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Dementia Care: “A Transformational Approach Toward Individualized Care”
Presented by:
Christine E. Bockis, Director of Recreation & Volunteers
Jan Davis, RN, Unit Manager
Vincent A. Maniscalco, MPA, LNHA, Administrator
Eileen Masterson, LNHA, RN, Director of Nursing
Facility Overview
• 230‐Bed Skilled Nursing Facility
• Middletown, NY (Orange County)
• Approx. 72 miles NW of Manhattan
• Four LTC Units
• One Post‐Acute
Rehabilitation Unit
• One 40 Bed Dementia Unit
(New Horizons)
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Our Journey
• Goals of New Horizons
• Teams
• Approaches
• Process
• Results
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Goals of New Horizons
• To optimize overall patient wellness and safety by providing an atmosphere that exemplifies basic human compassion, kindness, patience, and creativity
• To involve residents, staff, families, and the community in a collaborative effort to transform dementia care
• To create a transformational approach with an emphasis on the individual uniqueness of each person
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Teams
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Person0Environmental Changes
Therapeutic Activities
Staff Education&
Development
Dining & FoodServices
Person
Approaches• Select care partners that demonstrate:
– Kindness, energy, patience, compassion
– Genuine understanding of Dementia and desire to improve quality of life
– True “dedication” to accepting the challenges of the dementia unit and uniting to “make a difference” and realize that the rewards are priceless
– Ability to think “outside the box”; everyday is different
– Teamwork: must be continuous flow the entire shift, multiple activities, ambulation program in the corridor, sensory program in the great room, and poetry in the living room
– A “connection” with the residents: knowing about their “life” (i.e. occupation, hobbies, past life experiences, likes/dislikes, origin, etc…)
– A “connection” with everyone that works on the unit
– Pride in even the smallest of patient gains
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Environmental ChangesBefore Renovations
• Traditional Nurses Station with back office
• Resident “clustering” in front of
Nurses Station
• Exit Doors with Stop Signs and Alarms
• Lack of Resident Space
• “Institutional Look”
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Environmental ChangesAfter Renovations
• Shift From Institutional to Home‐like
• Happy Hour and Fireside Sing‐alongs
• Emphasis on Resident Space
• Increased Programming Areas
• Exit Door Murals
• Elevator Door Murals 8
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Therapeutic Activities• Partnership with Goshen Art League
• Resident Shadow Boxes
• Reminisce Boards
• Personalized Music Play Lists
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Therapeutic Activities• Horizon Happenings
• Music Therapy
• Gardening Club
• Pet Therapy
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Dining & Food Services
• Fiesta Tableware
• Puree Molds
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Dining & Food Services
• Daily Happy‐Hour
• Finger Foods
• Restaurant Style
Dining
• Beverage Stations
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Staff Education/Development
• Behavior = Communication
• Person Centered Care
• Respecting Individuality
• Supporting Resident Choice
• Allow Resident Control
• Behavior Based Training – It’s all in the Approach 13
Staff Education/Development
• OASIS Training – A model for improving quality of life for residents, families, and staff.
• A lifestyle that focuses on person centered care with emphasis on those that have dementia.
• Higher quality of life for residents
• Greater family satisfaction
• Fewer resident incidents
• Greater job satisfaction
• Less staff turnover
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Community Integration
• Intergenerational Programming
• Community Education
• Alzheimer’s Assoc.
• Goshen Art League
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Results
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MDS 3.0 Facility Quality Measure Report Jan‐14 Jun‐14 Dec‐14 Variance
Behavioral Symptoms Affecting Others 37.20% 14.70% 14.80% 22.23%
Excessive Weight Loss 5.40% 5.90% 2.70% 2.80%
Antipsychotic Meds in Long Stay Residents 13.50% 11.20% 10.00% 3.50%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
Jan‐14 Feb‐14 Mar‐14 Apr‐14 May‐14 Jun‐14 Jul‐14 Aug‐14 Sep‐14 Oct‐14 Nov‐14 Dec‐14
Behavioral Symptoms Affecting Others
Excessive Weight Loss
Antipsychotic Meds in Long StayResidents
MDS 3.0 Facility Quality MeasuresJanuary ‐ December 2014
Perce
nt
Month
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Resources• NYS Health Facilities Association – www.nyshfa.org
• American Health Care Association – www.ahcancal.org
• Foundation for Quality Care – www.thefqc.org
• Advancing Excellence – www.nhqualitycampaign.org
• MA Senior Care Foundation – www.maseniorcarefoundation.org
• Pioneer Network – www.pioneernetwork.net
• National Institute on Aging – www.nia.nih.gov
• Hand in Hand – www.cms‐handinhandtoolkit.info
• Eden Alternative – www.edenalt.org
• Alzheimer’s Association – www.alz.org
• The Society for Post‐Acute and LTC Medicine ‐ www.amda.com
• The American Geriatrics Society – www.americangeriatrics.org
• American Society of Consultant Pharmacists – www.ascp.com
• National Council of Certified Dementia Practitioners – www.nccdp.org
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Inspirational
"Kindness is a language which the deaf can hear and the blind can read."
~Mark Twain
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Transformation Video
• https://www.youtube.com/watch?v=cP17IljcQe0
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Questions?
Contact Info:
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