New long-term care regulations are pushing skilled nursing facilities and memory care agencies to embrace best practices as a matter of policy. At Dementia Care Specialists, we’ve been working hard to enrich and evolve our core curriculum to help organizations empower and retain talented staff, excel at delivering person-centered care, and enrich the experience of residents and their loved ones with an interdisciplinary approach to long-term care.
Review some of CMS’ latest requirements, and how Dementia Care Specialists’ enhanced and expanded Dementia Capable Care training—particularly the new Behaviors component on the second day of our Foundation course—provides essential, effective, and practical strategies for person-centered care.
Person-centered care is now a matter of policy, not just a best practice.
CMS has stated:
Facility staff members must implement person-centered care approaches designed to meet the individual needs of each resident.”
Competency involves staff’s ability to communicate and interact with residents in a way that promotes psychosocial and emotional well-being, as well as meaningful engagements.
These reasonable accommodations may be directed toward assisting the resident in maintaining and/or achieving independent functioning, dignity, and well-being to the extent possible in accordance with the resident’s own needs and preferences.”
Dementia Capable Care training is anchored in person-centered practices that support an individual’s best abilities to function. We’ve continued to enhance and deepen our curriculum to identify practical strategies that all staff can implement to support a quality care plan for every individual, including integrating behavioral interventions and non-pharmacological strategies into a quality plan of care. It takes care partners beyond assessment-level applications of the Allen Cognitive Levels and empowers them to constructively and effectively respond to resident behaviors in a safe and supportive way.
We’ve previously shared research that found person-centered care contributed to the following positive outcomes in individuals with dementia:
- Cooperating with staff
- Revealing personal information about themselves (showing trust and security)
- Contributing to conversations
- Asking for clarification
- Increasing politeness toward staff
And their care partners subsequently reported regarding their clients more positively than ever before. Why? Because a person-centered approach positions both the care partner and care recipient in roles of empowerment and respect.
Behaviors must be documented and addressed supportively—and the use of pharmacological interventions in place of a person-centered care plan must come to an end.
CMS has stated:
The intent of this requirement is that the facility implements gradual dose reductions and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication.”
“Behavioral interventions” are individualized, non-pharmacological approaches to care that are provided as part of a supportive physical and psychosocial environment, directed toward understanding, preventing, relieving, and/or accommodating a resident’s distress or loss of abilities, as well as maintaining or improving a resident’s mental, physical or psychosocial wellbeing.”
“Expressions or indications of distress” refers to a person’s attempt to communicate unmet needs, discomfort, or thoughts that he or she may not be able to articulate. The expressions may present as crying, apathy, or withdrawal, or as verbal or physical actions such as: pacing, cursing, hitting, kicking, pushing, scratching, tearing things, or grabbing others.”
Dementia Care Specialists founder Kim Warchol has emphasized that challenging behaviors in individuals with dementia are often attempts at communication. Some examples include:
- Individuals with dementia often misinterpret their environment—an individual might hear someone talking on TV and not realize that the voice is coming from the TV, so they may respond to the person. If the voice is angry, the person may respond angrily—and thus come across as delusional, when they’re simply misinterpreting what they’ve heard.
- If the environment is noisy, chaotic, or overstimulating, the person may express fear by becoming agitated and anxious.
- These individuals need reassurance because they do not always recognize their environment. Such a person often reverts to memories of a childhood home, where they felt safe and secure, and may even start to physically seek that environment. During these moments, the person with dementia may not recognize the current environment as a place in which they have been living, and they may become agitated and attempt to leave. This disorientation is a result of their ability to use their strong long-term memory to remember and seek a place (and feeling) of safety.
- Egocentric behavior in a person with dementia is often misinterpreted as hostility—for example, they may become upset or irritable if someone else is in their room or sitting in their chair. This egocentricity is in fact the person’s best ability. The person has lost the ability to consider other people's needs and is now focused on self-protection.
- Individuals with dementia do sustain a basic need for a sense of productivity and purpose. They may have lost the ability to sequence themselves through a familiar task, but they still want to be engaged in valued activities. If boredom sets in, the person with dementia may express this through irritability or agitation.
