When the Alzheimer's Association released its first set of quality care recommendations in 2005,Alterra Healthcare Corporation was one of the largest providers of assisted living in the United States. Of the 300 plus communities that Alterra operated in more than 20 states, approximately 25% were freestanding dementia-specific assisted living http://communities.As a national provider of assisted living that touched the lives of so many persons with dementia, Alterra had made a commitment to set a standard of excellence in care and services by providing state of the science care guidelines to our staff. It seemed a natural extension to utilize the Alzheimer's Association's Dementia Care Practice Recommendations to further enhance our own platform of excellence. We were particularly aware of the unique opportunities and challenges presented by the assisted living environment about health and wellness issues. In general, there are a limited number of healthcare professionals employed within assisted living settings and no medical directors; there is also intense focus on the importance of resident rights, freedom of choice, and http://autonomy.The ability to provide guidance to direct care staff is essential within this kind of structure to ensure that quality care is delivered to those older adults who reside there, while respecting the cornerstones of privacy, dignity, and personalization. Alterra Healthcare Corporation is now part of Brookdale Senior Living and the commitment to these standards remains strong.
The initial focus of the Alzheimer's Association's Dementia Care Practice Recommendations on food and fluid consumption, pain management, and social engagement highlights 3 critical issues within the assisted living care setting that not only contribute to quality of life for persons with dementia but also, equally important, reduce risk. Brookdale uses the Alzheimer's Association Dementia Care Practice Recommendations to reinforce the relevance of our existing care programs through standard setting, staff training, as well as an opportunity to increase awareness among families and professional referrals of our commitment to excellence. To emphasize the last point, a 2-sided overview of Brookdale's response to the national recommendations was created that summarized what Brookdale has in place to meet the standards; this has been a very successful tool to educate consumers and professional referral sources about Brookdale's different and better story in the area of dementia care. The next sections describe how the recommendations in each of the specific care areas were adapted for use.
PAIN MANAGEMENT
It is well documented that persons with dementia may exhibit challenging behaviors in response to undiagnosed or untreated http://pain.These behaviors may lead to use of medications such as antipsychotics and benzodiazepines that may contribute to increased fall risk and other adverse http://events.The Alzheimer's Association's focus on pain management allowed Brookdale to reinforce a process we had previously instituted within our company specific to residents with dementia known as the Survey of Discomfort in Dementia (SDD).The SDD process, which is based on the work of Christine Kovach, PhD, provides a systematic review of a resident's challenging behavior and guides staff to look for potential contributing factors, for example, the unrelieved pain/discomfort may be contributing to the http://behavior.The SDD process addresses both physical and emotional discomfort as potential contributing factors and when applicable after other reversible causes have been ruled out (eg, urinary tract infection), and directs staff to offer recommendations to prescribers for the use of regularly scheduled mild analgesics, increasing the dose/strength in collaboration with the resident's primary healthcare http://provider.This is often a new concept to many prescribers, and on occasion is met with skepticism; the staff has had success in responding to the skepticism by sharing the Alzheimer's Association recommendations-an important use of the national guidelines that should not be overlooked. Nonpharmacologic strategies are also utilized to reduce the potential http://discomfort.Through this comprehensive approach to pain management, challenging behaviors have been reduced, as has the use of antipsychotic and benzodiazepines and the negative outcomes from adverse side effects of these http://medications.The impact on quality of life for persons with dementia because of the SDD process and the focus on pain management within the Alzheimer's Association's Dementia Care Practice Recommendations have been significant in the lives of hundreds of residents within our care settings.
FOOD AND FLUID CONSUMPTION
Another focus area of the initial Dementia Care Practice Recommendations is food and fluid consumption. The guidelines emphasize the importance of good screening and preventative systems to identify and respond to actual or potential nutrition concerns. Again, Brookdale has been able to reinforce an existing program known as the Nutrition Tracker and Nutrition At-Risk Program in the context of the guidelines.We regularly weigh residents, tracking their body mass index, and carefully look for changes that may indicate a decline. Established protocols delineate when staff should contact the healthcare provider, but more importantly, at the earliest possible time, including specific questions on our personal service assessment, Brookdale associates work with the resident and their family to identify preferences and abilities in the area of nutrition and dining so that the likelihood of decline is reduced. Consultation with Brookdale's corporate dietitian, memory care specialists, registered nurse case mangers, and ancillary service team of occupational and speech therapists completes the picture and allows for a comprehensive approach to this issue.
Food and fluid intake can also influence behavior in persons with dementia, especially when hydration status is compromised enough to contribute to high serum sodium level (ie, hypernatremia). Hypernatremia can cause delirium and may be exhibited as challenging behavior, for example, agitation or increased confusion. Hydration status can be a risk factor for falls in that dehydration can contribute to orthostatic hypotension in which there is a drop in blood pressure when a person stands, causing dizziness and creating a propensity to fall. In addition, older adults, including those with dementia, may be on medications that contribute to dehydration, such as diuretics ("water pills"). Persons with dementia may forget to drink and need reminders or a schedule to do so. Here again, the Alzheimer's Association's platform allowed us to reinforce one of Brookdale's guidelines known as the Fluid Program. This program provides standards for the Brookdale care staff to follow to increase the likelihood that residents will not have hydration challenges. The Nutrition Tracker, Nutrition At-Risk Program, and Fluid Program allow Brookdale to highlight how we have embraced the Alzheimer's Association's Dementia Care Practice Recommendations to enhance quality of life for our residents with dementia. Families and professional referral sources again have applauded Brookdale's effort to respond to these national standards.
SOCIAL ENGAGEMENT
The last of the initial quality care standards, social engagement, epitomizes assisted living in that this standard is a hallmark for the industry. Brookdale associates collect information from the residents and their loved ones during the move-in process to build a detailed social history that is used to create a personalized resident social profile. Life enrichment, which is a philosophy of person-centered activity-based care is provided both in a structured and in a spontaneous fashion every day;life skills are offered to residents to meet their needs to feel useful and reflect prior roles. Also, shadow boxes outside each resident's suite are decorated by the resident with assistance from our associates and the resident's families to reflect the resident's life story and unique interests. Brookdale has also recently introduced a signature program known as Optimum Life that embraces the idea that all people have the potential to live an optimal life regardless of their age or http://abilities.Through Optimum Life, dimensions of high-level wellness are being redefined for persons with dementia so that direct care staff and others can see dignity in all human experience and work with residents to achieve an optimum life. Families in particular appreciate this connection to the national guidelines and value Brookdale's effort to honor and celebrate the human spirit.
The Alzheimer's Association's Dementia Care Practice Recommendations have helped Brookdale Senior Living show the outside world that standards of excellence are not just platitudes on paper, but exist as real-life opportunities when acted on by care providers to enhance quality of life for persons with dementia and their families.