategies for organizing and planning

• Provide strategies for Executive Functioning deficits

• Practice socially acceptable behaviors

Cognitive‐Based Leveling:Level 5: Mild Cognitive Impairment• Movement Information:

• Independent with ADLs, IADLs, and Self‐Care. (May need weekly check‐ins)

• Spontaneous motor actions are exploratory in nature.

• When teaching to use a new device/technique due to a new diagnosis, procedure, etc.:

• Provide situation‐specific training

• Provide strategies for planning/organizing in new situations

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Cognitive‐Based Leveling:Level 5: Mild Cognitive Impairment

Modes

5.8Consults with other people; Seeks opinions about the expected effects on objects to avoid unwanted secondary effects; Socially tactful; May drive motorized vehicle.

5.6Considers social standards; Anticipates secondary effects in activities & social situations; Varies pace; Gets organized before tasks; Socially, can express sympathy for others; Uses figurative and metaphorical speech, asks rhetorical questions

5.4Self‐directed learning Independently makes changes when working to improve efficiency; aware of spatial properties; Socially self‐centered, but responds to feedback; Initiates cleanup.

5.2Considers surface properties; Rotates objects & makes postural adjustments when working; Capable of supportive employment (job coach); Oriented to primary consequences of interpersonal actions, but not secondary.

5.0Compare & change variation; Makes neuromuscular adjustments; movements are fluid and continuous; Stops working in order to talk; Socially egocentric in conversation; May live alone with weekly check‐ins; Can follow Dr. orders and prescriptions.

Cognitive‐Based Leveling:Level 6: Planned Activities – Normal Cognitive


• Capable of Executive Function

• Lives independently

• May hold an important job

• Plans ahead

• Self‐initiated motor actions

• Deductive reasoning intact

• Considers secondary effects of actions on objects

• Able to analyze facts & question accuracy of others

• Time is useful with PAST, PRESENT, & FUTURE

Cognitive‐Based Leveling:Level 6: Planned Activities – Normal Cognitive

• Executive Functions:

• Initiation

• Analysis

• Anticipation of consequences and secondary effects

• Planning to avoid problems

• Organization

• Prioritization

• Pacing

• Self‐Monitoring

• Using feedback/consulting others

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Cognitive‐Based Level:Determining the ACL• ACLS

• Routine Task Inventory

• CDM

• FAST

• GDS

• Cognitive Checklist

• Skilled Observation

• Sensory Stimulation

ACLS-6

Cognitive‐Based Level:Determining the ACL

Implementation:Red/Yellow/Green Light Program• Developed by Linda Riccio, OTR

• Determine ACL.

• Group patients into three groups based on ACL.

• RED: lowest level

• YELLOW: intermediate level

• GREEN: highest level

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Red LightACL 1.0‐2.8 (Late and End Stages)• Requires extensive assistance for resident participation

• Goal is for comfort, alertness, and interaction for increased quality of life, improved social interaction and increase in PO intake

• Responds to cause and effect movements

• Activities include: shiny visual stimulation, tactile items, balloon toss, parachute activities, sensory lotion/smells, simple songs, music clapping/marching, use of all senses

Red Light Activity Ideas

• Calming or alerting music

• Bells or tambourine

• Olfactory activities‐ garlic, lemon, apple, cinnamon and/or

• Gustatory activities‐ sweet/sour spray, lemon swabs, and/or toothettes in mouthwash

• Proprioceptive‐ light touch or deep pressure

• Vestibular tasks‐ rocking, chair dancing etc.

Color My Day Red – March 2012 SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

**Red Light residents can attend cooking class and other food related activities to help stimulate

f i d

**Red Light residents can attend sunshine club and movin’/groovin’ type activities to maintain range of motion

1 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 12:00 come to your senses-AD

2 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 11:00 Bible Study-D 12:00 come to your senses-AD 2:00 Manicures-D 2:30 Happy Hour-AD

3 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 12:00 come to your senses-AD 4:00 Drive In Movie??-D

4 10:00 Sunshine Club-C 12:00 come to your senses-AD 2:00 Ice Cream Sundae-D

5 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 11:00 Manicures-D 12:00 come to your senses-AD

6 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 12:00 come to your senses-AD 4:00 Soda Fountain-D

