Magnolia Post Acute Care is a 99-bed facility with approximately 75 percent of its residents being long-term. Although we have an activities department to assist with group activities, we were noticing how many residents were unable to participate due to the activity being too low/high level or it not being of interest to the resident. In addition, some patients who were not engaged in activities were demonstrating behaviors such as anxiety or agitation, frequent falls and staying in bed. The Abilities Care Approach Program gave our team an opportunity to address this issue and use a therapeutic approach to impact our residents’ lives.

First we identified residents who may benefit from this program and initiated an OT and/or ST evaluation. OT goals focused on identifying current or prior roles or activities of interest, creating life story boards, creating and implementing an activities prescription, and staff training. ST goals focused on using life story boards to encourage staff and patient communication. ST also addressed non-verbal communication strategies for improved pain assessment by nurses. This program has helped our staff communicate effectively with our patients who have limited communication skills.

Examples

Example 1: Ms. H. often demonstrated agitated behavior throughout day, refusal of care, anxiety associated with chest pain and frequent falls.  OT was able to assist Ms. H. with identifying an activity of interest in order to manage these behaviors by providing an activity that would distract and calm Ms. H. Her activity prescription included latch hooking and listening to rock and roll music. (photo)

Example 2: Mr. M. had a CVA that left him with R sided hemiplegia. He spent a lot of time in bed and did not attend group activities due to frustration over his aphasia and decreased use of RUE. Through a therapeu

tic approach, OT and ST were able to evaluate MR. M. and get to know who he was and create a storyboard that helped staff communicate and get to know him better. His story board included pictures of him in his high school football uniform, his favorite sport (boxing) and his favorite musician, Michael Jackson. During

his sessions, he re-learned how to play the piano using a one-handed technique to “Beat It,” played boxing on Wii, and communicated his interests with staff during care.

Results

Overall, six out of eight patients have had successful results with The Abilities Care Approach Program during the time the patient is on therapy caseload. The challenging part was carryover to activity department and nursing staff. With proper training and demonstrations, activity staff soon took advantage and started to provide individualized activities from activity prescription to resident. Other barriers that we faced were payer resource, limited treatment time due to HMO B authorizations, language barriers, lack of family/friends to obtain information about the resident and high staff turnover. In addition, we faced the challenge of how to actually follow the program in its entirety. However, we were most successful by tailoring the program to fit the needs of our patient population and liberally customizing it with the end goal to improve our patients’ quality of life.

Looking ahead, our goal is to broaden this program beyond activities staff and make it a facility-wide program by color coding the story boards with ACL levels in order to define how we can communicate and understand our patients better at all cognitive levels. We also plan to provide in-services with IDT and eventually nursing staff so they can have more tools to help manage our residents’ challenging behaviors.

View poster: Abilities Care Approach Program: Its Beginning Stages (PDF format)

By Katie Case MOT, OTR/L, Jemelie Koda SLP, Nicole Veniegas, DOR/MS, OTR/L
Magnolia Post Acute Care, El Cajon, CA