Innovations in Person-Centered Dementia Care
January 25, 2017 | by Debra Wood, R.N.
As care for those with dementia becomes more sophisticated, providers are finding new ways to customize services.
As care for those with dementia becomes more sophisticated, providers are finding new ways to customize services.
More than a buzzword, person-centered care reflects a culture and philosophy that puts the resident and his or her needs and desires first, not the tasks that must be completed. LeadingAge members have taken this concept when working with people with dementia to a new level with innovative programs.
“The goal is to be treating the whole person, starting from where his or her needs are, not the organization’s,” explains Sally White, executive director of Iona Senior Services in Washington, DC.
A philosophy of person-centered engagement creates bonds between residents and staff members, and helps residents connect with others and have a more fulfilling life, reports John Moniz, executive director of Goddard House in Brookline, MA.
Kathleen Blake Curry, former vice president [now retired] of Strategy for Dementia Care at Integrace in Eldersburg, MD, prefers to call the concept person-centered living, going beyond caregiving to incorporate all aspects of life. Staff members get to know the people receiving services and what brings them joy and can build on that.
“Person-centered care is all about genuine relationships between caregivers and people,” adds Kelly Carney, executive director of the Center for Excellence in Dementia Care at Phoebe Ministries in Allentown, PA. “We come to understand the person, their values and interests and then provide what they need in the way they want it.”
Those relationships can become a source of support and connection for staff, as well as for the residents, Carney adds. Additionally, preconceived notions about a group, whether an ethnic group or older population, break down when people get to know members of that group more personally.
“That’s how we break down any prejudice or stereotype,” Carney said.
Iona’s Wellness & Arts Center is an adult day health program designated as a Center of Excellence by the Alzheimer’s Foundation. Person-centered care is central to Iona’s success in serving individuals with a wide variety of strengths and challenges, including individuals with early memory loss alongside those in the later stages of dementia. Key to this success is identifying each person’s strengths, engaging participants in structured activities of their liking and celebrating their successes.
All staff members at Iona’s wellness center learn how to deliver person-centered care and how to recognize the value of each individual. Iona uses a capacity-risk model, which helps guide staff in assessing people’s strengths and identifying ways to increase their capacity, while minimizing any risks in their situation.
“The focus needs to be what each person can do, not what they cannot,” White says. “Even with dementia they can have positive new experiences.”
During the participants’ first few weeks at the center, a program staff member, guided by a social worker, shadows the new attendee and helps ensure a successful transition to actively participating. The center offers multiple activities, giving participants choices throughout the day for a variety of ability levels and interests.
“The people with early stage are helping out those with more advanced memory loss,” White says. “They may help them participate in an activity or get from place to place. They have found a new purpose in helping others in the program.”
Iona’s center offers an art-therapy program in collaboration with The Phillips Collection, an art museum in the Dupont Circle neighborhood of Washington, with an extensive collection of modern and contemporary art. Day center participants visit the museum bi-monthly to study the art and then return to Iona’s art therapy studio, where Iona’s licensed art therapist facilitates the participants’ therapeutic and creative responses through making art. Additionally, the museum sends educators to the center to engage participants in conversation about their thoughts and feelings regarding specific pieces from the gallery.
“Central to the success is the art therapist’s ability to meet each individual where he or she is and adapt the materials and process of making art to those strengths,” White says.
The program culminates in an exhibit of the participant’s artwork at The Phillips each November, helping to show the public that older adults can produce art and continue to be contributing members of the community as they age.
“The art program has helped people bloom in so many new ways,” White says. “It’s a great program to show the value of person-centered support.”
Carney considers the journey toward person-centered care a process. Phoebe provides a high level of training for all employees in the person-centered concept and gives them tools to properly deliver care in that way. Clinical staff members receive additional training. The organization has developed policies and procedures to support person-centered care, and the leadership team supports delivering care that way and allows staff the freedom to take time with residents.
Phoebe has developed a rehabilitation program for people with dementia that incorporates their interests and preferences to encourage engagement in therapy, after therapists recognized that more and more patients admitted for short-term rehab suffered from cognitive impairments. That often led to those people ending up in a higher level of care, because they would become distracted, did not want to do the exercises and did not make progress, necessitating discharge from rehab.
“We wanted to do a better job,” Carney says. “NET is training for the therapist, so he or she can fully engage the individual. That therapy is offered in a clinical care setting based on person-centered care [principles] and designed to support people with cognitive impairment, ensuring that all aspects of the rehabilitation stay are therapeutic.”
NET combines Montessori techniques, life review, and preferred tasks and activities that are familiar and enjoyable for the person. Phoebe trains the therapists, during a 12-hour session, in how to assess and approach the client, and therapists initially work with mentors to perfect their skills. NET has enabled therapists to overcome their apprehension in working with those with dementia.