7 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 12:00 come to your senses-AD 2:00 Cooking Class??? -AD


9 10:00 Tropical Elem. -AD 10:45 Sunshine Groovin’-C 10:45 Bible Study-D 12:00 come to your senses-AD 2:00 Manicures-D 2:30 Happy Hour-AD

10 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 12:00 come to your senses-AD 1:00 Destiny Church-D 4:00 Drive In Movie???-D



13 10:00 Sunshine Groovin’-C 10:45 Lutheran Service-D 12:00 come to your senses-AD 4:00 Soda Fountain-D



16 10:00 Top of the morning Sunshine Club-C 10:30 Irish Jig Party-AD 12:00 come to your senses-AD 2:00 Lucky Manicures-D

17 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 11:00 St. Patty’s Party-AD 12:00 come to your senses-AD 4:00 Irish Movie-D







24 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 12:00 come to your senses-AD 1:00 Destiny Church-D 4:00 Drive In Movie????-D



27 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 10:45 Lutheran Service-D 12:00 come to your senses-AD 12:30 Lunch Bunch-D 2:00 Deal Me In/ Soda Fountain-D

28 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 12:00 come to your senses-AD 2:00 Cooking Class???-AD



31 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 12:00 come to your senses-AD 2:00 Bingo with Joel-D 4:00 Drive In Movie???-D

C-COURTYARD D-DAYROOM-WEST AD-ASSISTIVE DINING

Color My Day Red – March 2012 SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

**Red Light residents can attend cooking class and other food related activities to help stimulate

f i d

**Red Light residents can attend sunshine club and movin’/groovin’ type activities to maintain range of motion



3 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 12:00 come to your senses-AD 4:00 Drive In Movie??-D






9 10:00 Tropical Elem. -AD 10:45 Sunshine Groovin’-C 10:45 Bible Study-D 12:00 come to your senses-AD 2:00 Manicures-D 2:30 Happy Hour-AD

10 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 12:00 come to your senses-AD 1:00 Destiny Church-D 4:00 Drive In Movie???-D



13 10:00 Sunshine Groovin’-C 10:45 Lutheran Service-D 12:00 come to your senses-AD 4:00 Soda Fountain-D



16 10:00 Top of the morning Sunshine Club-C 10:30 Irish Jig Party-AD 12:00 come to your senses-AD 2:00 Lucky Manicures-D

17 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 11:00 St. Patty’s Party-AD 12:00 come to your senses-AD 4:00 Irish Movie-D







24 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 12:00 come to your senses-AD 1:00 Destiny Church-D 4:00 Drive In Movie????-D



27 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 10:45 Lutheran Service-D 12:00 come to your senses-AD 12:30 Lunch Bunch-D 2:00 Deal Me In/ Soda Fountain-D

28 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 12:00 come to your senses-AD 2:00 Cooking Class???-AD



31 10:00 Sunshine Club-C 10:30 Movin’ & Groovin’-AD 12:00 come to your senses-AD 2:00 Bingo with Joel-D 4:00 Drive In Movie???-D

C-COURTYARD D-DAYROOM-WEST AD-ASSISTIVE DINING

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Yellow LightACL 3.0‐3.8 – Middle Stage• Requires limited assistance for resident participation

• Will not initiate activity‐they enjoy hands on tasks

• Activities include: throwing/catching, dusting/washing table, busy boxes, laundry folding/sorting, simple crafts, and simple games –midline focusing activities

Yellow Light Activity Ideas

• Balloon Batting

• Ball toss

• Parachute ROM

• Calming or alerting music

• Midline busy box tasks

• Laundry folding/hanging

• Simple sorting ‐ sewing or tackle box

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Green LightACL 4.0‐5.0 – Early Stage• Requires supervision‐independent assistance for activity participation

• Lower 4’s –require step by step directives

• Activities include: bingo, games, ball toss/catch, cooking, puzzles, music programs, ex class, crafts and socializing

Green Light Activity Ideas

• BINGO

• Current events and coffee socials

• ‘Helping’ others – delivering mail

• Music and interactive activities

• Cooking classes

• Community outings

• Gardening tasks

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Cognitive‐Based Leveling: Treatment Focus on Remaining Abilities

