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As more residents grapple with memory-related challenges, operators are developing new approaches.
As more residents grapple with memory-related challenges, operators are developing new approaches.

As more seniors are diagnosed with dementia and memory loss, assisted living operators must find new and creative ways to keep residents engaged, enriched and satisfied. 

Fulfilling this need isn't easy, however. Increasing comorbidities and care needs that often rival those seen in skilled nursing facilities — coupled with limited resources and sometimes inadequate staff training — can set facilities and their residents up for frustration and failure. Sometimes, assisted living operators recognize the importance for highly individualized care plans and resident enrichment programs, but they lack the knowledge, resources and tools to make it happen. The result is often a one-size-fits-all approach that, at best, fails to reach residents in uniquely satisfying ways and, at worst, leaves residents and staff feeling agitated and disconnected, sources told McKnight's Assisted Living.  

“We have an obligation to be committed to addressing the needs of individuals with dementia,” says Loretta Bartz, ORT/L, VP of clinical training and program development for Heritage Healthcare/HealthPRO Rehabilitation. “It's essential that we acknowledge that traditional approaches to addressing [resident] needs are not going to be successful.”

Play detective

Enriching resident experiences and delivering fulfilling programs and services takes facility-wide commitment and involvement, and recognition that residents can stay positively engaged, regardless of where they fall on the dementia scale.

“We tend to think people with dementia are separate species when, in reality, they have the same needs we all do. They want to be connected to others, to feel loved and valued, and — to the best of their ability — contribute something to others,” says Kathy Laurenhue, CEO, Wiser Now Inc. “If we start with that universal premise, we can create a warm and comforting atmosphere that [serves as] the basis for everything else.”

Staff must be well-educated in dementia care, and this goes for all members of the care team, from admissions and nursing to therapy, activities, dietary, and more. Often, providers ask staff to do their best, but don't give them the right tools to make that happen. Activity staff, especially, may lack cognitive impairment training and not understand disease management basics, which can hamper their ability to delivery resident-centric programming and care, according to Ryan Ries, president of TranslaCare. 

“This can progress to the point where the elder becomes increasingly disconnected and has more care challenges, and can no longer remain in assisted living.” Another common misstep is hiring activity consultants to ensure compliance with survey requirements, without recognizing that compliance doesn't automatically mean all needs are being met, Ries says. 

Further, some facilities design aesthetically-pleasing spaces, but don't give enough thought on how to use them effectively. “What I see too often is a gorgeous-looking space where nothing is really happening. Engagement is a wonderful concept, but it requires a team effort — where everyone is involved in program planning and participation,” explains Laurenhue. “That means asking residents, families and staff for their input and their talents.”

Assessments upon admission and then on an ongoing basis are key to meeting residents' unique and ever-evolving needs. Upon admission, staff should inquire about personal preferences, past occupations and interests, and meaningful life roles. 

“ALF staff must include families in order to get a comprehensive understanding of the individual's life prior to the onset of dementia,” says Bartz. “By understanding the unique way a resident engaged in even the simplest activities, such as the way one initiated involvement in brushing their teeth, will help staff replicate the context in which this resident completes the task. They will also be able to provide the cues needed to continue carrying out [the task], rather than ‘taking over' and just doing the task for the resident.”

Activity assessments, too, must delve deeper than just leisure skills and interests, adds Ries. “When I retire to assisted living and an activities person interviews me, I won't have hobbies to report. I will have important life roles to talk about. Too many activities focus on leisure skill areas, and not enough are geared toward life roles.”

Facilities may struggle with adapting personal preferences and past roles into meaningful programming. Staff may know a resident's interests, but it takes ongoing investigation to apply that information to programs that facilitate engagement and socialization, and deliver therapeutic outcomes.

“We must become comfortable in our role of detective and in uncovering the strengths to ensure the highest quality of life,” says Bartz.

Direct caregivers need strategies, standards and tools to collect and analyze life stories, plan around existing abilities, easily access and update ongoing preferences, engage and educate family members, train support staff, and provide them with consistent guidelines, pointed out Gina Cambre, national director of CL University/senior director of Operations for Connect Living.

