Rehabilitation and Focused Dementia Care Survey
The Courtyard Rehabilitation & Healthcare Center is a 56-bed facility that has been selected to participate in pilot of a Focused Dementia Care Survey, which examined dementia care in nursing homes. The survey examined the processes for prescribing antipsychotic medications and was later expanded to look at standards of care along with over utilizations of antipsychotic medications.

The Courtyard was selected for this pilot program due to a high census of people with dementia diagnoses. A survey was conducted in March 2016, and it was determined that 49 out of 51 residents had a dementia diagnosis.

 

Method

We selected five residents who had a diagnosis of dementia (Alzheimer’s, Lewy body, vascular disease and other dementias) and required different levels of assistance with ADLs. The residents were screened by Physical Therapy, Occupational Therapy and Speech Therapy. Our method included the following steps:

  • The involvement of and conversations between facility leaders, including the DON, unit managers, medical directors and administrators, were examined for appropriate individualized approaches to initiate care.
  • Interdisciplinary and intra-disciplinary conversations about specific triggers of distress as well as desired outcomes were monitored among disciplines and across shifts.
  • Staff consistently communicated about the plan of care during IDT meetings.
  • Residents were examined for any sudden change in condition and medical causes of behavior (delirium or infection).
  • Alternatives to psychopharmacological medications were discussed. These included family/caregiver involvement, rehab, activities, and the Music and Memory program.
  • Therapy established a plan of care for residents having deficits in safety awareness, poor static/dynamic balance with ADLs, difficulty with bed mobility, sequencing with dressing/hygiene/grooming, orientation to facility, and poor phases of gait.
  • Residents participated with rehab services for an average of 27 days. Nursing, family/caregivers, physicians, activities and restorative aides worked closely with the rehabilitation department, reporting positive and/or negative changes in behavior.
  • Specific preventive measures to undesired behaviors were also determined to each individual, such as time of day.
  • We integrated treatments with morning ADLs (getting out of bed, grooming, dressing, hygiene, transfers, toileting, walk to dine, etc.).
  • We worked closely with the Activities Department and also encouraged family involvement.

Conclusions

Patients who were at a higher level of function, by requiring the least amount of assistance outside therapy services, showed the most significant improvement physically with rehab services. We saw success with nursing staff examining alternatives to psychopharmacological medications, family and caregiver involvement, and individualized activities determined by the Activities Department.

Lower-functioning residents showed improvement with alertness, engagement with activities and family members, decreased anxiety/agitation, and responsiveness to nursing with Music and Memory. As part of the Music and Memory program, iPods were loaded with specific songs to trigger memories of past events such as weddings and anniversaries.

Residents continue to work with restorative, Activities Department and nursing for the most effect non-psychopharmacological treatments. Ultimately, the goal is to maintain highest level of function and improve residents’ quality of life.

Submitted by The Courtyard Rehabilitation & Healthcare Center, Victoria, TX