Stretching boundaries

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Stretching boundaries
Stretching boundaries

As more senior living residents arrive with memory-related challenges, operators are adapting. This is especially the case in rehabilitation care, according to industry experts.

Data gathered by the National Institutes of Health underscores why senior living operators need to consider the effects of Alzheimer's disease and dementia: 29% of residents have been identified as having mild cognitive impairment, 23% have moderate and 19% have severe cognition challenges.

“That research is from 2014, so this is recent data showing a significant number of people living with some form of dementia in these facilities,” says Kathleen Weissberg, education director for Select Rehabilitation. “Assisted living is feeling the shift more than any other sector.”

To the sector's credit, operators are recognizing the situation and responding by adding memory support wings, building therapy gardens and implementing new programs to help residents live with cognitive impairment. Yet there are some major steps that still need to be taken, Weissberg says. 

“The residents should be in charge of the activities they participate in and they aren't,” she says. “Facilities are still focusing on basic care needs and less on leisure pursuits. As a result, they are pigeonholing residents into available activities instead of asking them what they want to do.”

One of residents' chief complaints about their facilities is “lack of control” over their activities, Weissberg notes, suggesting that the key to solving that problem is simply asking residents about their interests.

“Find a way to make it happen — everyone has a passion, so make an effort to identify what it is,” she says. “It could be beer or wine tasting, chess, or even beekeeping. Get creative and involve everyone.”

Weissberg is an adherent of the Canadian Occupational Performance Measure, an evidence-based outcome measure designed to capture a client's self-perception of performance in everyday living, over time. That model recommends engaging residents daily about their priorities and activities focus.

“If they're focused on what is meaningful to them, it results in better attitude, health and outcomes,” Weissberg says. “Meaningful activities maximize benefits — they give residents a sense of purpose.”

Cognitive engagement

The memory support field is indeed evolving and the senior living community needs to be apprised of the new tools available, says Lori Snow, marketing director for It's Never 2 Late.

“There is greater demand not only for cognitive therapy but for cognitive engagement,” she says. “The next generation of cognitive programming includes therapy, lifelong learning and recreational enjoyment … and technology is a big, if not the main component of that cognitive programming.”

A comprehensive program should include “person-centered” engagement and therapy performed with the new sophisticated tools and products available, Snow says. At its heart, the program must function with “the understanding that dignity and age appropriateness matter,” she says.

As an increasing number of residents with cognitive impairments enter the senior housing sector, Snow says facility operators need to take a hard look at their programs to determine if they are serving residents' needs properly.

“As dementia hits closer and closer to home, it becomes easier to assess, a little more real when we ask ourselves ‘Would my parent be comfortable with this or would I want to do this myself?'” she notes.

Interdisciplinary effort

Occupational therapists tend to be the program directors within senior living rehab programs, but memory care also should include a physical therapist and speech language pathologist to ensure all aspects of the resident's condition are considered, says Kristy Brown, president and CEO of Centrex Rehab.

“We spend a tremendous amount of time training caregivers to get clients to participate more in daily living skills, ambulation, swallowing and speaking to the best of their abilities,” she says. “After we are alerted to a marked change in their performance, we get involved again to determine the levels of performance and provide appropriate training for the caregivers.”

Overreliance on what one single therapist says offers only a one-dimensional perspective, Brown says, while an interdisciplinary team “brings distinct specialties to develop a plan of care that best meets of need of each person. The input of everyone, including the aides — who see the client more often than other staff — is essential in the overall care plan for the client.”

Partnering with a wellness coordinator to carry out strategies for each resident also is optimal, observes Judy Freyermuth, physical therapy national clinical specialist for Rehabcare.

“The wellness coordinators who are working with the residents on a regular basis also assist in recognizing further decline, need for modifications to the approaches or referral for more skilled intervention,” she says.

Freyermuth identifies key program personnel as speech, occupational and physical therapists, activities directors, nurses and administration. 

“There may also need to be involvement from maintenance, for example, if modifications need to be made to the environment,” she says. “Based on the setting and resident, different members of the IDT would need to be involved to varying degrees.”

Together, the team can devise therapies that are at the appropriate cognitive level for the client, fostering enjoyment and satisfaction from the activity, Brown says.

“When they know how to interact with the activity, it allows clients a feeling of freedom and accomplishment they wouldn't have felt if it had been at a level beyond their comprehension,” she says.

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