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

Understanding the lives of people living with dementia, and knowing how best to maximize their fulfillment and comfort, are central to the work of LeadingAge members.

Technology makes the task easier, both by helping caregivers understand how their residents perceive the world, and by giving them tools to manage common challenges for their residents.

Here is a look at just a few ways providers can use technology to address the needs of their residents with dementia.

A Comprehensive Approach With a Technological Component

The Green House Project (GHP), famous for its long-term care model based on small-house design and person-directed living, is now using technology for 2 purposes: to boost frontline caregivers’ knowledge and to give them new insight into the world of people living with dementia.

The 2 technology initiatives, dubbed “Best Life Impact,” are part of GHP’s Best Life initiative, launched in 2019. Best Life—which is available to all providers, not just Green House partners—is the organization’s way of leveraging its years of experience in serving older adults living with dementia. It is built around 4 principles:

  • The Power of Normal refers to creating “a culture of normalcy” to allow residents to live in the least restrictive environment possible.
  • A Focus on Retained Abilities is designed to help residents experience real relationships with pets, nature, and people of all ages, especially children.
  • The Dignity of Risk highlights the belief that people living with dementia have the right to take risks.
  • Advocacy is about the duty of caregivers to advocate for people living with dementia—for their right to have more experiences and choices, and the right to rehabilitation.

The “Best Life Impact” initiative has 2 pillars, both focused on technology and built around partnerships.

Project ECHO is a “telementoring” program, a model developed by ECHO Institute at the University of New Mexico's Health Science Center, originally to help patients with hepatitis-C. Using the Zoom video conferencing and education platform, the model connects geographically far-flung caregivers with health care specialists to help the former better treat their patients. It involves collaborative, interactive sessions using case-based learning to discuss issues in caring for patients and handling difficult cases. Frontline caregivers benefit from the specialists’ expertise, and the experts gain insight into caregivers’ challenges.

It’s easy to see how this model can be adapted to skilled nursing staff caring for older adults. Susan Ryan, GHP senior director. describes Project ECHO as a “hub and spoke” model, with the specialists in the middle and aging services provider communities as the spokes.

Ryan cites the statement of Sanjeev Arora, M.D., the creator of Project ECHO, that “We're moving knowledge, not people. We’re demonopolizing knowledge so that all teach and all learn.”

Best Life Impact is being operationalized by a group of 11 aging services provider organizations, almost all of them LeadingAge members. The specialists working with the 11 pilot sites include Anne Ellett, MSN, NP, a dementia specialist and author of the Best Life dementia care approach; Al Power, M.D., geriatrician, author, and educator; and Michael Belleville, an individual living with dementia and a patient advocate.

GHP holds monthly ECHO sessions with the 11 participating providers. Each month, says GHP Director Of Communications and Marketing Meg LaPorte, “a spoke site will present a case. It might be a problem behavior or something that they're experiencing that they need expert help with, but at the end of the session, one of the experts will do a contact hour (CEU) session approved for nurses and administrators.”

From a sustainability perspective, Ryan says, it’s more than just “checking the box” to gain the CEUs: “I really believe that we are changing the landscape and better equipping our workforce. We invite Shahbazim [the term for direct care staff in the Green House model] to be a part of the sessions.”

The Green House Project first connected with Project ECHO at the suggestion of the Robert Wood Johnson Foundation, which has funded both organizations.

The second pillar of Best Life Impact is a partnership with Embodied Labs, which uses virtual reality (VR) technology to help caregivers experience the world of a person with dementia. Using a VR headset and a laptop logged onto the Embodied Labs application, users can put themselves in the shoes of people living with a variety of conditions, including dementia, visual or hearing loss, Parkinson’s, and more.

“What I like about Embodied Labs technology is that it doesn't portray the person living with dementia in a devalued way,” says Ryan. “They have been very careful and intentional about wanting to portray them in a more positive way, giving perspective for what it's like to live in their shoes.”

Ryan says GHP believes every participating organization should buy at least one Embodied Labs kit; GHP negotiated discounts and secured some grant funding to help participating providers get the equipment.

Training Staff to Better Understand Residents

Otterbein SeniorLife, based in Lebanon, OH, has adopted the Virtual Dementia Tour (VDT), created by Second Wind Dreams, as a training tool for all staff, not just direct caregivers.

Like the Embodied Labs system, the Second Wind Dreams system helps users experience the world of people living with dementia, though the latter does not use virtual reality headsets.

A series of patented devices, developed by Second Wind Dreams’ founder, P.K. Beville, is used to simulate physical issues that affect older adults with dementia: special glasses that simulate the loss of peripheral vision or macular degeneration; shoe inserts that cause discomfort when walking; gloves that diminish manual dexterity; and headphones that play specially mixed soundtracks, including chatter that can’t be understood, mundane sounds that can cause agitation, and more.

Susan Susskind, director of independent living services for Otterbein SeniorLife, says the organization committed to ensuring that all employees who touched residents would undergo the experience.

“A lot of our residents have early onset dementia, or are progressing through dementia, so we wanted to come up with a way to get our employees—we call them ‘partners’ here—have better understanding, compassion, and patience.”

