Caregiving Care communities rise to challenges

Care communities rise to challenges

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More than 5 million Americans are living with Alzheimer’s disease, according to the 2014 Alzheimer’s Association “Alzheimer’s Disease Facts and Figures” report. About 25,000 of those are people age 65 and older living in Maine.

That number is expected to rise by 16 percent in Maine by the year 2020, making treatment and care options for Alzheimer’s and related dementia patients an important topic for many families in the state. Throughout Maine, long-term care facilities are looking at new ways to rise to the challenge of caring for the growing number of individuals affected by the disease.

Specific Alzheimer’s and dementia training for staff is one of the ways facilities across the state are using to provide the best care for patients, and support for their family members.

Sedgewood Commons in Falmouth offers individualized care for those with Alzheimer’s disease or other forms of dementia. Gary Currier, administrator at Sedgewood, a Genesis HealthCare Specialized Alzheimer’s Homestead Community, said staff members are trained specifically in caring for dementia patients.

“We promote consistent relationships with staff and residents to provide an ongoing routine, which is very important to those living with dementia,” said Currier. “Each person’s family is an integral part of the care team. By providing education and keeping family members informed, our goal is to enhance interactions and support these meaningful connections to promote an optimal quality of life.”

The type of training Sedgewood and other facilities are utilizing involves habilitation therapy, developed by Dr. Paul Raia, who has been active in the fields of gerontology and psychology for some 30 years, the last 25 of which have been at the Alzheimer’s Associations of New Hampshire and Massachusetts.

According to Diane Kibbin, director of assisted living at Falmouth House and Legacy Memory Care at OceanView in Falmouth, Raia’s work focuses on treating the symptoms of dementia by using the capacities patients still have.

“Developing a better understanding of how an individual thinks, feels, communicates and responds to change and emotions can have profound breakthroughs in treatment,” said Kibbin. “Active engagement and individualized care management can improve the quality of life through all stages for individuals and their families.”

Angela Mastrella, social program director of the recently opened Avita of Stroudwater, in Westbrook, agrees.

“We focus on a social model with an habilitation approach at Avita,” said Mastrella. “During staff orientation we focus on this team approach. Every employee involved in engaging our residents uses the approach of going into the resident’s world.”

Social histories are filled out by residents’ families so that the staff at Avita is better able to understand what is of interest to the individual with Alzheimer’s.

“We use those histories to base our engagement with them,” said Mastrella. “When I create programming, I can focus on what is of interest and has meaning for them. We also work with families to help them to interact in a way that is more positive.”

The Alzheimer’s Association, Maine Chapter offers training and education programs that are geared to professionals working in both community-based and residential care settings.

According to the Alzheimer’s Association, one of those programs is “Caring for People with Alzheimer’s Disease: A Habilitation Training Curriculum,” which the chapter offers at various times throughout the year. The curriculum was developed through Raia’s work.

“We are continually talking to facilities across the state to make sure they take advantage of training opportunities,” said Laurie Trenholm, executive director of the Alzheimer’s Association, Maine Chapter.

The habilitation curriculum is a “train-the-trainer” model, created to prepare attendees, already familiar with Alzheimer’s and dementia care, to train direct staff in a wide array of care settings. The training curriculum covers habilitation therapy best practices.

Angela Hunt, executive director of The Cedars, a senior living community in Portland, has worked with the Alzheimer’s Association in training staff.

“Training has helped with our communication skill building,” Hunt said. “There is a move in memory and dementia care to understand the life stories of the people we care for. Families help us with information about what a person did in life, and what are some of their habits, likes and special interests. We can talk with that person using their life history and provide activities that are meaningful to them.”

When Sedgewood Commons opened in 1994, there were very few opportunities for people with dementia to receive specialized care. Currier said the facility has since transitioned from a traditional activity model to a therapeutic recreation model employing certified therapeutic recreation specialists and activity aides. When a resident is admitted to the facility, staff members conduct an assessment of the resident’s cognitive abilities and learn about the individual’s history and past interests, which helps to determine a starting place for individualized programming for the resident.

“We try to get every individual more involved in programming to their interests and abilities rather than a traditional activities program that may focus more on providing entertainment opportunities for the residents,” said Currier.

In addition to training staff, the Cedars has developed a life enrichment program for residents, including a salon and day spa, according to Hunt.

“The physical environment makes a difference for the person,” said Hunt, “as does activity with purposeful engagement. We are taking our long-term care units and working to make them more personalized.”

Legacy Memory Care at OceanView was designed specifically for individuals with memory loss and dementia, using architecture and color to enhance activities for residents, which the executive director said helps staff to provide the best care possible.

“Active engagement and individualized care management can improve the quality of life through all stages for individuals and their families,” said Kibbin.

For residents at the Cedars, engagement includes a new music therapy project, helped by 30 iPod Shuffles from Music & Memory, a nonprofit that provides music options for people with memory problems.

Music & Memory trains facility staff, elder care professionals and family caregivers, in the creation of personalized playlists using iPods and related systems that, according to the organization, “enable those struggling with Alzheimer’s, dementia and other cognitive and physical challenges to reconnect with the world through music-triggered memories.”

Hunt said Cedars staff members are certified in the program and will begin using music therapy for socialization and to help with behavior.

“We can set up a playlist that includes favorite music, the voices of family members, and even relaxation sounds like ocean waves,” said Hunt.

Another area that has improved care for Alzheimer’s and dementia patients is an initiative announced by the Centers for Medicare and Medicaid Services in 2012. The “Partnership to Improve Dementia Care” was established to ensure appropriate care and use of antipsychotic medications for long-term care facility patients. The partnership between federal and state agencies, facilities and other providers, advocacy groups and caregivers set a national goal of reducing use of antipsychotic drugs by 15 percent by the end of 2012.

Brenda Gallant, executive director of the Maine Long Term Care Ombudsman program, is happy to report that Maine reached that goal and has surpassed it.

“To date Maine has had a 31.9 percent reduction in the use of antipsychotic medications,” said Gallant. “We have been working with providers across the state on this initiative as well as providing education with direct care staff. There has been an active statewide coalition in place since 2012.”

The reduction of drug use ties in with the increased emphasis on training staff and understanding behavior as communication, Gallant said.

“With alternatives to the use of antipsychotics the focus is on the resident and knowing as much about them and their habits as possible,” said Gallant. “What is the resident trying to tell us, what has been meaningful to them? The understanding of that is important in providing the best care.”

Working to ensure a person with Alzheimer’s or dementia issues is seen and treated as an individual, and that family members are included in the process, in whatever form it takes, is the most important trend in memory care today.

“At Sedgewood Commons it is not just the resident care that is of great importance to us but it is helping the family of the resident through this journey also,” said Currier. “We are seeing more and more people come to visit because they want to still be involved in their loved one’s life. We encourage families to visit and to stay involved because it certainly does take a village to care for folks with dementia.”

Melissa Craig, acting executive director of a new 20-apartment facility for individuals with Alzheimer’s and dementia under construction at 18 Black Point Road in Scarborough and scheduled to open in February 2015, said the new building will “offer a safe and secured area for residents.” The new space, part of Brookdale Senior Living, has yet to be named. Craig said representatives of the facility will be offering community discussions on topics such as caregiver stress during September.

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