Editorial Note: This Q&A has been transcribed from HCPro’s On-Demand webinar, Dementia Care in Assisted Living: New Strategies for Improving Resident Centered Care presented by expert Kerry Mills, MPA. Listen here!
Q: What do you do about residents who are fairly independent in getting dressed, but always wear the same thing?
A: They’re probably wearing the same thing because they do what you or I do: They get undressed at the end of the day and they throw their clothes on either the end of the bed or a chair. Then in the morning, when they wake up, they see their clothes there from the day before and say “Oh, I should just put that on.” This creates a continual cycle and they end up wearing that same outfit.
The easiest way to break the cycle is to go into their room after they’ve gone to bed and remove the clothes from that area. If they’re upset in the morning that somebody took their clothes, you can replace the old outfit by laying out something new for them to wear. Or, you can hang their clothes back up, placing the outfit in the middle of the closet so that when the resident goes there, they’re now going to see other things, which will encourage them to wear something else.
Q: Our doctors always defer to medication to manage behaviors. How do we influence them not to do this?
A: People go to the doctor looking for him/her to fix the problem. Since medicine is a doctor’s field of study, it’s common that his/her natural deferment to fix an individual’s ailment (i.e. cognitive impairment, depression, UTI) is to prescribe medication. Instead, you can let the doctor know that you’d like to do something different. Ask him/her if s/he has any ideas or suggestions; ask if the facility can try giving prune juice instead of a senna pill, or instead of taking the Seroquel, having a staff member take the resident for a walk.
Most traditional doctors aren’t going to suggest that right away because we, as the professionals, haven’t given them the space to try to give us those other suggestions. In my experience, requesting an alternative or giving the doctor the space to suggest alternative options is how my team has been able to get around continually being prescribed medication as a solution.
Q: Some of our residents appear paranoid, accusing us and their family of stealing things. Is this normal with the disease process?
A: The whole issue of paranoia is not cut and dry. Yes, it is true that people with dementia often will be labeled as paranoid. However, if we look at it from their perspective, they actually aren’t as paranoid as we think. For example, we had a female resident who had started to get a lot of trinkets on her bookshelf. Some of the pieces had started to fall down and break, and her family members as well as the facility staff were worried that she would hurt herself. So the staff recommended to the family that they take the trinkets home. Two days later, all of the sudden, the resident claimed that someone took all of her things. First of all, that statement was true. Somebody did remove all of her things. And so while we as professionals and caregivers may get accused of this, the best thing we can do is to look at it from the individual with dementia’s perspective and evaluate how this “paranoid” state makes sense to him or her, and then determine what, as caregivers and professionals, we can do about it.
In the case I just mentioned, the family brought in more trinkets so the resident had items on her shelves again. In some cases, you may decide to change the schedule or the routine of what some of the staff are doing during any given time so that the resident isn’t seeing it happen. When we alter what we’re doing as professionals and caregivers, we’re able to change the perception of the resident to avoid upset. So to answer the question, yes, it’s normal for a resident with dementia to display paranoia, because, again, from their perspective, it makes sense. But it doesn’t mean that we should accept it as “just the disease” and not look into it more closely.
Q: Can you talk about how to help families understand when it’s time to move to memory care from the traditional ALF?
A: This is one of the hardest questions for healthcare professionals, because, naturally, our concern is that the family members are happy. However, a lot of times, if you have somebody who is taking up all of your staff’s time in the ALF setting, it’s going to be a lot harder to care for the rest of the residents’ needs. The best thing to do is to talk to the family members early on. If, all of the sudden, you hit a crisis, it’s going to be a hard conversation, because the family is already dealing with other emotions. And if it’s something that’s been building up and you haven’t been communicating with the family about it, they’re not going to understand why it is a problem all of the sudden.
The best way to stay ahead of that is to make sure you’re communicating with families along the way about changes in the resident. Have them visit your memory care program so they start to understand the difference between facilities. I just published a book with HCPro on dementia care and assisted living that includes an assessment tool for staff to keep track of resident behaviors and know when a safety issue arises so that they can address it proactively. If your facility has a resident who’s hanging around the door and he tries to leave unannounced, or he’s up during the middle of the night wandering halls in a traditional ALF, you need to move him into a secure space for liability purposes as well as for your facility’s reputation. The chances of an individual with dementia wandering at some point are one in three, and the effects can be devastating.
In terms of deciding when it’s time to move someone from the traditional ALF setting to memory care, you should create a system that works for your facility and determine:
- What your staff can handle well enough in traditional health for a particular resident
- What needs can be met in memory care for that particular resident, and
- Use that assessment to guide your team
That assessment is also supportive when you go to talk to families; you have confirmation to support that you can care for them better, and that they can be more independent once they move to that memory care.