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February 22, 2000
Illinois Nursing Homes Provide Specialized Services for Residents with Alzheimer’s Disease
(Chicago) -- Alzheimer’s care
is undergoing a dramatic shift in philosophy, and it
is affecting Alzheimer’s care programs in nursing
homes around the state.
Ten years ago, Alzheimer’s
professionals would tell caregivers to “correct”
memory mistakes of persons with Alzheimer’s.
This was called “reality orientation.”
If a person with Alzheimer’s insisted that
this was 1959, the “reality orientation” philosophy
would want caregivers to “correct” the mistake
(No, it’s not 1959, it’s the year 2000,”
or “No, I’m not your mother; I’m your
daughter.”)
But now many researchers believe that reality
orientation is unnecessarily combative, frustrating
persons with Alzheimer’s rather than helping them.
Much more prevalent now in nursing homes is an
approach called “validation therapy.”
If someone insists that it is 1959, caregivers
are more likely ask what was enjoyable about the year
1959, and steer the discussion to the positive and enjoyable
memories of a person’s life rather than force current
reality.
Similarly, ten years ago, many professionals
were told that allowing a person with Alzheimer’s
to wander was dangerous, or enabling a person to cuddle
a stuffed teddy bear was undignified and “childlike”,
or permitting a person to perform repetitive tasks was
too demeaning.
Much of that attitude has changed in today’s
caregiving environment in nursing homes.
Rather restraining a person from wandering, nursing
home professionals are finding that safe, supervised
wandering helps reduce anxiety, is good exercise, and
helps a person sleep.
Circular “wandering paths” have been
designed, often in an enclosed garden area, allowing
a person to wander without “wandering off.”
Professionals have also realized
that objects, such as a stuffed teddy bear, rather than
be undignified, often prompts pleasant past memories,
and helps a person become more communicative.
Also, the more involved a person with Alzheimer’s,
the better, even if it involves folding the same clothes
over and over again.
The person still has a continuing sense of contribution
and accomplishment. Giving a person those feelings of involvement, contribution,
and accomplishment is far more important than what actually
gets accomplished.
“Even though persons with dementia
can’t do what they used to do doesn’t mean
they can’t enjoy life at the moment,” says
Dr. David Bennett, director of the Alzheimer’s
Disease Center at Chicago’s Rush-Presbyterian-St.
Luke’s Medical Center.
Working with what researchers have
discovered in the past ten years, Illinois nursing facilities
have developed a variety of successful programs to meet
the specialized needs of residents with Alzheimer’s
disease and related dementias. Among the distinguishing
factors of these programs are increased training for
staff on dementia care issues; therapeutic activities
that focus on resident abilities and enjoyment of life
as they see and feel fit; education and support programs
for family members; and supportive physical environments
that reflect these residents’ unique sensory and
cognitive needs.
Alzheimer’s disease is a progressive,
degenerative disease that attacks the brain and results
in impaired memory, thinking, communication and behavior
and, ultimately, in death. The disease typically runs
from two to ten years, but its course can take as long
as twenty years.
Families face a variety of challenges
in caring for a loved one with Alzheimer’s disease.
During the early stage of the disease, some of the common
symptoms include impaired memory, time and place disorientation,
and mistakes in judgment. As the disease progresses,
persons with Alzheimer’s disease can become increasingly
forgetful, agitated, and restless. They lose their ability
to communicate and become increasingly dependent on
others for the simplest of everyday tasks.
As caring for a loved one with Alzheimer’s
disease becomes almost a 24-hour job, families reach
the sometimes difficult decision of finding a nursing
home. Illinois nursing facilities have responded to
the needs of families by developing specialized dementia
care programs that promote the safety of their loved
ones, tap into their remaining abilities, and optimize
their feelings of comfort.
According to the latest resident
assessment data as of December 1999 submitted to the
Health Care Financing Administration, there are currently
15,749 residents in Illinois nursing homes who have
a diagnosis of Alzheimer’s disease or a related
dementia. 196 Illinois nursing facilities have specialized
care units dedicated to the care of residents with dementia.
