Person Centered Care and Dementia Care PDF

Person Centered Care and Dementia Care Supporting Clients who are Living with Dementia  It is important to remember that a person with dementia may not experience all the symptoms of this diagnosis. Though dementia can affect several different area of the brain, but not always at...

Person Centered Care and Dementia Care Supporting Clients who are Living with Dementia  It is important to remember that a person with dementia may not experience all the symptoms of this diagnosis. Though dementia can affect several different area of the brain, but not always at the same time. By understanding the reasons for the changes in behavior of a person living with dementia, we can improve our ability to support and help the person make use of their remaining abilities.  The group of symptoms that commonly appear in individuals with dementia are referred to as the 8 A’s of Dementia.  Amnesia Agnosia Aphasia Anosognosia Altered Attention Apraxia Apathy Perception Deficits The 8 A’s of Dementia  Amnesia Definition: Pathological Key Features: Strategies for HCAs: forgetfulness. Loss of memory. A person with dementia May forget and Keep routine not remember later, especially things Repeat as needed that happened more recently. Provide visual cues The last thing learned is the first thing lost. Try an agenda, calendar, white board The person may ask and repeat the same questions and comments  Agnosia Definition: Loss of the ability Key Features: Strategies for HCAs: to recognize people, sounds, objects and their purpose Loss of recognition crosses all senses Introduce yourself such as vision, hearing, smell, touch and Offer one item at the time taste. Demonstrate use of objects A person with dementia may have trouble understanding the meaning of Use other senses what is seen. Heard smelled touched and taste. The person may not recognize familiar faces. The person loses recognition of people in the order that they last came into their life  Aphasia Definition: Loss of language. Key Features: Strategies for HCAs: Includes impaired speech and/or comprehension. A person with dementia may have Use gestures & visuals difficulty both expressing their self and Give directions clearly understanding what is said. Speak slowly, shorter phrases These losses are unique to each person. Patient, positive body language Do not assume that the person understands what you were saying just because they can speak. Also do not assume the person does not understand if they cannot express themselves Anosognosia Definition: Loss of self- Key Features: Strategies for HCAs: awareness. The person with dementia doesn’t know they know don’t know. A person with dementia may be unaware Validate concerns & feelings of the changes caused by the disease Avoid challenging the person process. Try personal safety devices The person does not recognize the effects of the disease on their daily Try visual aids, whiteboards functioning. They may be unaware of the problems with insight, judgment, planning, controlling, impulses, concentration and attention  Apraxia Definition: Loss of purposeful Key Features: Strategies for HCAs: movement. Loss of ability to plan, sequence and execute steps. A person with dementia loses the ability Simplify the task to plan and carry out the steps of a Focus on 1 instruction at the time particular task in the correct order even though they are physically capable of Demonstrate actions performing them. Use previous routines Every task has an order and the person loses the ability to organize the sequence. Apraxia is often a combination of not recognizing items or how to use them  Altered Perception Definition: Loss of perceptual Key Features: Strategies for HCAs: abilities including depth perception, 3D, and acuity causing illusions. A person with dementia is often Visible, large print signage misperceiving what they see or hear to Contrast to highlight or diminish be something it is not. Keep lights on & use dimmer Some people may see or hear things that do not exist Eliminate shadows.  