How Dementia Stages Impact Nursing in Long-Term Care

In a world of medical model institutions the opportunity for a nurse to identify and embrace a resident's specific dementia stage is not always the easiest path to follow. In fact, many times the dementia-specific nursing path is so covered with the brush and overgrowth of the traditional medical model it is not even visible to the busy nurse passing his/her medications, recording physician orders, and trying to survive the shift in general. 

Therefore, it is necessary for nurses to first have a vision and belief that there is a better way to care for the seniors we serve and to establish that we, and the residents, are capable of more than surviving or existing through the shift. 

Recognition and knowledge of the specific hallmarks within each dementia stage enables nurses to again celebrate the resident and the abilities that remain beyond the diagnoses.

This facilitates the ability to:
 

• Define a plan of care specific to the resident
• Supervise the care team and families to provide care/assistance at the just-right fit
• To proactively address high-risk areas to facilitate better outcomes

When nurses embrace and understand specific dementia stages, this serves as a roadmap to care, with the residents and their remaining abilities becoming the focus of the journey. 

Nurses become nurses to provide care and promote well-being. Through defining a resident's specific dementia stage, nurses can see abilities where disabilities would previously dominate the nursing perspective. When nurses are trained to assess resident abilities that remain at every dementia stage it is possible to celebrate all that is right with the resident. Knowledge of the abilities that remain within each resident offers the hope that ignites the compassion and caring that drove most nurses to select an occupation to serve seniors. 

Ironically, through recognition of resident abilities, outlined by the Adapted FAST (and/or Allen Assessments), nurses also gain a positive perspective, a sense of their own abilities, and purpose to foster the well-being of residents. It is around the defined, predictable resident abilities within each dementia stage that the nursing team can develop successful interventions.

Nurses gain the expertise to design a resident-specific care plan that is truly individualized only when they possess an understanding of dementia stages. The Adapted FAST tool and related abilities-based dementia training provides the missing link for nurses and families to provide care that takes advantage of the resident's remaining abilities.

For example, nurses and care partners (CNAs) with knowledge of dementia stages would be aware that a resident functioning within Adapted FAST 6/Allen Level 3 has the core remaining ability to follow a one-step instruction. The care plan and approaches would recognize this fundamental remaining ability to enable this resident to perform at the highest ability possible. A plan of care that is individualized to the resident, and accurately represents cognitive level, replaces typical paper compliance care plans by offering a defined roadmap for successful care.

Nursing teams that gain expertise in dementia stages replace their all too common, trial-and-error approach for workable interventions with abilities-driven, proactive approaches that promote the resident's best ability to function and safety at every stage of dementia. Nurses, specifically, utilize expertise with dementia stages to supervise and lead care teams to provide the just-right fit for achieving the resident's best ability during ADL and leisure activities. Knowledge of dementia stages enables a nurse to identify areas of high risk so that intervention plans can be in place before the problem occurs. Knowledge of hallmark abilities and characteristics of dementia allows nurses and supervisors to conduct simple quality assurance audits during every observation and resident interaction. 

EXAMPLE: A nurse is in the midst of passing medication to a resident in the dining room who is functioning within Adapted FAST 6/Allen Level 3 and recognizes a CNA providing too much hands-on assist for eating and drinking. The nurse who is schooled in dementia stages will recognize the opportunity to educate this CNA about the fact that a person functioning within Adapted FAST 6/Allen Level 3 possesses a remaining ability to grasp familiar objects, including utensils. The resident in this example will perform best and likely eat better with simple, one-step, verbal, visual, and/or tactile instructions. This will promote the resident to dine with support, rather than total assist, and reduce the risk for weight loss and aspiration pneumonia.

Recognition of a resident's best ability to function within his or her specific dementia stage also allows for improved time management by guiding the team to support, rather than do for the resident. Team assignments can be more time sensitive by balancing responsibility for residents that need set-up help with those that require one-to-one support. In addition, it is easier to instruct the care team and family of changes in condition which should be reported to their supervisor or physician when the expectation of the resident's best ability to perform is objectively defined by the dementia stage. 

Overall, dementia staging offers nursing teams the unique opportunity to see the PERSON rather than the diagnoses. As a result we are able to see what is right with the resident, design a care plan reflective of the person, and direct our care team of interventions to celebrate and respect the remaining abilities defined within each dementia stage. 

By partnering nursing expertise of dementia stages with knowledge of resident preferences, nurses have the information and skill necessary to improve clinical outcomes, reduce excess disability, and promote resident well-being. Dementia staging won't reverse the progression of the plaques and tangles that are characteristically blocking connections in the minds of residents with Alzheimer's and related dementias. However, knowledge of dementia stages does reverse the nursing barriers and tangles of trial-and-error care, thereby clearing the way for a strong, successful connection between the nurse and the resident.