Resident-centered care

Health Progress, Nov/Dec 2001 by Gould, Marianne Osborn

Teresian House made all levels of staff aware of the findings. Our administrator, Sr. Pauline Brecanier, wrote her own vision statement and challenged all staff members to write their own vision statements and set their own goals. Leadership then convened meetings to consolidate and prioritize goals.

The formation of a specialized, interdisciplinary steering committee to study the care

and treatment of our residents with dementia was high on the priority list. The purpose of this steering committee was three-- fold:

* To address the needs of residents with early dementia

* To demonstrate the feasibility of providing specialized dementia care in an existing unit without disturbing the organization and placement of residents

* To demonstrate whether progression of dementia can be stabilized or slowed

Over the course of the next several years, the Dementia Program Project was implemented. The first challenge was to create separate, smaller dining areas where residents with dementia could eat in a pleasant environment with minimal distractions. A third-floor lounge was considered suitable because an adjoining closet could be modified to serve as a kitchen serving area, and restrooms were nearby. We also decided to serve the residents with dementia one course at a time. (This deceptively simple approach was immediately successful. Rather than being distracted by the soup and salad available at the same time and eating neither one, the residents in the special dining program began to eat or drink all their soup before approaching the next course!)

Although our emphasis was on the dining experience, we also planned to train staff to interact with residents with dementia around the clock and in all situations. To provide continuity of approaches, profiles were completed for each resident accepted into the special program unit. These profiles listed the physical needs of the residents as well as descriptions of their interests and individualized hints for staff on how to avoid confrontations, which, in those with dementia, are so often merely the result of an inappropriate approach.

Because our plan included specialized training of staff to conduct programs, we posted notices asking for a show of interest. Twenty-six aides representing all three shifts applied for the course. After being interviewed and ranked, 12 applicants were selected for the 12-hour course. An interdisciplinary team consisting of the administration, nursing services, social services, activities, occupational therapy, and staff development departments developed and taught the curriculum.

The Dementia Program Project was successful on a number of levels:

* We developed criteria for identifying needs in a population incapable of communicating in "ordinary" ways.

* By recognizing the individuality ot caregivers, and matching their strengths to the needs of residents with dementia, we proved that a team pulling together can accomplish more than any individual could, no matter how highly motivated.

* The project forced us to consider unconventional approaches, not only toward dementia, but also toward all behavioral challenges.