Attention Deficits Definition: Inability to sustain Key Features: Strategies for HCAs: or shift attention. Easily distracted or perseverates. A person with dementia often has Only one person speaking difficulty maintaining attention and is Reduce distractions and noises easily distracted Use smaller visitor groups Present one item at the time  Apathy Definition: Loss of initiative Key Features: Strategies for HCAs: and motivation. Does not occur to the person participate. A person with dementia may not be able Assist with task initiation to initiate an activity on their own, but Keep activity props nearby can engage in conversation or activity if someone else begins. Offer verbal cues Apathy is sometimes interpreted as a Utilize remaining strengths symptom of depression. The difference is that a person may participate if engaged by someone else. It is not because the person does not want to engage, but rather because they lost the ability to initiate Providing DIPPS for the Client Living with Dementia Dignity Dementia-driven behaviors (e.g., forgetfulness, agitation) are not under the client’s control. Treat clients with respect, patience, and calmness. Always explain care procedures clearly. In the advanced stages of dementia, they may not know or be able to exercise their rights, but they are still entitled to them. Avoid making clients feel embarrassed or ashamed; maintain their dignity during care. The dementia is responsible, not the client. Independence Encourage autonomy and support clients in doing what they can for themselves, as long as it is safe. Individualized Care Adapt care to align with the client’s preferences, strengths, limitations, and emotional needs. Understand emotional cues, especially when language skills are diminished, to meet their preferences and alleviate fears. Preferences Honor personal choices, even in moderate to advanced stages of dementia (e.g., selecting clothes or keeping meaningful items). Avoid removing items that provide comfort or security, even if the client can no longer articulate their importance Privacy Respect the client’s right to privacy and confidentiality. Avoid sharing personal details or stories about their behavior unnecessarily. Safety Maintain a calm and safe environment to enhance quality of life. Use restraints only as a last resort under a physician’s order and not for staff convenience, as restraints can worsen agitation.  Providing Safe, PCC for Clients with Dementia Maintain a Safe Environment: Clients with dementia often do not recognize hazards, making them prone to falls and injuries. Remove or secure harmful items (e.g., sharp objects, electrical equipment, and chemicals) to minimize risks. Maintain Lock doors to hazardous areas like kitchens, utility rooms, and housekeeping closets. Provide Reassurance and Communication: Clients may feel fearful or disoriented even in safe environments. Use a calm, soothing voice and explain actions clearly and repeatedly. Provide Avoid using force or restraint if a client becomes agitated or combative; instead, reassure them until help arrives. Implement Preventive Measures: Use unbreakable eating utensils and safety plugs in outlets to reduce injury risks. Implement Store personal care items, medications, and smoking materials securely to prevent misuse. Supervise Risky Activities: Closely monitor clients during activities like smoking to ensure their safety. Supervise Supervise movement to prevent falls and gently redirect them from unsafe areas.  Providing Safe, PCC for Clients with Dementia, cont. Promote Fall Prevention: Keep walkways clear of clutter and ensure proper lighting. Promote Use non-slip mats, handrails, and other aids to reduce fall risks. Encourage Safe Independence: Provide tools that enable safe independence, such as adaptive utensils or assistive devices. Encourage Offer verbal and physical cues to guide clients through tasks without exposing them to hazards. Engage Family and Caregivers: Educate family members about safety measures and alternatives to restraints. Engage Encourage collaboration to create a safe, supportive environment at home or in care settings. Monitor Behavioral Triggers: Identify and address triggers for aggression or agitation, such as loud noises, unfamiliar settings, or discomfort. Monitor Redirect clients to calm, familiar spaces when agitation arises. Prepare for Emergencies: Ensure fire safety measures are in place, such as smoke detectors and fire extinguishers. Prepare Have an emergency plan for situations like falls, choking, or fires.  Adapt to Cognitive Create a Calm Promote Frequent, Encourage Personalize the Address Resistance Monitor Nutritional Engage and and Physical Environment: Small Meals: Hydration: Dining Experience: with Compassion: Intake: Stimulate: Abilities: Clients with later- Minimize noise and Offer smaller Clients with Seat clients with Use gentle Be aware of clients' Provide simple stage dementia may distractions to help portions throughout moderate to severe similar cognitive redirection for dietary preferences conversation or forget how to use clients focus on the day for clients dementia may not abilities together to clients who resist and restrictions. gentle prompts utensils; offer eating. who struggle to sit recognize thirst. encourage eating, focusing on Offer foods they during meals to finger foods