Care Plan Contest Winner!

Hello everyone,

We are excited to announce the winner of our Person-Centered Care Plan Contest! Kelly Cox, the ADON at Meadows Nursing & Rehab in Pennsylvania, sent us her creative solution to an issue she was having with a resident who was not safely transferring:

My most recent person centered care plan was for a resident who was a famous musician and every day he comes into the office and gives the nurses music trivia and due to a stroke, he cannot play guitar anymore. 

He is very impulsive and has poor safety awareness and short term memory loss. He has had many falls related to toileting and recently has started self transferring by standing and twisting his legs while he turns to sit. He’s not supposed to do it by himself, but since we know he does anyways… we need to a least help prevent an injury.

I figured out a way for him to park his chair and to avoid this strain on his legs while he transfers, but he can’t remember each time, so, with his permission, I posted this musical themed sign in his bathroom to help him remember and to make him smile! 

Be sure to see the attached photograph! Maybe this would work with someone in your community?

Congratulations Kelly and your team at Meadows Nursing! Your gift card is on its way!

Have a great week!

Chubby Checker picture

Care Plan Snapshots

Hello everyone,

Developing and updating care plans to ensure they include the required information takes a lot of staff time and attention. Unfortunately, they don’t usually live up to their potential for day to day usefulness and practicality.

To help address this, we’ve developed a Care Plan Snapshot…a “Readers Digest” version of a care plan that highlights the key information that a GNA or other caregiver would find most helpful day to day. It includes short and long terms goal(s), guidance on ADL care that helps residents maintain or improve function, behavioral issues with suggested approaches to care, and motivational ideas based on a resident’s interests. All in just a few pages!

Attached is an example of a Care Plan Snapshot for “Mr. WXYZ”, along with an example of a completed capability test for him, which guided the development of the care plan’s goals and ADL care approaches. We invite you to take a look, share with staff, and discuss how this might be beneficial. Feel free to use and adapt as you’d like for your facility. For example, if family members are involved with a resident’s care, you may want to add a section on what family members can do during visits to help their loved one meet his/her goals.

We are planning to hold a live webinar in late August to further discuss developing person-centered care plans. We will announce the date and time in a future tidbit, so stay tuned! 

And finally—don’t forget to send us an example of a person-centered care plan for our contest!!! You can simply send in a behavioral, environmental or functional aspect of a care plan that you have made person-centered for a resident. Entries are due by Sunday, August 5th.

Have a great week!

 

Capability Test_example

Care Plan Snapshot form

Care Plan Contest!

Hello everyone,

 

We hope you had a chance to read and share this week’s tidbit about developing person-centered care plans. We are announcing a new contest, and the winning entry will win a $100 gift card to buy items for your community!

 

How? Send us an example of a person-centered care plan for a resident that focuses on the environment, function focused care, or behavioral interventions (or all 3!). Please email your entry to vigne1@verizon.net by Sunday, August 5th.

 

Good luck and have a great week!

Tips for Integrating Person-centered Approaches into Care Plans

Hello everyone,

Many of you are working on integrating more person-centered approaches into your care plans, and looking for ways that GNAs and other staff can easily access information about the social histories and preferences of residents, which is critical information when caring for people who have dementia. Those “golden nuggets” of information can help caregivers motivate, distract, engage, and calm residents with BPSD.

So how do your current care plans stack up, and what can you do to improve them? Grab a care plan for one of your residents and look for the following:

