A blended approach
Keeping residents engaged is a constant challenge facing the field.
With more than half of all assisted living and nursing home residents having some form of dementia, senior housing operators must work harder than ever to keep those residents engaged and acclimated to their surroundings and living in an environment that recognizes and appreciates residents' unique needs, interests and abilities.
Reaching that goal can be challenging, but those committed to the task agree their efforts deliver substantial rewards. Dementia affects not only memory, motor skills and sensory abilities, but also visual perception. As dementia progresses, language and overall communications skills also diminish. Such deficiencies may increase agitation and confusion and the need for psychotropic drugs. Additionally, they may up the risk for isolation, falls and elopement, and subsequent illness.
Innovative practices and solutions geared toward residents of all levels of cognitive decline can help mitigate those risks, improve quality of life and allow residents to age in place longer.
“Well-developed memory care programs are important to market because they offer a competitive advantage, but more importantly, they are tied to reduced hospitalization and other health and wellness benefits for the resident,” says Charles de Vilmorin, CEO of Linked Senior.
New learning and delayed dementia progression can occur when those with mild cognitive impairment are supported through targeted programming; however, they aren't the only ones to benefit. Even those with severe dementia can stay connected and positively engaged if there's a facility-wide commitment to delivering person-centric programs and services.
Today's most enriching and successful resident engagement approaches combine hands-on, human interaction with innovative, intuitive and easy-to-use technologies that are scaled to each resident and facilitate positive exchanges between caregivers, loved ones and residents.
“We believe that the most effective way to help caregivers better engage with dementia residents and acclimate them safely and effectively to their surroundings is to facilitate closer and more constant contact and communication,” says Neil Sullivan, chief operating officer at Connected Living.
Getting to know each resident well is a critical first step to successful, ongoing engagement. Previous roles, interests and values help care- givers tap into a resident's procedural memory — which remains an area of strength for many people living with dementia. “Procedural memory is the way we do things that are unique to each of us,” says Loretta Bartz, ORT/L, VP of clinical training and program development at HealthPRO-Heritage. “Tapping into those memories and using tasks that are meaningful to the individual allows us to support the person's ability to remain engaged. It doesn't mean that they will continue to do the same level of complexity of tasks as they had previously, but we can find a means to modify the activities so they can still participate in a more simple, but meaningful way.”
It's also critical that the care team understand who each resident is now — every day and in that very moment, reminds Jenni Dill, life engagement director at Chelsea Place, an Anthem Memory Care community.
“While it is important to know and draw on people's past likes, interests and strengths, it is also important to expose residents to new and novel things in their world and make space for spontaneity,” she says. Layered questioning also can lead to richer relationships between residents and caregivers, and more purposeful communication and programming. One of the best lessons Dill learned from a colleague was to always ask one more question. This is especially important when learning about a person's occupational history, she says. Instead of asking about his or her occupation, she recommends asking the resident whether he or she enjoyed it — and whether it is something he or she wishes to continue in some capacity. “Ask, ‘What are your interests now? Is there something you've wanted to do that you haven't tried yet? How can I help make that happen?' The questions can go on and on.”
Baseline and ongoing assessments are equally important to ensure residents are always met at their current levels of cognitive ability. Unfortunately, free and accessible tools, such as the Global Deteriorization Scale, which assesses primary degenerative dementia, aren't always used to their fullest, de Vilmorin says.
“We need to know where each person is cognitively. Are they only mildly cognitively impaired or [severely] impaired? Tools like the GDS can help determine if a resident can be part of a larger group activity, for example, or would do better in a small group or one-on-one for only brief periods of time,” he explains. “We need to meet residents where they are and avoid doing too much or too little.”
Gaining insight into a resident's past experiences and preferences helps the care team develop meaningful activities and programs. “All humans have an inherent drive to remain engaged and have purpose. This does not vanish with the onset of dementia,” Bartz says. “They continue to have strength that caregivers must recognize and learn to champion.”
Plugging into tech tools
A wide range of technologies can help residents with dementia connect with caregivers, interact with family members and other residents, and safely adapt to their environment. Computer- and web-enabled solutions, in particular, are bringing useful applications to the masses, and many can be uniquely tailored to a community's broader memory care and wellness programming.
