Elkhorn, NE: Dementia Program’s Goal: To Change People’s Perceptions

Miekka and Cameo

Team members started by changing the way they interpreted behavioral expressions and then spread the word to others.

By: K. Miekka Milliken, CSW, NHA, and Cameo Rogers, CTRS, CDP, CDCM

Perhaps the long term care management company, Vetter Health Services, Omaha, Neb., with 30 long term care communities across five states, has always been weird. In fact, staff try hard to stand out!

The introduction of the American Health Care Association/National Center for Assisted Living Quality Initiative goal of safely reducing the off-label use of antipsychotics caused staff to look at their current practice of responding to behaviors in a unique way. The very words, “encourage alternative strategies for responding to challenging behavioral expressions in persons living with dementia before considering medications,” were strongly motivating.

Here’s What—The Facts
The national statistics are alarming, as “20 percent of all medications are prescribed off-label, and no medication is currently approved for use in behavioral and psychological symptoms of dementia—all medications used for it are off-label. Up to 90 percent of nursing home patients with dementia present behavioral symptoms,” according to the American Society of Consultant Pharmacists on its website, www.ascp.com.

So What Was Needed
Vetter is setting out to Change the View of long term care. Staff began the journey with a Let’s Get Weird tour of their communities. The purpose was to change how caregivers think and act in their profession.
As it relates to dementia care, the team started by changing the way it interpreted behavioral expressions. Rather than searching for methods of response, it wanted to focus on strategies for prevention. Team members then sought out programs and mentors to help them improve the quality of life for their residents with dementia.

What Was Done
Once the team found a program with the framework that made sense to them, they partnered with the creator to build on the framework and create synergy with a three-year futuristic vision. Everyone knows how it feels to introduce a program and watch it go nowhere, but how does a program get enough momentum to survive the long term care environment? Once broken down, it becomes simple.

The program needs to:
■ Enhance the way caregivers deliver service without creating additional tasks
■ Ease challenges
■ Gain efficiencies while maintaining proper techniques
■ Break techniques into the most simplified instruction and action
■ Create immediate results.

All team members must:
■ Know the residents individually, and personalize care (no routine, cookie cutter processes)
■ Embrace the concepts and learn to speak the same language
■ Identify champions in each community and equip them to carry the program forward
■ Practice the approaches daily and celebrate successes.

The home office team had to:
■ Revise company standards on the use of antipsychotic medications
■ Develop ways to perpetuate the program through ongoing training and support
■ Focus on prevention of out-of-character responses
■ Include the new training in general orientation
■ Inform and enlist assistance from medical directors and consulting
■ Establish relationships with consulting psychiatrists and tele-health services that understand and support the vision
■ Provide regular communication that reinforces new techniques to champions and provides a forum for sharing of success stories and best practices
■ Make consistent community visits for support, encouragement, and enhancement of interdisciplinary problem solving.

Now What—The Results
Life Enrichment Team members were previously called to intervene and take responsibility for residents exhibiting out-of-character responses, pulling those team members away from other responsibilities and creating frustration, as meaningful engagement is almost impossible when a behavioral expression exists.
This no-win situation is being eliminated with team members across all departments working together to identify the causes for the out-of-character response and creating opportunities for meaningful engagement focused on prevention. Everyone is becoming a detective. Knowing and understanding residents on an individual basis has a positive impact on all other work.

Approach and communication techniques specifically designed for individuals with dementia are helping team members achieve greater levels of success with daily care while preventing confusion and out-of-character responses.

Team members create the mood for the household when focused on opportunities for smiles and laughter. These techniques stimulate the release of positive hormones, resulting in self-medication that can set the residents up for success and reduce the need for antipsychotic medications.

Nonclinical and clinical team members are becoming natural allies focused on prevention. Their efforts are strengthened by “speaking the same language” and understanding the goal to prevent out-of-character responses through proactive approaches.

Therapeutic tools, including personalized music, aroma therapy, and the use of adaptive engagement technology, combine with approach and communication techniques to provide opportunities for moments of joy.
Gathered Stories And Data
Observing residents with out-of-character responses was heartbreaking.

At the end of a difficult shift in a memory support neighborhood, the team was noted to look physically drained, walking with their heads down and silent. Equipping team members with these techniques has lightened their loads and made their jobs more joyful.  Since the program was implemented, they say, “Work is fun again.” They look forward to discussing techniques and ideas to continually improve the lives of their residents.

Since the introduction of the comprehensive dementia care program one year ago, the communities with memory support households have experienced a 14 percent reduction in the use of off-label antipsychotic medications, a 31 percent reduction in behaviors affecting others, and a 31 percent reduction in pain.
This three-year journey goes beyond residents with dementia. Vetter staff will continue sharing and growing long after their three-year goal has been met. It is becoming less of a “program” and more of a way of life in Vetter communities.

Now What—Future Plans
Champions in each community will work with home office coaches to learn new skills, teach them to their team members, and oversee programming at the facility level. Ongoing education, including site visits to celebrate successes and continue problem-solving as an interdisciplinary team, will provide necessary boosts of encouragement and enthusiasm.
Vetter staff firmly believe that they are changing the view of long term care by rethinking, reimagining, and recreating the way they serve their residents with dementia.

Reprinted with permission by American Health Care Association Provider Magazine

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