1. Creating Positive Conditions Oasis 2.0™ Module V Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-161

2. THANK YOU For coming For all that you do For being here For all you do Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-162

3. Key topics Module I Introduction to Oasis in the World of Long Term Care Module IIRecovery and Person-Directed Care Module IIIDementia: Outside in/Inside out Module IVBehavior is Communication Module VCreating Positive Conditions Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-163

4. Let’s Revisit Goals of Oasis 2.0™ Competent, confident, compassionate staff Supporting a resident’s personhood Avoiding unnecessary antipsychotics ◦Limited effectiveness ◦Morbidity/Death Core human needs ◦Abraham Maslow & Thomas Kitwood Addressing unmet needs ◦Jiska Cohen-Mansfield Changing our own behavior ◦ Linda Teri Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-164

5. Checking In Any questions or comments about what you’ve learned so far? Any Oasis moments to report? Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-165

6. Review: Module IV About Behavior All behavior has… All behavior is an attempt to … Our first question is not How do I get a resident to stop? but …. Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-166 communicate What is this person trying to tell me? meaning

7. Objectives Create a safe environment Engage families as partners Practice good self care Use non-pharmacologic interventions Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-167

8. What would you like to learn? Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-168

9. Moving In HOW DID YOU FEEL? WHAT DO WE DO WELL? WHAT COULD WE DO BETTER? Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-169

10. Family Feelings Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1610 guilt isolation Sadness Loss grief anger isolation frustrations denial Letting go relief

11. Stand in their shoes Be sensitive to emotions family members may experience Avoid judgments Be kind and respectful Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1611

12. Natural Supports FamilyFriends Paid HelpOthers Oasis 2.0™ ©Susan Wehry MD 2015 MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-16 12

13. Families as Partners In maintaining personhood In understanding behavioral communications In care planning and decision-making Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1613

14. Learning Circle WHAT CAN I DO TO MAKE VISITING A POSITIVE EXPERIENCE? WHAT CAN WE DO TO ENCOURAGE FAMILIES TO BE OUR PARTNERS IN CARE? Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1614

15. Strategies for Positive Relationships Show support ◦Family tours ◦Clear communication processes ◦Validate emotions ◦Develop realistic expectations ◦Compliment ◦Report good news Promote successful visits ◦Offer suggestions and support ◦Bring in family videos, pictures ◦Activities Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1615

16. Families are critical TO OUR SUCCESS IN REDUCING ANTIPSYCHOTIC RATES Oasis 2.0™ ©Susan Wehry MD 2015 MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-16 16

17. Is using medication EVER OK? WHAT ARE THE RISKS? WHAT ARE THE BENEFITS? Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1617

18. Problem of antipsychotic medications No “anti-agitation/anti-aggression” medication Off-label use ‘OK’ ◦risk/benefit equation more critical Antipsychotics  ◦  mortality ◦  stroke Misses the point Side effects are considerable ◦Sedation ◦Stiffness ◦Difficulty walking ◦Dehydration ◦Falls ◦Chest infections ◦Accelerated cognitive decline Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1618

19. Potential for medications Non-narcotic pain medications have potential value Antipsychotics have a focused and limited role Short term treatment with risperidone helps severe aggression that is interfering with quality of life ◦ Husebo, B., Ballard, C. et al. BMJ 2011;343:d4065 Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1619

20. Best practice guidelines Care plan Medical assessment Pain management All alternatives first Document Involve resident, family Lowest effective dose Monitor for effect Monitor side effects Review after 6 weeks Discontinue at 12 weeks Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1620

21. Alternatives to medication Successful Interventions Green House Model Music & Memory Recreation Activity based care (Massage) (Aromatherapy) Companionship/Walking Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1621

22. Music and Memory Beloved music renews lives Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1622 www.musicandmemory.org Meet Henry

23. What practices help us NOT Use Medication Changing our behavior ◦Using person first language, not labels ◦De-escalate, not escalate ◦Monitoring own fear response ◦Monitoring environment for ways to meet basic needs ◦Treating our job as building relationships, not doing tasks Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1623

24. What practices help us NOT Use Medication Changing our practices New paradigm ◦Behavior = Communication ◦Unmet needs, Not symptoms ◦Prevention not intervention ◦Address loneliness, helplessness, boredom ◦Individualized care plans that emphasize strengths, choice ◦Paying attention to caregiver stress Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1624

25. Stress A total body and mind experience Stress can lead to poor quality care, quality of life and abuse and neglect Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1625

26. Signs of Stress in Caregivers  Anger  Anxiety  Fatigue  Diarrhea/Constipation  Exhaustion  Joint pain  Headaches  Health problems  Irritability  Lack of concentration  Too little/too much sleep  Social withdrawal Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1626

27. Effect of chronic stress Chronic stress shrinks the brain Shrunken brains  ◦More mistakes ◦More anger ◦More forgetfulness De-stress: Brain recovers! Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1627

28. Learning Circle WHAT PRACTICES COULD OUR FACILITY ADOPT THAT WOULD HELP WITH STRESS? WHAT PRACTICES CAN CO-WORKERS ADOPT TO HELP EACH OTHER DE-STRESS? Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1628

29. Stress busters Sleep Pray/meditate Physical Exercise Mindful breathing Massage Enjoy positive relationships Laugh Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1629

30. Stress busters The belly balloon The nose, knows Shoulder shrug Sigh sigh blackbird Breathing for Beginners Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1630

31. Positive Affirmations I did a good job today and I’m proud of it. You did a good job today I’m glad you’re my co-worker Thanks for helping me Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1631

32. Re-Cap and Action Steps Create a safe environment ◦I will knock before I enter a residents room Engage families as partners ◦I will make a point of saying hello to families when they visit Practice good self care ◦I will use one stress buster each day Use non-pharmacologic interventions ◦I will ask “what is this person telling me about what they need?” Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1632

33. THANK YOU For coming For all that you do For being here For all you do Oasis 2.0™ ©Susan Wehry MD 2015MASS SENIOR CARE FOUNDATION LEADERSHIP IN DEMENTIA CARE 2015-1633