Dementia Care Specialist Level 1 Training · © Teepa Snow, Positive Approach, LLC –to be reused only with permission. The world is full of obvious things which nobody by any chance

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

Welcome“It’s all about You”

Provincial Long Term & Continuing Care Conference

May 14, 2019

Charleen Phelps, R.N. Teepa Snow, Positive

Approach, LLC

Be a Detective


The world is full of obvious things which nobody by any chance ever

observes. Arthur Conan Doyle


The Basics for Success

Be a Detective NOT a Judge

Look, Listen, Offer, Think…

Use Your Approach as a Screening Tool

Sequence for CUES – Visual Verbal Touch

Match your help to remaining abilities

Teepa Snow, Positive Approach, LLC - to be re-used

only with permission


How we Take in Information

1. What you see

2. What you hear

3. What you feel/ touch

4. What you smell

5. What you taste


How We Give Information

Visual – How we look

Verbal – What we say

Touch - What we do


The person’s brain is dying


Four Truths About Dementia

1. At least 2 parts of the brain are dying

2. It is chronic and can’t be fixed3. It is progressive and will get worse4. It is terminal

Teepa Snow, Positive Approach, LLC - to be re-used

only with permission


Tab 1

Page 6


Normal Brain Brain with Alzheimers


When my brain makes mistakes;

I make mistakes!

• Learning, memory, way finding

• Visual regard

• Language (lost/retained)

• Sensory motor

• Executive Control


GEMS®: A Positive FrameworkSapphires: True Blue - Healthy Brain - Slower but

Fine

Diamonds: Clear/Sharp – Routines and Routines Rule – Change is Hard – Cutting

Emeralds: On the Go with Purpose – Naturally Flawed – Time Travel

Ambers: Caught In a Moment of Time – Caution Required – All About Sensations

Rubies: Deep and Strong – Others Stop Seeing What is Possible – Stop and Go – Big Motions or Still

Pearls: Hidden in a Shell – Immobile - Beautiful Moments to Behold

Tab 1

Page 13


Dynamic Assessment

Visual regard

Ability to speak and understand

Skill in movement


Top Five Human Needs and Emotional Indicators of Distress

• Five Human Needs

IntakeHydration, nourishment,

meds

Energy Flowtired or revved up

directed inward or outward

OutputUrine, feces, sweat, saliva,

tears

Comfort4 Fs and 4 Ss

Pain-Free!!!Physical, emotional, spiritual

• Five Expressions of Emotional Distress

Angryirritated – angry – furious

Saddissatisfied – sad – hopeless

Lonelysolitary – lonely –

abandoned/trapped

Scaredanxious – scared – terrified

Lacking Purposedisengaged – bored – useless

Tab 1

Page 24


Environmental Preferences:

Four F’s for you to keep in mind:

•What features of an environment provide you a sense of:• Friendliness: I am liked here, I am wanted here

• Familiarity: I am comfortable and at ease in this place

• Functionality: I know what I am to do here

• Forgiveness: I can make mistakes and errors and it will be OK

Four S’s for you to keep in mind:

•What features matter for you, what do you like and dislike:• Spaces (intimate, personal, public)

• Sensations (sights, sounds, feels, smells, tastes)

• Surfaces (sit, stand, work on, rest on, walk on)

• Social (groups, activities, roles, expectations)


Circadian Rhythms:Natural 24-Hour Cycle

•What is your natural rhythm?• Early bird, night owl (predator/prey), deer

• What happens if you are off schedule?

• How do you recharge - rest and restore? • What options do you use and prefer?

• What is the best frequency, intensity, duration for them?

• How do you know when you are great/good/low/out of gas?

• How and when do you like to be productive?

• How and when do you like to play – have fun?

• How and when do you like to take care of yourself?


