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What Makes Our Special Care Unit Special

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... no tub baths, no showers. Incontinent product-pullup/brief ... 'Normalized care', bathroom routine. When resident requires care, approach and 'be with' resident ... – PowerPoint PPT presentation

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Title: What Makes Our Special Care Unit Special


1
What Makes Our Special Care Unit Special ?
  • Deer Lodge Centre
  • Dementia Care Unit
  • Maureen Chouinard, Manager of Resident Care
  • Arlis Decorte, Clinical Resource Nurse
  • Nancy Fiebelkorn, Social Worker

2
SCU Tower, SCU-West
  • 47 beds on two units
  • Tower opened in 1988, West opened in 2006
  • Higher staff to resident ratio
  • Units address behaviours, care needs
  • Male or female veterans or community
    applications

3
Philosophy of Care
  • Equal, individualized, respectful and safe care
  • A persons individuality is unique and does not
    change because of cognitive impairment
  • Staff are advocates
  • A specialized environment is required for
    dementia care
  • Families have the right to be informed

4
Philosophy of Care (continued)
  • Specialized skills and abilities are essential
  • Interdisciplinary team approach
  • End of life care
  • Upholding Residents Bill of Rights
  • Effective and efficient use of available resources

5
SCU Admission Criteria
  • Age
  • Primary and secondary diagnoses
  • Environment
  • Behaviours
  • Risks

6
How to Access the Special Care Unit at DLC
  • WRHA Behavioral Panel
  • Contact the panel secretary at 940-3600
  • Access Office is at 490 Hargrave St.
  • Application should include an A/A form, a
    Dependency Assessment Supplement and the
    Behavioral Assessment Supplement.
  • A brief summary of the resident/client will be
    submitted along with behavior maps, recent
    progress notes, consults and lab work.

7
Behavioural Panel Purpose
  • To facilitate the management of individuals with
    challenging behaviors in the most appropriate
    care setting.

8
Behavioural Panel Guiding Principles
  • Behaviors are not being managed in their current
    environments
  • Existing resources already accessed
  • Information meets panel criteria and standards
  • Panel meets monthly
  • Additional problem-solving may be required to
    ensure placement in proper environment

9
Behavioural Panel Who Sits on the Panel?
  • Medical Director of the Rehab/Geriatrics Program
  • Director of the LTC Access Centre or designate
  • A representative from a PCH
  • A representative from the Geriatric Mental
    Health Team
  • A CNS for the WRHA long term care program
  • Access Coordinators
  • Health care professionals/family who have been
    integral to managing the individuals care needs

10
Preadmission Visits
  • Purpose
  • Confirm the information provided by panel
  • Meet needs of the applicant?
  • Plan for any special needs or equipment
  • Meet the applicant and family
  • Completed by the Social Worker and Unit Manager
    once accepted by Behaviour Panel
  • Visit usually within one week, at applicants
    current residence

11
The Interdisciplinary Approach
  • The SCU at Deer Lodge Centre utilizes an
    interdisciplinary approach to care.
  • Weekly meetings
  • Goal is to review each resident on a quarterly
    basis.
  • Post-admission and Annual conferences
  • All members of the team are available to family
  • Contact information provided

12
The Interdisciplinary Team Consists of
  • The Resident and Family
  • Attending Physician and Consultant Psychiatrist
  • Manager of Resident Care
  • Clinical Resource Nurse
  • The Nursing Team-RNs, RPNs, HCAs

13
The Interdisciplinary Team Consists of
(continued)
  • Social Worker
  • Pharmacist
  • Physiotherapist
  • Occupational Therapist
  • Dietician
  • Recreation Facilitators
  • Spiritual Care

14
What Gives Us a Sense of Well-being? -The
Bradford Dementia Group
15
Well-Being (continued)
  • What do we need to maintain a sense of
    well-being?
  • A sense of control
  • A sense of who we are
  • A feeling of safety and security
  • The ability to communicate with others
  • The feeling that we are socially included

16
Well-Being (continued)
  • Having meaningful things to do
  • Being taken seriously- do others respect and
    recognize when we feel frustrated, angry, sad,
    anxious, tired/exhausted, confused, lonely,
    frightened?

17
Reactive Behaviours
  • Reactive Behaviour- the way in which a person
    responds to a specific set of conditions.
  • P.I.E.C.E.S. program
  • All residents on the Special Care Unit have a
    behavioural history which has made residing in a
    regular personal care home setting difficult or
    impossible.

