OAP/ODP Organization for Oregon Activity Professionals Organization for Oregon Dementia Professionals
OAP/ODPOrganization for Oregon Activity Professionals Organization for Oregon Dementia Professionals

REALLY, DEMENTIA FOCUSED SURVeys.......

OAP/ODP Oregon activity and Oregon Dementia Practitioners

REALLYCongratualations to Curtis Cooper, who raised $1380.00 at a fund raiser for Alzheimer's.  This is the second year that Curtis has sponsored the LONGEST DAY DRUM CIRCLE EVENT.  This year the event covered 2 days and 2 different facilities.  The first day was at Waterhouse Ridge Memory Care, with 30 residents participating in the drum circle and 20 guest. They were also entertained with a cello/flute due,  cello solo and a small Jazz ensemble. In addition pizza, salad and drinks were available to help raise the funds.  The second day, was at Bonaventure of Tigard where 40 seniors participated in the drum circle and too many guest to count attended.  Along with the music and drum circle a silent auction was held with the sale of bird houses made and painted by residents in the Memory Care Unit and water color prints from Memories in the Making Project.  The goal for the two day event was $1600.00 if you would like to contribute there is still time> Please go to Alz.org/longestday and look up the team name: BEAT ALHEIMERS DRUM CIRCLE and donate whatever you can.  We thank you in advance and please join this wonderful cause next year.  You will have a great time and serve a great cause.  

 

 

 2017/New Notes

Yes, really… a dementia focused survey!   Recent studies show that 40% of Activity Programing and Implementing are not currently passing survey standards nationwide.   That is right…. but while this seems difficult…. as good Activity Professionals, you probably are doing everything you are should be doing to successfully past this phase of the survey. Just in case you are not, I will share the most proven suggestions to help you succeed.  Dementia Units that have good activity programming in place and use cultural change and person centered care have reduced routine medication use by 11%, reduced medication for bowel management by 40%, reduction of anti-anxiety medication by 50%, reduced sedative hypnotics by 50%, have a 50% increase in activity levels and a 100% in social interactions.  Long Term Care Units have had a 33% reduction in PRN medication for anxiety and depression, a 44% decrease in staff absenteeism, a 60% reduction in in- house decubitus ulcers, a decrease of 25% in bedfast residents, and a decrease of 18% in the of restraints when person centered care methods were used with meaningful activity programs and environmental changes that eliminated institutional environments.

But first how and why did this come into being… will help you understand it’s importance and what the expectations are.  In 2014, the Center for Medicare and Medicaid Services (CMS) completed a pilot project to examine the process for prescribing antipsychotic medications and assessment of federal requirements related to dementia care practices in nursing homes.  In 2015, an expansion of the Focused Dementia Survey involved a more intensive, targeted effort to cite poor dementia care and the overutilization of antipsychotic medication.  So, some examples that they found were: residents were often misdiagnosed / receiving antipsychotic medications, that residents were found wearing the exact same clothes for five days in a row, many residents were not being interacted with, did not have meaningful activities or activities that related to their skill levels. That residents were not being engaged with during meals with conversations while staff discussed their personal lives, resident were not offered choices either verbally or option to choose by a non-verbal method.  Now really, we know that this is not supposed to happen in our communities, but we know it does. And really, when it is not corrected it becomes the norm for our staff. Before you know it, they reply, well really, she is always that way or she really can’t decide. 

On several occasions, I have asked surveyors how do you really know that a facility is a good one or has good quality care when you’re not here.  These were some of their answers:  the community has a really pleasant and happy feel, there is no tension between staff they really work well together – they work in teams, they really know what to do and what residents really need and when. Residents really have things to do that they enjoy, or are meaningful and not just routine or busywork. Residents really feel the staff knows them and they know the staff. That’s when you REALLY KNOW that this facility is like this all the time, you can’t just make this happen for the week we are here, you really know that these patterns are practiced all the time because it is really natural not just a forced effort.

The results of Focused Dementia Care Study are still a work in progress in partnership with the Advancing Excellence in America’s Nursing Homes Campaign and the National Partnership to Improve Dementia Care in Nursing Homes, CMS GPRA goals, Qualify First, the Campaign for Quality Care and the culture change movement.  But it would really help you know what the surveyors are looking at by going to the CMS website and type in Focused Dementia Care Surveyor Worksheet or the F309 compliance with regulations 483.25. and some of the things are watching for.

 As an Activity Professionals do you really know: the diagnosis of different dementia, do you know the policies and procedures for dementia care, as a recreational staff member have you received dementia care training, do you have an understanding of behaviors as a form of communication and do you understand the meaning behind these behaviors.