More than 500 Otterbein employees have gone through the training, which includes an 8-minute session wearing the devices. It is preceded by a brief introduction to the program, and then followed by a debrief to gauge reactions.

Susskind says many employees are very moved by the experience.

“Honestly, the people that you think it's going to affect the least, it affects the most,” Susskind says. “We have people who get halfway through it and have to come out because they're crying and just emotionally can't take it anymore. But we do hear, across departments, that they get it.”

Snoezelen Therapy

One way of helping residents cope with anxiety and agitation is creating a calm and unthreatening environment. One unique approach is Snoezelen® therapy, which first grew out of the work of Dutch therapists in the 1970s. Snoezelen rooms are designed to create a soothing environment, using creative lighting effects, colors, sounds, aromas, tactile surfaces, and more. The therapy is also used with special-needs children and adults with brain injuries or varying levels of developmental disabilities.

Woldenberg Snoezelen 1
Inside the Snoezelen room at Woldenberg Village.

 

One LeadingAge member that maintains a Snoezelen room is Woldenberg Village, New Orleans, LA. Its 500-square-foot Snoezelen room is available to skilled nursing residents, including those in the organization’s 20-resident memory care unit.

“One different thing we do is design [a resident’s] therapy around who they were,” says Joe Townsend, former CEO of Woldenberg Village, in a 2019 interview. “When the family comes in, [we] sit down with the family and they do a complete baseline report—what they did for a living, whether they were active in the community, what they liked to do.”

“There was one gentleman here who was a rather big man. He was pretty aggressive at times, and the Snoezelen room really calmed him,” says Townsend. He mentions a woman who was generally lethargic but was always energized by listening to Michael Jackson's Thriller in the room.

Nursing Assistant JoAnn Jordan, who has helped residents use the Snoezelen room since it was installed in 2016, says each resident is introduced to it one at a time (though the room can accommodate small groups of up to 6 people).

Most “sessions” in the room last 15-20 minutes.

Woldenberg Snoezelen 2
Lighting effects in Snoezelen rooms help create a calming
environment.

“I bring them in if they’re agitated,” Jordan says. “I put on soothing music, [use] aromatherapy, a vibrating music recliner, I dim the lights, and usually within 10-15 minutes they’re sleeping. I let them sleep until they wake themselves up. It all depends on their moods.”

Music is chosen to match the resident’s preference. Both relaxation and stimulation are available; ball tosses, balloon tosses, or a bowling game are available for residents.

“It helps to modify behavior,” Jordan says. “I have only a few who have a hard time. It’s like something new to them every day.”

Family members are also invited to join their relatives in the room.

Cuddly Technology

Another common technique for dealing with anxiety and agitation in a person living with dementia is to encourage the resident to focus on familiar and comforting objects.

Garvey Manor, Hollidaysburg, PA, is one of many providers who have adopted robotic pets and babies for the benefit of some residents. Grant funding allowed the organization to purchase a number of Hasbro Joy for All™ robotic pets for residents of the Marian Center, Garvey Manor’s 36-resident special care unit for those living with dementia and other related cognitive disorders. The pets cost around $100 apiece.

“We have a lot of residents who enjoy animal visits,” says Barbra Hileman, director of activities, who notes that Garvey Manor does not allow pets to live on site. “We have people that bring real dogs here, though cats have always been a challenge to bring from an activity standpoint. If you know cats, you know, they're not good visitors. So, I was particularly interested in the [robotic] cats.”

A number of residents have responded enthusiastically to the cats, which meow, purr, and roll over.

“For some people who are nonverbal, it’s great to see the response from them—they reach out and want to hold onto something—because the power of human touch will never be taken away,” says Hileman. One woman in a wheelchair is energized by having the pet on her lap; she instantly becomes more active.

Another resident has a favorite robotic dog—a golden retriever puppy—that he has named, and which improves his demeanor without fail.

Garvey Manor ensures that each pet is the property of only one resident. “We really need to consider infection control with these dogs and cats,” says Hileman, “especially during flu season. Each pet wears a collar labeled with its resident’s name.”

Hileman adds that the pets are part of the residents’ care plans, and families are consulted before the intervention occurs.

“They're definitely not for everybody,” she says. “It has to be person-appropriate. When you assign this for the appropriate person, it certainly does work. One [story] that is always going to stick in my mind was a resident who was Polish. She was holding the cat, and all of a sudden started talking about her cats at home, and in her native language. It was just beautiful to see what [the pet] could bring out of a resident.”

Hileman thinks that some residents believe the pets are real. (This has led to some disputes about whether they should be allowed in dining areas—an issue that may require creative solutions.) At the same time, many residents know they are not real, but enjoy them anyway.

Director of Development Holly Keller, who got grant funding for the pets, also got funding to buy a group of Ashton Drake baby dolls for residents’ benefit. As with the pets, the babies are well-loved by some residents.

Hileman tells the story of one resident whose daughter was brought to tears by her mother’s interaction with the baby.

“The day I called this particular family member, she said ‘You’re never going to believe how much this means to me. I just had my first grandchild today, and when you give my Mom a baby to hold it makes me think she's practicing on holding her great-granddaughter.’”

Gene Mitchell is editor of LeadingAge magazine.