INSTITUTE FOR PERSON-CENTERED CARE

NEWSLETTER

November 2013

Until We Can Invest In Significant Renovation, True Culture Change Is Futile               By Rhonda Rotterman, Program Director Creating an environment that is not institutional is a "nice" addition to your person-centered, culture change journey if you have the financial means, but it's not the only part, and in the hierarchy of things, I would say it is the least important part. Innovations in design, such as neighborhoods, villages and small houses, help to foster and support resident-centered care in organizations that have the ability to renovate or rebuild because they are smaller, promote individualized care, and thereby avoid "institutional creep". For those that are currently unable to undertake major environmental changes, however, transformation can still take place in settings of older, outdated buildings. Low or no cost changes such as eliminating overhead paging, signage, uniforms and cookie-cutter décor; introducing healing and storytelling art, or redecorating the common spaces and bathing areas with things from the resident's home that would be given away anyway. These things and many others can have a major impact on the atmosphere with little to no cost. At Maimonides Geriatric Centre in Quebec, various collections of donated art are displayed on the walls along with a history of their connection to the community. Evergreen Retirement Community is designated as a stop on a local art walk through the city of Oshkosh, Wisconsin and also displays a collection of photos of individual residents'hands with a quote of what those hands have done. In some communities, residents choose the color to paint their room. Focusing on the more foundational (but less tangible) aspects of culture change, such as creating a receptive environment where residents, staff and family members are encouraged to speak up with concerns and ideas about the environment sets the stage for wise investments once construction or major renovation is an option. As with any change within a person-centered community, the changes to the building are not made for residents and staff, but with them, and their involvement in this process builds ownership and pride in that community.

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People Living With Dementia and Acute Care Services: Food For Thought:Richard Taylor (http://www.richardtaylorphd.com/) a psychologist turned dementia care advocate and a person who currently lives with a diagnosis of dementia, probably of the Alzheimer's type, recently had the unfortunate experience of receiving "care" in a hospital. As a result of his stay, he has come up with a suggested "list" of things people living with dementia need in order to cope in acute care environments. Here is that list: 

         First responders (e.g. emergency medical professionals), are not trained in dementia care. Ideally someone who knows the person should accompany them to the hospital;         Acute care staff does not understand how to communicate or "connect" with people who have dementia, would it be possible to have someone who knows the person stay with them in the acute care setting?         If your stay in acute care is planned, speak with the staff in advance so that they know how best to connect with you and what you need to feel included and empowered;         Bring seven copies of your current medications list with you, including a summary of disabilities related to the dementia to avoid withdrawal or affecting the maintenance levels of the medications;         Have signage posted by your bed that reads something like this: Hello my name is Richard and I have dementia. That requires you to spend a bit more time explaining things in simple ways that I can understand. I need you to patiently listen and be sure I understand what you are telling me. Don't ask me about current events as they are of no value to me, especially when I am ill. I need to understand what is happening to me. Ask for clarification and paraphrase to be sure I understand. ALWAYS introduce yourself and tell me why you are here and what you need to do WITH me, rather than to me. Ask about my family in the room, talk about real life, friends, hobbies and things that are meaningful to me. It makes no difference to me who the President is, or if I can count backwards by 2's, that acts as a continual reminder of what I cannot do, it also has no current contextual meaning for me.

For Richard, in a perfect world, dementia specialists would be available in acute care settings 24/7, similar to having a translator on staff to communicate with those who do not speak English. He emphatically believes that all staff should be trained in how to

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connect and communicate with people living with dementia and we couldn't agree with him more! Vibrant Living Prevents Falls and Eliminates Need for Alarms:Alarms are meant to immobilize people to prevent falls. However, immobilization also leads to all sorts of maladies we are trying to prevent such as pressure sores, weakness, loss of strength and balance, which, in turn, all lead to more risk of falls. Alarms also cause psychological distress and by startling them, can even cause falls. In fact, we've seen homes that have eliminated alarms report fewer falls. Read more here:http://bit.ly/135RyhY Could Hot Cocoa Improve Brainpower in Seniors?This study about chocolate is important for more than what it seems to reveal about cocoa. It also shows a "convincing link" between blood flow in the brain, the physical makeup of the brain and brainpower, and this connection could lead to better treatments for brain diseases and declines in brainpower. http://bit.ly/19fq7KK Will New DSM-5 Diagnosis End 'Dementia' Stigma?An estimated 5.4 million Americans are currently living with Alzheimer's dementia, that's a lot of people unjustly deemed crazy... From calling those folks insane, to treating them as such, only a fine line that gets easily crossed, both at home and in institutions. I find it heartening that the medical profession is finally acknowledging the pejorative or stigmatizing connotation of the word "dementia." http://huff.to/HXxFzw The Faces of Alzheimer's:The prevailing view of people with Alzheimer's is often a depressing one: the patient slumped in a chair or parked in front of a television set. But a new book and photo exhibition in New York show another side of the disease, one in which people with dementia can still be engaged, lead active lives and experience love and joy. http://nyti.ms/19lE1Fc

By

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