This article is sponsored by SafelyYou. This article is based on a Senior Housing News discussion with Shirley Nickels, Chief Operating Officer at SafelyYou, Melissa Dillon, Corporate Director of Memory Care at Senior Resource Group (SRG), and Jim Altrichter, National VP of Clinical Services at Anthem Memory Care. The discussion took place on July 21, 2022 at the Senior Housing News BRAIN Conference in Chicago. The article below has been edited for length and clarity.
Shirley Nickels: Today, we’re going to talk about how to transform dementia care by uniting both clinical and programming standards, moving them from standard to stand out. I have two amazing panelists joining me: Melissa Dillon, who has a Master’s in Gerontology and is the Corporate Director of Memory Care at the Senior Resource Group, and Jim Altrichter, who is a Registered Nurse at Anthem Memory Care.
Let’s start with current standards in dementia care? We understand in dementia care that there are typically two primary pillars that need to be considered: a clinical pillar and a programming pillar. Can you each talk about your respective pillars and elaborate on what you consider as standard for each?
Jim Altrichter: From a nursing perspective, most clinicians are very well aware of regulatory requirements. Our standard of clinical care includes making sure that you are performing a comprehensive assessment of residents that come to live with you. In the clinical world, we look at the assessment as being a combination of what the physical presentations are, possible complications, and diagnoses that the person is presenting with. In our assessment document, we also look at and capture any psycho-social aspects that could impact that resident, when we are developing their plan of care. This includes a cultural review. With this information, we craft that blueprint for care.
Our process is to capture all of those elements through the assessment that our nurses perform for a resident at the get-go and from there, develop that care plan. For those of you who are nurses in this audience, we understand that there is a nursing process which includes assessing the individual, however sometimes we might have a tendency to jump right to that care plan. We have to pause and be sure that we’re collecting data, that we are thoroughly assessing that individual and that we’re actually creating the right goals and associated planning.
If a person is presenting in a certain way, I’m already thinking about the plan..oh my gosh, they’re a level two..they are going to need this..they have a continence issue.
As nurses, we are already going down that pathway and we probably haven’t really fully thought about who this person is and what outcomes we are really looking for with that resident. The bottom line is that we really try to stress following that nursing process, which includes the assessment, making some nursing diagnoses, and making some predictions about what this resident is going to really require. Then, finally the care plan is ultimately developed. As part of this evaluation, we need to ask ourselves if this was an effective assessment process.
From a regulatory perspective, various states require resident reassessments. Reassessments might need to occur every 14 days. It might be 7 days. It might be 30, or sometimes they might be required if there is a significant change of condition and then annually thereafter. The point being, is that regardless of what your state requires for that reassessment and reevaluation, you have to be sure that you are really in tune with what’s happening with that resident and be able to identify any changes that would then prompt you to reassess.
Nickels: Melissa, can you highlight from a programming perspective what this encompasses?
Melissa Dillon: I want to be very intentional about the utilization of the word programming. Oftentimes, it is interchangeable with life enrichment, activities, and engagement. I believe that programming is an umbrella that is covering everything that we do differently in memory care. Engagement in memory care may look a bit different than lifestyle engagement in independent living.
I think there are other pieces that we focus on to create a memory care program, like dining. We do things in dining a bit differently because they are necessary for the person living with dementia. We look at our living environment as a whole. What does this community represent, and what are the functionality pieces that we have to incorporate to make the resident feel good, loved and at home.
I always say that there’s something special about memory care. When you walk in, you can just feel it, there is love in this place. We ask ourselves, how do we actually quantify the living environment component of the program, to ensure that it is good for a person living with dementia.
Programming is a necessary part of our training. There’s clinical training, and then there is programming training.
For me, this training ensures that all of our team members truly understand what dementia is, what loving a person with dementia looks like, and understands how we connect and communicate with someone with dementia. When we marry the programming and clinical pillars, then we’re going to actually get to person-centered care.
Nickels: That’s what dementia care should be. It’s all about person-centered care. From my own experience, working with our operators, typically it feels like clinical and programming operate in silos and have limited resources. We need to address how we actually collaborate today.
