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Define Your Program

Thursday October 26 2017, 9:47pm

Dementia will bring with it challenging behaviors. Caregivers do well to remember the aggression or confusion is a disease, not the person.

The DSHS Dementia Care Specialty Training names our care responses GENTLECARE.

There are three key components to GENTLECARE: people, programs, and physical space.

People are the essential therapeutic agents in dementia care. People form a vital support system that must be maintained throughout the disease process. All people the person has contact with affect the health of the person with dementia.

The beliefs, attitudes, and language of these people shape the life of the person with dementia. Patience, respect, and good humor positively affect the person with dementia.

Programs consist of activities throughout course of the entire day of a person with dementia. Rather than adopt a rigid system of activities driven by artificial wake-up, sleep, and meal times, GENTLECARE carefully uses all activity in the life of the person to enhance and ensure a meaningful life.

Programs for persons with dementia are most effective when they are an integral part of the daily living process, rather than “add-ons” or “take-outs” to the life process.

The Physical Environment of the person with dementia needs to be simple, normalized, and therapeutic.

  • Secure perimeters
  • Indoor and outdoor walking loops
  • Appropriate way-finding cues and signage
  • Multiple small social and dining areas
  • Reduction of glare, noise, and confusion
  • “Family cluster” arrangements.

Excellent caregiving considers all care to be a prosthesis that supports the person with dementia. Gentlecare ties in closely with person-centered care.

“One of the core values of a person-centered care model focuses on viewing things from the perspective of the dementia patient. Activities and personal approaches/interventions are determined and implemented based on their relevance to the individual’s specific needs, interests, culture, and background.” Mark D. Coggins, PharmD, CGO, FASCP

An excellent exploration of gentlecare is the book by Moyra Jones, Gentlecare: Changing the Experience of Alzheimer’s Disease in a Positive Way.

Every year millions of Americans experience memory loss and confusion resulting in a dementia diagnosis. Researchers have identified a gene connected with Alzheimer’s. But so far no cure.

American families are forced to decide whether they hire care for their loved one at home, bring him or her to live with them, or find a facility. The cost for care may induce sticker shock.

Families are concerned about the quality of care you will provide in your AFH. You will either deliberately develop a care plan around your residents’ personal needs and likes, or you will fall into a pattern of care that meets your administrative needs.

The  CCAL-Advancing Person-Centered Living is a non-profit national advocacy and education organization “whose mission is to raise awareness about and advocate for the widespread implementation of Person-Centered living values and practices.”

Creating a Person-Centered program is not as simple as allowing your residents to sleep until they choose to get out of bed in the morning. Switching from an institutional focus to a person-centered focus involves re-evaluation of the entire culture in your home.

Teepa Snow, an advocate for Person-Centered care says, “It’s the right thing to do, and it makes caregivers’ jobs more enjoyable and safer.”

People with dementia still have a human desire to connect with other people and have a sense of self, Snow adds. She illustrates implementing this integrated program on her website Positive Approach LLC and on   teepasnow - YouTube  https://www.youtube.com/user/teepasnow

“You have to know the person and who they truly are, know their interests and values,” she advises. “Don’t focus on what they cannot do, but what they enjoy and can do. It’s about creating warm, caring relationships.” For example, Person-Centered care involves residents in meal planning and preparation as they are able. Residents sit at the kitchen table with a cup of coffee, tea or juice and respond to the cook’s questions and observations about what is needed for the meal. The cook doesn’t need input; the residents need to feel involved and important.

An Adult Family Home knows their facility, their residents, their caregivers and develops a program that builds on the strength of each.

We all wander around reality from time to time. Studies show that the average person lies several times a day. These lies may be compensations to deal with reality we find uncomfortable. Like using makeup to cover flaws and combovers to camouflage hair loss. Or telling a friend they don’t look fat; they look beautiful.

The person with dementia may have a different view point of reality. Unless they are in physical danger, we use Gentle Deception to help them cope.

A typical reality shift during late afternoon tells the person with dementia that they need to go “home.” We call this chemical change in the brain Sundowners.

There is no kindness in telling the person with dementia that they can’t go home because their children sold their house and this is where they live now. Or, your mother isn’t looking for you because she died forty years ago.

Or, your husband died last year so you don’t need to make dinner for him anymore; isn’t that wonderful. How much better to tell her that he is taking the car to get it fixed. While we wait for him, will you please help me set the table?

Gentle Deception also helps caregivers avoid arguments with the person with dementia. If she sees a man in her closet, act on this hallucination and emphatically order the bum out or you will call the police.

If a man with dementia insists on dressing up and waiting by the front door because his son is coming to get him, sit with him. To carefully explain that the son died last year from lung cancer will cause him to grieve again unnecessarily. If the man becomes violent because “nobody told me,” you deserve the challenging behaviors you will get.

Pop his favorite cookies into the oven and when they are ready, show him the phone and explain the son was called to an emergency. Redirect him to the table for cookies, a drink and happy socialization.

Trying to orient the person with dementia to your reality may frustrate them and make them distrust you. Let the person with dementia say whatever he or she wants to say, and when they are ready, you can redirect.

Dementia will bring with it challenging behaviors. Caregivers do well to remember the aggression or confusion is a disease, not the person.

The DSHS Dementia Care Specialty Training names our care responses GENTLECARE.

There are three key components to GENTLECARE: people, programs, and physical space.

People are the essential therapeutic agents in dementia care. People form a vital support system that must be maintained throughout the disease process. All people the person has contact with affect the health of the person with dementia.

The beliefs, attitudes, and language of these people shape the life of the person with dementia. Patience, respect, and good humor positively affect the person with dementia.

