Directing an
Alzheimer’s/Dementia
Care Unit
Funded by:
Indiana State Department of Health
Co-sponsored by:
IAHSA
IHCA
HOPE
Module 1:
Review of Dementia and Care
Practices
In this section, we will cover:

Definition of dementia and Alzheimer’s disease

Alzheimer’s disease progression

Differences between dementia, depression, and
delirium

Importance of person centered care and its
implementation

Importance of stress management with family
and staff
What is Dementia?

Dementia is a disease process
– Progressive decline in cognitive function
– Memory loss

Over 170 irreversible dementias
– HIV, Vascular, Lewy Body, Parkinson’s,
Alzheimer’s

Some forms are reversible (treatable)
– Thyroid disorders, drug interactions,
dehydration
Alzheimer’s Disease

Most common form of irreversible
dementia
– Nearly 70% of all dementias are Alzheimer’s
– Over 4.5 million Americans have Alzheimer’s
– It is estimated that 60% of all nursing home
residents have Alzheimer’s disease

Alzheimer’s is not normal aging
– Learning new information make take longer
– May be difficult to filter out noise
Brain Scan
Stages
Early

Needs
reminders

Daily
routines
difficult

Concentration is
difficult
Middle

May need
hands on
care

May get lost
easily

Changes in
personality
Late

Severe
confusion

Needs hand
on care for
most
personal
care

May not
recognize
self or
family
Areas of the Brain Affected
Cognition
Behavior

Memory

Learning

Language

Praxic
Function

Abstract
thinking

Lapses in
clarity

Psychomotor speed

Hallucinations

Delusions

Communication

Safety

Personal
care
deteriorates
Emotion

Disregulated

Disorganized

Apathy (loss
of energy,
willingness)

Lability
(moods
change)
Delirium, Depression, and
Dementia

Delirium
– Acute onset, can be treated
– Altered state of consciousness

Depression
– Gradual onset, can be treated
– Look for signs, such as low self-esteem

Dementia
– Gradual onset, might be treated
– Memory loss and decline in cognitive function
Medications

Cholinesterase
Inhibitors
–
–
–
–
Cognex
Aricept
Exelon
Reminyl

Glutamate Receptors
– Namenda
Person Centered Care


Person centered care is truly putting the
PERSON first
Characteristics
– Behaviors are a desire to communicate
– We must maintain and uphold the value of the
person
– Promote positive health
– All action is meaningful
Person Centered Care, Cont.

Core psychological needs must be met
to provide quality care
–
–
–
–
–
–
Love
Inclusion
Attachment
Identity
Occupation
Comfort
Implementing
Person Centered Care
Recognition
Negotiation
Collaboration/
Facilitation
Play
Timalation
Celebration
Relaxation
Validation
Holding
Person Centered Care
and Families

Know what families are looking for
– Kindness and respect
– Looks are important
– The extras

Be sensitive to the emotions family
members may be experiencing
Module 2:
Administrative Practices
In this section, we will cover:

The role of the unit manager and its
responsibilities

Review of human resources practices

Philosophy of care

Admission/discharge requirements

Policies and procedures of a special
care unit
Role of the Unit Manager

Identify your commitment
– Become dementia-capable
 Know the disease process
 Know types of supports for families
 Be willing to provide services for those with
dementia

Evaluate
– Evaluate for effectiveness of care
 Quality indicators
 Communication
Empowerment!

Challenge the process

Inspire and share vision

Enable others to act

Model the way

Encourage the heart
Ownership and Leadership
Challenge
Inspire
Enable
Model
Encourage
Empower
Philosophy of Care

Create mission statement and purpose

Approach to care

What’s “special” about special care?

Communicate the message
Characteristics of
Good Dementia Workers
Compassion
Fairness
Supportive
Creativity
Warmth
Respect and
honor
Honesty
Dependability
Appreciation of
teamwork
Sense of fun
Flexibility
Sense of
humor
Unconditional
positive regard
Integrity
Energetic
Skills of Good Dementia Workers
Assessment
Energy
Problem solving
Dementia-capable
communication
Observational
Respectful
Conflict resolution
Prioritizing
Hiring Staff with Knack

Ask current staff for recommendations
and to participate in process

Look for nontraditional candidates

Walk candidate around unit

Can the candidate have fun?

Share your philosophy

Ask for stories
From: Best Friends Staff. Bell and Troxel.
Orientation

Normal aging vs. dementia
 Dementia process and progression
 Communication techniques
 Behaviors and approach
 Philosophy, policies, procedures
 Admission/discharge criteria
 How to work with families
 Stress reduction techniques
Stress!

Stress can lead to poor quality care,
quality of life, and abuse and neglect

Signs of stress
–
–
–
–
–
Too little or too much sleep, nightmares
Fatigue
Headaches, backaches, joint pain
Diarrhea/constipation
Frequent accidents
Assessments
Medical
Functional
Emotional
Social
Cognitive
Behavioral
Special needs
Special
interests
Talents
Habits
Interventions

Ascertain validity of diagnoses

Level of functioning

Preferences

Family wishes

Advanced directives
Religion
Care Plans

Focus on individual needs

Flexibility to enable a person to live the
life he or she would want

Emphasis on resident’s own sources of
self-esteem and pleasure

Regular reevaluation

Build in specific objectives and
strategies
Immediate Problem Analysis

Task
– Too complicated, too many steps, not modified,
unfamiliar

Environment
– Too large, too much clutter, excessive stimulation, no
clues, poor sensory, unstructured, unfamiliar

