SHN BRAIN Conference: Transforming Dementia Care: Uniting Clinical Engagement And Technology To Move From Standard To Stand Out Senior Housing News
SHN BRAIN Conference: Transforming Dementia Care: Uniting Clinical, Engagement And Technology To Move From Standard To Stand Out – Senior Housing News https://collincountynewsonline.com/shn-brain-conference-transforming-dementia-care-uniting-clinical-engagement-and-technology-to-move-from-standard-to-stand-out-senior-housing-news/
This article is sponsored by SafelyYou. This article is based on a Senior Housing News discussion with Shirley Nickels, Chief Operating Officer at SafelyYou, Melissa Dillon, Corporate Director of Memory Care at Senior Resource Group (SRG), and Jim Altrichter, National VP of Clinical Services at Anthem Memory Care. The discussion took place on July 21, 2022 at the Senior Housing News BRAIN Conference in Chicago. The article below has been edited for length and clarity.
Shirley Nickels: Today, we’re going to talk about how to transform dementia care by uniting both clinical and programming standards, moving them from standard to stand out. I have two amazing panelists joining me: Melissa Dillon, who has a Master’s in Gerontology and is the Corporate Director of Memory Care at the Senior Resource Group, and Jim Altrichter, who is a Registered Nurse at Anthem Memory Care.
Let’s start with current standards in dementia care? We understand in dementia care that there are typically two primary pillars that need to be considered: a clinical pillar and a programming pillar. Can you each talk about your respective pillars and elaborate on what you consider as standard for each?
Jim Altrichter: From a nursing perspective, most clinicians are very well aware of regulatory requirements. Our standard of clinical care includes making sure that you are performing a comprehensive assessment of residents that come to live with you. In the clinical world, we look at the assessment as being a combination of what the physical presentations are, possible complications, and diagnoses that the person is presenting with. In our assessment document, we also look at and capture any psycho-social aspects that could impact that resident, when we are developing their plan of care. This includes a cultural review. With this information, we craft that blueprint for care.
Our process is to capture all of those elements through the assessment that our nurses perform for a resident at the get-go and from there, develop that care plan. For those of you who are nurses in this audience, we understand that there is a nursing process which includes assessing the individual, however sometimes we might have a tendency to jump right to that care plan. We have to pause and be sure that we’re collecting data, that we are thoroughly assessing that individual and that we’re actually creating the right goals and associated planning.
If a person is presenting in a certain way, I’m already thinking about the plan..oh my gosh, they’re a level two..they are going to need this..they have a continence issue.
As nurses, we are already going down that pathway and we probably haven’t really fully thought about who this person is and what outcomes we are really looking for with that resident. The bottom line is that we really try to stress following that nursing process, which includes the assessment, making some nursing diagnoses, and making some predictions about what this resident is going to really require. Then, finally the care plan is ultimately developed. As part of this evaluation, we need to ask ourselves if this was an effective assessment process.
From a regulatory perspective, various states require resident reassessments. Reassessments might need to occur every 14 days. It might be 7 days. It might be 30, or sometimes they might be required if there is a significant change of condition and then annually thereafter. The point being, is that regardless of what your state requires for that reassessment and reevaluation, you have to be sure that you are really in tune with what’s happening with that resident and be able to identify any changes that would then prompt you to reassess.
Nickels: Melissa, can you highlight from a programming perspective what this encompasses?
Melissa Dillon: I want to be very intentional about the utilization of the word programming. Oftentimes, it is interchangeable with life enrichment, activities, and engagement. I believe that programming is an umbrella that is covering everything that we do differently in memory care. Engagement in memory care may look a bit different than lifestyle engagement in independent living.
I think there are other pieces that we focus on to create a memory care program, like dining. We do things in dining a bit differently because they are necessary for the person living with dementia. We look at our living environment as a whole. What does this community represent, and what are the functionality pieces that we have to incorporate to make the resident feel good, loved and at home.
I always say that there’s something special about memory care. When you walk in, you can just feel it, there is love in this place. We ask ourselves, how do we actually quantify the living environment component of the program, to ensure that it is good for a person living with dementia.
Programming is a necessary part of our training. There’s clinical training, and then there is programming training.
For me, this training ensures that all of our team members truly understand what dementia is, what loving a person with dementia looks like, and understands how we connect and communicate with someone with dementia. When we marry the programming and clinical pillars, then we’re going to actually get to person-centered care.
Nickels: That’s what dementia care should be. It’s all about person-centered care. From my own experience, working with our operators, typically it feels like clinical and programming operate in silos and have limited resources. We need to address how we actually collaborate today.
I know this is what we want to get to. Jim, can you talk us through, when do you all actually work as collaborative entities as the pillars combine?
Altrichter: We can become comfortable in our silos. Sometimes if we operate in our own silos, the people that report to us or our care line staff, they see that and replicate that behavior. Silos aren’t necessarily bad, but you need to keep them in check.
The bottom line is that you have to have the ability to work in your silo to get the work done that is required, but not be so focused, that you are not considering programming and resident engagement.
Nickels: I once attended a transfer training with one of our operators, I really wanted to understand the transfer techniques, as we’ve witnessed falls from a poor transfer. I remember being lifted in a Hoyer. It’s extremely scary. I was sitting there thinking, “Wow, you guys just strapped me in, and moved me over.” I was wondering, “Where is that training for making sure that I’m comfortable? Where is that training to make sure that I’m ready?” The training instruction was, “We’re going to strap you in, lift and move you, and then you’re done.” How do we better incorporate clinical training with resident engagement? You want to have that feeling that you are integrating person-centered design.
Dillon: Right, because it’s more than just the clinical step of transferring someone safely. It’s secondarily, how have we connected, to ensure that we’ve met that person’s needs.
Nickels: Otherwise you would’ve had an event crisis, right?
Dillon: Yes. We’re usually not going to bring the two together until someone is so combative in the Hoyer, and they don’t let us do it. We need to find a way to do that from day one, that we agree with each other, that this partnership is person-centered care.
Each of us has a culture in our communities. We have a brand and brand standards in which we are trying to emulate. I feel like I will sing to the choir in this room that our cultures cannot be brochures, they are not alive and not real. They do have to be the living beings that we are with each other. At SRG, we introduced a culture called “leading with love.” Essentially we’re taking Teepa Snow’s coaching model, and attempting to empower our team members, instead of looking at tasks, whether it be care or engagement, or rather culturally, where are you coming from? If you work in memory care, you probably are there because you have a big heart. When you ask the team members, “Why did you pick this job? You could have picked an easier job.” The general answer is, “It’s my residents, I love these people.”
Altrichter: We have a community relations director in Minnesota, and she is the best salesperson we have. She’s the best life engagement director. She is the ambassador for that community. When she does her pre-move-in profile, she gets to know the person and the family. She’s built a relationship with the family before they even come into the community.
I got to know her and what she does, she’ll say to the nurse, “Hey, I’ve got this person. This is what they’re all about.” I’m not just talking about a paragraph of information. She comes to prospect meetings, armed with information from the needs assessment she has completed. She knows their background. She knows their culture.
You can imagine if you have that volume of information coming in at the outset and that person moves in today, and everybody is doing their jobs then and introducing caregivers and that profile of what that person is all about, how the move-in is just set up for success.
I’ve recently taken that experience and used that as the benchmark of what our move-in should be like. Not telling the CRDs necessarily what they should do, but using this as the standard for what our nurses should expect when a resident is handed off.
It’s definitely a live and learn sort of thing, but you’ve got to take and find those jewels in each of your communities and really exploit them. It is okay to set that as the new standard until somethin...
