By Susan Saldibar
There is a great article I read recently out of the New Yorker called “The Sense of an Ending” about how the Beatitudes Campus in Phoenix approaches dementia care. It’s a bit long but worthwhile read. One of the things that really caught my attention was this:
“In nursing homes, staff are held responsible if a resident falls. Since they are watching over several people at once, there is an understandable tendency to insist that people remain sitting down, instead of altering the environment to make falls less likely, or using physical therapy to strengthen legs. Mitchell told me, “We have to give residents the right to fall . . .”’
The Right to Fall
Giving residents “the right to fall” is a core element of every good senior living community. Mobility and freedom are core values of every good community. And yet . . . senior communities have the obligation/privilege of reducing those risks for at least these reasons:
It is the right thing to do
It is good for residents
It reduces the risk of legal action
Best of all . . . it will improve length of stay
As the article notes, rehab therapy can be a powerful tool in the prevention of falls
After reading the article I reached out to Donna Diedrich, Director of Clinical Services/Education and Program Development for Aegis Therapy, a Senior Housing Forum partner, to talk about how they work with skilled nursing and assisted living communities to put individual programs together for dementia care residents. Donna described the process they go through.
Assessment – The therapy assessment process is a thorough one that involves gathering input from the nursing staff and other care professionals on several levels. It’s important, as an example, to assess a resident’s cognitive and mental state as well as their physical condition prior to designing a therapy plan of care. This is particularly important because it will serve as the foundation for each resident’s therapy program. And it will be the point of reference, when any program changes are being considered.
The assessment of a resident’s current level is key to determining the path which can predict their declining function and cognitive level. Being prepared for these stages of decline and how that may impact their level of participation downstream enables staff to create planning strategies. Getting the assessment right is paramount to designing an effective program.
Plan creation – In order to optimize the results of therapy, care plan development needs to take into account each individual’s unique personality, ability level, physical strength and stamina and the changes associated with stages of dementia. The plan must allow for frequent changes to keep pace with the resident’s changing needs. This ensures that, at any stage of physical and cognitive ability, the plan is adjusted to optimize results.
Working with the resident – This is where all points come together to provide a therapeutic experience for residents that aligns perfectly with his or her unique situation. When the assessment and plan creation process are conducted properly it gives the therapy sessions a greater chance of success. Donna makes the point that Aegis works diligently to make this experience as motivating as possible, keeping the patient engaged in therapy and working toward their program goals.
Reassess – As critical as the original assessment, this is a process that must be ongoing and conducted more frequently as a resident’s emotional, cognitive and physical condition changes. Periodic screenings to determine if skilled reassessment is needed is critical to optimizing care and sustained outcomes.
Why is this important?
The progress being made in the area of dementia resident therapy is changing not only the way senior healthcare professionals approach dementia care, but also the standards by which best practices are measured.
“The industry has moved away from a ‘contain and restrict’ mentality to an ‘enabling’ mentality,” says Donna. “We anticipate that the result of this shift in thinking and in practice, will be a more physically enabled and more meaningful experience for both dementia residents and their families.”