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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Person-Centered
Care Planning:
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Traditional Dementia Care:
- Run by caregivers
- Based on what we can and ‘need to’ do to the person
- Work shared among 3 shifts of staff or all on one
- Safety and health care issues are top priority
- Medical model
- Organized by departments that are task specific
- You are sick and you need care for your diagnosis
- Paternalistic: father knows best
- Often driven by the givers of care
- Driven also by grief and loss and an effort to ‘help’
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
What’s Wrong with this Model?
- Who wants to live in a hospital?
- Who wants to do everything you are
‘supposed to’?
- Who wants to have someone else telling
what to do and when to do it?
- Who wants to have to talk to three different
people to get something done?
- Who wants to live in a nursing home?
- Who wants someone else running your life?
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What Does Getting Older Do To
This Whole System of Care?
- Increased risk of cognitive changes
- Increased risk of ‘losses’ that affect
emotions and life-time patterns
- Increased risk of physical changes
- Increased sense of needing to be ‘me,’ to
matter, to be respected, to count
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How Does Dementia Fit?
- Increasing numbers
- Increasing severity at admission
- Increasing ‘wait’ pre-admit
- Increasing desire for families to get more for
less
- Family desire to have person be the way they
‘used to’ or ‘should’
- Staying at ‘home’ until further along in the
journey
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So…There’s Something New
Going On:- Focused on people
- Focused on relationships
- Trying to put the person first
- Trying to honor the person’s preferences
- Trying to work as a community
- Trying to share decisions
- Trying to respect people: residents and staff
- Trying to create homes
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What is Person-Centered Care?
Combination of:
Person’s wants
Person’s needs
Still can do
Can’t do
Can do with support
Individual good
Common good
Family needs
Family wants
Balanced with:
Care partner skills
Care partner availability
Private space
Public space
People resources
Equipment resources
Safety and Security
Rules and regulations
Others needs and wants
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What Matters?
Personal history: status
Health history: status
Cognitive status: abilities
All staff: approach and assist
Environment
Schedule and flow of the day
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Personal Preferences and
Values:
- Who have you been?
- What did you value?
- Who are you now?
- What do you value now?
- Why does it matter?
- Who gets a ‘say’?
- Who gets to set the priorities?
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Know Each Person
Health Status
medical conditions,
medications,
limitations & abilities
Life History
Who the person has
been…
Personal history and
background
Cognitive Status
thinking, memory,
processing skills and
limitations
Emotional status
psychological
condition and mental
health & limitations
Routines and Habits
patterns of behavior,
daily routines, time use
& schedules
Sensory Status
sight, hearing, touch,
balance, coordination,
temperature regulation
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Life Story:Family: past, present
Living place(s)
Work history
Leisure History
Music history
People history
Plant history
Animal history
Plant history
Sensory environment preferences
Cultural history and concerns
Food likes and dislikes
Daily routines
Organizations and memberships
Roles and responsibilities
Comforts and irritants
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Personality Traits:
Who Are You?
- Introvert or Extrovert?
- Lots of Details or Big Picture Only?
- Logical or Emotional?
- Planning Ahead or Being in the Moment?
Who is the person you are trying to help?
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Introvert – Extrovert:
Introvert
Likes to be alone
Likes to think it out
Likes personal space
Needs alone time
Private
Extrovert
Think out loud
Talk it out
Seek out people
Share a lot
Not good with
boundaries
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Details - Big Picture:
Details:
Lots of facts and
figures
Wants the specifics of
what to do
Likes to get going and
doing
Big Picture
Likes to know ‘why’
Likes to think about it
before doing anything
Likes to hear the big
plan
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Logical – Emotional:
Logical:
Head First
Fair
Reasonable
Rational
Emotional:
Heart First
Nice
Kind
Empathetic
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Planning Ahead - In the
Moment:Planning Ahead:
Aware of the future
Sets priorities - plans
Likes routines
Likes a schedule
Likes to do things as planned
Needs to be in control
In the Moment
Being flexible
Go with the flow
No forward thinking
Running late
Putting other things off
Go with the flow
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What About Medical Conditions?
What is essential?
Good care is delivered
The person is receiving the
care they need and want
Conditions are assessed
Decisions are made based
on good info
There is agreement on what
to do and what not to do
Thinking/planning ahead
What is optional?
When it is done
Where it is done
Who does it
How often it is done
How strictly it is followed
It depends on the person
and their situation
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
The GEMS® Progression of
Dementia:
Sapphires – True Blue – Slower but Fine
Diamonds – Repeats and Routines, Cutting
Emeralds – Going – Time Travel – Where?
Ambers – In the Moment - Sensations
Rubies – Stop and Go – Big Movements
Pearls – Hidden in a Shell - Immobile
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Care Partners:
- Be a partner, not a boss
- Be an advocate, build a team
- Do with me, not for me or to me
- Learn the ‘So What?’ philosophy
- Learn to let go not give up
- Learn what you are good at, and what not
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Build Care Partner Skills
Environmental
Management skills
Using space &
keeping up the
place
Problem-solving
skillsFiguring out what to
do when it does not
work right
1:1 Interaction
Skills
Do you work
with your
partner(s)…
Group Leading
Skills
Getting people
together &
having fun
Customer
Relations Skills
With families,
clients,
volunteers
Documentation
Skills
Record
keeping and
reporting
Practical
Hands-on
Skills
Crafts, games,
cooking,
working…
Planning & Time
Management
Skills
What to do &
when to do it!