  1. Does the care plan include resident preferences related to activity, distraction, personal care, and/or specific caregivers? Be specific here. Saying that someone should engage in “an enjoyable activity” is not specific enough. But saying that a resident “enjoys playing cards and listening to jazz music” is very helpful when a caregiver is looking for a way to calm down an agitated resident.
  2. Does the care plan include function focused care approaches? Meaning, do caregivers encourage residents to participate in as much of their care as possible using cueing, role modeling, encouragement, and hand-over-hand technique?
  3. Does the care plan address how to best communicate with the resident? Verbally? Visually? Communication board?
  4. Are environmental preferences included, such as level of stimulation, open area for walking, dislikes large groups, needs privacy for personal care, etc.?
  5. Are there person-centered tips for how to provide care to prevent or decrease specific behaviors, such as noise level, water temperature, time of bath, location for oral care, how meals are presented, etc.?
  6. Is there a plan for care when a challenging behavior does occur? Does the person do best when taken back to her room for quiet? Or does a small group activity work better? Does the person enjoy a hand massage to calm down, or is it better to be hands-off and simply offer a reassuring smile and play music?

 

Let these guide you as you review and update care plans. Next week, we’ll show you an example of a “Care Plan Snapshot” and a care plan template that you may find helpful as well. We welcome your feedback.

 

***Lastly, please don’t  forget to send us your DICE examples to win a prize! Please send them to vigne1@verizon.net by next Sunday.

 

Have a great week!

Exercise Ideas for People with Dementia & Contest Reminder

Hello everyone,

DailyCaring.com has a great article this week with ideas for exercises to do with people with dementia, tips for how to get them to participate in physical activity, and a list of the many benefits of exercise for this population. Much may sound familiar to you as it echoes many of the things we’ve discussed in past tidbits, but it is a great summary and easy to share with your staff.

Click on the link below to read the article:

http://dailycaring.com/12-ideas-for-exercise-and-physical-activities-for-seniors-with-dementia/?utm_source=DailyCaring&utm_campaign=36809770cf-DC_Email_2018-07-03&utm_medium=email&utm_term=0_57c250b62e-36809770cf-123152321

Second, a reminder to send us a brief example of how you and your staff have used the DICE model (Describe, Investigate, Create & Evaluate) to address a challenging behavior of one of your residents. The communities that send us the best examples will cordless sweepers! These are great to use with residents who like to help clean, because they take away the risk of tripping and falling (no cord to worry about), and they are quiet—so no loud noises to bother others. 

Please send us your entry by July 22nd!

 

Have a great week!

Emotions Linger Longer

Hello everyone,

Last month, DailyCaring.com had a great article by Dr. Elaine Eshbaugh about how the emotions of a person with dementia (whether positive or negative emotions) can remain with the individual long after the situation or event that caused the emotion to occur. For example, if you startle a person with dementia by coming up from behind them or speaking too loudly, that person may remain agitated for the whole afternoon. Out initial interactions with people with dementia, therefore, are critical.

Below is a link to the full article. We encourage you to take a look, and pay special attention to the tips she gives for smart ways to begin an interaction with someone who has dementia:

How Emotion Lasts Longer Than Cognition In and Out of Dementialand

Have a great week!

All Hands on Deck–Working with Champions to Reduce BPSD

Hello everyone,

To change how everyone in your settings manages behavioral and psychological symptoms associated with dementia, we need all hands on deck!  Your identified champions are your leaders and role models.  These individuals play a vital role in implementing the strategies we want all staff to use when working with residents with behavior and psychological symptoms of dementia.

Champions (along with other stakeholders such as administrators, nurses and social workers) not only act as role models, but also cheerleaders, teachers and observers. Encourage your champions to take a few minutes and watch the ways in which their co-workers interact with residents to make sure they are following the resident’s care plan and using person centered approaches during care interactions (e.g., having the individual participate in his or her bathing and dressing; walking the individuals to the bathroom regularly to avoid agitation; or singing the resident’s favorite song during an unpleasant care interaction).  Acknowledge, praise and reward the individual when an effective behavioral intervention is implemented.  Examples of such acknowledgments include:

  • A simple “Great job, keep up the good work!”
  • A write up in a newsletter recognizing their exemplary work
  • A Starbucks gift certificate (or an alternative treat!)