Brookdale Senior Living's Clare Bridge Memory Care program relies on technology to assist with person-centered engagement content. The tool, named InTouch by Brookdale and created by It's Never 2 Late, lets caregivers and residents pull customizable content at the touch of a fingertip that supports each domain of well-being. Juliet Holt Klinger, senior director of dementia care and programming for Brookdale, says she receives stories from communities almost daily on how the technology has improved resident lives. There are instances where the technology brought someone closer to a relative via video chat, for example, or brightened a resident's day when he or she was able to read the home- town newspaper again after many years. One resident's anxiety and behavioral expressions diminished by playing drums on the virtual drum kit, she says.
One of Holt Klinger's biggest surprises with the technology was how successfully it was adopted by residents with later stages of dementia. “In fact, our residents living with moderate to advanced dementia were the earliest adopters of resident-use technology at Brookdale,” she notes.
Jack York, president and co-founder of IN2L, says successful memory care programming hinges on operators' and caregivers' understanding that people with dementia still have so much to give and live for — and that technology tailored to the individual can provide the ability to reach a resident where he or she is and at the appropriate level. “Once the mindset changes, caregivers and family members are open to solutions, like technology, that are outside the box of traditional thinking.”
Even residents who are not self-directed can enjoy the programming features of computer technologies if they have some assistance, stresses Nancy Allegrezza, RN, director of sales for Telikin. “Staff can use computers to provide both individual or group activities.”
When considering how technology will be incorporated into a community, she recommends selecting computer technology with a user-friendly interface, meaningful software applications and a touchscreen to help remove usage barriers.
Also essential is a technology's ability to provide exercises that precisely match a user's ability at that moment in time. This allows individuals with dementia to receive cognitive stimulation without the fear or frustration of failure, explains Dan Michel, founder and Executive in Charge at Dakim Inc.
“When caregivers observe individuals with dementia performing on Dakim BrainFitness above their expectations — say, in language, computation or visuospatial orientation — it forces caregivers to reassess their overall perception of the potential and capabilities of the individual,” he says. “You can imagine the profound impact this shift in perception has on the [person's] care and quality of life.”
That's certainly been the case for Prestige Care communities. The operator's robust and activity-rich memory care programming program, named Expressions, received an Innovators Award in 2012 from the International Council on Active Aging. At its heart are innovative care techniques and treatment approaches that turn daily activities into memorable and meaningful events for residents with dementia. Programming focuses on learning, the arts, spirituality and the development of new skills. Technology plays an important role, explains Hollie Fowler, senior director of product and brand development at Prestige Care. The same is true of Prestige's lifestyle program, Celebrations, which uses a wellness-based curriculum that emphasizes cognitive exercises to strengthen brain health and decrease the risk of degenerative brain diseases.
“We chose a solution that could offer customizable programming and be tied to our programming,” she says of the Linked Senior platform, which allows the care team to align computer-based content to its wellness themes. For example, for Prestige's heart healthy programming, Linked Senior content provided food demonstrations as well as music and trivia geared to the theme. The platform's interactive touchscreen kiosks and tablets let Prestige custom-design interactive therapy for each individual. Fowler says they also use the dashboard to track and monitor progress, and see how communities are using the tools.
Simpler may be better
Sometimes, technologies' greatest benefits come in their more basic offerings. Computer-based technologies that give residents with dementia easy access to photos from their past or images of their various interests can provide comfort and help them relive happy moments in their lives.
“A senior living community's directory of residents and staff can also help seniors with dementia remember the names of caregivers, or make new friends,” says Ashlee Bartko, marketing manager for Touchtown Resident Engagement Solutions. Touchtown's Community Apps also can help family members stay informed about the community and loved ones.
Connected Living's CL Mobile App allows for private family and friend networking and the sharing of social pictures that can be turned into a digital memory box in slideshow mode. The application also offers an activity tracker and has geolocation features that allow seniors, caregivers and family members to set a specific location and receive an alert when anyone comes or goes from that location.
“The experience of seniors, families and caregivers being connected all the time, not just for one hour of service, is a game-changer,” Sullivan says. “With a mobile device, the socialization, reduced depression and isolation and ability to have meaningful, two-way conversation becomes immediately available.”
Whichever approaches a community takes to reach its residents with dementia, the community must stay committed to helping caregivers understand and respond to each resident's wants and needs, and then use that understanding to engage meaningfully with residents.
“Effective engagement doesn't need to be a complicated process. If we know a certain resident takes coffee with two sugars and a creamer, for example, that can go a long way toward improving communication and building trust in the moment. The resident may not remember the caregiver from the day before but will know that the caregiver knows who they are,” Sullivan adds.