THIS ISSUE June 11, 2004

In This Issue:

1- National Council of Certified Dementia Practitioners
2- Take the Pledge for Training
3- Is your staff certified?
4- Train the Trainer
5- Proactive Management of Dementia Residents
6- Upcoming Seminars
7- Alzheimer’s and Developmental Disabilities
8- Dementia Units and Activities

NCCDP Sponsosrs

Train the Trainer Seminar will be offered in October 9th, 2004.

About:
National Council of Certified Dementia Practitioners

The National Council of Certified Dementia Practitioners was formed in 2001 by a group of professionals with varying work and personal experience in the field of dementia care. Their backgrounds include Psychiatry, Nursing, Therapeutic Recreation, Social Services, Long Term Care Administration, Hospital Administrators, Dementia Unit Coordinators and Elder Law Attorneys. The council was formed to promote standards of excellence in dementia education to professionals and other caregivers who provide services to dementia clients. As the number of dementia cases continues to increase nationwide and worldwide, there is a great necessity to insure that caregivers are well trained to provide appropriate, competent and sensitive direct care and support for the dementia patient. The goal of the Council is to develop and encourage comprehensive standards of excellence in the profession and delivery of dementia care.

Alzheimer’s and Developmental Disabilities

More and more people with developmental disabilities and specifically those with Down syndrome are being diagnosed with Alzheimer’s disease. The life expectancy of people with developmental disabilities has increased dramatically in the last 25 years, putting them at increased risk of developing Alzheimer’s disease. In addition, for a number of years, it has been known that there is a well-established link between Alzheimer’s disease and Down syndrome. The extra gene dosage that results from the extra copy of all or part of Chromosome 21 in people with Down syndrome may, in fact, have a causative relationship.

Studies show that significant Alzheimer’s disease type changes-neuritic plagues and neurofibillary tangles-occur in virtually 100% of people with Down syndrome after they reach age 40. While it is important to note that not all people with Down syndrome develop the clinical signs and symptoms of Alzheimer’s disease, they are certainly at greater risk-in fact, up to 3-5 times greater than the general population.

While less is known about the nature of Alzheimer’s disease among adults with a developmental disability other than Down syndrome, the American Association of Mental Retardation, in Practice Guidelines for Clinical Care Management and Assessment of Alzheimer’s Disease among Adults with Mental Retardation, state that, “Adults with Mental Retardation at risk for Alzheimer’s disease are not only those with Down syndrome over 40 years of age, but also those with mental retardation over 50, and those are from families with a history of Alzheimer’s disease.

Fred Brand
New Jersey Association for Non Profit Homes for the Aging

If you would like more information or have question about this article, please email Fred Brand at nationalccdp@aol.com or visit the web site at www.nccdp.org. 

Take the Pledge for Training

Congratulations to Cambridge Healthcare Corporation for taking the initiative to train and certify all their staff. They trained and certified over 100 at Buckingham at Norwood and will be continuing to do this for their other facilities. If you believe that in order to provide quality care, a huge component is training, than we are asking all long-term care facilities to pledge support through corporate sponsorship at www.nccdp.org

Proactive Management of Dementia Residents

As an administrator, I routinely received status reports on wounds, weight loss, incidents and even psychoactive medications use, but rarely did I receive updates specific to my residents with Alzheimer’s and related dementias. Yet these are the residents that usually experience the falls, weight loss and other changes in their conditions that often trigger for sample on survey from regulatory bodies. They also present the greatest challenges to us in the management of their care.

Consideration should always be given to the impact of dementia on a residents care. Of the top 10 deficiencies cited for the SNF’s in the nation, almost all could and frequently do have considerations for the dementia residents. These deficiencies, to name a few, include: F309-provision of care and services at the highest practical level for the resident, F323- hazard free environment, F281-services provided meet professional standards of care, F324-spervision and use of assistive devices to prevent incidents (consider your merry walkers), F279-development of a comprehensive care plans and of course F241-dignity.

A suggestion that I have found successful for many of the facilities I manage, is to look at “residents at risk” instead of isolating residents with wounds, weight loss, etc. The place to begin is with those residents who have a diagnosis of dementia. A proactive approach will frequently prevent some clinical issues from occurring, enhance survey results and ultimately improve the lives of our residents.

Billiejean M. O’Brien RN, MSN, LNHA
OMNI Health Systems
Regional Director of Clinical Services
Bobrien09@optonline.net

Dementia Units and Activities:

Many facilities have taken the step of adding locked dementia units. Unfortunately, all too often we are seeing little or no programming for those residents. Additionally, we are seeing these day rooms with lack of supervision or not enough staff to work with the residents. Nursing assistants should be rotated into the day rooms for supervision and to assist the activity staff. It is recommended that activities on these units run 7 days a week from the hours of 9:30 A.M. to 8:30 P.M. Activities play a huge role during the evening hours when the nursing assistants are providing ADL’s. Your Safety Committees minutes clearly show a higher incidence of falls and accidents with residents who are left unsupervised in the day rooms during the evening hours. A strong dementia activity calendar should be designed to include daily music, exercise and reminisce programs. We recommend that you offer exercise and music programs in the morning. You have less time to provide activities that require “time” such as crafts and cooking programs due to the lunch hours. In addition, the residents are confused and have just gotten up. It is a lot to ask of them to complete projects that require concentration

Props should be utilized during programs as much as possible. The props will offer a visual and keeps their attention. For the exercise programs you could offer pom poms, maracas, wands, top hats and parachutes. At no time should ball toss or balloon toss be offered. One, because they are slow to respond so we should not be throwing anything at them and two, props engages the entire group and keeps their hands strong. The music programs should include props such as tambourines and musical instruments. We recommend Sing A Long With Eldersong for this population.

In the afternoon, we recommend horticulture, crafts and cooking programs when meal programs do not restrict time for activity programs. You can offer these programs at a slower pace and allow time for success and completion of the activities. A strong dementia calendar offers activities that change on the half hour, are flexible and geared to the residents interest. Offer coloring activities and simple craft projects, keeping in mind to make sure all activitites are age and ability appropriate. Remember, all activities that you offer, should be success oriented, failure free, purposeful and meaningful for every resident who is attending that event.

In the evening, we recommend non-stimulating activity programs. Instead offer; reminisce programs, pet therapy, doll therapy, Wake Up Program, Timeslips, folding towels or easy to understand movies. We do not recommend that the TV be shown except for light movies.

Remember to offer parallel programming. For those residents who cannot participate in an activity, have a table set up with tactile items. These items could be things to touch (pat mats) sorting items (poker chips and large buttons), folding items (towels and wash cloths). If they are low functioning you could offer a sensory room filled with bubble tubes, fish tanks, aromatherapy, music and tactile items. These rooms offer many benefits for the dementia challenged resident who still requires stimulation.

The day rooms should have many self-recreation items, such as jewelry boxes, theme boxes, sorting and folding items, theme books, sewing cards and magazines. These are items that can be given to the residents where there are no planned group programs.

If you need suggestions for dementia calendars, or props for programs (click on party supplies) & resources, please go to www.activitytherapy.com

Sandra Stimson, ADC, CDP, CALA
Executive Director
Alternative Solutions in Long Term Care
www.activitytherapy.com
activitytherapy@aol.com
973 729 6601