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Schedules-and-Routines

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					Developing Scheduled &
  routines that Work
            Creating a
        Culture of Change
         for People Living
      with Cognitive Changes

   Its not a Nursing Home or Facility
It’s a HOME where nursing care is given
                    Design Each Day

                                                                                   Offer a variety
 Make a                                                                            of activities
 schedule and                                                                      every day
 follow it
                                                                                    Leisure, work,
  Be structured                                                                     rest, self-care,
   BUT allow                                                                       groups and 1:1,
    flexibility                                                                      passive and
                                                                                         active
                    8 am – coffee circle
                    8:30 – songs of joy
                    9 am – time to ‘go’                                            Create a FLOW
Create Group        9:15 – take a hike – walk’n’roll                               for the day
schedules           10 am – cool down & stretch
                    10:30 – watering hole
                                                                                      Build up and
      BUT           11 am - ‘use your brains’ games
                    11:30 - time to ‘go’ – wash up                                  then slow down
   also build
   individual       11:45 – ‘set-‘em up’ crew
                    12 noon – let’s eat                                                Circadian
   schedules
                    12:30 – clean up crew                                              rhythms
                    1 pm – music and meditation
 Not everything     1:30 – coupons clipping
is for everybody!   2 pm – time to ‘go’
                    2:15 – let’s dance

                                                           Build a Foundation
                                                        of Familiar and Favorite
                                                                Activities

                                                                 Add a few
                                                       special events and something
                                                                  different
                       Understand Activities


                    What type of activity is it???
                    Self-care, leisure, work, rest…
                  Spiritual, social, physical, cognitive,
                         passive, active, solitary




                                                                 What is the
Analyze the
                                                                 activity all
 Activity…
                                                                  about?
What do you
need to do                                                          Doing
                                                                  something
     it?
                                                                     or
What skills,
                                                                   making
  abilities,
                                                                 something?
 interests?




                   Modify and Structure the Activity for
                                   Success
                 Change the materials, the complexity, the
               setting, the help offered, the task demands, or
                          the purpose of the activity
 Enough Supplies      The right
   & Materials     equipment for
                   clients’ needs




                       Skilled
  Good quality     leadership for
    lighting         the activity




                     Seating that
    Good work
                       works
     surfaces




Enough help for
                   A BACK-UP
 each person
                      Plan
      Traditional Facility Care
•   Run by administrators & nurses
•   Organized around staffing
•   Work shared among 3 shifts of staff
•   Safety and health care issues TOP
    PRIORITY
•   Medical model
•   Organized by departments – task specific
•   You are sick – you need care for your
    diagnosis
•   Father knows best!
 What’s Wrong with this Model?
• Who wants to live in a hospital?
• Who wants to do everything you are
  supposed to?
• Who wants to have someone else
  telling what to do and when to do it?
• Who wants to have to talk to three
  different people to get something
  done?
• Who wants to live in a nursing home?
    For People with Changes in
        Health and Abilities
• Need for help
• Need for equipment
• Need for changes in routines & habits
• Need to match needs with availability
  of help
• Need to ‘anticipate’ when and where
  you will do things, need things
     Cognitive Changes with
             Aging
•   slowed processing
•   less flexibility
•   more difficulty with new learning
•   more rehearsals needed
•   benign forgetfulness – immediate
    recall goes first
    Emotional Changes with Aging

•    increased incidence of depression
•    increased incidence of anxiety
•    with stress – mood swings
•    with some drugs – emotional side
     effects
    What Does Having Cognitive
     Abilities Do To This Whole
          System of Care?

•   Changes in memory & thinking
•   Changes in understanding & speaking
•   Changes in impulsivity & initiation
•   Changes in abilities & processing
    So Let’s Figure YOU Out…
• What time do you wake     •   When do you toilet?
  up?                       •   What do you do for work?
• How do you wake up?       •   What do you do for fun?
• What do you do when       •   What do you do when you
  you wake up?                  are stressed?
• When do you eat           •   ID two people you love…
  breakfast?                •   Where are you from?
• What do you eat for       •   What is your favorite food?
  breakfast?
                            •   What do you HATE to eat?
• How do you get ‘clean’?
• When do you get clean?
              Questions
• How would you DO    • How would you do
  living in your        on someone else
  community?            schedule?
• What would it be    • What would NOT be
  like if you had       OK?
  physical changes?   • What if it was the
• What about            rest of your life?
  cognitive           • What would you
  impairments?          want?
What is Veteran-Centered Care?