to Arrange for special through a full meal. Regularly offer socialization. creating a positive enjoy to encourage help clients stay promote mealtimes or Ensure meals are fluids and keep Consider using mealtime eating. engaged and independence. quieter dining visually appealing beverages easily brightly colored experience. Track their intake focused on eating. Those with spaces for those and easy to handle. accessible. plates or utensils to For those who to identify any signs difficulty who find crowds Adequate hydration help clients with become agitated, of malnutrition or swallowing may overwhelming. helps prevent visual or perceptual take a short break dehydration. require modified complications such difficulties identify and return when textures or feeding as UTIs and food items. they are calmer. assistance. constipation. Be patient and understanding with clients who resist assistance or display challenging behaviors like throwing or spitting food. PCC Dementia Care in the Dining Room What the HCA Needs to Know Before Providing Care in the Dining Room  Too much stimulation like increased crowds and noise may cause a person with dementia to have difficulty focusing on the task of eating.  Too many items on the table can cause confusion. Residents may get distracted or frustrated and leave the dining room.  Some residents May no longer understand or remember appropriate dining behavior. They may have difficulty using utensils or they may collect items on the table.  Some people with dementia do not know what to do and they might mix all of their meal options together How the HCA can Provide Care in the Dining Room  Minimize distractions by setting the table with only the required utensils. Turn off the television and music.  Serve only one part of the meal at a time.  Offer something to eat or drink when residents arrive so they have something to keep them occupied.  Seat residents of similar cognitive abilities together and help residents Converse with one another.  If a resident finds crowds and noise overwhelming, consider serving their meals earlier or later than the designated mealtime  To promote Independence for residents who have difficulty with utensils, consider providing smaller portions throughout the day or offering finger foods Case Study  Mrs. Andreas often forgets that she is already eaten. Sometimes she eats too much of her meal in the dining room. Other times she tells me that she has no money to pay for her meal, so she doesn't want to eat it. Today Mrs. Andreas walked away from the table while she was waiting for her soup to arrive.  What are the two A’s she is exhibiting?  What are some of the support strategies HCAs can implement? Encourage Address Follow Create Adapt Provide Promote Monitor Incorporate Encourage Address Follow the Create a Adapt Provide Promote Monitor for Incorporate Activity and Resistance Care Plan: Positive Activities to Gentle Social Signs of Routine: Movement: with Adhere to the Environment: Abilities: Encourageme Interaction: Discomfort: Schedule Physical activity Patience: client’s Ensure the Choose nt: Engage clients Watch for signs activities at is essential to Clients may individualized activity setting activities that Offer verbal in group of fatigue, consistent reduce the risk resist activities care plan, is quiet and match the cues and activities with agitation, or times to build of due to which outlines free of client’s physical demonstrations peers of similar pain, and adjust familiarity and complications confusion or suitable distractions to and cognitive to guide clients. abilities to the activity reduce like pneumonia fear of harm, activities based reduce anxiety. capabilities, foster a sense accordingly. resistance. on their Celebrate small and pressure becoming Use simple and such as chair successes to of community. Allow rest Gradually injuries. agitated or abilities, clear exercises, Encourage breaks and introduce new preferences, build Avoid forcing combative. instructions to walking, or confidence and family modify activities to clients to and needs. help clients light stretching. involvement in exercises to ensure comfort Remain calm, willingness to participate; reassuring, and understand Focus on participate. activities, accommodate and respect their patient when what is activities that which can the client’s acceptance. preferences and encouraging happening. bring joy or provide comfort needs. fears. participation. meaning, such and familiarity. as music, art, or reminiscence therapy. PCC Dementia Care During Activities What the HCA Needs to Know Before Providing Care During Activities  Some people with dementia may be confused and forget what loud noises mean.  