Programs consist of activities throughout course of the entire day of a person with dementia. Rather than adopt a rigid system of activities driven by artificial wake-up, sleep, and meal times, GENTLECARE carefully uses all activity in the life of the person to enhance and ensure a meaningful life.

Programs for persons with dementia are most effective when they are an integral part of the daily living process, rather than “add-ons” or “take-outs” to the life process.

The Physical Environment of the person with dementia needs to be simple, normalized, and therapeutic.

Excellent caregiving considers all care to be a prosthesis that supports the person with dementia. Gentlecare ties in closely with person-centered care.

“One of the core values of a person-centered care model focuses on viewing things from the perspective of the dementia patient. Activities and personal approaches/interventions are determined and implemented based on their relevance to the individual’s specific needs, interests, culture, and background.” Mark D. Coggins, PharmD, CGO, FASCP

An excellent exploration of gentlecare is the book by Moyra Jones, Gentlecare: Changing the Experience of Alzheimer’s Disease in a Positive Way.

Every year millions of Americans experience memory loss and confusion resulting in a dementia diagnosis. Researchers have identified a gene connected with Alzheimer’s. But so far no cure.

American families are forced to decide whether they hire care for their loved one at home, bring him or her to live with them, or find a facility. The cost for care may induce sticker shock.

Families are concerned about the quality of care you will provide in your AFH. You will either deliberately develop a care plan around your residents’ personal needs and likes, or you will fall into a pattern of care that meets your administrative needs.

The  CCAL-Advancing Person-Centered Living is a non-profit national advocacy and education organization “whose mission is to raise awareness about and advocate for the widespread implementation of Person-Centered living values and practices.”

Creating a Person-Centered program is not as simple as allowing your residents to sleep until they choose to get out of bed in the morning. Switching from an institutional focus to a person-centered focus involves re-evaluation of the entire culture in your home.

Teepa Snow, an advocate for Person-Centered care says, “It’s the right thing to do, and it makes caregivers’ jobs more enjoyable and safer.”

People with dementia still have a human desire to connect with other people and have a sense of self, Snow adds. She illustrates implementing this integrated program on her website Positive Approach LLC and on   teepasnow - YouTube  https://www.youtube.com/user/teepasnow

“You have to know the person and who they truly are, know their interests and values,” she advises. “Don’t focus on what they cannot do, but what they enjoy and can do. It’s about creating warm, caring relationships.” For example, Person-Centered care involves residents in meal planning and preparation as they are able. Residents sit at the kitchen table with a cup of coffee, tea or juice and respond to the cook’s questions and observations about what is needed for the meal. The cook doesn’t need input; the residents need to feel involved and important.

An Adult Family Home knows their facility, their residents, their caregivers and develops a program that builds on the strength of each.

We all wander around reality from time to time. Studies show that the average person lies several times a day. These lies may be compensations to deal with reality we find uncomfortable. Like using makeup to cover flaws and combovers to camouflage hair loss. Or telling a friend they don’t look fat; they look beautiful.

The person with dementia may have a different view point of reality. Unless they are in physical danger, we use Gentle Deception to help them cope.

A typical reality shift during late afternoon tells the person with dementia that they need to go “home.” We call this chemical change in the brain Sundowners.

There is no kindness in telling the person with dementia that they can’t go home because their children sold their house and this is where they live now. Or, your mother isn’t looking for you because she died forty years ago.

Or, your husband died last year so you don’t need to make dinner for him anymore; isn’t that wonderful. How much better to tell her that he is taking the car to get it fixed. While we wait for him, will you please help me set the table?

Gentle Deception also helps caregivers avoid arguments with the person with dementia. If she sees a man in her closet, act on this hallucination and emphatically order the bum out or you will call the police.

If a man with dementia insists on dressing up and waiting by the front door because his son is coming to get him, sit with him. To carefully explain that the son died last year from lung cancer will cause him to grieve again unnecessarily. If the man becomes violent because “nobody told me,” you deserve the challenging behaviors you will get.

Pop his favorite cookies into the oven and when they are ready, show him the phone and explain the son was called to an emergency. Redirect him to the table for cookies, a drink and happy socialization.

Trying to orient the person with dementia to your reality may frustrate them and make them distrust you. Let the person with dementia say whatever he or she wants to say, and when they are ready, you can redirect.

So many factors go into developing a Program for your AFH.

…and these are only the beginning decisions that will define your AFH and set you apart from other homes.

When families come to see your home and describe their vulnerable adult, your program will determine whether or not you can care for them.

For example, a well-dressed couple visited and soon into the conversation indicated they wanted us to care for their father. When we asked for more information about him, they included his Navy experience. This led me to ask if he smokes. When the answer was in the affirmative, we stated our No Smoking policy. –End of discussion.

Smoking, alcohol use, firearms, history of wandering or violence are issues you need to decide before considering a vulnerable adult and their family.

Music, book reading, puzzles, games all need consideration. Do you have table space to work a puzzle?

Will you hire musicians to come in and lead musical activities, or can you do it? Do you have wall space for a large calendar, menu board, framed art work they bring with them?

Is your kitchen large enough for a resident to assist in meal preparation? If you are not planning on cooking, you will want to hire a caregiver who enjoys cooking. Whoever does the grocery shopping will want to participate in menu planning.

I worked in a home where the caregiver came in at 3PM and at that time decided what to serve at 5PM. How do you thaw and cook a roast in two hours? The answer is that you don’t. The residents ate in silence while the caregiver sat in the kitchen texting on her cell phone.

Plan Your Program before you accept residents, before you hire staff. And, be prepared to change what you do and how you do it based on your residents needs and abilities.

Define Your Program

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