Combination of…         Balanced with…
• Person’s wants        •   Staff skills
• Person’s needs        •   Staff availability
• Still can do          •   Private space
• Can’t do              •   Public space
• Can do with support   •   People resources
• Individual good       •   Equipment resources
• Common good           •   Safety & Security
• Family needs          •   Rules & regulations
• Family wants          •   Others needs and wants
    Personal Preferences & Values
•   Who have you been?
•   What did you value?
•   Who are you now?
•   What do you value now?
•   Why does it matter?
•   Who gets a ‘say’?
•   Who gets to set the priorities?
Who Matters?

   All of Us
  Each of Us
        What Matters – When
       Illnesses Are Present?
•   Safety – Environmental modifications
•   Access - Availability
•   Timeliness of help
•   Flexibility in timing
•   Structure & predictability
•   Privacy and respect
•   Preservation of SELF
               Key Steps
•   Connect
•   Gather Information
•   Share Information
•   Use Information
•   Review Information
•   Make Changes
What About Medical Conditions?

What is essential?          What is optional?
• Good care is delivered    • When it is done
• The person is receiving   • Where it is done
  the care they need and
  want                      • Who does it
• Conditions are            • How often it is done
  assessed                  • How strictly it is
• Decisions are made          followed
  based on good info        • It depends on the
• There is agreement on       person & their situation
  what to do and what
  NOT to do…
     What are the Different Care
     Approaches to Consider?
•   Health Promotion
•   Curative
•   Restorative - Rehabilitative
•   Maintenance
•   Compensatory
•   Palliative
           Health Promotion
•   Check Ups
•   Annual vaccinations
•   Lower the numbers
•   Increase activity level
•   Eat well – moderately
•   Monitor all conditions for careful control
•   DO WHAT YOU SHOULD to be the BEST
    YOU CAN BE!
                  Curative
• Fix what is wrong
• Test to figure out what is happening
  then DO SOMETHING ABOUT IT:
  – Surgery
  – Medications
  – Treatment
• Full recovery of function – GOOD as
  NEW!
             Restorative
• Recovery of SOME degree of function
  or ability
• Focuses on the PERSON regaining
  skills and abilities with help
  – Rehab personnel
  – Special equipment
  – New techniques
• Not perfect, but BACK to a Higher level
  of Function
               Maintenance
• Maintaining the Status Quo – Keepin’ ON
• Not losing ground
• Depends on:
  –   Physical environment not changing
  –   Caregiver consistency
  –   Sustained abilities of the person
  –   All other things staying the same
• It’s HARD WORK … SO…
  – ‘IS what I have worth keeping???’
              Compensatory
• Providing what the person can’t do to ‘fill in
  the gaps so that LIFE GOES ON….
• Supportive
  –   Physical environment changes
  –   Caregiver cueing and helping changes
  –   Expectations change
  –   Schedules and routines change to
      accommodate
• End Point is the Same –
  – How we get there Changes
              Palliative
• Comfort Care
• TOP PRIORITY –
  – Honor personal preferences and choices
  – Manage Pain, Distress, Anxiety, Fear,
    Discomfort
• Identify & seek to meet social,
  physical, psychological, and spiritual
  needs
• Let go of FIXING and MOVE ON to
  Comforting
             The GOAL?

• Build a schedule and care routine that
  helps the person:
  – Be the way they want to
  – Do what they are able
  – Feel good about themselves
  – Feel OK about where they are
  – Enjoy the people who are there to help them
  – Get what they need
       Who Needs to Buy In?
•   Residents
•   Families
•   Front line staff
•   Managers
•   Community leader
•   Regulators
•   Public
•   Reimbursors
    So… What Do We Need from
        Staff & Families?
•   Awareness of the process
•   Participation in planning
•   Sharing about the past
•   Time to learn & try something new
•   Willingness to listen
•   Willingness to advocate AND negotiate
•   Flexibility as we figure this out

				
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posted:4/17/2012
language:English
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