MILDImpairment

MODERATEImpairment

SEVEREImpairment

Toileting: Limited Assist

“It’s time to go to the bathroom”

Bathing: Limited Assist

“It’s time for your shower”

Dressing: Limited Assist

“Would you like the red or the blue shirt today”

Toileting: Extensive Assist

“Let’s freshen up before lunch”

Bathing: Extensive Assist

“It’s your turn for a shower, hold this towel for me”

Dressing: Extensive Assist

“Would you like your shirt on or pants on first today”

Toileting: Dependent

“I’m going to roll you towards me”

Bathing: Dependent

“I am going to take you for your shower now”

Dressing: Dependent

“I am going to put your shirt over your head now”

What is a Functional Maintenance Program?

• Treatment plan designed to maintain function or prevent further decline

• Carried out by nursing staff or caregivers with time constraints in mind

• Can be created for any patient and customized to meet individual needs

• Can generally target maximizing cognitive status or address a specific behavior (i.e. difficulty dressing, behaviors related to meal time, etc)

• Updated as patient’s functional level changes through re‐evaluation by therapist and additional staff training

Example of a Cognitive Functional Maintenance Plan

Resident: ______________________________________ Date to Begin Program : _____________

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Successful Dementia Programs:EVERYONE Plays a Role

Resident

Therapy

Social Worker

Family

Dietary Services

Environmental Services

Nursing

Activities

Administrator

Screening Triggers: Alerting Therapy to initiate or update FMPs• New diagnosis of dementia or related disorder

• Changes in abilities that would benefit from increased cueing and assistance: eating, dressing, bathing, grooming, toileting, orientation, balance, ambulation, ROM, transfers, communication, etc.

• Changes in cognition that interfere with safety, function, or quality of life

• Behaviors that interfere with function, safety, and quality of life

• Poor activity participation and socialization

• Limited ability for interaction and at risk for sensory

Tangible Benefits of a Formal, Proactive Dementia Program• Residents maintain higher functional levels and improved quality of life with increased support from direct care staff

• Admission assessment and regular re‐evaluation by appropriate therapy staff for patients with dementia and other cognitive disorders

• Ongoing staff education provided by skilled therapists on multidimensional care of patients with dementia

• Interprofessional involvement in patient care leads to improved outcomes and patient satisfaction

• Improved CMS compliance

• Improved documentation of systematic care planning related to patients with dementia

• Improved Quality of Life for residents living with Dementia

Patients

Family Members

Staff

Surveyors

Cost

Health

Satisfaction

Safety

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6 Principles to Guide Care Approaches

1. Put the person first

2. Adapt activities for success

3. Focus on remaining abilities

4. Promote Best Ability to Function (BATF)

5. Communicate based on abilities

6. Take ownership and responsibility

Final Takeaways

• Implementing a formal Dementia Program requires a true team effort EVERYONE PLAYS A ROLE!

• A successful Dementia program involves a focus on remaining abilities and a person‐centered approach to care

• A successful Dementia program involves a risk‐based, proactive approach to prevent declines and maintain residents’ best ability to function in daily activities

• Successful Dementia program implementation can significantly impact community costs, health and safety of residents and staff, and overall satisfaction of residents, staff, family members, and surveyors

• Staging of residents with Dementia can guide a care team’s approach and result in positive outcomes for the interprofessional team.

Final Challenge: IF NOT ME, THEN WHO?? • IF I DON’T ADVOCATE FOR MY RESIDENTS, THEN WHO WILL?

• IF I DON’T CARE FOR THEM, THEN WHO WILL?

• IF I DON’T IMPLEMENT THESE THINGS IN MY FACILITY, THEN WHO WILL?

• “Be the change you wish to see in the world.”

~ Mohandas Ghandi

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Questions?


Corrie Dyson, MS, CCC‐SLPClinical Excellence Coordinator

Hedgehog Ambassador

CPI Certified Instructor of Dementia Capable Care Foundations and Behaviors Courses

Certified Dementia Care Specialist

[email protected]

1‐800‐804‐9961

Thank you


www.therapymgmt.com

T105 Dementia Staging - IHCA › files › Education › Convention › Session...Dementia Facts and...

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Transcript of T105 Dementia Staging - IHCA › files › Education › Convention › Session...Dementia Facts and...