1. A Nonpharmacological Approach to Support & Sustain Well-Being for Those Living with Dementia Dementia Care in the Long Term Care Setting: A Model for Well-Being A Person Centered Proactive Approach
Bethany Moore, RN, CDP, CADDCT
Associate Director
South Arkansas Center on Aging
UAMS Reynolds Institute on Aging

2. All Rights Reserved ©2017 Angela Norman, DNP, AHCA and AHCF

3. Objectives
Upon completion of this module, members should be able to:
Identify and describe the pathways to well-being (domains of well-being) for those living with dementia
Identify and describe nonpharmacological interventions for behavioral issues associated with dementia
Describe a model of care that is person centered, strength based and proactive

4. Demonstration Project
Improved patient and family satisfaction
Improved employee satisfaction
Reduction in % of antipsychotics
Reduced transfers to geripsych, ED, hospital
Relative Rate of Improvement was 62%

5. New Model of Care
Well-being Model- proactive, person-centered, strength based approach
Built on domains of well-being (Power, 2014)
Requires culture change
Adopted by OLTC and AHCA as state model
Arkansas 3rd most improved state in reduction of unnecessary use of Aps

6. Reframe: Our Thinking, Our Approach
Proactive approach instead of reactive approach
Strength based approach- not deficit approach
Not focused on what they cannot do , but what’s good and what they can do
Person-centered and person directed
Better understanding of what dementia is and why behaviors occur
New ways to communicate (tone, melody, body language, use of validation therapy)

7. Primary Goals of Care
Enhancing the well-being of those living with dementia
Understanding distress and supporting the person
Notice the goal was not to “fix the behavior”

8. Secondary Goals of Care
Reduction of unnecessary antipsychotics and other potentially harmful medications
Reduce transfers to Geripsych units, ED, hospital, different home

9. Domains of Well-Being Identity Connectedness Security Autonomy Meaning
Growth
Joy
Power, 2014

10. Transformational Success
Success requires transformation in three areas
Personal transformation
We change how we believe-changes our responses
Operational transformation
We apply our knowledge to practice
Physical transformation
We make changes to the physical environment

11. Identity
“being well known; having personhood; individuality; wholeness; having a history” (Fox et al. 2005).
Occupation
Cultural background
Relationships
Standing in community
Faith

12. Identity Discuss how this domain is part of the resident’s daily life
Describe positive behaviors if present
How does dementia challenge this domain
Describe what behaviors occur if absent
Give examples of personal, physical and operational transformation

13. Connectedness
“A state of being connected, belonging, engaged, involved, connected to past present and future” (Fox et al. 2005).
We spend a lot of our lives seeking connections.
Connect with people (friends and family)
Faith
Culture
More than verbal communication.

14. Connectedness
Discuss how this domain is part of the resident’s daily life
Describe positive behaviors if present
How does dementia challenge this domain
Describe what behaviors occur if absent
Give examples of personal, physical and operational transformation

15. Security
“Freedom from doubt, anxiety, or fear; safe certain assured; having privacy, dignity and respect, internal familiarity and comfort with one’s surroundings” (Fox et al. 2005).
Feeling safe, secure, free from harm
Free from doubt and/or anxiety
Having privacy, dignity, respect, comfort

16. Security Discuss how this domain is part of the resident’s daily life
Describe positive behaviors if present
How does dementia challenge this domain
Describe what behaviors occur if absent
Give examples of personal, physical and operational transformation

17. Autonomy “Ability to choose our life’s path” (Fox et al. 2005).
Making choices in daily routine
Sense of control in one’s own life

18. Autonomy Discuss how this domain is part of the resident’s daily life
Describe positive behaviors if present
How does dementia challenge this domain
Describe what behaviors occur if absent
Give examples of personal, physical and operational transformation

19. Meaning
“Significance, heart, hope, value, purpose; reflection; sacred” (Fox et al. 2005).
A reason to get up in the morning
Significance, value, purpose in activity, communication in daily routine
Can use music and art to assist in connectedness and meaning

20. Meaning Discuss how this domain is part of the resident’s daily life
Describe positive behaviors if present
How does dementia challenge this domain
Describe what behaviors occur if absent
Give examples of personal, physical and operational transformation

21. Growth
“Encompassing the following qualities: development; enrichment; unfolding; expanding; evolving” (Fox et al. 2005).
Most difficult to visualize
Don’t think “disease, decline”
Allowing growth
Think of the first 5 elements are providing fertile soil for growth
Music and art can lead to growth.

22. Growth Discuss how this domain is part of the resident’s daily life
Describe positive behaviors if present
How does dementia challenge this domain
Describe what behaviors occur if absent
Give examples of personal, physical and operational transformation

23. Joy
“Happiness; pleasure; delight; contentment; enjoyment” (Fox et al. 2005).
Ultimate outcome
Not just respite joy, but sustainable
We must cultivate the other 6 elements of well- being so that JOY can be sustained

24. Joy Discuss how this domain is part of the resident’s daily life
Describe positive behaviors if present
How does dementia challenge this domain
Describe what behaviors occur if absent
Give examples of personal, physical and operational transformation

25. When Behaviors Do Occur….

26. Not all behaviors are a problem. Learn to see behaviors as…
New response
As a form of communication
Unmet need

27. Decoding Distress
Medical
Environmental
Experiential

28. Ain’t this the PITTTTS! (medical/environmental causes)
P- Pain
I- Illness or Injury
T- Toxicity of medications
T- Temperature
T- Thirst
T- Toileting
S- Stimulation (over and under)

29. Experiential Causes Meaning: Build on the domains of well-being
Use of validation therapy
Not redirecting
Meaningful activities
Changing the environment and culture

30. Understanding Distress
Gather the team
Record and reflect on observations
Ensure the person is well known (Identity)
Look through the person’s eyes
Turn your focus to well-being (I Can see a moment gaining Joy)

31. Sustainable Success Culture Change Developing leaders
Changing your mind set
More than changing our vocabulary
Reframe approach to proactive not reactive
Put the resident in the center
Let the resident lead the approach (person- directed)

32. References
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Brackey, J. (2007). Creating moments of joy: For the person with Alzheimer's or dementia (4th ed.). West Lafayette: Purdue University Press.
Center for disease control and prevention. (2017, February 27). Retrieved from
Dementia signs, symptoms and diagnosis. (n.d.). Retrieved April 14, 2016, from dementia.asp
Feil, N. (2017). What is validation? Retrieved from
Florida Atlantic University. (2011). Interventions to reduce acute care transfers. Retrieved from
Fox, N., Norton, L., Rashap, A., Angelelli, J., Tellin-Nyak, V., Grant, L., Thomas, W. (2005). Well-being beyond Quality of Life, 1-4. Retrieved from
Halter, J. B., Ouslander, J. G., Studenski, S., High, K. P., Asthana, S., Supiano, M. A., & Ritchie, C. S. (2009). Hazzard's geriatric medicine and gerontology (6th ed.). New York, NY: McGraw-Hill Education.
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Merriam-Webster. (2017). Retrieved from
Music & Memory. (2013, May 30). Music and memory. Retrieved from
National council of certified dementia practitioners. (2001). Retrieved from
National institutes of health. (2017). Retrieved from
Pharmacological management of persistent pain in older persons. (2009). Journal of the American Geriatrics Society, 57(8), doi: /j x
Power, G. A. (2017). Dementia beyond disease: Enhancing well-being. Baltimore, MD: Health Professions Press.
Snow, T. (2017). Positive approach to brain change. Retrieved from