Exemplary Programs To Reduce Visual Ambiguity

August 30, 2007

Long-term care statistics show that more than half the residents in a skilled nursing facility are diagnosed as having some form of dementia, many of the Alzheimer type. It is a challenge for a nursing home to design program activities that will meet the needs of the Alzheimer patients. Special planning and coordination is required to make dementia patients a part of things even though they cannot completely understand or participate fully.It is important that nursing homes provide a smooth transition when moving the Alzheimer patient from the home to the facility. Some homes have a social worker or nurse specialist who conducts group sessions for family members. Family members can assist the transition by accompanying their loved one to the nursing home. It is helpful that a few familiar things accompany the patient to the nursing home.

Once the patient is established as a resident, the family should gain a clear understanding of what provisions exist for handling medical and nursing services. What arrangements exist for medical emergencies? The family will also want to know what types of social programs and rehabilitation services are available.

Most nursing homes will routinely develop individualized patient care plans. A care plan is a specific overview of the patient’s strengths and weaknesses, specific objectives for patient self-management, and the staff assistance required to help the patient with daily activities. Such a plan calls for prioritizing activities on an individual basis. The care plan should also include documentation of what is to be done for the patient when, how, and by whom.

The better Alzheimer programs are designed with the patient in mind. Special planning is given to exercise, social activity, privacy, and respect for personal rights. Exemplary programs designed specifically for Alzheimer patients may include any of the following -

1. Architectural and interior design planning to reduce visual ambiguity and to encourage independence by facilitating ease in identifying people, places, and time for example, pictorial signs to identify important areas, large wall clocks, and name tags for staff.
2. Secure wandering areas are important. What precautions have been made to ensure that the patient does not wander off? Alarms or bells on exit doors will alert staff that someone has left the facility. Since patients will frequently remove identification tags (such as those worn on the wrist), identifying labels sewn into clothes, or special articles that the patient is unable to take off, may facilitate identification and return of a lost patient.
3. Reality training, orientation therapy, and reminiscence therapy are excellent programs to encourage both social activity and orientation to the environment.
4. Music therapy and art therapy are often provided to Alzheimer patients.
5. An exercise program is very important.
6. Family education and support services will be included in the best programs.
7. Self-care (e.g., grooming, eating, and the like) will be encouraged by staff who are trained to break down tasks into manageable units and then assist only as needed. Frequently it is easier for the staff members to do something for the patient rather than allow the time for the individual to work through it. This, however, does not promote optimal levels of independence.
8. Good programs will provide a daily patient routine that is consistent and structured such that the patient is not left alone for long periods of time.
9. Good programs will encourage affectionate contact (e.g., patting hands, a hug or two, etc.) and as much social interaction with the staff as the patient is able to tolerate comfortably. The staff will be encouraged to treat patients with respect, preserving their personal dignity.
10. Efforts will be made to ensure that the staff remains as constant as possible, avoiding nurses and aides having frequent shifts in the units that they serve.
11. A good program will invite family input regarding the patient’s preferences and needs.
12. There should be regularly scheduled in service training seminars on management of Alzheimer patients. (Staff turnover will be minimized by providing good training and by responding to the staff’s emotional needs.)
13. The best programs will have on staff, or will work closely with, professionals who have been trained in behavior modification principles.

Volunteers can make a positive contribution to the patients’ quality of life, particularly in providing help feeding those who need assistance. This type of service can be extremely helpful to both the patients and the staff.

Alzheimer patients require more direct care than other patients. This type of work is stressful and requires staff who can manage their own thoughts and feelings. Traditionally, a high turnover in staff has occurred in nursing homes; these rapid changes in personnel are hard on the patients and expensive for the facility. Nursing homes are becoming more alert to personnel needs. Staff members definitely need a release valve for their own frustrations and disappointments.

Problem Patients

The aggressive Alzheimer patient may be refused admission to a nursing home or may be asked to leave if the nursing staff is unable to manage. Nursing home aides are frequently female and may not be strong enough to manage large, aggressive patients. If aggression is likely to be a problem, this should be addressed to the nursing home administrator when the family is touring a prospective facility. Reliance on restraints to manage behavior is counterproductive. Although restraint may be needed on rare occasions, it is not an acceptable substitute for the proper management of behavior problems. Honesty with nursing home administrators regarding problems in managing the patient’s behavior will lead to better care and an increased likelihood that the home will be able to manage the patient effectively.

In the event that a nursing home rejects a patient on grounds of behavior problems, search out other nursing homes whose staff may be better prepared to handle the problem behavior. It may become necessary to return the patient to the home and provide twenty-four-hour nursing care. Commitment to a state hospital may also be possible if it is determined that the patient is a danger to himself or others.

Although physical abuse is unlikely to occur in nursing homes, there are rare occasions when untrained personnel may react in kind to an aggressive response. If the family has any reason to believe that abuse is occurring, or may have occurred, concerns should be relayed to the nursing home administrators, who will address the problem. Families should be alert to neglect, which is another uncommon form of abuse. Most nursing homes make every effort to provide a safe, humane environment, but there are exceptions. Federal law now requires that each state have a State Nursing Home Ombudsman who investigates and resolves complaints on behalf of nursing home residents.

Posted in Medical Aspects