I know this is what we want to get to. Jim, can you talk us through, when do you all actually work as collaborative entities as the pillars combine?
Altrichter: We can become comfortable in our silos. Sometimes if we operate in our own silos, the people that report to us or our care line staff, they see that and replicate that behavior. Silos aren’t necessarily bad, but you need to keep them in check.
The bottom line is that you have to have the ability to work in your silo to get the work done that is required, but not be so focused, that you are not considering programming and resident engagement.
Nickels: I once attended a transfer training with one of our operators, I really wanted to understand the transfer techniques, as we’ve witnessed falls from a poor transfer. I remember being lifted in a Hoyer. It’s extremely scary. I was sitting there thinking, “Wow, you guys just strapped me in, and moved me over.” I was wondering, “Where is that training for making sure that I’m comfortable? Where is that training to make sure that I’m ready?” The training instruction was, “We’re going to strap you in, lift and move you, and then you’re done.” How do we better incorporate clinical training with resident engagement? You want to have that feeling that you are integrating person-centered design.
Dillon: Right, because it’s more than just the clinical step of transferring someone safely. It’s secondarily, how have we connected, to ensure that we’ve met that person’s needs.
Nickels: Otherwise you would’ve had an event crisis, right?
Dillon: Yes. We’re usually not going to bring the two together until someone is so combative in the Hoyer, and they don’t let us do it. We need to find a way to do that from day one, that we agree with each other, that this partnership is person-centered care.
Each of us has a culture in our communities. We have a brand and brand standards in which we are trying to emulate. I feel like I will sing to the choir in this room that our cultures cannot be brochures, they are not alive and not real. They do have to be the living beings that we are with each other. At SRG, we introduced a culture called “leading with love.” Essentially we’re taking Teepa Snow’s coaching model, and attempting to empower our team members, instead of looking at tasks, whether it be care or engagement, or rather culturally, where are you coming from? If you work in memory care, you probably are there because you have a big heart. When you ask the team members, “Why did you pick this job? You could have picked an easier job.” The general answer is, “It’s my residents, I love these people.”
Altrichter: We have a community relations director in Minnesota, and she is the best salesperson we have. She’s the best life engagement director. She is the ambassador for that community. When she does her pre-move-in profile, she gets to know the person and the family. She’s built a relationship with the family before they even come into the community.
I got to know her and what she does, she’ll say to the nurse, “Hey, I’ve got this person. This is what they’re all about.” I’m not just talking about a paragraph of information. She comes to prospect meetings, armed with information from the needs assessment she has completed. She knows their background. She knows their culture.
You can imagine if you have that volume of information coming in at the outset and that person moves in today, and everybody is doing their jobs then and introducing caregivers and that profile of what that person is all about, how the move-in is just set up for success.
I’ve recently taken that experience and used that as the benchmark of what our move-in should be like. Not telling the CRDs necessarily what they should do, but using this as the standard for what our nurses should expect when a resident is handed off.
It’s definitely a live and learn sort of thing, but you’ve got to take and find those jewels in each of your communities and really exploit them. It is okay to set that as the new standard until something else makes it better.
Dillon: Not every operator has a memory care specialist. The person that is saying, “This is what memory care is, and this is what makes it different.” I’ve been fortunate to have a seat at the table as a clinician, and being able to raise my hand more consistently. We want to ensure that programming addresses all needs, because we love all of the people that stay with us. Our residents in memory care are residents that are less vocal. They can’t and don’t stand up for themselves. Having a voice allows me to stand up for so many people, which feels cool.
Nickels: Do you ever include non-clinical staff as part of the assessment in care plan development?
Altrichter: We do. When we start an initial assessment, for example, for a prospect of moving in, as I mentioned earlier, our community relations director is that first person that engages that person. They bring that information back, and then, if all goes well, and it looks fine, then, in our world, the clinical services director nurse visits and does that nursing assessment piece. That’s just validating and verifying that they’re meeting appropriateness for our setting, basically, from the regulations.
If at that point, they are deemed appropriate to move in, then other people come in, dining service director, environmental, they’re all brought into that day one of move-in where they’re meeting and establishing a relationship with that power of attorney, in our case, certainly, the resident, and so on. There’s that first, initial thing. What we do subsequent to that is that the care planning process, the care conferences, whatever you might call them, they’re done periodically. That’s where we cast a broad net. In our care conferences, it’s just not a nursing thing.
