Recognizing Remaining Abilities in Those With Alzheimer’s/Dementia (Unrestrained Episode 31)

Tender Touch Rehab Services Discovers Dementia Care Specialists

A shift in perspective from what a person can’t do to what they can do is often a crucial step in providing more effective memory care.  
 
Lori Blaire, the vice president and compliance officer for Tender Touch Rehab Services of Lakewood, New Jersey attends the annual AOTA convention looking for advances in approaches to memory care to better serve their customers who reside in skilled nursing facilites.
 
Tender Touch Rehab Services provides therapists to over 160 such facilities in the New York, New Jersey, Pennsylvania, Maryland, Massachusetts, and Connecticut areas. They offer occupational therapy, physical therapy, and speech therapy staffing, as well as comprehensive rehabilitation management services. Tender Touch is considered an industry leader, with a focus on providing hands-on therapy services and desirable patient outcomes. The company’s motto is "excellence is our only outcome."
   
As the manager of the company’s education department, Lori chooses the continuing education courses for Tender Touch’s therapy staff. It was at the 2014 AOTA Conference that Lori met Dementia Care Specialist Account Manager Kris Palazzi, and was introduced to Dementia Care Specialists training. Through talking with Kris, Lori became aware of advances in the approach to memory care, and she wanted to learn more.
 
When she returned to Tender Touch after the convention, Lori polled her regional management team, and asked them if they thought that becoming Dementia Capable Care Therapists would benefit their clients, their residents, and the company at large. According to Lori, the answer was a resounding yes.
 
Lori explains, “We as a team felt we had only basic clinical knowledge of how to treat the dementia patient. However, we lacked a theoretical base, a good evaluation, and a treatment foundation that was practical, measurable, and would give us better outcomes. This is what we thought we could expect going in, and the specific reason that drove the decision to have our team of therapists attend the two courses to become Dementia Capable Care Therapists.”
 
So in November of 2014 and May of 2015, 38 Tender Touch staff members, including OTs, PTs, and SLPs, completed the Two-Day Foundation and Dementia Therapy Applications course and the Two-Day Dementia Therapy Intermediate course.
 
According to Lori, the benefits of the DCS training were readily apparent: “We immediately saw the value of the course, as these individual attendees left the course with a much better understanding of the Allen Cognitive Levels, and the strategies for how to stage and treat these patients within a ‘what they can do rather than what they can't do’ attitude, and this includes myself. And each therapist was so excited to return to their facility with a renewed passion and interest in the dementia treatment. And to be frank, as a business, it gave us a new marketing strategy that we could talk about. It's a specialty program that few of our competitors can boast about.”
 
The training also had the additional benefit of conferring DCCT (Dementia Capable Care Therapist) status on the 38 Tender Touch therapists who attended. (For more information on how you can become a Dementia Capable Care Therapist, call 877.816.4524.)
 
Going forward, Lori believes that DCS training will help her staff become better clinicians, and she is so convinced of its value and importance that she believes it should be mandatory. “It should become a requirement in some form for all students and new graduates. They need to learn the DCS philosophy. I believe it's one of knowledge and respect for the patients who live with dementia. It also teaches the clinician to look past the old views of the dementia patient, that they will never improve, to let's see what they can do, will do, and may do,” explains Lori.
   

How DCS Training Helped Carolyn Garrett, an SLP for Tender Touch

As a speech-language pathologist and a regional manager for Tender Touch, Carolyn Garrett works closely with the company’s other therapists for clinical mentoring, program development, and providing services to patients in the skilled nursing setting. Many of the patients Tender Touch therapists encounter in this setting live with Alzheimer's or a related dementia.
 
According to Carolyn, “We see patients at every stage of dementia. Some of the patients we see have been living in the community and have come to a facility for rehab after being hospitalized. Others are long-term care residents, who may be in the later stages of dementia, and need a significant amount of assistance for all of their daily needs.”
 

A Shift in Perspective

After receiving DCS training, Carolyn was excited to share how it could help other Tender Touch therapists and their clinical teams to better understand and serve people with Alzheimer’s/dementia.
 
