Dementia care boost

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Kim Warchol, OTR/L Founder, Dementia Care  Specialists Inc.
Kim Warchol, OTR/L Founder, Dementia Care Specialists Inc.

A paradigm shift is occurring within dementia care as care management experts discover new models that improve outcomes and quality of life for persons with dementia. An individualized, abilities-based care approach is giving the entire interdisciplinary team, including occupational, physical and speech therapists, nurses, activities and other direct care staff, the tools they need to ease their job burden and enable those with Alzheimer's disease and related dementias (ADRD) to thrive.

This person-centered care model incorporates essential life story information while also prioritizing the discovery and facilitation of the person's best ability to function at every dementia stage.

At Parc Provence, a state-of-the-art skilled nursing facility for seniors with memory loss in Creve Coeur, MO, the entire team took on the challenge of “person-centered, activity-focused resident care.” Following the Forget-Me- Not ™ Care Model, team members gathered life stories about each resident in order to gain an in-depth understanding of his or her interests, routines, likes and dislikes, religious beliefs, family situation and vocational and leisure interests.

In addition, the therapy team was expert in using the Cognitive Disabilities Model by Claudia Allen to identify the person's Allen level or dementia stage, and the preserved cognitive abilities within each stage.

The therapy team worked with the entire interdisciplinary team to facilitate the greatest degree of independence in activities of daily living, mobility and leisure activity. Individual residents and groups of residents were matched to therapeutic activities that brought meaning and joy to their lives and these activities were adapted to the “just right challenge level” for successful participation for individuals at every stage of dementia.

Food, not supplements

For example, dining is an area where challenges may arise in persons with dementia, as it could lead to weight loss or malnutrition. While supplement use is always an option, the staff at Parc Provence have used 10 key steps to encourage residents to eat appropriate amounts of nutritious food at mealtimes instead of relying on supplements:

1. Encourage exercise. Walking, dancing or capability-specific exercise classes helps residents to build an appetite.

2. Over-flavor food. Because the ability to taste decreases with age, and because this decrease can be accentuated by dementia, some residents prefer food with a little extra seasoning.

3. Provide the most calories at the meal at which the resident is most alert. Especially with residents who can feed themselves, it's important that they are alert and motivated enough to engage in the meal.

4. Learn and incorporate residents' individual food preferences. Offering favorite foods helps stimulate both the appetite and the desire to eat.

5. Facilitate self-feeding skills whenever possible. Using utensils appropriate to the individual resident's skill set—such as plates with plate guards, spoons instead of forks and clear, easy-to-grasp glasses or cups—helps enhance self-feeding abilities. High-contrast placemats at a square table helps them visualize their own space, and sitting well supported at a comfortable distance and angle to the table makes it easier to reach their food and drink.

6. Reduce distractions in the dining room. Turn off televisions, keep staff chatter to a minimum and clear the tables of items not related to mealtime.

7. Monitor individuals' oral health and status. Residents' abilities to chew and swallow should be evaluated regularly, and meals adjusted accordingly.

8. Ensure food is cut into easy-to-chew pieces. Small, tender pieces of food encourage residents to eat more and to self-feed more often.

9. Provide frequent meals and healthy snacks. Special snacks and food-related events such as afternoon tea, daily happy hour and periodic ice cream socials allow residents to experience favorite foods and engage socially.

10. Present food within the person's visual field, and help the person to initiate eating. Placing food and drink within 14 to 18 inches of eye level enables residents to see and smell the food on the table, and gives an appropriate cue to begin eating, helping them to be more independent and successful.

Monitor all changes

Above all, each resident should be closely observed for any changes in their eating behavior that might indicate a problem, decline in ability or other issue that needs to be immediately addressed.

Under this model of care, weightloss at Parc Provence was in only 1% of the census and supplements were used in just 3%.

Ongoing observation of each resident is vital to an in-depth understanding of his or her needs, desires, fears and perceptions. Activity leaders monitored participation.

Families of Parc Provence residents were able to witness the positive results of this activity-focused program, which used a person-centered, abilities-based approach.

Most importantly, the person-centered model adds meaning and fullness to the lives of residents and their families. Rather than sequestering people with dementia in an impersonal, one-size-fits-all setting, person-centered care offers them an opportunity to share their life stories and embrace their past, present and future in an environment where they feel safe, productive and appreciated. n

Kim Warchol is the creator of the Forget-Me-Not Care Model.