Reactions to loud noises can vary from person to person ranging from fright and withdrawal to anger and frustration.  Loud noises or other types of stimulation during activities may trigger memories from the past. For example, some may think the fire alarm is a wartime air siren How the HCA can Provide Care During Activities  Keep calm and relaxed.  Consider seating residents who may feel overwhelmed by loud noises or crowds at the end of a row so that you can easily move them and reassure them if required.  Document and communicate to staff on the next shift that loud noises or an event that occurred so that they are aware of any changes in behavior.  Encourage new staff and volunteers to ask current staff how to encourage a person with dementia to attend an activity. A family member's name may motivate the resident to attend for example "Ingrid your wife told me that you like music"  Consult documents such as "All About Me" or other forms used by the agency that are usually completed by the family or other caregivers. This information about the person's backgrounds likes dislikes routines and other special considerations Case Study  During the bath day, Mr. Pavlovich thought the bathtub had no bottom, which frightened and upset him later. Later in the day just before a concert in the large gathering room, I saw him sitting in his wheelchair, in the hallway. He seemed content, but I know he loves music and would like to attend a concert. The HCA explained to the agency volunteers that Mr. Pavlovich is unable to initiate activities on his own, so they brought him to the front of the room. During the concert, the guitars stand fell over and made a loud sound. These startled. Mr. Pavlovich, and he was visibly upset. Before immigrating to Canada, he lived in a war zone, so he thought that the loud sound was a bomb.  What are the two A’s he is exhibiting?  What are some of the support strategies HCAs can implement?  Assist Monitor Respond Support Create Use Prevent Ensure Prevent Address Assist with Monitor for Respond to Support Create a Use Prevent Ensure Prevent Skin Address Hygiene and Pain or Resistance Elimination Comfortable Individualize Resistance Dignity: Breakdown: Behavioral Infection Discomfort: with Needs: Environment d During Care: Handle Regularly Challenges: Prevention: Observe for Patience: Provide : Approaches: Use positive accidents check for skin For clients Clients with signs of Clients may frequent and Ensure Adapt your reinforcement discreetly and issues like urinating in moderate or conditions resist regular privacy and approach and validate compassionat dryness, inappropriate severe causing pain personal care assistance for maintain a based on the the client’s ely. Avoid redness, or places or dementia may (e.g., skin due to fear or elimination to calm, client’s feelings. scolding or sores, and removing not lesions, ill- confusion, prevent soothing preferences Explain what showing take incontinence understand fitting becoming accidents and atmosphere and care you are doing frustration. preventive products, the need for clothing, or agitated, maintain to reduce fear plan. Use step by step, Encourage measures maintain a hygiene and dental issues) combative, or dignity. and anxiety. familiar using a calm independence such as regular rely on HCAs during distressed. Offer perineal routines to and where moisturizing toileting Use warm and ensuring to maintain personal care. Remain calm, care after water and foster reassuring possible, such schedule and cleanliness Address these urinary and cooperation. tone. as allowing clean, dry use visual or explain soft materials skin. and prevent issues actions fecal during Offer the client to verbal cues to infections. promptly to clearly, and elimination, personal care distractions wash parts of guide them to Assist with enhance use gentle, and never to enhance like music or their body if the handwashing comfort and slow restrict fluids comfort. conversation they are able. bathroom. after prevent movements to to control to ease Seek support toileting, agitation. avoid causing elimination. agitation. from coughing, skin tears. supervisors sneezing, for persistent eating, or any challenges or time hands resistance. are soiled. PCC Dementia Care During Personal Care What the HCA Needs to Know Before Providing Care During Personal Care  Some people with dementia may lose interest or forget good hygiene like brushing their teeth, bathing using the toilet or changing their clothes  Due to decline in memory, coordination and the ability to sequence activities. People with dementia may not know where to start or continue activities like getting dressed.  