18
Reactive Behaviours (continued)
  • Reactive behaviours may include
  • Restlessness Calling out
  • Wandering Hoarding
  • Resistance to Care Agitation
  • Anxiety Aggression
  • Withdrawal
  • Inappropriate Sexual Behaviour

19
Reactive Behaviours (continued)
  • Staff are encouraged and trained to monitor and
    document reactive behaviour
  • Antecedents (Triggers)
  • Behaviours
  • Interventions
  • Consequences

20
Reactive Behaviours (continued)
21
Reactive Behaviours (continued)
22
Key Elements of Care Alzheimers Australia, 2003
  • Assessment
  • Individualized Care
  • Interdisciplinary Team Approach
  • Programming
  • Relationships

23
Key Elements of Care (continued)
24
Key Elements of Care (continued)
  • Communication Skills
  • Physical Environment
  • Flexibility in Routines and Practices
  • Staff Training and Education

25
Communication
  • Communication with persons who are cognitively
    impaired may be difficult and frustrating at
    times for both you and them
  • Remember that behaviour is a form of
    communication for residents that have impaired
    expressive ability

26
Communication Areas to focus on include
  • Approach in a gentle manner and identify yourself
    by name
  • Maintain eye contact
  • Provide gentle direction
  • Do not make an issue of a mistake, they happen
  • Avoid asking facts

27
Communication Areas to focus on include
(continued)
  • Reduction of distractions and background noise
  • Reorientation may not work
  • Appropriate touch
  • Items and illustrations to convey messages

28
Visiting
  • May be difficult for families/caregivers We, by
    nature, need something from our visits
  • Love
  • Reassurance
  • Support returned to us
  • Ease of guilt
  • Confirmation of our decisions
  • To feel that a connection remains

29
Visiting (continued)
  • Goals of Visiting
  • Who should Visit
  • When to Visit
  • Where to Visit
  • What to do when you Visit
  • Why Visiting may be difficult
  • Saying goodbye after your Visit
  • When younger family members Visit

30
Caregiver Support Group
  • Informal group for families/friends that meet
    once a month
  • Connections for them, connections for us
  • Share questions and information about SCU
  • Supportive and safe environment
  • Luncheons

31
Case Study
  • 79 year-old gentleman residing on a general
    medical hospital ward.
  • dx of Alzheimers/Parkinsons disease.
  • hx of resistance and aggression during care,
    occasionally towards co-residents.
  • Poor response to psychotropics -
    oversedation-minimal effect on behaviour.

32
Case Study Care Plan in General Hospital Setting
  • 6 staff to provide care
  • Resident to be restrained on bed utilizing 4
    staff, 2 staff to prepare and provide care.
  • Broda with lap table for meals and rest periods.
  • Current Rx
  • Carbamazepine 200mg bid
  • Trazodone 75 mg od 1800

33
Case Study Care Plan on SCU - Goals
  • Gain the residents trust.
  • Create a resident-friendly care plan.
  • Involve resident and family in care
    planning-create an environment where resident and
    family have decision-making authority.
  • Ensure Consistency/reliability.

34
Case Study Care Plan on SCU - Interventions
  • ADL Care
  • Broda chair and table for meals.
  • Bath-in-a-bag products - no tub baths, no
    showers
  • Incontinent product-pullup/brief/overnight
  • Monitoring behaviour on unit
  • Plan all care - Scheduled………..CONSISTENT

35
Case Study Care Plan on SCU (continued)
  • Initially provide 4 staff for care and safety
  • Normalized care, bathroom routine
  • When resident requires care, approach and be
    with resident
  • Reapproach after a break period, invite him to
    attend his room with you, or simply walk to room
    with him.
  • If care required more urgently, need to be more
    matter of fact

36
Case Study Care Plan on SCU (continued)
  • Adjustment to medication following admission
  • Trazodone Rx on revised care plan
  • 0700 - 25 mg.
  • 1200 - 50 mg.
  • 1700 - 50 mg.

37
Case Study Care Plan on SCU - Outcomes
  • 2-3 staff to provide care, dependant on mood -
    (do not provide care alone)
  • Aggression with co-residents
  • Broda chair/table for meals
  • ADL/Bathing
  • Ongoing staff education
  • The challenge of CONSISTENCY

38
End of Life Care
  • Advance Care Plan/Health Care Directive
  • Care planning around a progressive illness
  • What is Comfort Care and its focus?
  • Pain
  • Difficulty Swallowing
  • Lack of Appetite
  • Labored Breathing
  • Skin Breakdown
  • Loving Presence

39
When the Resident No Longer Requires SCU
  • Resident no longer requires the specialized
    programs of our unit.
  • Social Worker prepares the family
  • Move to another unit in DLC or another facility

40
Barriers to Discharge
  • Long Wait Lists
  • History of reactive behavior
  • Families reluctance to move
  • Concerns of receiving facility
  • Small unit vs large unit
  • Treatment unit vs long-term care unit

41
Conclusion What Have We Learned?
  • The value of the unit staff
  • Admissions need to try new things
  • Environmental challenges
  • Closed-in vs. open spaces, Wall protection,
    Decoration
  • Low stimulus is a great idea but……
  • Require a balance between environment and
    pharmacological treatment
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