Peer
Relationship
Skills
Helping each
other
Observation
skills
What you see,
hear, sense…
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Learn How To:- Do something new
- Learn a new type of exercise or activity
- Simplify a dance
- Re-look at a old skill and make it easier
- Share a tasks
- Do something without touching things
- Get someone to do something without words
- Give positive feedback and say “thanks”
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Take a Look, Listen, Feel:- Lighting: enough, non-glare, focused
- Sounds: background, distracting, volume
-Temperature
-Space: how crowded; intimate, personal,
or public
-Work surface
-Seating surface
-Walking surface
-Familiar? Friendly? Fun? Forgiving?
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
What Do People with
Dementia Need?- Daily routine!
- Help to fill their day with meaning
- Balance of:
- Productive activity: feeling valued
- Leisure activity: having fun
- Self-care activity: wellness, health, personal care
- Restorative activity: sleep, rest, and re-energizing
- A match-up for preferences: large group, small group, 1:1, alone
-Active versus passive activities
-Sensory options: visual, auditory, tactile, olfactory, gustatory
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
What Does It Take
To Make a Day Have
Meaning and Joy?
Know each
PERSON!
Understand
ACTIVITIES!
Make & Use a
SCHEDULE!
Build staff
SKILLS!
Manage the
ENVIRONMENT!
Resources to
succeed
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Two Examples:
Paying Bills:
Do it independently
Together – use a calculator
Together – do all of them
Together – do one at a time
You do most, they sign and put in envelopes
You do all but the signature
They put on stamps
Both take them to the mail box
Washing Dishes:
Do it independently only after meals
Do it independently –when needed to fill time
Together – one wash one dry
Do parts
Watch and guide
Carry dishes to/from sink
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Two Options:
DOING:
Filling socks: rice, beans, corn
Adding herbs: lavender, citrus, eucalyptus, mint
Putting a sock inside another sock
Heating the socks
Rubbing the socks over muscles
Emptying socks out
MAKING:
Fruit salad from fresh fruit
Fruit salad from canned fruit
Fruit salad from pre-cut fruit
Fruit salad: one fruit and yogurt
Fruit salad: dried fruit, granola, yogurt
Putting the fruit salad in small cups or bowls
Serving the fruit salad
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Key Activities to Consider:
Productive - Work
Enjoyment - Leisure
Wellness - Personal Care
Restorative - Rest
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Productive Activities:Helping another person
Helping family members
or caregivers
Completing community
tasks
Making something
Sorting things
Fixing things
Building things
Creating something
Caring for things
Counting things
Folding things
Marking things
Cleaning things
Taking things apart
Moving things
Cooking/baking
Setting up/breaking down
Other ideas….
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Active: Passive:
Socials
Sports
Games
Dancing
Singing
Visiting
Hobbies
Doing, Talking, Looking
Entertainers
Sport program/event
Presenters
Living room or lobby
sitting
TV programs – watching
Activity watchers
Being done to
Leisure Activities:
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Cognitive: Physical:
Tabletop tasks:
• Matching, sorting, organizing, playing
Tabletop games:
• Cards, board games, puzzles
Group games:
• Categories, crosswords, word play, old memories
Exercise
Walking
Strengthening tasks
Coordination tasks
Balance tasks
Flexibility tasks
Aerobic tasks
Personal care tasks
Self-Care and Wellness
Activities:
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Rest and Restorative Activities:Sleep/naps
Listen to quiet music with lights dimmed
Look at the newspaper
Look at a calm video on TV screen
Rock in a chair
Swing in a porch swing
Walk outside
Listen to reading from a book of faith
Listen to poetry or stories
Listen to or attend a worship service
Stroke a pet or animal
Stroke fabric
Get a hand or shoulder massage
Get a foot soak and rub
Listen to wind chimes
Aromatherapy
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Good Activities
Are Ones That Involve:
- Plants
- Animals
- People
- Music
- Objects
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To move from traditional to
person-centered care
requires:
Culture Change!
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The Goal:
Build a plan of care that helps the person:
-Be the way they want to
-Do what they are able
-Feel good about themselves
-Feel okay about where they are
-Enjoy the people who are there to help them
-Get what they need
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
So What Do We Need From
You?
- Awareness of the process
- Participation in planning
- Sharing about the past
- Time to learn and try something new
- Willingness to listen
- Willingness to advocate and negotiate
- Flexibility as we figure this out
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Key Steps:
- Connect
- Gather Information
- Share Information
- Use Information
- Review Information
- Make Changes
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The content contained in this presentation is strictly for informational purposes. Therefore, if you wish to apply concepts or ideas
contained from this presentation you are taking full responsibility for your actions. Neither the creators, nor the copyright
holder shall in any event be held liable to any party for any direct, indirect, implied, punitive, special, incidental or other
consequential damages arising directly or indirectly from any use of this material, which is provided as is, and without
warranties.
Any links are for information purposes only and are not warranted for content, accuracy or any other implied or explicit purpose.
This presentation is copyrighted by Positive Approach to Care and is protected under the US Copyright Act of 1976 and all other
applicable international, federal, state and local laws, with ALL rights reserved. No part of this may be copied, or changed in any
format, sold, or used in any way other than what is outlined within this under any circumstances without express permission
from Positive Approach to Care.
Copyright 2017, All Rights Reserved
Teepa Snow and Positive Approach to Care
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