As the symptoms of dementia progress. A decline in physical capabilities can affect their ability to independently perform daily activities like showering.  People with dementia may also experience abrupt changes in their mood and they may feel confused or frightened by the shower or bathing equipment.  The lack of privacy and loss of dignity can make personal care, especially challenging for the person with dementia How the HCA can Provide Care During Personal Care  Involve family members to help with dressing, bathing and oral care. Staff could ask Ms. Cullen's daughter who helped bathe her mother for the past 3 years to come to the first few baths to help her with the transition and help Ms. Cullen become more comfortable with a new person, bathing her  Learn techniques and preferences from family members. Ms. Cullens daughters know that she prefers a washcloth over her eyes when washing her hair. Doesn't like getting her hair wet and likes cream on her body after a bath  Give Ms. Collins cues on how to brush her teeth and get dressed.  Use the hand under hand technique for brushing teeth, combing hair and buttoning clothes Case Study  This morning, Miss Cullen dressed herself and put on three dresses, one on top of the other. Later in the washroom. She didn't recognize her toothbrush and tried brushing her hair with it. When it was time to wash, Miss Cullen was very confused about the bathing equipment, which made this daily task very stressful for both her and the HCA.  What are the two A’s she is exhibiting?  What are some of the support strategies HCAs can implement?  Address Enhance Promote Create Provide Adapt Monitor Ensure Encourage Address Enhance Promote Create a Calm Provide Adapt to Monitor for Ensure Encourage Physical and Sleep Daytime Environment: Reassurance: Individual Underlying Safety: Gradual Safety Needs: Routine: Activity for Ensure the Use a calm and Needs: Issues: Arrange Transitions: Disoriented Follow Better Sleep: bedroom is soothing tone to Tailor bedtime Look for signs furniture to If the client clients rely on consistent Limit caffeine comfortable, ease anxiety routines to the of pain, minimize the resists going to HCAs to meet bedtime rituals intake to avoid with dim and client’s discomfort, or risk of falls. bed, allow time their needs due to create sleep lighting and disorientation preferences, medical issues Provide visual for them to to their familiarity and disturbances. minimal before such as specific (e.g., restless cues, such as settle down impaired reduce stress. clutter. bedtime. nighttime legs, urinary clearly labeled gradually. Discourage naps decision-making Use night lights and encourage Address any Offer activities or discomfort) doors or Use gentle and memory. to prevent physical activity factors that comforting familiar objects that may pathways, to redirection if Fatigue and accidents and during the day may contribute routines, such like a favorite prevent restful reduce they become visual changes, disorientation. to support a to discomfort, as reading a blanket. sleep, and nighttime agitated or common in Reduce healthy sleep- such as room book or playing address them confusion. insist on staying dementia, can environmental wake cycle. temperature, soft music. promptly. awake. cause stress and noise to noise, or increase promote a calm clothing. nighttime and soothing confusion. atmosphere. PCC Dementia Care During Bedtime What the HCA Needs to Know Before Providing Care During Bedtime  People with dementia thrive on consistent routines. Changes can cause confusion and agitation  Dim lighting, noise, and clutter in the bedroom can increase restlessness and anxiety.  Unfamiliar objects or clothing may be misinterpreted or rejected, leading to resistance.  Some residents may experience increased confusion or agitation in the evening, such as sundowning, which can disrupt bedtime routines.  Residents might not verbalize their fears or discomfort but instead resist care. How the HCA can Provide Care During Bedtime  Create a calming environment. Use warm lighting and reduce noise or distractions. Ensure the bedroom is free of clutter and objects that may appear unfamiliar or frightening.  Follow a consistent bedtime schedule and familiar pre-sleep rituals (e.g., listening to a book or listening to soothing music).  Provide reassurance. Use calm, soothing language and validate the resident’s feelings.  Gently redirect when they express concerns, such as going to work, by saying, "Your shift is covered, and now it’s time to rest."  Support independence. Allow the resident to participate in tasks they can manage, such as choosing their pajamas or turning down their bed.  