What's more, staff must understand that memory care, engagement and quality of life are not merely a philosophy, but an organization-wide practice. 

“We need to use a practical approach to providing person-centered care, consistently, every day for every resident, and allowing them to maximize their abilities daily, at every stage of their journey,” says Hollie Kemp, PTCCL, CDP, CADDCT, corporate director of dementia services for Compass Pointe Healthcare System. 

Stay in the moment

Recognizing dementia stages and being creative in modifying approaches to allow residents — even those with severe dementia — to stay engaged is essential. This helps slow cognitive decline, which helps maintain a higher level of independence and quality of life for each resident, assures Dana Tingley, MS, CCC-SLP, regional VP of operations, Heritage Healthcare/HealthPRO Rehabilitation. 

“Many times, we focus on the disability and what a resident cannot do, rather than recognizing their continued strengths and skills,” she says, adding that another common mistake is labeling many observed behaviors as problematic or negative. Often, these behaviors are a resident's attempt to communicate to staff their confusion, lack of recall, frustration, or even pain, she explains.

Therapists can recognize the root cause of “behavioral” issues and collaborate on identification of effective strategies and how best to implement them to maximize independence and participation, notes Bartz. 

Early-stage dementia residents may begin withdrawing from previously enjoyed activities because of the emotional impact of their symptoms, and their inability to be engaged with a typical system of behavioral prompts. They may no longer recall days and times of activities featured on monthly calendars, or may not know the day or time. Transitional programs allow providers to begin a series of interventions that prevent isolation, according to Cambre. For early-stage dementia residents, this may include prompting for daily calendars, calling residents prior to activities, or initiating “pick me up” groups where residents knock on one another's doors and travel together to activities.  

Those with mid-level dementia often live in the past. Familiar activities, such as watching television show from the 1950s or 1960s, can be done for 20 to 40 minutes at a time, whereas new learning activities like handicrafts that involve direction-following can be done for one to two minutes at a time, says Ries. Late-stage dementia residents require multi-sensory activities involving at least three senses for maximum engagement, he adds. “This also requires interdisciplinary integration of therapy and daily living activities to ensure all cognitive levels are included.”

Tap technology

Today, there's a breadth of technologies to further enhance resident engagement, familial connections and quality of life. These solutions can evolve with residents and provide meaningful interaction — in a group or one-on-one — no matter the degree of cognitive impairment. 

Computer- and web-based technology is gaining momentum, some offering extensive content libraries that can hold each resident's unique preferences, profiles and targeted engagement programs, and let staff gear activities accordingly. If a resident was once an avid hunter, for example, he could perhaps be given a Nerf gun, so he can watch on a large television screen a video of a deer crossing in the woods, and be instantly “transported” to the north woods, says Lori Snow, regional sales and marketing director for It's Never 2 Late. A resident who enjoyed ballroom dancing can watch various dances with the click of mouse on a custom home page, she adds.

Increasingly, solutions are tapping the benefits of existing technologies and allowing residents to stay better connected with loved ones. “We're driven by social impact, and committed to the idea that a connected life transforms the experience of aging,” Cambre notes.  Connected Living's private resident and family portal provides a secure, easily accessible mobile database of individualized care plans and evolving preferences. “We partner with industry thought leaders to bring guided, therapeutic, multi-sensory life enrichment content for the highest level of engagement.” This includes music therapy and games via Ph.D. music therapists, guided reminiscing and more.

Solutions like Skype are also providing meaningful, therapeutic interactions, Snow says, and even televisions themselves are being designed with resident-friendly features that offer far more than just entertainment. SeniorTV's
PlaybackNOW automated DVD system lets staff schedule and play movies and create soothing videos.  

“Another built-in feature on our own brand of LED TVs allows a USB card to be plugged into the TV, so pictures and music media can be played by pushing a button on the remote,” says Savy Sabino, sales manager, Stella Private Cable Systems – SeniorTV. “The USB card can be loaded with family pictures and memories by a family member.”

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