with guest susan wehry, m.d., commissioner vt department of disabilities, aging and independent...

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With guest Susan Wehry, M.D., Commissioner VT Department of Disabilities, Aging and Independent Living Slide 2 For being here For all you do For participating Slide 3 + ACTIVATE Inspire Transform Slide 4 Discuss the (new) dementia care Use new tools State readiness to facilitate learning Bust barriers/Build buzz Slide 5 Adult learners Set aside AND draw from experience Re-think outcomes Slide 6 Slide 7 Activate Learning The New Culture: why now? Tools of the trade OASIS Hand in Hand Lets Get Practical Slide 8 Recap Nothing Succeeds Like Success HSAG Tool Kit: Balancing Dementia Care DSD of the Year! Bust the Barriers Putting it All Together Slide 9 Slide 10 Identify your goal Slide 11 Knowledge and Experience Personal history and concerns Bias and perceptions Language Slide 12 Rocks, rolls and rules Seniors, Elders, Older adults, Consumers Residents, Patients, People-First Slide 13 Its a brave new syzygy world Slide 14 Slide 15 High prevalence of dementia Affordable Care Act 2010 CMS National Partnership AHCA/NCAL Quality Initiative OIG report New Guidance Slide 16 New needs knowledge, skills, attitudes, partnerships New opportunities HCBS Quality Workforce development New risks Slide 17 Slide 18 Person-Centered Care Slide 19 Political correctness Personal computer PC Care Slide 20 A philosophy Values fundamental humanity of the people in our care AND the people who care for them A set of best practices to improve outcomes A base on which to build successful non-pharmacologic strategies Slide 21 The process and manner by which carers maintain the personhood of those who receive services The Bradford Group Slide 22 I see you I see our common humanity I see your uniqueness It implies recognition, respect and trust Thomas Kitwood, Dementia Reconsidered, 1997 Slide 23 Slide 24 Slide 25 The Residents Point of View NCCNHR 1985 From B&F Consulting Slide 26 Slide 27 http://oig.hhs.gov/oei/reports/oei-07-08-00150.pdf Slide 28 Slide 29 Who did what wrong what process would make it less likely to happen again Error prevention Culture of quality & safety Culture of Continuous Quality Improvement Slide 30 Fewer falls pressure ulcers acquired catheters Less Turnover Absenteeism Higher occupancy * Staff feel valued and respected Slide 31 Improved Sleep Mood Appetite Better transition home from sub-acute care Fewer Falls Pressure Ulcers Less Agitation Depression From B&F Consulting Slide 32 The New York Times October 12, 2006 JAMA 36: 1359-69 2011 Meta Analysis Confirms: Effectiveness in Dementia is Weak Slide 33 No benefit and cognitive decline with quetiapine AGIT-AD Ballard et al, BMJ, 2005 Meta Analysis shows effectiveness is weak JAMA 306:1359-69 2011 38 RCTs in dementia Lower survival rates Slide 34 New York Times April 11, 2005FDA Black Box Warning 2005 Warning Increased Mortality in Elderly Patients with Dementia related Psychosis Slide 35 Causes of death (Ballard et al, 2010) Pneumonia Stroke Pulmonary embolism Sudden cardiac arrhythmias Likely mediating factors Dehydration Over sedation QT prolongation Slide 36 Increased falls Failure to thrive Increased risk pressure ulcers Diminished quality of life Slide 37 Slide 38 Slide 39 DOCTORS NURSES SURVEYORS DIRECT CARE STAFF Slide 40 Slide 41 Data shows antipsychotics cause harm Data shows they are of limited use The side effects negatively effect quality of life Regulators require we be concerned as do elder rights Slide 42 Slide 43 After a break See you in 15 minutes Slide 44 Slide 45 Slide 46 I dont know what to do! Slide 47 Underlying principles Slide 48 Those who care for them Slide 49 Ways of knowing Ways of processing Ways of learning Slide 50 Well-being, strengths, personhood Slide 51 In their shoes Loss exercise Slide 52 Slide 53 PERSON with Dementia Slide 54 The process and manner by which carers maintain the personhood of those who receive services The Bradford Group Slide 55 All behavior communicates All behavior has meaning Slide 56 All behavior expresses core human needs Slide 57 Behavior Slide 58 MEANING ESTEEM & SELF RESPECT BELONGING & AFFECTION SAFETY AND SECURITY PHYSIOLOGIC INTEGRITY With or without dementia Slide 59 DIGNITY MEANING RESPECT Slide 60 What is this person trying to tell us? Slide 61 Slide 62 Slide 63 + ENGAGE Model Respect CARING Slide 64 4 Modules/8-10 hours learning activities Whos Who Person-Centered (Dementia) Care and Recovery All About Behavior (2) Interventions Learning outside the classroom Slide 65 Training Manual Resource Guide DVD Video clips Power points Podcasts Slide 66 Slide 67 Behavioral and Psychological Symptoms of Dementia Slide 68 Brain-behavior relationships of 5 As Medical approach to symptom control Slide 69 Memories Slide 70 Regulate emotions Fear Anger Slide 71 Slide 72 WHO a person is, is as important as WHAT he or she has Slide 73 Slide 74 PatienthoodPersonhood What causes behavioral and psychological symptoms? What is this person trying to tell me? Slide 75 Shifts primary perspective person rather than disease abilities rather than inabilities relationships rather than task Slide 76 Slide 77 Slide 78 Old paradigm: Behavioral symptoms common Goal is elimination New paradigm: Not all behaviors are symptoms Behaviors are efforts to communicate Need, desire Goal is interpretation, addressing need, preventing Slide 79 Current (old) model Emerging model Loss of ability to modulate Lump together Explaining Intervention Unmet human need More precision Understanding Prevention Slide 80 Slapping thighs Clapping Yelling Screaming Self-referred Something is wrong with me Do something! Slide 81 Slide 82 Hitting out Kicking Pinching Biting Threatening Swearing Slide 83 Common triggers Fear Anxiety Frustration Medications Sensory loss Crowded or noisy environments Abrupt, tense or impatient staff Slide 84 FEAR Slide 85 STOP LEAVE ME ALONE! Slide 86 WHERE AM I? Slide 87 I cant get away! I have to fight! Slide 88 Is there a history? NOT a green light for dismissal Is there a pattern? What works/what doesn't What do we know? How can we Create sense of safety How can we change our behavior? Slide 89 Slide 90 DAY 2 Slide 91 Environment Eden Alternative (loneliness, helplessness, boredom) Music www.musicandmemory.orgwww.musicandmemory.org (Massage) Recreation (Aromatherapy) http://www.alz.org