Address sensory needs. Offer familiar and comfortable clothing and bedding to reduce misinterpretations. Case Study  Mrs. Robinson, a resident with moderate dementia, often becomes restless at bedtime. Tonight, she repeatedly tells the HCA that she has to "go to work" and refuses to get into bed. She occasionally accuses the HCA of "stealing her blanket" when the HCA tries to adjust it for her. When Mrs. Robinson finally gets into bed, she removes her pajamas, stating that she "can’t sleep in strange clothes.  What are the two A’s she is exhibiting?  What are some of the support strategies HCAs can implement?  Address Ensure Communicate Create Use Adapt Provide Follow Monitor Engage Address Ensure Communicat Create a Use Gentle, Adapt to the Provide Follow Monitor for Engage the Cognitive Safety: e Clearly: Calm Patient Client’s Reassurance Individualize Signs of Client: and Physical Follow proper Explain each Environment Approaches: Abilities: : d Care Discomfort: Talk to the Limitations: lift and step of the : Avoid rushing; Encourage the Validate the Plans: Watch for client during Clients with transfer transfer Minimize take time to client to client’s Adhere to the signs of pain, the transfer dementia may techniques as calmly and in distractions ensure the assist with feelings and client’s fear, or to keep them not outlined in simple terms, and noise to client feels the transfer explain the specific lift agitation calm and understand the client’s even if the help the secure. as much as purpose of and transfer during the engaged. the purpose care plan to client may client focus If the client they are able, the transfer plan, as it transfer and Simple of lifts or prevent not fully and feel at resists, pause promoting (e.g., "We’re accounts for address these reassurances transfers, injuries to understand. ease during and try gentle independence moving you to their physical immediately. or light leading to both the Use a the transfer. redirection or and reducing a comfortable and cognitive Adjust the conversation resistance, client and the soothing tone reassurance anxiety. chair to needs. process as can help caregiver. Ensure the distract and fear, or and positive space is free before Tailor your relax"). Use the needed to agitation. Use body language continuing. approach to Use touch and enhance comfort of obstacles equipment them. Reduced appropriate to ease fear and well-lit to their physical eye contact specified in comfort and mobility, equipment, or anxiety. reduce and cognitive to build trust the care plan safety. disorientation such as disorientation capabilities. and reduce and ensure it , and anxiety mechanical. fear. is functioning can lifts, to correctly. complicate ensure safe the process. and smooth transfers. PCC Dementia Care During Lifts and Transfers What the HCA Needs to Know Before Providing Care During Lifts & Transfers  The resident could be unaware of the changes in their physical condition and may not understand what the lift is for.  The resident may be at higher risk for falls if they walk or transfer without assistance. This risk May further increase if they are incontinent and try to go to the bathroom without assistance.  Understanding instructions may be difficult.  The use of restraints may result in behaviors such as restlessness, calling out or grabbing other people How the HCA can Provide Care During Lifts & Transfers  Ensure that the person with dementia understands what you want to do. Explain slowly one instruction at a time. Show what you are about to do.  Keep the room quiet and is free of distraction as possible.  Continually reassure and communicate with the person with dementia.  Help the person with dementia relax by making conversations about subjects of interest to them  Ensure two staff members are present when using the lift, one to operate the lift and one to prepare the wheelchair and reassure the person with dementia.  Ensure all alternatives have been tried before using restraints. They're to be used as a last resort.  Ensure that the person with dementia is comfortable and safe in the restraints. Check on them every hour and remove the restraint every 2 hours at a minimum or according to their care plan.  Review your long-term care homes policy on using restraints Case Study  Mrs. Robinson, a resident with moderate dementia, often becomes restless at bedtime. Tonight, she repeatedly tells the HCA that she has to "go to work" and refuses to get into bed. She occasionally accuses the HCA of "stealing her blanket" when the HCA tries to adjust it for her. When Mrs. Robinson finally gets into bed, she removes her pajamas, stating that she "can’t sleep in strange clothes.  What are the two A’s she is exhibiting?  What are some of the support strategies HCAs can implement?