Though LeadingAge members follow a variety of approaches to dementia care, what they have in common is a commitment to personal connections with residents and clients.
Using Life Stories to Build Bonds, Make Residents Comfortable
A few years back, when Christian Care Communities in Louisville, KY, decided to focus solely on senior services, the organization wanted to try something different and acquired the Best Friends™ Adult Day Center, reports Mary Lynn Spalding, president and CEO of Christian Care Communities.
The Best Friends™ approach is based on the person with dementia’s need for a “best friend,” whether that person is a staff member, family or a friend. The friend maintains a positive attitude and helps the person with dementia feel valued and safe by learning the person’s life story. Virginia Bell and David Troxel developed the Best Friends approach to dementia care nearly 30 years ago while working at the University of Kentucky’s Alzheimer’s Disease Research Center in Lexington. It is now practiced in more than 40 countries.
Christian Care has expanded use of the Best Friends approach to its residential communities, requiring education of staff and identifying leaders who embrace the concept. Bell now volunteers with the Christian Care program, teaching staff.
“You have to have people who have the ‘knack,’ who value the relationship with the elder and are able to react in the moment,” Spalding says.
Upon admission, staff members complete a life story of the resident and what he or she was like prior to coming to Christian Care. It may include something the person enjoyed years ago or something special to the person.
“The person is still there,” Spaulding says. “Every person’s life story is different, and what is special to them is different.”
Staff can use that information to calm someone. For instance, Spaulding recalls a lawyer with dementia who had spent much of his life reading legal briefs. The staff put together a document that appeared to be a legal brief and would hand it to him when he became anxious. He immediately calmed down. Another example was a baker with Alzheimer’s who came to Best Friends in an angry demeanor. The staff would observe her mood, and when she became agitated they would put her hands in flour and tell her it was time to make biscuits. She would self-regulate her emotions without further pharmaceutical intervention.
All staff members know all residents’ life stories and are empowered to use that knowledge. Staff members go along with the resident’s reality and do not try to reorient the person. If an individual exhibits unwanted behaviors, employees look for triggers, so they can come up with a solution and prevent it from happening in the future.
CNAs tell Spaulding it’s tough but rewarding to form such bonds with residents. Staff members must be willing to work “in the moment” and “critically think the entire time they are working with individuals,” she adds. “You create the environment and let it happen.”
Every afternoon, Christian Care serves ice cream as residents tire and start to exhibit sundowning behaviors. Ice cream, typically, holds good memories for folks.
It takes more than a year to fully implement and consistently practice the Best Friends approach, Spaulding says. Leaders encourage creativity. In buildings that have fully implemented Best Friends, turnover is down. CNAs advocate for their residents.
“Having 100 percent of your staff be in relationship with these individuals is a tough thing to do, but I am pleased with the progress we have made,” Spaulding reports. “You can see the interaction, and it looks like family.”
A Multifaceted Team Approach
The Community at Brookmeade in Rhinebeck, NY, also emphasizes employees forming relationships with residents. The organization follows a full interdisciplinary approach called TEAM (Train Every Available Member), which includes housekeeping, dietary, maintenance and administrative staff. Life stories are posted outside the residents’ rooms, and any staff member can read it before entering the room and use that information to connect with the resident, perhaps commenting on the resident being a Mets fan or having worked in a certain industry.
Everyone completes the Centers for Medicare & Medicaid Services “Hand in Hand” education program and knows how to successfully interact with residents, some of who may call the clouds purple or carry on a conversation with a dead relative. For instance, staff members are trained to respond to a woman who wants to meet her children at the bus by walking her out to the garden and a bench near a “bus stop” sign.
“Whatever the resident’s reality is, is where we focus,” says Karen Zobel, CEO/administrator of the Community at Brookmeade.
Zobel reports that staff members from various departments appreciate the opportunity to engage with residents. Their jobs become more than tasks to do.
“They enjoy connecting with individuals,” Zobel says.
The training includes connecting while maintaining boundaries and remembering that the staff member is the professional and is there to provide customer service and hospitality for the resident. While the training requires time, Zobel considers it a good use of resources, saying that the residents’ improved quality of life more than compensates for any expenses associated with the training.