“What we have found is that therapists love it and are less hesitant to work with this population,” Carney says. “Some embrace it.”
The therapist learns from the family or resident about the person’s past interests. For instance, once the therapist discovers the client liked to dance, the therapist and can play music and invite the person in rehab to dance rather than to walk. Or a patient who liked to play soccer when younger might respond better to kicking a soccer ball than repetitive leg lifts in a PT room.
“Person-centered care super-charges the therapy,” Carney says.
Caregivers on the unit receive the full 12 hours of training and follow through and engage the person when they are not in therapy. During Community Care Team meetings, an interdisciplinary team approach to developing person-centered behavioral support plans and developed at Phoebe, the hands-on caregivers can learn to change how to give a bath or serve a meal to support the therapy and engage the resident.
“Person-centered care is the context in which we can deliver these modalities,” Carney says.
Phoebe conducted a study, funded by the Alzheimer’s Foundation of American, to assess functional outcomes. That found that patients in the NET group made greater gains in function and daily living skills as compared to a traditional therapy group.
All units at Phoebe Ministries follow a person-centered approach. Most use community care team meetings, led by a mental health professional. The meetings can include the housekeepers or others on staff at the community. Rather than the traditional medical model of reporting on problems, it focuses on the person’s strengths and psychosocial needs. It creates a dynamic conversation about the person. That helps convince caregivers about the need to provide care in a person-centered way and to show compassion.
“We are changing hearts and minds one person at a time,” Carney says. “When they go out and try it and see it makes a difference, then you have a believer.”
Integrace’s Copper Ridge Institute has also transitioned to a resident- and family-centered care-planning process to make it consistent with the “pathway” philosophy of meaningful living. Families receive a clinical package about a week before the meeting, so the family members can prepare and ask questions. Medical problems are addressed but so are psychosocial needs and engagement.
Copper Ridge began implementing person-centered concepts about 2 years ago in the skilled nursing home and is now moving it into assisted living. Caregivers think beyond the task to the whole picture. It’s a different mindset.
“The journey is ongoing, because we are dealing with people,” Curry says. “Most people have embraced it, because they feel valued.”
Integrace embraces a pathway philosophy, with customized pathways for the person, the family, colleagues and the environment that empower each person to live in a way that is natural, to explore, choose and contribute. It also honors residents’ abilities and possibilities.
At Integrace’s Fairhaven retirement community, staff, residents and family members put on plays and invite the public to watch. People get to watch older adults acting, which helps break down misperceptions about older people and their abilities.
“It’s building relationships and getting rid of walls by having people enjoy people,” Curry says. “There is a great effort at Integrace not to segregate people. The more you allow relationships to flourish, the more barriers will disappear.”
As a consequence, Curry reports residents are more engaged and life is better for them. Residents in the assisted living houses tend to gardens, with rabbits the residents can hold and pet, and walking paths. The residents can enjoy the fresh air and natural surroundings.
Goddard House has taken the gardening concept to a higher level—an outdoor farming project—to encourage resident engagement. Additionally, families can visit with residents in the garden. The organization teamed up with Green Center Growers of Somerville, MA, which manages the garden, takes residents into the garden to tend to the produce and provides the plants and 3-foot high raised beds. Goddard House also has an indoor garden for year-round activity. As the farm project matured, Goddard House looked for new and interesting ideas, adding bees and chickens.
“It’s a very sensory experience and you can watch people get into that,” says Ginny Mazur, community partnership director at Goddard House Assisted Living. She adds that many residents had lived on a farm or loved gardening when they were younger. The farm allows them to continue that enjoyment in their current home. Moving forward, Goddard House may allow the chicken eggs to hatch and have chicks for the residents to interact with and watch.
The farm grew more than 250 pounds of vegetables last year. Produce grown at the farm is turned into food in the Goddard House kitchen. Residents enjoy seeing the carrots, beets and other produce they harvested in their meals. Foundation grants have helped pay for the construction and maintenance of the farm, which amounts to about $12,000 annually.
Goddard House staff creates educational programs for residents about the bees and other farm activities. Residents write narratives about their connection to the garden and how it relates to their younger lives.
“We include the farming project as part of life in the community,” Moniz says.
Residents talk to the chickens, which talk back. The hens laid more than 400 eggs last year. The eggs are donated to people in need outside of Goddard House.
A local grammar school brings about 8 students to the farm as part of an afterschool program. The students work with the residents and share the farming experience.
“We are trying to create a universal approach with an intergenerational experience,” Moniz says.
Additionally, the greater community has an opportunity to witness persons with memory loss participate in a successful and positive project, countering the fear and prejudice often associated with dementia.
“Any reticence people had about bringing children to a dementia unit, went away right away due to engaging people in a skillful way,” Mazur says. “We are educating the community about people with dementia, and that there are so many ways to engage with them.”
Debra Wood, R.N., is a writer who lives in Orlando, FL.