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How to Establish Dementia Care Best Practices and Why They Matter

Dementia Care Best Practices
Today, there are millions of individuals around the globe living with Alzheimer’s/dementia, and there will be many millions more as baby boomers continue to reach senior citizenship.
 
As the dementia population expands steadily, we must adapt our world to accom­modate the needs and experiences of its members, ultimately fostering a Dementia Capable Society—a rich landscape that enables people with dementia to engage in meaningful activities and maintain a fulfilling life, a landscape that also supports loved ones through the journey of disease.
 
Indeed, in Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes [PDF], the Alzheimer’s Association states that “engagement in meaningful activities is one of the critical elements of good dementia care,” underscoring that such opportunities can not only help residents preserve their functional abilities, but enhance their overall quality of life.
 
To that end, the organization defines three key goals on which its social engagement recommendations in the document are based:
 
  • Providing an ongoing context with personal mean­ing, a sense of community, choices, and fun
  • Designing activities to do with—not to or for—a resident
  • Respecting the preferences of the resident, even if this means honoring his or her affinity for solitude
 
Creating such experiences is vital for promoting the well-being of all parties affected by today’s dementia care climate, from those living with the disease to their care partners and healthcare providers, all of whom may struggle physically, emotionally, and financially from their various relationships to the disease.
 
But shaping holistic dementia living and care spaces doesn’t happen overnight. It requires a steadfast, consistent, yet adaptable approach that the whole de­mentia care team can rally behind. A core component in developing such a comprehensive dementia care offering is establishing underlying best practices that stem from current research, yield measurable data, and demonstrate enough malleability to meet the needs of each individual resident—essential factors in facilitat­ing consistent positive outcomes.
 
This article distills the core principles of dementia care best practices and reveals strategies for shaping the parts into a cohesive system of care that is success­ful, sustainable, and applicable to the entire nursing home community.
 

Core principles

When creating a standard for dementia care that will be used across the nursing home, it’s important to establish principles that are rooted in objective, mea­surable goals for residents, such as:
 
  1. Optimizing each individual’s quality of life, func­tional independence, health, and safety
  2. Guiding and supporting loved ones and care partners
  3. Reducing hospitalizations and psychotropic drug use
 
While it’s important for providers to develop their own goals and principles based on the specific circumstances of their resident population, many of today’s leading dementia care experts, including the Alzheimer’s Asso­ciation and the American Occupational Therapy Society, have reached consensus on certain general principles that make up the foundation of virtually any Alzheimer’s/dementia best practice. When implemented suc­cessfully, these elements work in tandem to produce care that is person-centered and abilities-focused. Let’s break down the key attributes of these sister philosophies.
 
Person-centered care
Person-centered care is a term with many roots, in­cluding the social psychology of Dr. Thomas Kitwood. It involves providing services and interventions that are fueled by what we learn about an individual patient. Values that govern this modern approach, particularly when applied to dementia care, include choice, dignity, respect, purposeful living, and self-determination. The primary areas of emphasis are prioritizing the person rather than the task or disease, and framing care with the wants and needs of the recipient.
 
Abilities-focused care
This is another concept with dispa­rate origins, though two of its primary drivers are the work of Claudia Kay Allen, an esteemed occupational therapist and developer of a landmark rehab model for people with cognitive disabilities, and the occupational therapy profession itself. These sources suggest that it’s critical to focus on what a person with chronic, progres­sive cognitive impairment (such as that related to Al­zheimer’s/dementia) can still do, rather than the skills he or she has lost. Helping the individual access these retained capacities at every stage of disease and in every setting of care can promote ongoing positive outcomes.
 

Steps for transforming principle into practice

Transforming dementia care principles into practices that produce objective, measurable change requires a process, system, and tools. Specifically, key compo­nents of a dementia care best practice protocol include:
 
Holistic assessment of a new resident’s core experiences and abilities at the start of care. Important areas to evaluate include:
 
  • Cognition: Use functional cognitive screens and assessments to identify dementia stage and re­maining abilities.
  • Life story: Gather key information to learn what’s familiar and meaningful to the person.
 
Individualized, therapeutic care plans, in­terventions, and programs. Therapeutic plans and programs—such as those surrounding dining, activities of daily living, and emotional well-being (also called be­havior management)—should be designed according to each resident’s needs, capabilities, and preferences as identified in the holistic assessments. As a result, these services should optimize a resident’s participa­tion in care and make a positive, measurable impact on his or her function, health, safety, and/or quality of life.
 
Environmental support. The entire physi­cal environment of the facility—including interior and exterior social spaces and personal rooms—must be designed to encourage and support independence, engagement, and safety among all residents. Examples of practices that support these aims include:
 
  • Reducing disruptive stimulation and excess noise
  • Incorporating appropriate props and cues into activities, particularly those that are navigational or wayfinding in nature
  • Identifying ways to address the unique needs of the aging elder, such as providing higher levels of light due to changes in normal vision or install­ing grab bars and non-slip floors to accommo­date shifts in balance
 
Trained and collaborative interdisciplinary teams. The facility’s clinical and direct care teams must be well trained to understand the characteristics of the different dementia stages and the appropriate therapeu­tic care techniques, including targeted communication and behavior management approaches.
 
To that end, the team should include dementia spe­cialized therapists, including occupational therapists who play a central role in first determining a person’s cognitive ability level, then designing intervention and maintenance programs to optimize function and safety.
 
All members of the interdisciplinary care team should be trained—and supported in their efforts—to deliver care that compensates for illness and deficits while capitalizing on strengths and abilities. Unsurprisingly, a one-time training is never enough. A dementia-capable, person-centered staff development program requires initial training as well as ongoing coaching and mentoring from nursing home leadership.
 
More broadly, SNFs should strive to instill a passion and commitment to cultivated best practices—one that extends beyond the direct care team to the organization at large. Owners, leaders, and other stakeholders across the facility must be clear on the designated dementia care philosophy, vision, and goals in order to provide the resources needed for success on the parts of col­leagues, residents, and the rest of the care community.
 
Consistent staffing. There’s clear value in hav­ing a consistent staffing plan through which a resident receives services from a familiar group of care partners over the course of his or her nursing home residence. This consistency fosters relationship development—in­strumental for obtaining an individual’s permission and participation related to care provision and support, as well as for learning about and honoring the person.
 
Family support and involvement. Family members should be partners in care from the first meeting with the facility through the resident’s final days. Whenever possible, they should participate in shaping the therapeutic plans and interventions by providing valuable information about their loved one (e.g., by sharing important events in the person’s life story) and helping make choices in the best interest of this person throughout the care journey.  
 
Editor’s note: This article originally appeared in Dementia-Capable Care Insights, a column by Kim Warchol, OTR/L, DCCT, featured in HCPro’s PPS Alert for Long-Term Care. Reprinted with permission from HCPro, Volume 18, Issue 10, October 2015. Download a PDF of the article.  
 
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