Conversely, when champions witness missteps by staff during resident interactions, they should turn these into opportunities to teach their colleagues a better way to handle those situations.  Role modeling a better way is one of the best ways to make new learning happen.  For example, when a caregiver tells a resident who is repeatedly getting up and down in an unsafe fashion to sit down they might fall…. And the resident persists and gets more agitated….it may be helpful to step in and show that taking the resident for a walk or having him or her stand and sing and dance for a minute or two may decrease the agitation.

Staying positive and persistent is key to changing the habits of staff and building a strong team of caregivers who help one another.

Lastly, please don’t forget to send us an example of how you used DICE to manage a challenging behavior in your community. You can win a free cordless push sweeper for residents to use!

Have a safe and Happy Fourth of July!!

 

End of the Fall Cycle

Hello everyone,

Now that we’ve finished discussing the DICE model for assessing and managing challenging behaviors, we’d like to hear from YOU! Please email us an example of how you and your staff have used DICE to address a challenging behavior of one of your residents. The communities that send us the best examples will cordless sweepers! These are great to use with residents who like to help clean, because they take away the risk of tripping and falling (no cord to worry about), and they are quiet—so no loud noises to bother others.

Speaking of fall risk…

Falling is an ever-present concern and challenge for care communities, and falls at home is often the reason why people move to a care community. Too often, however, staff and residents’ fear of falling can lead to a vicious cycle:

  • An ambulatory resident falls and gets hurt.
  • The resident recovers physically, but may now be afraid to walk for fear of falling.
  • The staff also fear that the resident will fall again, so they continually tell the resident to “sit down so you don’t fall,” reinforcing the resident’s fear.
  • The resident then sits more and walks less (if at all), and consequently becomes weak (which is just one of the many negative effects of immobility).
  • One day, the resident tries to walk or transfer without assistance (common among people with dementia who forget they need help) and falls because he/she is now so weak.

…And the cycle begins again.

How do we break this cycle?

Tricks of the trade:

  1. Review with staff why people with cognitive decline (who may not be able to communicate their needs verbally) want to get up and walk on their own. Are they bored? Do they hurt from sitting for a long period of time? Do they need to use the bathroom? Do they forget they need help to walk?
  2. A supervised 5-minute walk could be enough to satisfy their need to move for a while, and may help decrease negative behaviors later on due to boredom or discomfort.
  3. Instead of saying, “Sit down, you might fall!”, try to get in the habit of saying something like, “I see you want to walk. Please wait and someone will help you very soon.” Then take the individual for a short walk down the hall, to a common area, or outside to a patio or courtyard. Spending those 5 to 10 minutes walking with a resident will end up saving lots of time in the long run. Have staff take turns doing supervised walks.
  4. Perform fun “sit to stand” exercises throughout the day with residents….put on some music, have them grab the rails along the hallway and do 5 minutes of sit to stands with them. They help keep leg muscles strong and use up excess energy too.
  5. Spread the love and encourage physical function…..ask the resident, “Could you stand up and give me a hug?” –The reward back is a big hug from you!

Have a great week!

Create a Plan and Evaluate It–The final steps of DICE

Hello everyone,

This week we’ll finish discussing the four steps of DICE. We hope you had a chance to discuss the “Describe” and “Investigate” parts with your staff, and are finding the process helpful as you work to assess and manage behaviors of your residents with dementia.

The “C” in DICE stands for “Create a Plan.” Once you have described the problem behavior and investigated and determined a probable cause of the behavior (see last week’s tidbit), then next step is to create a plan to address the behavior.

When creating a plan, keep in mind that interventions should be personalized and meaningful. An intervention for one resident may not work for another. In addition, an intervention that worked for a resident 3 months ago may no longer work for that same resident now.

Creating a plan takes in interdisciplinary team to ensure that all are on board with the plan, that it will be communicated to all necessary staff, and the team will work together to see it through.

