LeadingAge Magazine · January-February 2020 • Volume 10 • Number 01

Dementia-Friendly, Person-Centered Innovation

January 17, 2020 | by Debra Wood, R.N.

Person-centered care for those living with dementia comes in many flavors. These 3 providers explain their varied approaches to improving the lives of residents.

More than 5 million adults in the United States live with dementia. LeadingAge members have embraced innovative approaches to memory care, all respecting the person with dementia and focusing on their strengths, abilities, and quality of life.

“It’s important […] that we recognize in-depth adoption of best practices is where you get the greatest outcomes,” says Kelly Carney, Ph.D., corporate director of memory care services at Acts Retirement-Life Communities, a life care provider with 26 communities, based in Fort Washington, PA.

Here is a look at 3 varied approaches to improving the lives of residents living with dementia.

Enhancing Engagement

When Acts set out to create more dementia-friendly communities, leadership completed a needs assessment and gap analysis and visited other communities for ideas and best practices it could implement within its campuses.

Acts photo 1
At Acts Retirement-Life Communities, residents
decide what activities they want to do; helping
with tasks gives residents a positive sense of
self. Photo courtesy of Acts Retirement-Life
Communities,

“We identified Montessori as a tool and resource to support enhancing engagement for people with dementia,” Carney says. “It is a critical best practice and aligns well with Acts philosophy of care.”

Montessori is a key part of one of the organization’s 12 building blocks of excellence, called Acts Engaged Living, Carney says. Others include vision, philosophy, staff knowledge, and evidence-based policies and procedures. Two Acts locations have become certified Montessori Inspired Living Communities. Carney is working with additional communities to make the transition to Montessori.

“Sometimes, we forget how much effort goes into creating transformative change,” Carney says. “You have to give the professionals giving the care support, education, and time to work through the change as a team.”

The Montessori philosophy focuses on harnessing a person’s strengths, not losses, to engage people in meaningful activities that are aligned with their interest, she explains. Staff members support residents to do more for themselves and encourage independence. Everyone learns about Montessori, and everyone in the community carries out the philosophy.

“It’s a game changer, and the way it should be living in long-term care,” says Jennifer Brush, a certified Montessori educator and founder of Brush Development Co. in Chardon, OH.

Maria Montessori, an Italian physician and educator, determined that people have human tendencies or needs, no matter one’s age, Brush explains. Montessori is a philosophy, not an activity program. For instance, it considers a person’s need for orientation, a purpose in life, and meaningful work.

“When you meet their intrinsic needs, you prevent the responsive behaviors,” Brush says. “Instead you have an environment with a strong sense of well-being and contentment.”

This orientation differs from “reality orientation,” used in years past, which upset people, in that this orientation is about space and the ability to find one’s room or the activity the person wants to attend. Brush incorporates memory books in the approach, to help families engage and reminisce with the older adult. The memory book contains information about the resident’s life.

Acts residents decide what activities they want to do. They may read books together, set the table, help make meals for the homeless, or plan a holiday party for staff members.

“That sense of helping other people is meaningful,” Carney says.

Residents become contributing members of the community, Brush adds. Tasks are designed for each individual, based on the interests or activities the person formerly engaged in. They are not intended to reduce staffing levels. Family members, typically, accept that their loved one might be setting the table, because it gives the resident a positive sense of self.

“When you present it to a family member like that, there is not a problem,” Brush says.

Acts staff members can spend extra time with residents. Someone might set up a visit by the resident’s dog. A culinary person might sit and talk with residents who are snapping green beans for dinner.

“Staff members say, ‘We will never go back.’” Carney adds.

Acts calls disruptive actions behavioral expressions, and considers them a method of communication about unmet needs or frustration. The team meets and conducts a root-cause analysis and develops a person-centered support plan, which is followed up to assess how well the plan is working.

“Meaningful research has studied the Montessori philosophy in long-term care, but more is needed,” Brush says. “Outcomes have included increased engagement, improved affect and reduced medications. There is a change in energy.”

Carney reports seeing significant changes since adopting the Montessori philosophy. Families notice as well.

