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Living with Dementia in a Continuing Care Retirement Community

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Living with Dementia in a Continuing Care Retirement Community Pilgrim Place Forum Thursday, January 12th at 11:00 am Presented by Sue Fairley and Sharon Berry – PowerPoint PPT presentation

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Title: Living with Dementia in a Continuing Care Retirement Community


1
Living with Dementia in a Continuing Care
Retirement Community
  • Pilgrim Place Forum
  • Thursday, January 12th at 1100 am
  • Presented by
  • Sue Fairley and Sharon Berry

2
Pilgrim Place - January 19, 2011 Forum on Health
Services
  • Excerpts from AAHSA meeting presentation in
    2010 by Westminster Place, Presbyterian Homes
    Evanston Il.
  • Aging happens, and not always in the way we
    expect.
  • Aging in place is sometimes overrated. By living
    at Pilgrim Place, you have options that others do
    not.
  • People adapt best when there is a good fit
    between their abilities and the demands of their
    environment.

3
Take Aways from Today
  • We are aware of the challenges in being a
    caregiver 24/7.
  • We need to partner with you to determine
    compassionate solutions for you and your loved
    one. Please dont shut us out, we are here to
    help.
  • Maintaining the status quo and doing nothing when
    individuals are struggling at their current level
    of care, is not an option.

4
Health Services Advisory Group2012 Mandate
  • Top Priority in 2012 will be to investigate
    options for secured memory care under the RCFE
    license or the LTC/SNF license and the financial
    feasibility for each option.

5
What is Dementia ?
  • Dementia is a general term for a decline in
    mental ability severe enough to interfere with
    daily life. Memory loss is an example.
    Alzheimer's is the most common type of dementia.
  • Dementia is not a specific disease. It's an
    overall term that describes a wide range of
    symptoms associated with a decline in memory or
    other thinking skills severe enough to reduce a
    person's ability to perform everyday activities.
    Alzheimer's disease accounts for 60 to 80 percent
    of cases. Vascular dementia, which occurs after a
    stroke, is the second most common dementia type.
    But there are many other conditions that can
    cause symptoms of dementia, including some that
    are reversible, such as thyroid problems and
    vitamin deficiencies.
  • Dementia is often incorrectly referred to as
    "senility" or "senile dementia," which reflects
    the formerly widespread but incorrect belief that
    serious mental decline is a normal part of aging.

6
Types of Dementia
  • Alzheimers disease
  • Vascular dementia
  • Dementia with Lewy bodies
  • Mixed dementia
  • Parkinsons disease
  • Frontotemporal lobar degeneration
  • Creutzfeldt-Jakob disease
  • Normal pressure hydrocephalus
  • Huntingtons disease
  • Wernicke-Korsakoff Syndrome

7
Reversible Dementia
  • UTI (Urinary Tract Infections)
  • Anesthesia
  • Medication
  • Alcohol
  • Brain injury
  • Sleep deprivation
  • Dehydration
  • Malnutrition
  • Vitamin imbalance
  • Infections

8
10 Early Signs of Dementia
  • Memory changes that disrupt daily life.
  • Challenges in planning or solving problems.
  • Difficulty completing familiar tasks at home,
    work or at leisure.
  • Confusion with time or place.
  • Trouble understanding visual images and spatial
    relationships.
  • New problems with words in speaking or writing.
  • Misplacing things and losing the ability to
    retrace steps.
  • Decreased or poor judgment.
  • Withdrawal from work or social activities.
  • Changes in mood.

9
Mild Cognitive Impairment(MCI)
  • Mild cognitive impairment (MCI) a condition in
    which a person has problems with memory,
    language, or another mental function severe
    enough to be noticeable to other people and to
    show up on tests, but not serious enough to
    interfere with daily life.
  • Because the problems do not interfere with daily
    activities, the person does not meet criteria for
    being diagnosed with dementia.