Nickels: During the last panel, we were talking about empathy, and when you’re interviewing your care team, you’re looking at the individual who has empathy. Some of it is also that you have to continuously create empathy and that type of training. Even with that empathy comes intuition, dementia care can be extremely difficult. You need to train on that, and what it has to do with person-centeredness. Can you highlight how you try and enable that for your caregivers?
Dillon: As an example, if I am a resident living in your community and I am at your door, pounding on it saying, “I want to get out of here.” If anyone comes up to me and says, “Melissa, this is your home now.” That is not going to work for me. If you know me, and you love me, you will know that I am from the state of Arizona, where it is hot and I like being warm. If I am in a cold space, I will be exit seeking.
Altrichter: I think that we’re all largely doing our very best to address empathy. You will find those individuals in your community that do pretty darn good, then others that don’t get what that means. Number one, I always talk to our clinical service directors and our executive directors. We all probably check the boxes as is required by the state to deliver some sort of training.
What we have tried to do over the last year at Anthem is to take those training requirements and make them our own. In the past, we used a computer-based training program company who shall go nameless. We just left that aside and we created our own training. We knew that we were missing the boat on making sure that our employees really understood what it was like to have dementia and how to anticipate their reaction.
When somebody is really anxious, when they’re ramping up and they’re heading for the exit door or engaging another resident physically, you have to be able to really look before that happens and start putting the pieces together and say, “What are we going to do? How can we engage them in something different?” The point being is that take a look at how you are educating your team members. I’m not saying you shouldn’t use a computer-based training program, but make sure that whatever training you use, make sure that it’s being facilitated and that you’re not just sitting people in front of a computer as we did maybe in the past.
It has to be brought home, and I can’t speak enough to the fact that you’ve got to walk the talk. That’s what I talk about incessantly with our CSDs about, if you are having trouble communicating or think your staff are communicating poorly or inaccurately or inappropriately with your residents, then look at yourself first and see how you’re doing that and so on.
Nickels: It sounds like we need to spend more time on how to predict what might happen versus how to redirect them. I don’t think we emphasize human prediction enough. We train on different tactics instead. How do you enable technology to become predictive about human behavior? We know that there’s predictive technologies on the market today and those types of technologies definitely require humans to interpret it. How do you use it?
Altrichter: Combining community growth, its size, the number of communities or number of residents with the complexities we’ve all experienced over the last two and a half years, technology has proven and needs to continue to prove itself. In our portfolio, we have motion detection throughout the community, we have employed communication tools, and an electronic health record. The point is that whatever technology you use, you have to use it and it has to show benefits.
Dillon: I remember a resident in one of our communities when we were working with SafelyYou. She was consistently found on the floor every single day. I think without the technology, it would’ve taken us a very long time to understand why this person was on the floor. Because we had the technology, we could easily see that there was no fall and that the resident was quite limber. We discovered through the technology and our discussions that she was an avid quilter and she sat on the floor. The technology helped us understand that she needed better engagement and connection. The engagement leader started working paper quilting with her. I had never seen this before. It is very cool. The resident was able to do the paper quilting and then she was no longer on the floor.
Altrichter: We’re doing a pilot with SafelyYou in four communities. One of them is in Bridge. I was over there yesterday and talking with the clinical service director. I said, “Tell me about SafelyYou. How’s it going?” She goes, “I love it, obviously. It doesn’t necessarily prevent our residents from falling,” but she says, “I love it because I see how my nurses and my caregivers are responding. When an event happens, and the recording is there, and I review that recording,” she says, “the value to me is in that teaching opportunity.”
“We have re-educated on gait belt use, we’ve re-educated on transfer training in general, we’ve re-educated on our own motion detection systems and how they can and they should be collaborative between the two technologies.” The bottom line is that, if you’re going to have technology, you have to leverage it.
SafelyYou is empowering safer dementia care with world-leading AI video technology and 24/7 remote clinical experts. To learn more, visit: https://safely-you.com.