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Arista Care Nostalgia Park
Nostalgia Park™: The Evolution of an Alzheimer’s/Dementia Unit
In June of 2008, AristaCare Health Services acquired a long term care facility in Whiting, New Jersey. Within the facility was a secured 60 bed unit for those residents suffering from some form of dementia. The unit ran like a typical floor in a nursing home and had an institutional feel. It was agreed upon by the corporate office, facility administration and staff alike that something was missing and perhaps the physical and emotional needs of the residents living there could be better served. Within a few months the unit was renovated with the unique needs of the residents in mind. For example, fluorescent lighting was avoided and emphasis was placed on having natural/soft lighting whenever possible, wall coverings and window treatments were chosen that best suited the needs of those with dementia, among other environmental design changes. With dementia, memory recedes in reverse, so long term memory is that last to be affected. Knowing this and the fact that our facility is in Ocean County New Jersey, the unit was designed to look and feel like a boardwalk setting and carnival playground to invoke pleasant memories that most residents have experienced at some point in their lives. As the unit was being re-modeled, efforts began to research best practices and standards of care and happily we discovered the National Council of Certified Dementia Practitioners (NCCDP) and soon after, Nostalgia Park™ was born.
Utilizing the concepts, research and resources set forth in the NCCDP’s curriculum and other resources, we re-built a unit that provides a warm, loving, and nurturing environment that fosters a strong sense of community and friendship, for residents and their loved ones. The first order of business was getting as many of our staff members as possible trained to become Certified Dementia Practitioners (CDP). To date, 59 employees are CDPs and we continue to offer the training on a bi-annual basis. It was important that everyone in the building be educated on the needs of those suffering from dementia so the training was opened to all departments such as nursing, housekeeping, therapy, dietary, etc. AristaCare’s belief in the training was so strong that it was provided free of cost to anyone interested.
Upon completion of the training, the next area of focus was assessment tools. In any medical setting, each discipline has mandatory assessments to complete within a required time frame. Those assessments remained intact, however given that dementia is a progressive illness that impacts one’s ability to recall, learn and communicate information, it was decided that additional assessments were required to assist residents, their professional caregivers and loved ones. Also the frequency with which the assessments were administered increased to ensure changes in care needs were recognized in a timely manner. Assessment tools currently in use were selected to ensure that a multidisciplinary approach to care is followed. The Dementia Care Manager administers the Cornell Scale for Depression in Dementia and well as the Neuropsychiatric Inventory Questionnaire (NPI –Q). The therapy department administers the Katz Index of Independence of Daily Living and either the mini-mental or the MoCA. The nurses administer the Pain Assessment in Advanced Dementia (PAINAD). The therapeutic recreation department and Certified Nursing Assistants, administer a reading assessment utilizing the Montessori Approach to Living with Dementia. These assessment tools guide the staff on issues such as symptom reduction, caregiver distress, pain management, maximizing functional independence and instilling a sense of purpose based upon the residents’ unique strengths.
Anyone caring for someone with dementia knows how challenging and unpredictable it can be at times. Caregivers who undertake this responsibility often have an innate sense of compassion, empathy and respect for the residents. Despite the best efforts of caregivers, behavioral disturbances occur that can leave them feeling frustrated, depleted and tense. This can result in caregiver burnout and residents lacking in opportunities for meaningful connections and communications. With this in mind, the staff at Nostalgia Park™ uses a variety of therapeutic interventions with residents and their loved ones. Techniques such as Validation Therapy by Naomi Feil, The Montessori Approach to Living with Dementia by Maria Montessori, and The Best Friend’s Approach To Alzheimer’s Care by Virginia Bell and David Troxel allow us to facilitate meaningful, purposeful days for our residents. This is achieved by drawing heavily upon their strengths along with cultivating their preferences, abilities and personalities. Care is taken to avoid labeling behaviors as “problematic” and instead the staff view these behaviors as opportunities to better anticipate basic human needs that residents have difficulty articulating due to cognitive impairment. Residents who have poverty of speech and are unable to actively participate in activities are not ignored. Instead they are engaged via approaches such as hand massage, music, laughter therapy, sensory room and gentle touch in order to validate their presence and foster mutual connection. Staff is provided with ongoing education based upon evidenced based best practices.
Since dementia occurs in stages and each stage has specific dimensions, Nostalgia Park™ has incorporated parallel programming with regards to therapeutic recreation and meal times. This ensures that all residents have the opportunity to simultaneously participate in activities and meals in groups established according to cognitive ability. The end result is that no one is left behind and residents are encouraged to function at their highest possible level.
Research reveals that having a sense of meaning and purpose is crucial to reducing behaviors such as wandering, sundowning, hoarding, aggression, hallucinations, paranoia, etc. The activity aides and certified nurse’s aides on the Nostalgia Park™ unit are cross trained to ensure that there is a sufficient amount of help during meal time and activities. For instance there are life skill stations and life skills kits available to residents who are fearful, cannot sleep, get overwhelmed by a lot of stimuli and enjoy being reminded of previous vocational/homemaker roles they occupied in the past. Cross training of the staff allows the residents to take advantage of the environment that is tailored to meet their special needs.
Additional programs that have been instituted to enhance the quality of life of our residents include: an outdoor walking club, a Sensory Stimulation room, a Restorative Dining Program, Brainstorms Cognitive Stimulation program and It’s Never 2 Late computer programming among other programs. These programs emphasize a home-like environment, maximizing nutritional intake, and maintaining/improving overall physical activity and cognitive stimulation. Family support is a key component in improving quality of life so Nostalgia Park™ offers a resource library, community events, and a caregiver’s support group run by facilitators who received training from the Alzheimer’s Association.
AristaCare at Whiting is continuously committed to providing excellent and innovative Alzheimer’s and Dementia services to our residents. We believe in respecting each resident and fostering an environment that promotes dignity, independence and respect. We strive to give our residents opportunities for success and meaningful socialization in a safe, caring atmosphere.
For additional information on Nostalgia Park™ please contact Pamela Gormley MSW, CDP at 732-849-4300 x323.
“How far you go in life depends on your being tender with the young, compassionate with the aged, sympathetic with the striving, and tolerant of the weak and the strong. Because someday in life you will have been all of these” ---George Washington Carver, American Botanist.
Written by: Pamela Gormley MSW, CDP and Melinda McGullam LCSW, CDP
For information contact Pam Gormley at firstname.lastname@example.org. Thanks so much!