Person-centered approach

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    I work in a skilled nursing and rehab facility which has a separate secured unit for dementia patients. He talks about opening up these dementia units and allowing people to live throughout the facility. He doesn't want Alzheimer's patients to feel like outcasts and be placed in lock-down units. While I agree with making the facilities more visually appealing and home-like, I don't believe it would be practical nor safe to allow residents to live freely throughout the facility. Anyone else have any opinions?
    lindarn likes this.
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    There's a lot of research on Alzheimers and daily living units being done lately including something like you said but other changes are also being done besides taking down the locks. It does help. Behavior outbreaks change with fewer need for medication to sedate and psychological support like toys to carry and chocolate on the carts helps too. Be sure to mention that other safety issues should be looked into. Sorry I don't have more detailed info. I believe I saw the article in one of the major nursing journals. Maybe someone else remembers more about this specific home which has done so much specifically and others are picking it up?
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    If you do come across that article, please post it here. That sounds very interesting. I would like to know how they achieved that. James Collins teaches that dementia is a cognitive impairment that stems from an underlying medical condition. For example, years of habitual intoxication may cause a type of dementia. The patient as an individual still exists, however, they are unable to think conventionally because of their condition.
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    I have worked in Alzheimer's & dementia units many times before. While I sort of agree with your point of view on this issue, I can also understand their side too. With the facility wanting to let these typical patients have more "freedom" there are many ways to make the facility safer for these patients. I've worked with pts. that liked to escape out of windows-well there are laser-like window alarms that they could use to help prevent this. There are red laser-like bands that are situated outside the windows & go off if a pt. tries to escape out the window. They could also have an alarm system/keypad code on all of the exits that would allow staff/the public easy access but make it difficult for the pts. to get out (and at the same time, make it easy for people to evacuate in case off emergency). They could put a fence outside with an alarm sensor for when the pts want to sit outside on the patio & "catch some rays" -just make sure there is supervisory staff in this area when the pt is outside. They would have to have keypads on the doors to the areas where the pt is not allowed (med closets, laundry closets, housekeeping, etc). There are those things called Wanderbracelets that you put on wandering pts that will go off if they go near an exit or somewhere they're not supposed to be. They can get security cameras placed @ all the exits to watch for "escapees" etc. Since these pts have an increased risk of falls there are also special floors that can be put down that would make serious injuries less likely if the pt were to fall. (I can't remember exactly what it was but there are some floor designs that make pts like these be @ an increased risk for falls). All of these gadgets can be monitored @ the Nurses' Station & if an alarm goes off there is a wall setup that will show exactly where it is located, etc., so staff can get to the area in record time. Finally, the staff would just have to be more diligent & make sure they're not leaving unnecessary items laying around for the pts to get into. If they incorporate some of these methods, the pts would be safer & further integrated into the everyday goings on of the facility, (like bingo, music therapy, pet therapy, church or just interacting with other patients etc.) improving their quality of life. Whew! I hope this helps you out.
    Last edit by KaringOne on May 3, '11 : Reason: misspelled word
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    It is difficult to mix dementia patients in with general population residents with no cognitive impairment because of the safety issues.

    I believe it is in the dementia patient's best interest to de-institutionalize their environment and allow them freedom to eat and sleep and "do" according to their needs rather than the needs of the staff and facility. We see less acting out, fewer falls, improved nutritional intake, etc when we make the dementia units more "homelike". Having said that, it is NOT easy nor cheap to accomplish these things.

    As others have said, mixing them with the other cognitively intact residents opens an entire safety consideration that may not be manageable. We all know that some dementia patients are "habitual wanderers" and know no boundaries for their walks. They freely enter other rooms and take/use/touch items that do not belong to them. Even in the dementia units it can be problematic if "mom's toothbrush is always highjacked by Bill down the hall" or "they found dad sleeping in _____'s bed again last night".

    While staff may be more diligent about keeping items away from residents with PICA, requiring elderly residents to keep track of their things in their own rooms to protect another resident is an entirely different matter.

    Good luck with this...
    CompleteUnknown likes this.
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    I tend to agree with your take on the living environment for dementia patients. They are habitual wanderers, and have a tendency to get themselves into a lot of trouble. They have a tendency to act out violently, enter rooms without permission, and steal others belongings. It's not so much an issue of not accounting for their individual needs, but rather protecting them from themselves. They have very little control over their own actions. Making the living environment more accommodating and home-like seems like a good idea.
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    I will also add that there just isn't enough staff available to monitor all of these patients. I can recall many times when the MRDD patient was found sitting naked outside. The staff were busy working with other patients and did not respond quick enough to his sensor alarm going off. His wander bracelet didn't trigger the alarm.
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    At the end of this posting is a thread leading to some information about the Eden Alternative. I find it quite interesting and have seen it in action. The man who developed it has been working on the concept for years. I had the opportunity to meet him and talk to him. He's truly dedicated to making life in nursing homes better for those who live there, including those in dementia-care units. See what you think:

    http://www.edenalt.org/about-the-eden-alternative
    b0rea1is, CompleteUnknown, and tewdles like this.
  11. 2
    Here's another couple of links you might find interesting:

    http://www.health.vic.gov.au/dementia/index.htm

    http://www.dementiacareaustralia.com...-approach.html

    The most interesting thing, I think, and the thing that is often the hardest for staff to truly buy into is the idea that challenging behaviours are for the most part a symptom of an unmet need. Workshops and training sessions I've been to go as far as saying that Sundowner's is a sign of poor care. When I first heard this I was skeptical but now I pretty much agree with it.

    Agree with the others, it would be difficult to mix residents with dementia (unless it is very early stages) with rehab/skilled residents because of the safety issues, but never say never I guess. Nothing stopping your facility moving towards a more person centred approach in both areas though, staff need a lot of support and training initially but it doesn't really require more staff, more a change in the way care is provided.
    b0rea1is and tewdles like this.


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