In total, 5217 Illinois residents live in these dementia
special care units.
The Alzheimer’s Association
estimates that 4 million Americans have Alzheimer’s
disease. It is expected that 14 million Americans will
have the disease by the middle of this century --unless
a cure is found. Alzheimer’s is the most common
form of dementing illness (accounting for about 60%
of all cases of dementia; other common causes of dementia
are Parkinson’s disease and multi-infarct dementia,
or small strokes). Alzheimer’s disease is the fourth
leading cause of death among older adults.
Illinois nursing facilities have
developed two basic approaches for meeting the quality
of life needs of persons with Alzheimer’s disease
and related dementias. The first approach is the Alzheimer’s special care unit,
whereby residents with dementia live together in a separate
environment that has been specially designed for persons
with dementia. They participate in daily programming
that reflects their unique interests, backgrounds, and
needs.
The second approach is the
dementia day program. With
this format, residents with dementia do not live together
in a separate wing of a nursing facility. Instead, they
come together for a daily schedule of activities, social
events, and meals, returning to their rooms in the evenings.
The only difference between a dementia day program and
an Alzheimer’s special care unit is environmental
-- reflecting an administrative decision on whether
residents with dementia should be segregated or integrated
with other residents in the facility.
Staffing plays a key role in
providing quality care to persons with Alzheimer’s
disease and related dementias.
Like many nursing facilities with specialized
Alzheimer’s care, GlenBridge Healthcare and Rehabilitation
Centre in Niles offers a comprehensive Alzheimer's training
program -- covering such salient topics as understanding
the symptoms and stages of Alzheimer’s disease;
effective communication techniques; dealing with behavioral
issues; and developing successful activity approaches.
"Our program utilizes a variety
of training techniques, including role-playing, case
studies, and problem-solving," states Angela Byrd,
GlenBridge's Special Care Unit Coordinator. "We
host a graduation ceremony at the end of our training
program to honor our staff members for their hard work
and dedication."
“There are two basic goals
with a staff training program,” states Anna Ortigara,
RN, Director of Resident Services for the Rush Alzheimer’s
Disease Center. “The first goal is to provide staff
with the knowledge and skills to be able to establish
positive relationships with the residents and promote
their feelings of well-being. The second goal is to
empower the staff so that they feel good about themselves
and the important work that they do.”
The driving engine of specialized
Alzheimer’s care is a therapeutic activities program
that focuses on resident abilities and provides meaningful
moments of success. Residents with dementia differ from
other nursing home residents in that they often are
physically well; it is their cognitive deficits that
can lead to withdrawal, agitation, and frustration.
By adapting and simplifying past interests to match
residents’ current levels of ability, caregivers
can greatly enhance these residents’ feelings of
self-esteem and quality of life.
Illinois nursing facilities have
created schedules of therapeutic activity programs that
have been tailored to meet the unique needs of residents
of dementia. At Peterson Park Health Care Center in
Chicago, developing activities begins with an assessment
process, whereby activity staff discover important information
about the residents’ past life roles, occupations,
community involvement, and recreational interests.
Peterson Park's Alzheimer's Program
Coordinator Cora Shenong says that this assessment information
leads to the creation of an activity calendar, with
necessary adaptations made for varying levels of ability.
For instance, residents who have an interest in golf
can still participate in several ways. A resident with
low cognitive impairment could putt on a facility putting
green. A more cognitively-impaired resident may be able
to putt with hand-on-hand staff assistance. A resident
with advanced dementia may enjoy sitting outdoors watching
other residents putt or may respond favorably to watching
a golfing video. The overriding goal is to enable residents
with dementia to continue participating in the activities
they enjoyed in the past, despite their cognitive limitations.
“The barometer of a dementia
care program is the response of residents to the activities
that are taking place,” explains Daniel Kuhn, LCSW,
Education Director for the Mather Institute on Aging.