The Community also has implemented the NEW DAY (Nurturing Everyone With Diverse Activities Year-round) program, a person-centered activities initiative that offers residents the liberty to pursue different leisure activities in a nurturing environment seven days per week. Residents of all abilities attend and are completing a variety of activities in different parts of the room. Some may be squeezing toys or folding linens, while others will cut photos from magazines to make collages. Higher functioning residents may play scrabble or bingo.
To make personal care easier, The Community created a spa, where residents can get pampered by volunteers. Music plays. Women get their nails done. Men get a shave. Folks drink coffee. Some receive a massage.
Other activities include Explorations in Art and Music is My Life programs. The organization has hired a professional chef to prepare meals. He also runs a couple of programs related to cooking.
“There can’t be just one activity; there has to be a number of things to meet the needs of the many,” Zobel advises. “Not everything is for everyone.”
If something does not work the first time, Zobel recommends trying again.
“Treat everyone how you would want to be treated,” Zobel concludes. “It’s that simple.”
The Montessori Approach for Aging and Dementia
Clark Retirement Community in Grand Rapids, MI, has started using the Montessori for Aging and Dementia method. It focuses on giving residents roles and activities they can successfully do, often something they had done in the past, explains Chris Simons, director of dementia and life services at Clark.
“We like the concept of people living with dementia who have a life and still can do things,” Simons says. “I thought this was a wonderful way to introduce activities they can do on their own. It’s a wonderful relationship-builder with the staff and residents. The staff person can sit down and watch or help the resident do the activity. We see residents helping each other as well.”
As with the other programs mentioned in this article, Clark completes an assessment about the resident’s life, which can be used to come up with activities that individual might enjoy doing at Clark.
“The residents are capable of doing much more than we may think they can do,” Simons says. “This program helps staff members see the residents have strengths.”
Clark provides staff training about the approach. Montessori offers staff members something to do with the residents besides caregiving tasks, and that builds relationships. Montessori activities may include folding towels, matching socks, putting nuts and bolts together or completing other similar tasks they were familiar doing in the past. Two residents take care of two garden areas; the woman also designs floral arrangements.
“We have all 40 residents coming out of their rooms,” Simons says. “There is always something for them to do. Our goal is to establish goals for each resident.”
Programming is built around the residents’ interests. For example, two residents who played the piano as younger women, one in church and the other with the Boston USO, now play together. As one woman’s skills deteriorated, Simons paired them on the piano, and the two women helped each other. Both women also sing in the choir.
“We’re trying to create a sense of purpose,” Simons says. “It helps their self-esteem, and they feel part of a community.”
Montessori also offers techniques for staff members to learn how to enable residents to do more of their personal care themselves, Simons says. Staff members learn that the residents still have value and a quality of life. Families can attend Montessori classes, so they can learn ways to interact with their loved one. Volunteers from independent units are now interacting with residents on the dementia unit.
As word has spread about the program, it has attracted staff and interns to Clark. Simons says caregivers want to do more than the caregiving tasks. They can work with residents in more meaningful ways.
“The residents experience joy, dignity and connections,” Simons says. “It changes the relationship between the staff person and the resident.”
Connections Matter in HCBS
While long-term care communities often become home for residents, community-based services enable many older adults to remain in their own homes and receive the services they need. Making connections between clients and staff is no less important in home and community-based services.
Well-Spring Solutions in Greensboro, NC, has embraced person-centered care at its Day Advantage & Connections day center. As new members join the program, staff members complete an assessment and a life profile, with likes, dislikes and interests.
“It’s the relationship that makes person-centered care, and every one of our staff members do an amazing job of connecting with our members,” says Anita Brock-Carter, director of Day Advantage & Connections for Well-Spring. “They become a part of our family, and we become a part of their family. We are able to convey that each person is special.”
Staff uses the information to tailor activities and care plans to the individual.
“We recognize that each person who attends our center is an individual with unique wants and needs,” says Jon Bullington, program coordinator at Day Advantage. “We strive to learn those needs and how to better serve each person based on those needs.”
Another way employees connect with members may be to share something personal about themselves, such as Bullington talking about his new baby or someone discussing things to which members can relate.
“It’s a window to walk into a conversation,” he said.
The focus remains on the member and making meaningful connections with him or her.
“Our goal at Well-Spring Solutions is to discover the gifts within each person and provide an atmosphere that exceeds their needs and expectations,” Brock-Carter says.
Debra Wood, R.N., is a writer who lives in Orlando, FL.