- Persons with dementia continue to have a need for relationships, even when their best ability is to respond to meaningful stimulation. They continue to have the basic need for love and interaction. Isolation or lack of stimulation can easily lead to agitation and depression.
Shifting the paradigm of care partners to interpret behaviors more accurately empowers them to respond more appropriately—and effectively reduce the need for unnecessary psychotropic use. Dementia Capable Care training equips staff to employ a straightforward approach to make an appropriate decision when responding to a challenging behavior:
- Describe the behavior expression
- Uncover the underlying cause of the behavior
- Identify an appropriate nonpharmacologic intervention for the behavior
- Observe the outcome and document how effective it is in addressing the severity or frequency of the behavior
The expanded behavioral components in Dementia Capable Care training cover this approach in-depth, by teaching care partners to identify and interpret behaviors accurately and choose responses that are the most likely to safely de-escalate these behaviors before a pharmacological intervention is necessary. Case studies are explored to identify practical solutions for staff so that the use of psychotropic medication can be effectively reduced or eliminated—and staff and residents can remain safe even when behaviors of agitation or distress are exhibited.
An interdisciplinary care approach that includes staff, residents, and their loved ones is imperative—but it also needs to be effective.
CMS has stated:
Providing behavioral health care and services is an integral part of the person-centered environment. This involves an interdisciplinary approach to care, with qualified staff that demonstrate the competencies and skills necessary to provide appropriate services to the resident. Individualized approaches to care (including direct care and activities) are provided as part of a supportive physical, mental, and psychosocial environment, and are directed toward understanding, preventing, relieving, and/or accommodating a resident’s distress or loss of abilities.”
As an example of non-compliance with this standard, CMS shared the story of a resident with repeated incidents of elopement—but whose chart had no documentation of the underlying anxiety that drove his attempts, nor of any efforts to treat it. So the behavior had continued to escalate, until the resident was injured during an elopement attempt. The attending physician, discovering that no efforts had been made to address this underlying agitation, concluded that even though there was an interdisciplinary care team in place at the facility, their failure to collaborate effectively meant that a preventable incident had resulted in the resident’s injury. Successful teamwork among care partners—not just the existence of a care team—is now being actively assessed and evaluated by CMS.
Again, understanding behavior—and the responsibility that each of us has in responding to it, regardless of one’s role within an org structure—is key to preventing its adverse outcomes. Part of what makes the newest Dementia Capable Care curriculum so vital to fulfilling CMS requirements effectively is that staff can become certified to train their colleagues. This means that every member of an interdisciplinary care team can be on the same page and use the same effective approach.
Adequate staffing is more critical than ever—flexible training options keep talented individuals in an optimal position to succeed.
CMS has stated:
The facility must have sufficient staff who provide direct services to residents with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facility’s resident population.”
An essential strategy to retaining quality staff members is equipping them with the training to keep them safe from injury and exhaustion on the job. A huge component of care partner turnover is that the risk of harm and the fatigue brought on by a lack of effective strategies to successfully provide quality care drive talented and compassionate people out of this line of work.
Training is also an opportunity to expand your professional network. Participating in an open Dementia Capable Care training program is a fantastic way to connect with peers in your region. Benefits of becoming a Certified Instructor include being able to participate in an exclusive community of fellow instructors across the country, supporting your ongoing professional development and growth.
Facilitating a Dementia Capable Care training session on-site helps staff find common ground, regardless of their individual roles within your organization, and improve the effectiveness of their team approach. With better collaboration and strategies that keep staff safer and more positively engaged with their work, retention and morale improve.
It’s time to talk to with your team about investing the time and training in exceeding these expectations.
These are only a few of the many CMS standards that Dementia Capable Care training can help your organization meet—to learn more, we encourage you to attend one of our open programs, or give us a call and find out what solutions work best for your team. Fulfilling regulatory requirements is just the tip of the iceberg when it comes to investing in the right training and development for your facility. Ideally, it’s a positive side effect of a truly person-centered, holistic approach to providing quality long-term care to individuals with dementia.
Care partners have already communicated that they need this kind of training—from CNAs to occupational therapists, your team is ready to embrace the positive and proactive strategies of Dementia Capable Care.
Ready to ensure your staff is prepared? Get this critical training for your team!