Carolyn remembers how one of the first activities in DCS training made her aware of a perspective common to herself and other clinician trainees that could be changed for the better: “I remember one of the first activities that our Instructor had us do was to brainstorm how we would describe dementia, and sure enough, most of the words and phrases that we all came up with were negative. Then we took those words and shifted them to a positive focus. And that perspective shift was really powerful and important in working with individuals who are diagnosed with dementia. It gives us the tools to help that person who has certainly lost some or many of their abilities, to be able to function. That activity set the tone for the training really well.”
  To illustrate how that shift in perspective helped her with a client, Carolyn tells a story that begins with wandering, one of the most challenging behaviors associated with Alzheimer’s/dementia.
 
A client named Rose was referred to speech therapy because of weight loss, poor intake at meals, and wandering. When Carolyn went to evaluate Rose at lunch time, she observed a nursing aide sitting next to her, feeding her. However, within only two or three minutes, Rose stood up and turned around to leave, causing the aide to redirect her to the table. Carolyn observed this same behavioral pattern again and again as the aide attempted to feed Rose. After each redirection, however, Rose accepted fewer and fewer bites of her meal, until finally she wouldn’t accept any food at all.
 
The dining room was very busy and crowded, and it was apparent to Carolyn that the hustle and bustle was creating a problem. So she approached the aide and asked to bring Rose back to her room to evaluate her swallowing. Back in her room, Carolyn discovered that Rose did not have trouble swallowing. This led Carolyn to understand that Rose’s wandering behavior was really a cognition issue, and that her weight loss was caused by her difficulty processing all the stimulus in the busy mealtime environment.
 
Over the course of several days, Carolyn was able to make sustained observations of Rose’s behavior and determine the real cause of her incessant wandering. “I was able to understand over a few days that, besides meals, Rose had really been wandering out of group settings consistently. We were able to work as a team to realize that her wandering was a communication that she needed to go to a quieter, less stimulating area. I used those therapy sessions to help her have a meal, and structure her meal in her room,” explains Carolyn.
   
A positive outlook on Rose’s remaining abilities—in this instance, the ability to chew and swallow—helped Carolyn understand how to redirect and present positive messages for Rose. “When she did lose focus on the meal, redirecting her in a pleasant communication: ‘Boy, that pasta looks good,’ you know, as opposed to ‘No, stay here,’ where she clearly was uncomfortable. It was really successful, and certainly that changed her mealtime behavior, and also gave us some information to look at how we can improve the rest of her day, in terms of helping her to participate in activities, and remain happy,” observes Carolyn.
 

Rethinking Ed

“Ed can’t do anything!” was the emphatic message Carolyn heard from the wife of a man who had come to rehab after a hospital stay. He couldn’t do anything anymore because he was confused, explained his wife, and would not benefit from Carolyn’s help. Carolyn remembers the apologetic look on Ed’s face after his wife’s remark.
 
Even though their interview made it clear that Ed had experienced cognitive decline over the past couple of months, it seemed to Carolyn that he was aware of his loss of independence, and that he could benefit from evaluation and therapy. And even though Ed was disoriented during their interview, and distracted by his wife’s evident frustration, Carolyn also noticed that he could speak and communicate fairly well, read, and even write some short phrases.
 
At this point, Carolyn recalled how DCS training had taught her to focus on remaining abilities, and she realized that “this was a real example of someone with a significant excess disability, because of their dementia being viewed from that negative perspective.”
 
So Carolyn set about finding ways to involve Ed’s wife in activities that would help her to see and facilitate his remaining abilities. Over the weeks that Ed was in rehab, Carolyn used the daily newspaper as a focal point for the couple. In the past, the couple had made a habit of sitting together and discussing the news items they had read that day. However, due to Ed’s wife’s perception of his cognitive decline, they had stopped talking about the newspaper.
 
Carolyn reintroduced this activity and the results were clearly positive. Although Ed could no longer recall as many specifics from the news, “he was able to enjoy sitting with his wife and communicating about those events that were there in the headlines at a very simple level, and it gave them back an activity that they were able to do, and maintain that function,” explains Carolyn. “It's so meaningful for them to be able to have that perspective shift.”