Written by Sarah Randolph; published in Kaw Valley Senior Monthly, July 2017, pg. 15
Alzheimer’s and dementia can be difficult, demanding on families, caregivers and individuals themselves. However, a positive whole person mode of care is emerging. Beginning with an ideology that is based on acknowledging but no longer focusing on the losses (loss of memory, loss of skills) an individual with dementia is experiencing. The focus is on what memories and skills remain intact and how to engage these. Providers embracing this positive, whole person model of care evaluate an individual for their demonstrable abilities and put together a specific plan for how to encourage the use of these daily.
George, age 72, has been diagnosed with vascular dementia by a health care professional. A traditional evaluation includes statements such as, “He is disoriented by his surroundings and will not recognize a familiar place such as his home,” “He cannot recall his address or phone number of 35 years,” “He cannot recall the day of the week or date,” “He does not recognize his grandchildren,” and “Despite his lifelong work as a college mathematics professor, he cannot count backwards from 20 by twos.” Most long-term care facilities use similar language in their care plans, the documents that guide their care.
A positive, whole person evaluation includes statements such as “George remembers his home when cues are used with him,” “George recognizes his wife, Carol, and his children, often by name,” “George can dress himself when seasonally appropriate clothing is available,” “George can feed himself and use the restroom on his own,” and “George remembers his own name and that he worked as a college mathematics professor.”
Caregivers, often exhausted, often feel the changes that come with progressing dementia insurmountable. Providers skilled in dementia care can help create a supportive environment that helps the person with dementia succeed. Identifying challenges one by one is necessary as well as asking whether each challenge is a problem for George or is it defined as a “problem” by a healthcare provider. Can each challenge be re-framed, redirected or viewed as a “new normal?” An example of this might be George pacing and walking constantly throughout the living and dining room seemingly unable to stop and sit down. This takes place at all hours of the day and night. His wife is experiencing symptoms of distress and anxiety and is unable sleep for fear George will walk out of the door in the middle of the night. While a difficult decision, the family decides to move him to a small memory care home to keep him safe and engaged, and to preserve Carol’s health. They want to enjoy family life again.
The staff takes several steps to create a supportive environment for George. The clinical director evaluates George’s medication and obtains a social history of George’s beliefs, talents, and habits. Information about George’s preferences is readily accessible to the staff. The staff establishes a familiar environment, consistent cues, and a familiar pattern. They set his room up with many personal items he can use. They only put seasonally appropriate clothing in his closet. George is set up at his own desk with pictures of Carol and his children, a daily calendar that is changed each day and a set of math texts with challenging problems to “work” on. George has the opportunity to teach a class within his new environment, even if his preference is to do so at 4 a.m. and the students are the staff members. He is asked by the staff daily about his progress in his work. When he does experience periods of pacing, he is not stopped or detained. And when weather is appropriate, he is encouraged to do so outside in the secured garden on the walking path so he can soak up the sunshine and hear the birds. George is encouraged to take a walk on the outdoor fenced wandering path to maintain his physical exercise and connection with nature. George’s diet is monitored to make sure he is receiving enough calories to offset the physical exercise. When he chooses to pace and walk inside, George’s path is free from items he could trip and provides sufficient sturdy items he can steady himself on. This failure-free environment eventually reduces George’s pacing and gives him a rewarding daily routine.
Carol is encouraged to join George for lunch and dinner, which is served family style with other residents and family members, every day. This allows a chance for the residents, family, and staff members to interact and support each other.
While it is normal to focus on what an individual has done prior to dementia but can no longer do, the new model of care supports what pleasures and capabilities are intact and crafts a day that is satisfying. A supportive failure free environment is one in which the individual with dementia can find success and family can experience joy with their loved one.
For further questions and resources, please call Sarah Randolph, Executive Director, Bridge Haven Memory Care at 785-371-1106 or visit www.mybridgehaven.com.