Physical health
– Medications, impaired vision/hearing, acute illness,
chronic illness, dehydration, constipation, depression,
fatigue, physical discomfort

Miscommunication
The 11 W’s

Who has the behavior?
 What is the specific behavior?
 Why does it need to be addressed?
 What happened just before?
 Where does it occur?
 What does the behavior mean?
 When does the behavior occur?
 What is the time, frequency?
 Who is around?
 What is the outcome?
 What is the DESIRED change?
Transfer/Discharge Criteria

Educate family during pre-admission
and in care plan meetings
 Compare reassessment data to
admission/discharge criteria
 Utilize RAI/MDS assessment data, RAPS,
and care plan process
 Is the resident still compatible with the
mission?
 Be consistent!
Module 3:
Educating Staff
In this section, we will cover:

Basic principles of adult education, including
needs of adult learners

Types of audiences within facility

Techniques for assessing for types of
educational needs

Understand materials provided

Explore and assess potential internal and
external resources for educational services
Basics of Adult Education

Adults who attend educational
opportunities have made a great effort
to attend

Adults have unique and individual needs

The educator is the organizer, guiding
learning
Successful Learning







Be prepared with extra information
Make the program safe and interesting
Make the learning goals clear, and stick
to them
Clarify the criteria of evaluation
Promote self-empowerment
Emphasize the felt needs of learners
Provide a variety of learning techniques
Alternative Methods of Teaching
Cross train
Bulletin or graffiti
boards
Articles or newsletters
Mini in-services
Group activities
Orientation
Audiences and Needs

Families
– Care plan, modeling, coaching, family
handbook, family programs

Resident councils
– Understanding disease process, administrative
practices, working with staff

Specific staff groupings
– Nursing, activities, night shift
Techniques for Assessment

Gather ideas
– Observation, questionnaires, records,
interviews, informal gatherings

Determine needs
– Organization, people, task

Create
– Objectives, content, techniques, organization,
visual aids
Educational Materials

Overview of Dementia

Person Centered Care

Communication Strategies

Understanding Behaviors

Activities of Daily Living

Family Dynamics
Internal Resources

Who is the best educator?
– Not everyone is right for every subject

Who has an interest in educating?

What can each person contribute?
– Line staff
– Administrative
– Managers
External Resources

Consultants

Medical Directors

Alzheimer’s Association

Service agencies

ESL
Module 4:
Regulatory Standards and Reducing
Deficient Practices
In this section, we will cover:

Overview of commonly sited F-tags

Key safety concerns and potential solutions

Relationship between person centered care
and resident rights

Family needs and potential opportunities

Potential situations leading to abuse and
neglect

Possible quality indicators
F-Tags









154: Right to be informed
157: Notification of changes
164: Privacy and confidentiality
207: Equal access to quality care
221/222: Resident behavior and facility
practices
223: Abuse
224/226: Staff treatment of residents
240: Quality of life
241: Dignity
F-Tags, Cont.








242: Self-determination
243/244: Participation in resident and family
groups
245: Participation in other activities
246: Accommodation of needs
280: Care plans
281/282: Professional standards of quality
309: Quality of Care
310: Activities of Daily Living
F-tags, Cont.

323/324: Accidents

353: Nursing services

495: Competency

497: Regular in-service education

498: Proficiency of nurse aids
Safety Concerns and Solutions

Environmental implications of
physiological changes
– Vision, hearing, thermal regulation, tactile
sensation, musculoskeletal, balance

Security
– People with dementia may not be able to judge
unsafe conditions

Physical supports
Resident Rights—Bell and Troxel








To be informed on one’s diagnosis
To have appropriate ongoing medical care
To be productive in work and play as long as
possible
To be treated like an adult, not a child
To have expressed feelings taken seriously
To be free of psychotropic medications if at all
possible
To life in a safe, structured and predictable
environment
To enjoy meaningful activities to fill each day
Abuse and Neglect

Willful infliction of injury,
unreasonable
confinement,
intimidation, or
punishment with
resulting physical harm
or pain, anguish, or
deprivation by an
individual of goods or
services that are
necessary to attain or
maintain physical,
mental, or psychosocial
well being

Physical

Sexual

Verbal

Mental
Family Feelings

Denial

Frustration

Isolation

Guilt

Anger

Loss/grief

Letting go
Conflict Resolution

Denial can be healthy
 Educate in small doses
 Do not push to hard
 Encourage support groups
 Acknowledge
 Listen
 Feedback
 Privacy
Internal Resources

Staff members

Library

Administrator

Family counsels

Care plan meetings
Alzheimer’s Association

Helpline

Family Education

Support Groups

Care Consultation

Safe Return
Strategies for Positive
Relationships

Show support
– Family tours, communication processes
– Validate emotions, develop realistic
expectations, compliment, report good news

Promote successful visits
– Offer suggestions and support
– Bring in family videos, pictures
– Activities
Quality Indicators

Number and frequency of medication adverse effects

Proportion of residents who are over-sedated

Incidence of falls, fractures, and elopements

Prevalence of restraints

Incidence and prevalence of skin breakdown

Incidence of symptomatic urinary tract infection

Incidence of dehydration

Use of futile or undesired treatments

Moment by moment comfort of residents

Comfort of caregiving staff
Quality Indicators, Cont.







Ability of staff to deal confidently with
situations
A coherence between values expressed in
mission and actual practice
Prevalence of agitated behaviors
Prevalence of fecal impaction
Prevalence of weight loss
Incidence of decline in ROM
Prevalence of little or no activity