10
CCRC Contractual Obligationsand Legal Liability
  • The purpose of the Care and Residence Agreement
    is to provide a statement of the services that
    Pilgrim Place will provide to you at the
    Community, and the legal obligations that Pilgrim
    Place will be assuming. This Agreement also sets
    forth your obligations to Pilgrim Place, both
    financial and non- financial

11
Care and Residence Agreement
  • Administration shall determine, in consultation
    with the clinical staff at the Community and you,
    and/or your legal representative, if any, or your
    family member(s), and your personal physician,
    when a level of care change is appropriate.
  • If assisted living services are appropriate but
    space is unavailable at Pitzer Lodge, or the
    Health Services Center, Pilgrim Place shall
    assist you in arranging for your care on a
    fee-for-service basis, either in your home or at
    an alternate site off the premises of the
    Community until something appropriate becomes
    available.
  • The limit for you to be bed bound in your home
    is14 days by regulation. During this time we
    will discuss with you your condition and whether
    it is a chronic condition where Hospice services
    may be appropriate or whether it is more
    appropriate for your needs to be met either in
    Pitzer Lodge or the Health Services Center
    depending on the prognosis of your condition.

12
Statutory Grounds for Transfer
  • Statutory Grounds for Transfer. Pilgrim Place
    may, at its discretion, transfer you if it
    determines that any of the following grounds
    exists
  • You become non-ambulatory as this term is defined
    in Section 13131 of the California Health and
    Safety Code, which provides that you are unable
    to leave your Unit without the assistance of
    another person during an emergency and your Unit
    is not -13- 1592548.8 approved by the State Fire
    Marshal for use by non-ambulatory residents (that
    is, residents who depend on mechanical aids such
    as crutches, walkers or wheelchairs, and
    residents who are unable, or likely to be unable,
    to respond physically or mentally to oral
    instructions relating to a fire danger)
  • You develop a physical or mental condition that
    endangers your health, safety, or well-being or
    that of another person
  • Your condition or needs require that you be
    transferred to an assisted living care or skilled
    nursing because the level of care required by you
    exceeds that which may be lawfully provided in
    your home or
  • Your condition or needs require that you be
    transferred to a nursing facility, hospital, or
    other facility, and Pilgrim Place has no
    facilities available to provide that level of
    care at the Community.

13
Department of Social ServicesResidential Care
for the Elderly
  • Licensee who accepts and retains residents with
    dementia shall be responsible for ensuring the
    following
  • Non ambulatory fire clearance for rooms or
    apartments used to accommodate persons with
    dementia who are unable or unlikely to respond to
    oral instructions relating to fire or other
    dangers or to independently take appropriate
    action.
  • Our response When a resident with dementia
    lives with a spouse or loved one who is the
    primary caregiver, we must, under the RCFE
    regulations guarantee, that the person is never
    left alone due to their inability to respond
    appropriately to an emergency. This is an area
    where staff work with the caregiver to develop an
    appropriate service plan to ensure the residents
    safety.

14
Department of Social ServicesResidential Care
for the Elderly
  • Licensee who accepts and retains residents with
    dementia shall be responsible for ensuring the
    following
  • The Emergency Disaster Plan must address the
    safety of residents with dementia.
  • Our response When a resident with dementia
    lives with a spouse or loved one who is the
    primary caregiver, we must, under the regulation,
    guarantee, that the person is never left alone
    due to their inability to respond appropriately
    to an emergency. Our resident Area Captains must
    also be aware of the residents in their area with
    Dementia so that they can respond appropriately
    in case of a real disaster and if by chance the
    caregiver gets hurt and is unable to assist the
    resident with dementia, the Captain is aware of
    the need for assistance.

15
Department of Social ServicesResidential Care
for the Elderly
  • Licensee who accepts and retains residents with
    dementia shall be responsible for ensuring the
    following
  • Night Supervision.
  • Our response When a resident with dementia lives
    with a spouse or loved one who is the primary
    caregiver, we must, under the regulation,
    guarantee, that the person is secure at night, in
    case they would decide to exit the home. There
    should be some device in place that would alert
    the caregiver who may be sleeping otherwise
    there would need to be someone awake and on duty
    in the home if the resident is residing there.
    If exiting presents a hazard to the resident, an
    auditory device or other staff/caregiver alert
    feature to monitor exiting must be used.