Some tips when creating a plan of care to address a specific behavior:

  • Be innovative—brainstorm ideas with staff
  • Use what you know about the resident—causes/triggers of the behavior, resident abilities and preferences
  • Minimize environmental change—limit the number of caregivers and reward caregivers that work well with a resident; minimize room and roommate changes
  • Control the amount of stimulation—too little or too much can precipitate behaviors
  • Modify communication techniques—verbal cues, writing things down, communicating “face on”, repetition, role modeling, and providing a vicarious experience with the resident can all aid in communication
  • Enhance sensory experiences and the environment—music, dance, pleasing fragrances, favorite foods, tactile stimulation and supporting physical activity can all help with some challenging behaviors
  • Provide individualized care—be flexible when scheduling functional activities, anticipate challenges, distract, use creative explanations to prevent a catastrophic reaction and let the resident “do her own thing” when safe to do so

The final step—the “E”—is to “Evaluate the Plan.” Did the plan work?

  • Decide upon a time frame for re-evaluation.
  • Use objective instruments for target behaviors: Cohen Mansfield Agitation Inventory; Neuropsychiatric Inventory (short form or nursing home version); Cornell Scale for Depression in Dementia; Resistiveness to Care Scale
  • Review use of PRN medications
  • Listen to staff report

If the approach worked, continue with the plan of care. If not, go back to investigate other potential causes of the behavior and revise your plan.

Have a great week!

Investigating Behaviors: The Second Step in the DICE Model

Hello everyone,

In last week’s tidbit, we discussed the DICE process for assessing and managing behavioral issues in residents with BPSD. We focused on the “D”—describing a resident’s behavior with specific details that provide important clues about the cause of the behavior.

 

This week we focus on the “I”Investigate. Once we have a detailed description of the behavior, we can investigate the influence of factors such as cognitive status, environment, caregiver approach, physical/medical disorders, and psychiatric symptoms on the resident’s behavior. In many cases, a resident with dementia is having difficulty communicating something to us. She could be trying to tell us that she is in pain or depressed, that we are rushing her, that it’s too noisy in the room, or that she simply doesn’t understand what we are asking her to do. When we don’t get the message, the resident can become agitated, resistant to care, anxious or even aggressive.

Cognitive impairment includes amnesia (memory loss); aphasia (language impairment–receptive or expressive); apraxia (impairment of learned motor skills); and agnosia (perceptual impairment). Cognitive impairment can have a significant impact on behavior. It can lead to  behaviors such as a resident urinating in a trash can instead of the toilet, pushing caregivers away when they try to take her to the bathroom, or using a call button constantly to ask for someone to take her home and complaining that no one is helping her.

We should also consider the environment: temperature, noise level, over and under stimulation, too much or too little space, familiarity and routine. An alteration to an element of the environment can have an immediate impact on a person’s behavior. For example, construction work being done in a facility brings noise, new people and changes to a space. These can all lead to anxiety and stress for a resident with dementia. Lack of stimulation can lead to boredom, which can result in behaviors such as wandering or disruptive vocalizations.

Caregiver approach can also influence a resident’s behavior. Older adults with moderate to severe dementia have difficulty understanding verbal directions. They can also misinterpret touch that occurs during care activities, perceiving it is a threat. When this happens, a resident can become fearful and either fight the caregiver (hitting, biting, etc.) or flee (resist care).

Physical/medical disorders in older adults with dementia can result in pain, constipation, infection and medication use (with a variety of side effects). Do any of these examples sound familiar?: “He’s so sleepy it’s hard to get him to eat. The food runs out of his mouth”; “He cries when we get him up to transfer to the chair”; “She’s up at night asking to go to the bathroom every 30 minutes.”

Psychiatric disorders obviously affect behavior. Some examples: “She has been tearful almost every evening and doesn’t want to get out of bed in the morning”; “She thinks someone took her children”; “He doesn’t sleep and is so irritable”; “She saw a snake outside her window.”

Now that you’ve learned about describing a problem behavior and investigating possible causes of it, next week we’ll discuss…you guessed it—the “C” in DICE, which stands for Create a plan. We’ll review interventions you can use to address these challenging behaviors.

Have a great week!