“It brings a new life to a community,” Carney says. “It’s contagious how it catches on. Staff, residents, and families are enjoying it.”

Access to the Community for All

Several years ago, leadership at Carol Woods, a life-care community in Chapel Hill, NC, decided it wanted to strengthen its inclusive approach to caring for residents.

“We believe persons living with dementia have a right to freedom, just like everyone else, and have a right to access the life of the community,” says Jen Wilson, vice president of well-being at Carol Woods. “Our belief in human rights has led us, since our establishment in 1979, to not have a separate, locked unit for persons living with dementia.”

Carol Woods created 4 neighborhoods and educated all staff about well-being. People with and without dementia live side-by-side. Leadership has articulated 7 domains of well-being, and staff members work to increase residents’ well-being through planning and acting on those plans.

Staff members problem solve and feel a sense of trust. They also believe they can express their views and opinions, and they respect others’ opinions.

Acts photo 2
Photo courtesy of Acts Retirement-Life Communities.

 

At change of shift, all staff members, including resident life specialists, coming on duty and those leaving “huddle” for 10 minutes at the beginning of the shift report to focus on aspects of well-being. They discuss resident needs and how to support the people in their care, says Melanie Johnson, director of nursing.

“There have been some interesting conversations,” Johnson adds. “Everyone has information.”

Leaders in the organization also may attend huddles and encourage participation from all employees. Anyone can bring up a concern. Rather than thinking about people living with dementia having disruptive behaviors, staff members look at unmet needs and how to address those.

“We try to understand what is leading them to express their distress in this way,” Wilson says. “Since we started the huddles and getting ‘upstream,’ and helping people have as many good days as possible, we do not see people with high levels of distress.”

Structuring Learning

Developed by the Kumon Learning Therapy Center in Japan, SAIDO Learning offers a nonpharmacological program based on a learning intervention for enhancing individuals’ engagement with staff and everyday life. The individualized, structured sessions include mental exercises focusing on simple arithmetic, a number board, reading aloud, and positive reinforcement and change, says Jill Ricker, director of operations for SAIDO learning with Covenant Living Communities and Services, a life care provider based in Skokie, IL. Residents are called learners.

“It’s about finding our learners’ ikigai,” Ricker says. “In Japanese, that means a person’s reason for being. No matter our stage in life, we all have one.”

People living with dementia at Covenant and partner communities participate in SAIDO Learning’s cognitive training sessions 30 minutes per day, 5 days per week. The worksheets focus on information the residents had learned long ago. Participants are assessed prior to starting SAIDO Learning, and then every 6 months.

“We can place [the learners] at a level just right for them,” Ricker says. “It’s not too easy and not too hard, so they feel, ‘I can do this.’”

One supporter, a staff member or volunteer, works with 2 residents at the same time, promoting relationships and a sense of belonging. Staff members from throughout the organization may be trained to conduct the sessions.

SAIDO photo
The SAIDO Learning model includes use of individualized cognitive learning sessions designed to enhance resident engagement. Photo courtesy of Covenant Living Communities and Services.

 

Learners’ conditions can range from mild cognitive impairment through severe dementia. Supporters learn more about the residents, which positively affects their day.

“SAIDO gives us an opportunity to get to know residents deeply,” Ricker says. “Staff often say that doing a session is the best part of their day.”

Ricker has observed residents become more engaged and self-confident after participating in SAIDO Learning. It may be a resident making eye contact, smiling or reengaging with others, or being able to recite poetry aloud again. Families often report more quality visits.

“We see changes that make a difference in residents’ lives,” Ricker says. “It’s a commitment, like anything else, but one that brings dignity and joy to our residents, families, and staff as we face this challenging disease.”

Covenant Retirement is the Master License Holder in North America for SAIDO Learning. SAIDO Learning was introduced to the U.S. by another LeadingAge member, Eliza Jennings of Cleveland, OH.

“We are identifying like-minded partners to spread this across the country,” Ricker concludes. “It’s a commitment, like anything else, but man, it’s impactful.”

Debra Wood, R.N., is a writer who lives in Orlando, FL.