Wednesday, July 9, 2014

Speaking Fluent Alzheimer’s

Marguerite McLaughlin

In the nursing center where I worked for many years, families and visitors would often exclaim with surprising delight, “Wow! It’s as if you speak fluent Alzheimer’s!” What they unknowingly were describing was the phenomenal ability of a gifted team who genuinely could read a situation and anticipate the needs of residents. Speaking fluent Alzheimer’s is a type of intuition. It allows for staff to be deeply in the moment rather than hovering above it, trying to manage it. Staff understand the language (even if the words don’t make sense) and gestures, the moods and the ethos. Virginia Bell and David Troxel authors of the The Best Friends Approach to Alzheimer’s Care would go on to describe the phenomenon as “having knack”. You can spot it when you see it! Staff devote themselves entirely to caring and watching and responding. They become part of the unit or program and recognize the subtlest needs. They are profoundly aware and active in creating a positive and empowering environment for the folks whose lives are connected to theirs.

 A good example that took place occurred when a gentleman named John came to be part of our program. John was tall and lean, walked miles a day and was described by his wife as having a great appetite. But, try as we might, we were unable to get him to eat. Over the course of several days we tried every variety of food, worked with his wife to find favorites, and because of our unique program, tried a number of delivery styles. By day three we were starting to become really concerned. After another failed attempt we invited John out for a ride with other residents to a beach not far from our center. We watched the waves roll in while chomping blissfully on dough boys. John had five! Speaking fluent Alzheimer’s meant that we had to analyze the situation and figure out what was going on that made John eat here and not back at the ranch. During a lull in the action, one of the staff talked with John and through a series of hilarious responses, we came to realize that John’s wife had taken his wallet. Because he couldn’t pay for his food, he would not eat and he was too embarrassed to share this. Being in a small group (and being ravenously hungry) brought his defenses down. That is not entirely the “fluent Alzheimer’s” part of the story though. Staff hurriedly got to work to respond. His wife was called and immediately asked for his wallet; our social worker dropped by for a “business meeting” to offer John reassurance that all was paid; the rec therapy team created “checks” complete with name and address, routing numbers and a signature line. The checks were delivered to John in a box. The checks were registered in his care plan as an intervention that would enhance his well-being and sense of security. John would go on to eat well. Staff would leave a bill at the end of the meal and John would write a check. Sometimes . . . . we even got a tip!

How do you get your staff to “speak fluent Alzheimer’s”? Some already have it. Some need direction and can gain it, some never will. In an effort to capture some of this and identify the skills, knowledge and attitude that staff need in order to become fluent, AHCA created a guide that can be a big help. A Guide to Reducing Antipsychotic Drugs While Enhancing Care for Persons with Dementia - A Competency Based Approach.

It can be used in a variety of different ways, but key to its use is the opportunity to view the necessary actions from a competency-based perspective. To manage antipsychotic use, AHCA has identified the competencies that staff would exhibit in their daily work.

Improving dementia care is a sure way to reduce antipsychotic drugs in your center. Scientific research has found that:

 1. Antipsychotic drugs are frequently overused in people with dementia. Frequently centers that have not developed the knack of speaking fluent Alzheimer’s rely on drugs to solve their problems.

2. These drugs are not as effective as believed and put people with dementia at risk. Studies show they are more likely to fall, have fractures, develop urinary incontinence, have an unsteady gait and are at higher risk for strokes and increased risk of death. This goes against the effort to create a positive and empowering environment .

3. Many behaviors that caregivers find challenging in people living with dementia are natural responses to situations or perceptions and do not require a medication. Skilled staffs can respond to the needs of the person living with dementia in ways that minimize challenging behavioral responses.

Take a look at the Guide; give it to your QAPI team. Talk with staff and see if they speak fluent Alzheimer’s.  If not, download the Rosetta Stone of Alzheimer's.

  A Guide to Reducing Antipsychotic Drugs While Enhancing Care for Persons with Dementia - A Competency Based Approach

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