Sharps in Activity Programs:

Be very mindful of the use of sharps in activity programs. Sharps include, sharp knives, scissors, box cutters and other sharp projects that can pose a threat to confused residents. Never leave the day room when you have sharp objects as part of your activity. At all times keep the sharp objects either in your hand or put them immediately away. A suggestion would be to utilize a cart with a locked compartment where you can immediately store sharps the moment they are no longer in your hand. Additionally, activity rooms must keep all sharps locked in a secure cabinet or drawer. You must have an MSDS for every product that can be ingested and pose a health threat. You must keep an MSDS book in alphabetical order with a table of contents. You can obtain the MSDS from the company you are ordering products from. This includes cleaners, nail polish, nail polish remover, Styrofoam, helium, paints, glues, etc.

NCCDP Sponsor

Coming Soon!

THIS ISSUE August 26, 2004
In this issue:

1, Dementia Units: Importance of Admission and Discharge Criteria Agreements
2. Sharps in Activity Programs!
3. Why is Corporate Sponsorship Important?
4. “ Take the Corporate Pledge for Dementia training”
5. Train the Trainer Seminar October 9th, 2004
6. Upcoming Seminars
7. Coming This Spring..Free Online Education Training!
8. Take the Path to Certification as a CDP
9. Important Links to Know

Dementia Units and the Importance of Admission and Discharge Criteria Agreements

Fifteen years ago, dementia units were almost unheard of. Now more and more nursing homes and assisted living facilities are offering secure units to keep their wandering residents safe. Many of the secure units offer specialized dementia activities, individualized meal options and trained staff in the area of dementia care. One problem that dementia units are having is discharging residents from the unit to another more appropriate unit, once the resident has declined and no longer benefits from the unit. Frequently, family members are refusing to move their loved one. Not only is the resident not appropriate for that unit, the slot is not utilized by a resident who could benefit from the dementia program.

The family member must understand the admission and discharge criteria agreement and sign it at the time of admission. Family members must clearly know in advance and understand at what point their loved one will be transferred to the step down unit.

The admission / discharge criteria cannot be vague and open to interpretation. It must clearly state the criteria for admission on to the unit. Such as: ambulatory, able to participate in daily activities, able to participate in their ADL’s, not be violent to themselves or others, able to feed themselves and have a diagnosis of dementia. In addition, it should also state that they score lower than a 6 (3-5) on the testing forms you are using, such as Global Deterioration Scale, Brief Cognitive Rating Scale, Functional Assessment Testing, Geriatric Depression Scale, etc. The Mini Mental Test should not be the only test conducted for Dementia residents.

These tests should be conducted as a baseline upon entering the facility and then at minimum on an annual basis. This will give a baseline and track decline. The test should be administered in a quiet place, allowing an adequate environment and enough time for the resident to respond. Staff should be trained to administer the test and utilize only the explanations accompanying the test to score the results. It is recommended that only the staff psychiatrist provide this test, as the answers residents give can be very subjective. Not everyone performs well when being tested. The resident may not be in the mood, tired, sick and a host of other reasons that could affect their score. The test scores would also be used as part of criteria for admission and discharge. The test should not be the only criteria for admission or discharge. It is a part of the whole picture to determine your criteria for admission and or discharge.

On the flip side, the discharge criteria agreement also needs to spell out clearly the criteria for discharge from the unit. The criteria should include at minimum, the resident is: unable to participate in activities, unable to feed himself, requires total care, be at risk to harm themselves or others, etc. The discharge determination must involve the team and the family or responsible party.

The team will gather all the facts and in a team meeting discuss the possibility of discharge. Families must be kept in the loop each time the resident has a change or declines. The family member or responsible party must be told in advance that the change in condition is leaning towards discharge because the resident is no longer benefiting from the services provided on the dementia unit. At each meeting review the discharge criteria with the family member.

These meetings must clearly be documented in your care meeting notes and family member or responsible party should be signing the care plan note.

Facilities that do not have admission / discharge criteria agreements with families / responsible party face problems when it is time to discharge. Families may refuse to move their loved ones to another unit. Some are in denial and don’t want to face that their loved one has declined. But most families are refusing to move because they were never told that they would have to transfer when the loved one declined or they did not understand the criteria. The facility may have a discharge policy and the policy is so vague that it makes it hard to determine when to discharge. If, families clearly understand the discharge criteria and are kept in the loop as the resident’s condition changes, they may not be happy about moving their loved one but at least it should not be a shock or surprise when the time comes to discharge. The other reason making it difficult to transfer, is that the facility is not following their own discharge criteria. They are not consistent. Every resident who no longer fits your criteria has to be moved. Families will not move their loved one if they see other residents who have not been moved off the unit.

Additionally, the staff that work on the unit need to be educated about the discharge criteria. The staff become attached to the dementia resident and may not want to discharge a resident to another unit. They can sabotage management’s efforts to discharge by reporting to the family members their personal feelings about discharge.

Prior to admission, the facility should be interviewing family and resident for suitability for the unit, review medical records and medications to determine if the resident is appropriate, complete preadmission screening (cognitive and function tests, physical exam, blood work (Metabolic Screen), Thyroid test, B12 and test for Syphilis, as well as a psychiatric evaluation and neurology evaluation. The Admission team should also complete a wandering assessment form. The form would include information about places a resident may have wandered to in the past, triggers for wandering, description of the resident, words he may answer to, etc. Finally, explore resident’s use of common words and their meanings, so that staff may anticipate his needs. For example, a repetitive word used by a resident may be, “TA TA”, which to this resident may mean, “toilet”. All of this combined would determine eligibility to the dementia unit as well as a truly comprehensive assessment.

When facilities do not follow their discharge criteria they then encounter all kinds of problems. Families will refuse to move their loved ones because they see other residents who may be more debilitated than their family member who have not moved from the unit. They may refuse to move their loved one based on “resident rights”.

When you are unsuccessful in moving clients, your resident demographics will soon look like all the other units. Everyone is now low functioning! Now your premier unit is no longer unique or more special than any of your other units. This will affect your future admissions. Prospective resident families who are touring do not see higher functioning residents. The hardest part of running a successful unit is discharging. Other departments are competing for the same beds on other units, such as new admissions, rehab residents who now qualify for long term care placement, room changes and dementia residents moving off the unit. It’s a challenge for all facilities. If you follow your admission / discharge criteria you will have a smoother transition when the time comes for discharge. Every department knows in advance that there is a transfer pending from the dementia unit.

Facilities have put a lot of time and energy to develop premier units that offer extra services, but facilities need to give a reason for family members to cooperate. The units that their loved ones are transferring to must be just as beautiful and home like. Recreation departments must be offering activities that fit the needs of the lower functioning populations, such as sensory rooms, music program, pet therapy, aviaries, activity pillow/aprons, mobiles over beds, aroma therapy, touch therapy, doll therapy, etc. As long as families see that even though their loved one is moving to another unit, they will be offered the same amount of services that your premier unit provides, they will be more apt to move. Your dementia unit offers special services that will benefit the dementia client and your step down units should also provide palliative nursing and sensory activities to fit their current function levels.

Join us in our National Campaign to spread the word about the importance of providing an initial minimum 8 - hours of dementia training and continued ongoing dementia in-service training for your staff. It may be the most important aspect of providing competent and loving dementia care. For corporate sponsorship information please go to www.nccdp.org