“When I visit a dementia care program, I look to
see if the residents are active, involved and having
a good time. A quality nursing facility will have a
wide range of rewarding activity programs that represent
the lifestyles and interests of the residents.”
Nursing facilities with Alzheimer’s
care programs offer a variety of helpful services for
family members. Families face a variety of emotional
challenges in having a loved one with Alzheimer’s
disease and benefit from meeting with other individuals
who have undergone similar types of experiences. In
response to this need, many Illinois nursing facilities
such as Regency Healthcare and Rehabilitation Centre
in Niles have partnered with the Alzheimer’s Association
in sponsoring support groups for family and community
members that address emotional concerns.
In addition, Illinois nursing facilities
sponsor Alzheimer’s education programs to help
families understand the Alzheimer’s disease process.
Facility events enable families and residents to enjoy
quality time together. Regency sponsors a quarterly
"Family Social" that includes an elegant dinner
plus an education session about a health care topic
of interest. "Most family members still want to
be actively involved in their care and well-being of
their loved ones," states Paula Tagliere, Director
of Activities. "Efforts to involve families in
the life of the facility are very much appreciated."
Alzheimer’s special care units
at Illinois nursing facilities include a variety of
thoughtfully-planned environmental elements that reflect
the unique sensory and cognitive needs of persons with
dementia. Most special care units, including the unit
at GlenBridge Healthcare and Rehabilitation Centre,
feature soft, muted colors and relaxing music to reduce
resident agitation. Glenbridge's interior includes decorative
objects from the 1920’s through the 1940’s
to tap into resident memories. Familiar odors such as
coffee perking and cookies baking add to a pleasant
environment.
Many families are very concerned
about their loved ones (who are cognitively impaired
and may feel the need to wander) leaving the facility
unescorted. Security systems have proven to be very
helpful in preventing resident egress and promoting
safety.
Special care unit interiors feature
a variety of areas to spark interest, such as aquariums,
plant areas, and game tables. At Forest Villa Nursing
Center, residents enjoy watching and feeding the birds
in the facility's aviary. Secured outdoor areas at Illinois
nursing facilities feature walking paths, park benches,
bird feeders, and flowers to enhance resident quality
of life.
In developing dementia care programs,
Illinois providers have been challenged to `plug into
the reality’ of persons with dementia and plan
settings, routines, and activities that reflect their
perceptions, needs, and interests.
“Alzheimer’s disease robs
persons of their memory, judgment, and reasoning which
is a frightening experience and results in a great of
frustration,” states Terrence Sullivan, MS, Executive
Director of the Illinois Council on Long Term Care.
“We as caregivers must make every effort to understand
the world of persons with dementia and design interventions
that increase their feelings of security and self-esteem.
Specialized dementia care programs at Illinois nursing
facilities have been a very successful tool for achieving
this goal.”
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The Wealshire: A Model of Progressive Alzheimer’s Care
(Lincolnshire) -- The Wealshire is
the first freestanding facility in the state of Illinois
dedicated solely to the care of residents with Alzheimer’s
disease and related dementias. The facility features
a home-like environment, creative activity programs,
and a staff committed to approaching care from the residents’
sense of reality.
The Wealshire is a sprawling 76,000
square foot, one-story building that appears to be nothing
more than a series of red brick townhouses on a wooded
20 acre tract of land. Inside the facility are seven
individual households for groups of 16 to 22 residents
who live together like extended families: eating meals,
washing clothes, and sharing everyday experiences.
Each household contains a living
room with a fireplace; dining area; kitchen with refrigerator;
and an L-shaped corridor with private and semi-private
rooms. Off the living room is an outdoor courtyard with
raised flower beds, benches, and a circular path. Between
the units are common areas for residents to participate
in activities. Three of the households have been designed
for residents with early stage Alzheimer’s disease;
three for residents in mid-stage, and one for residents
requiring skilled nursing care.
At the heart of the Wealshire is
a philosophy of activity-focused care. “We emphasize
the residents’ abilities, rather than their disabilities,”
states Carly Hellen, Director of Alzheimer’s Care.