Amygdalae:

Dangerous Need

Risky Want

Dislike Alert/Aware Like

Tab 1

Page 10


Dangerous

Risky

Annoying


Amygdala – Emotional StatesAlert

Low – Amygdala ActiveAlert

Medium – Amygdala Stressedat Risk

High – Amygdala in ControlEndangered

IrritatedBothered

AngryFrustrated

FuriousEnraged

Dissatisfied Blue

SadUnhappy

DevastatedHopeless

Missing some______Missing freedom/control

Lonely – DisconnectedConfined/restricted

Abandoned – IsolatedImprisoned

NervousAnxious

ScaredWorried

TerrifiedPanicked

DisengagedAntsy

Bored Roaming

Useless –PurposelessFrantic


Amygdala Emotional States -Pleasure

Low – Amygdala ActiveLiking It

Medium – Amygdala StressedWanting to Do More

High – Amygdala in ControlNeed Something

Excited Hyped Up Hysterical

Happy Boisterous Slap Happy or Delirious

Connected or In Control Can’t seem to get “it” Controlling or Clingy

Energized Rev’ed Racing Around

Full of Purpose Committed Demanding Others Get Purpose


Six Pieces of the Puzzle

Brain

ChangesThe Environment

The

Person

The

Stakeholders

Wellness, Health, and Fitness Time


Six Pieces of the Puzzle

Brain ChangesDementia, Delirium, or Depression?

Dementia

• Type(s) Alz, FTD, VaD, LBD, usually more than one

• PLwD’s awareness of their brain change

• Fully aware, somewhat aware, unaware, aware but covering

Note GEMS® level(s)

• Changed abilities and retained abilities

• Variability – time of day, situation

• Onset and duration

The EnvironmentFour Fs and Four Ss

Four Fs – is the area…

• Friendly – are there people she knows?

• Familiar – does she know the area?

• Functional – is she able to do what is needed?

• Forgiving – is she allowed to make mistakes?

Four Sx – how will he/she interpret…

• Space – Intimate, personal, public

• Sensations – See, hear, feel, smell, taste

• Surfaces – Sit, stand, lie down, work

• Social – People, activity, role, expecations

The PersonPast and Present

Life Story

• Where did he live when younger?

• What did, or does, he do for a living?

• What hobbies or activities does he enjoy?

Personality Traits

• Personal preferences – likes and dislikes

• Key values in life

Roles

• Does he prefer to watch, talk, or do?

StakeholdersCare Partners and Others

• Personal history with the person – Background

• Awareness – What do they know about the person’s health?

• Knowledge – What do they know about dementia?

• Skills – Do they have the skills to work with a PLwD?

• Competency – Can they put the PLwD first in everything they do?

• Relationship – Personal, professional, family, other

• Agenda – Why is the person here?

Wellness, Health, and FitnessHealth Conditions and Physical Fitness

• Fuel and Fluids

• Medications and Supplements

• Emotional and Psychological Condition

• Sensory Systems Function

• Health Beliefs of Note

• Recent Changes – i.e. Acute Illness

TimeCare Partners and Others

• Where in life is the person?

• What time of day is it?

• How long has passed for the person?

Four Categories of Time

• Productive – gives value

• Leisure – fun, playful

• Wellness and Self-Care – brain and body

• Restorative – calm, recharge


Can you complete the puzzle?

1. What is the challenging behavior?

2. What do you know?

3. What don’t you know?

4. What is the unmet need or trigger?

5. What do you want to try?


CONSIDER

• Pace• Visual Cues• Verbal Cues• Physical Cues

Tab 1

Page 16


A Dynamic AssessmentTool for a Shared Relationship

Use the

Positive Physical Approach™


Positive Physical Approach™* (PPA™)*

• Stop moving at 6 feet out

• Greet: hold your open hand still next to your face, say their

name

• Offer hand in a handshake position

• With their acceptance, slowly come in from the front within

visual range

• Move into supportive stance, turn shoulders

• From the handshake, move into Hand-under-Hand®

• Get low: sit, kneel, or stand at or below their level

• Make a connection: PPC, then wait for their response

• Deliver a message: use V-V-T Cues and a PAS

* = if in public space and you start the interaction

Tab 1

Page 18


Hand-under-Hand®:


TEN WAYS TO DE-ESCALATE

1. Create Space

2. Remove the Threat

3. Be on his or her side

4. Get at or below eye level

5. Use hand under hand

6. Breathe in Sync

7. Calm voice

8. Relax Body

9. Attend to needs

10. Be willing to go where he/she is


THANK YOU!


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Dementia Care Specialist Level 1 Training · © Teepa Snow, Positive Approach, LLC –to be reused only with permission. The world is full of obvious things which nobody by any chance