Aa an Activity Professional do you really know to how implement good practices when working with dementia residents:  by knowing when language or routines impact on dignity and function, wearing socks/non-skid socks and gowns instead of clothes, soiled hands and nails, uncombed hair,  attempts to quiet or prevent residents from moving around verses efforts to walk with or talk to residents, lack of social interaction, lack of dining experiences and socialization  that are appropriate, dementia approaches for impairments and maximal independence, encouraging physical activity and outdoor time, redirecting high stress environment, allowing for preferred location and environments, providing stimulation to avoid boredom, adequate number and types of activities on all shifts, addressing loneliness/isolation, choices availability or limiting choices to avoid confusion, assessment for residents sleeping often during activities, assess for sensory deficits and how they affect cognition, use of adaptive equipment for appropriateness and consistency. Was an adequate interview done to assess previous life patterns, choices, cultural patterns, preferences, sleeping patterns, food desires, exercise, hobbies, outdoor time, relevant resident’s comfort, well-being and rituals, what calms or soothes the resident, is evidence present that supports activities are implemented based on the resident’s known hobbies, routines and life patterns, does resident have preferences for meals, snack and beverages that are planned for the resident, are services presented so the resident maintain their highest practicable level of functioning.

So REALLY, these things I at times have seen done well for our residents and at times I know should have been done better for our residents (but were not always care planned well so the whole staff knew what to do). Or REALLY, staff was not willing or strong enough in their leadership skills to suggest, remind, insist that if be implemented.  But REALLY, if you were the resident wouldn’t you want it done that way. REALLY is it so hard to implement these guidelines. REALLY, how much effort does it really take to be social at dinner with a resident who is cognitively impaired.  It only takes a second, and it creates a moment of pleasure and trust and reassurance, even if the conversation is not totally understood, the feeling of trust is communicated.  AND REALLY, that can help to displace lack of trust and fear when you interact with that person in a different situation.

We strongly encourage all Activity Professionals to take the Dementia Care Training Class, and OAP-ODP is committed to offering these class at a reduced rate to ensure that all Activity Professionals are REALLY reaching their residents and enjoy each day.

 As Always, Connie

All information in this commentary was taken from the CMS website:  Focus Dementia Care Survey Tools: Ref: S&C:16-04-NH; Focused Dementia Care Surveyor Worksheets; F-tag 309; the 2016-2017 Nursing Home Action Plan. All opinions expressed by the author are drawn from personal experiences.

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Some Corporations are requestion that employees complete the CDP - Certified Dementia Practitioner training courses and receive their Certification....new trends are developing and Activity Directors and Life Enrichment Coordinators may be asked to complete this requirement by some employeers.  In Long Term Care facilities, the CMS Focused Dementia Care Survey is being revised and preview surveys are happening  in some Oregon Facilities. This survey is in review / development in Oregon   This will require that in LTC facilities -training is offered for dementia care education for the front line staff, nursing and administrative employees. The CMS is asking facilities to verify there dementia care experience and education in questions 8b, 8c, 9, 10a,and10e of the Focused Dementia Care Survey.

 

Some States are dropping State Certification Requirements and replacing it with National Certification ...  yes, this is a trend that started three years in some states, suggesting that if could be replaced with the NCCAP National training standards or the NAAPCC standards. However there are individual educationers that are offering an education course in Activity Training. These classes are not stating that they offer a state certification or a national pathway to certification with their training, please be careful to investigate exactly what you will be receiving with the training. 

 

What is a GERONTOLOGIST? This is a new field that works with the elderly and in the past several years has gotten a lot of professional recognition.  These individuals usualy work directly in the communities with our elderly.  They deal with many social and pychological issues facing the elderly.  Including but not limited to activities and community events, aging and health, death and dying, role changes and coping techniques, intervention for community help and resources.  More information can be gotten from Portland Community College, Gerontology Department Sylvannia Campus.

 

Changes for Social Service Directors in Long Term? Under consideration by CMS Guidelines is changing the requirements for Social Service Directors in LTC from having a Master's Degree to a Bachelor's Degree.  Social Service Directors responsiblities include but are not limited to replacement and discharge back into the community after a healtcare change. Adjustments to these changes from a physical and pychological imact, family roles and successful placement into a safe and successful environment.  We will continue to follow this change as it activity/life enrichment professionals also deal with these issues with the social service department.

 

 

 

Still have more questions?

Contact us directly.  We'd be happy to assist you personally.

 

OAP/ODP

Contact info:

cratti@oap-odp.com

cratti@outlook.com

activitydirectorclass@hotmail

or call 503-740-9706

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