16
Department of Social ServicesResidential Care
for the Elderly
  • Licensee who accepts and retains residents with
    dementia shall be responsible for ensuring the
    following
  • Annual Assessment by staff including a
    Physicians visit
  • Our response When a resident with dementia
    lives with a spouse or loved one who is the
    primary caregiver, we must, under the regulation,
    guarantee, that the person is reassessed annually
    to determine if their needs have changed. The
    service plan that determines the care and
    supervision for the resident would then be
    updated to include alterations or changes.

17
Department of Social ServicesResidential Care
for the Elderly
  • Licensee who accepts and retains residents with
    dementia shall be responsible for ensuring the
    following
  • Activity Program
  • Our response When a resident with dementia
    lives with a spouse or loved one who is the
    primary caregiver, we must, under the regulation,
    guarantee that the person has access to a program
    that addresses the needs and abilities of the
    resident, including large motor activities and
    perceptional and sensory stimulation. This may be
    done in conjunction with the caregiver and
    entered into the Service Plan for the resident.

18
Department of Social ServicesResidential Care
for the Elderly
  • Licensee who accepts and retains resident s with
    dementia shall be responsible for ensuring the
    following
  • Safety Modifications
  • Our response When a resident with dementia
    lives with a spouse or loved one who is the
    primary caregiver, we must, under the regulation,
    guarantee, that the person does not have access
    to oven ranges, heaters, wood stoves, or other
    heating devices.
  • Another option Install kill switch or unplug
    items that could be dangerous. Knives, matches,
    firearms, tools and other items that could
    constitute a danger to the resident must be
    inaccessible. Over-the-counter medication,
    nutritional supplements or vitamins, alcohol,
    cigarettes, and toxic substances such as certain
    plants, gardening supplies, cleaning supplies and
    disinfectants, must also be inaccessible.
  • What this means is that either the caregiver
    makes these items inaccessible or has some way to
    monitor/supervise their loved one with dementia.

19
Department of Social ServicesResidential Care
for the Elderly
  • Licensee who accepts and retains residents with
    dementia shall be responsible for ensuring the
    following
  • Safety Modifications
  • Our response When a resident with dementia
    lives with a spouse or loved one who is the
    primary caregiver, we must, under the regulation,
    guarantee that the person shall either be
    supervised when outside the home, or be in an
    enclosed area to protect the safety of the
    resident. GPS or other tracking/identification
    items may be worn, provided the item does not
    violate the residents rights. The resident with
    dementia may never be left alone in a locked
    home, as this is considered abuse and neglect of
    the resident with dementia.

20
In the meantime
  • Caregiver Support Group will be starting on
    Wednesday January 25 from 2-3pm in Napier/Brunger
    led by Cathy Brown, MSW.
  • Memory Support Group will also be starting on
    Wednesday January 25th from 10-11am in
    Napier/Brunger led by Cathy Brown, MSW.
  • Clinical Team will be meeting with residents and
    developing service plans in cooperation with
    caregivers.
  • HSAG will be working on feasibility of Memory
    Care Secured option.
  • Scholarships are available for residents to
    attend the Enrichment Group at HSC on Mondays,
    Wednesdays, and Fridays.

21
Additional Resources for Brain Fitness and
Caregiver Support
  • Dakim BrainFitness Software
  • Memory Trainer and Memory Matrix by Lumosity.com
    (applications for iPhone and smart phones)
  • CogniFit.com
  • Coach Broyles Playbook for Alzheimers
    Caregivers a practical tips guide
    (www.alzheimersplaybook.com)
  • www.alz.org (Alzheimers Association)
  • 24- hour Help Line (800) 272-3900
  • Safe Return Program (http//www.medicalert.org/alz
    heimers-safereturn)

22
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