Best practice: Oral care

Oral care is extremely important for everyone, and older adults are no exception. Yet sometimes, after we help a behaviorally challenging resident get bathed and dressed, proper oral care can become an afterthought. It can also be one of the most difficult personal care activities to have a resident perform. Here are some tips to help you work with a resident with BPSD who needs assistance with oral care:

  • If a resident is reluctant to brush her teeth or refuses when you initially ask, try to distract her with another brief enjoyable activity or conversation and then try again.
  • Have supplies ready before you begin: toothbrush, toothpaste, cup, and mouthwash if using.
  • If a resident will not open her mouth, ask her to say “eeeee” as this will naturally get her to open her mouth enough to sneak in a toothbrush. Or you can try singing together and sneak in the toothbrush then.
  • Since teeth brushing can feel invasive and even threatening when done by a caregiver, encourage independence in this task. By role modeling in front of a mirror, while you stand beside the resident, you can cue the resident to engage in the task without having to touch him/her.
  • If a resident is physically unable to brush his/her teeth independently, use the hand-under-hand technique so the resident is still participating in the activity with you and can maintain a sense of control. If the resident can’t hold the brush or resists, shake hands with him, turn your hand palm up so they only see their hand, use your skill fingers (thumb and first two fingers to hold the toothbrush and you can guide it in.  Those with significant dementia think they are doing it rather than you.  If a resident is able to hold the toothbrush and just needs some guidance, you can simply place your hand over their hand and help guide them.
  • Some people don’t do well in the bathroom. Considering having residents brush their teeth while sitting on their bed.
  • Lastly, keep in mind that the toothpaste is the least important factor. The friction from a damp toothbrush is the most important, and every brush helps!

This 3-minute video illustrates these tricks of the trade in action: http://www.functionfocusedcare.org/oral-care

 

Increasing resident engagement in activities

We’ve talked about how encouraging residents to participate as much as possible in their own care can help maintain or even increase function and decrease negative behaviors. Let’s remember that residents with moderate to severe dementia can have fun too!

How often do we see a group of residents participating in a recreational activity, but notice that at least a few of them are left out? Sitting in the corner looking on? Often, these more “challenging” residents are the people who most need to be active and engaged in activity so they avoid feelings of frustration, agitation, and boredom.

To help with this, here are some activity ideas that your nurses, nursing assistants and recreation staff can use to get residents with cognitive decline in on the fun:

  • Flyswatter volleyball: Give residents plastic flyswatters have them hit a balloon back and forth to each other
  • Dance, dance, dance! Turn off those televisions and turn on some music and dance. Have staff members take turns playing music from their iPods through a speaker. Fast or slow, old or new, music has the power to move everyone.
  • Horseshoes: Now that summer is here, horseshoe games are everywhere. Look for the foam kind and play inside or outside on a patio. Residents can play while standing or sitting.
  • Foam swim noodles: Get a bunch of these, cut them in half, and start bending. These make for great resistance exercises! Leave them out in common areas for a safe, easy way to start spontaneous exercise.
  • Movement scarves: These can be found on enasco.com, or you can make your own with a lightweight material. Toss these colorful scarves in the air and have residents try to catch them. These scarves can be better than throwing a ball back and forth since people with slower reflexes and limited hand flexibility can catch them more easily.
  • Chores! Yes, chores. Your kids might not agree, but for older adults with dementia, doing familiar household chores can be calming and comforting. Grab a basket of cloth napkins and ask them to help you by folding them. Give them a broom and ask them to help you sweep the floor since company will be coming. Get some pillowcases or old clothes, hang a clothesline between a few walls, and give them some clothespins. They can hang the laundry.
  • Don’t forget to go outside! Warmer days are here now, so in the morning or early evenings when it’s a bit cooler, go outside. The sunshine, change of scenery and fresh air is something we all need. Look at the flowers, look for birds, and have some lemonade.

Function focused care exemplars

As you continue to work with the “Champions” at your nursing homes, we encourage you to show them these brief videos from our website: http://www.functionfocusedcare.org/videocoaching

The six videos offer great tips on how to engage residents with cognitive impairment and help them perform activities of daily living such as dressing, oral care and toileting, and reinforce the information we presented during the training sessions. You can even show the videos on a mobile device to GNA’s and other busy staff, as each video is only about 3 minutes long. Consider showing a different video at each of your next staff meetings, and discussing the ideas presented. Could some of the approaches from the video work with one of your more challenging residents?