“Residents are often more capable than we think
they are. They strive to live up to our expectations.
They have a need for recognized moments of pride that
will validate their self-image and sense of self worth."
The facility’s programming features
structured activities that simplify routines, break
tasks into steps, and allow residents to do things for
themselves. Some of the facility’s creative activity
programs include a resident choir, pet therapy program,
and exercise program (“Movercise”) tailored
to residents with dementia. “It is really a matter
of empowering and focusing on the residents and our
ability to fit in their world because they can’t
fit into ours,” Carly points out.
The Wealshire actively encourages
family members to become “partners in caregiving.”
Many individuals participate in the monthly Family Council
program, which provides social events, support groups,
and educational sessions on a variety of helpful topics.
Family members have volunteered their time at the Wealshire
to help with such activities as nature walks, table
games, and sing-a-longs.
Staff training is an essential ingredient
in delivering quality Alzheimer’s care. Front line
professionals go through a fifteen-hour course on Alzheimer’s
care and also take advantage of opportunities for informal
training. As Carly points out, “We try to empower
the staff by having them become the trainers, educating
others about their experiences and successes. We have
found that situational, hands-on training is often the
most effective form of education.”
Through a variety of innovative approaches,
The Wealshire is successfully providing a warm and home-like
environment to persons with dementia that fosters their
feelings of safety, comfort, and success. By basing
its architectural design and programming around the
unique needs of these residents, the facility has become
a role model in the development of specialized Alzheimer’s
care.
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Alzheimer’s Care Program Successfully Addresses Needs of Family Member
(Niles) -- Caring for a loved one
with Alzheimer’s disease can be a very stressful
and frustrating experience that can lead to a search
for caregiving alternatives. Such was the case with
Lottie Sowinski, who faced many challenges in looking
after her grandmother. Eventually, Lottie placed her
grandmother at Regency Health Centre, which offers a
full continuum of services for persons with dementia.
Realizing that her grandmother was
experiencing difficulties with such daily tasks as paying
bills and driving, Lottie originally had her grandmother
move to her house. “I remember the doctor’s
words when my grandmother was first diagnosed with dementia:
`If you think it’s hard now, you don’t know
what you’re in for`,” Lottie points out. “The
doctor was right -- it became increasingly difficult
to take care of her.”
Lottie saw an advertisement for Regency’s
Senior Day Care Center, which provides a full schedule
of daily activities along with transportation services.
“I needed some hours during the day to get some
things done,” Lottie explains. “My grandmother
loved the day care program. She was up early every morning,
all excited about going to `the club’. She made
new friends and had a great time.”
When Lottie and her husband were
planning their vacation, they inquired about Regency’s
respite care program. Regency has a very unique arrangement
whereby individuals can attend programs at the day care
center mornings and afternoons, and stay overnight at
Regency nursing center. Respite care enables a person
to stay at the nursing center for a short period of
time, generally one to four weeks.
“When my husband and I came
back from vacation, we couldn’t believe how well
my grandmother adjusted to the facility,” states
Lottie. “My grandmother felt like she too had been
on a vacation. I was truly in shock.”
As Lottie describes it, some of the
reasons for her grandmother’s successful adjustment
to facility life were: having a structured program of
daily activities, participating with people who have
similar levels of cognitive ability, and interacting
with compassionate staff members who have been trained
to work specifically with persons who have dementia.
Currently, Lottie’s grandmother
is living at Regency’s nursing center full-time
and is doing very well. Lottie attends the facility’s
Alzheimer’s support group, which provides an opportunity
to meet with other individuals who have undergone similar
types of experiences in caring for loved ones with dementia.
“If my grandmother’s happy,
I’m happy,” Lottie notes. “The Alzheimer’s
Unit at Regency is like a large family. When I’m
visiting the unit, I see firsthand the quality of care
taking place: staff members who treat the residents
with kindness and respect; activity programs that the
residents enjoy. I was lucky to find such a wonderful
place for my grandmother.”
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