1. With guest Susan Wehry, M.D., Commissioner VT Department of Disabilities, Aging and Independent Living

2. For being here For all you do For participating

3. + ACTIVATE Inspire Transform

4.  Discuss the (new) dementia care  Use new tools  State readiness to facilitate learning  Bust barriers/Build buzz

5.  Adult learners  Set aside AND draw from experience  Re-think outcomes

7.  Activate Learning  The New Culture: why now?  Tools of the trade  OASIS  Hand in Hand  Let’s Get Practical

8.  Recap  Nothing Succeeds Like Success  HSAG Tool Kit: Balancing Dementia Care  DSD of the Year!  Bust the Barriers  Putting it All Together

10. Identify your goal

11.  Knowledge and Experience  Personal history and concerns  Bias and perceptions  Language

12.  Rocks, rolls and rules  Seniors, Elders, Older adults, Consumers  Residents, Patients, People-First

13. It’s a brave new syzygy world

15.  High prevalence of dementia  Affordable Care Act 2010  CMS National Partnership  AHCA/NCAL Quality Initiative  OIG report  New Guidance

16.  New needs  knowledge, skills, attitudes, partnerships  New opportunities  HCBS  Quality  Workforce development  New risks

18. Person-Centered Care

19. Political correctness Personal computer PC Care

20.  A philosophy  Values fundamental humanity of the people in our care AND the people who care for them  A set of best practices to improve outcomes  A base on which to build successful non-pharmacologic strategies

21.  The process and manner by which carers maintain the personhood of those who receive services  The Bradford Group

22.  I see you  I see our common humanity  I see your uniqueness It implies recognition, respect and trust… Thomas Kitwood, Dementia Reconsidered, 1997

25. The Residents’ Point of View NCCNHR 1985 From B&F Consulting

27. http://oig.hhs.gov/oei/reports/oei-07-08-00150.pdf

29. Who did what wrong  what process would make it less likely to happen again Error prevention  Culture of quality & safety Culture of Continuous Quality Improvement

30.  Fewer falls pressure ulcers acquired catheters  Less Turnover Absenteeism  Higher occupancy * Staff feel valued and respected

31.  Improved  Sleep  Mood  Appetite  Better transition home from sub-acute care  Fewer  Falls  Pressure Ulcers  Less  Agitation  Depression From B&F Consulting

32. The New York Times October 12, 2006 JAMA 36: 1359-69 2011  Meta Analysis Confirms:  Effectiveness in Dementia is Weak

33.  No benefit and cognitive decline with quetiapine  AGIT-AD Ballard et al, BMJ, 2005  Meta Analysis shows effectiveness is weak  JAMA 306:1359-69 2011 38 RCTs in dementia  Lower survival rates

34. New York Times April 11, 2005FDA Black Box Warning 2005  Warning  Increased Mortality in Elderly Patients with Dementia related Psychosis

35.  Causes of death (Ballard et al, 2010)  Pneumonia  Stroke  Pulmonary embolism  Sudden cardiac arrhythmias  Likely mediating factors  Dehydration  Over sedation  QT prolongation

36.  Increased falls  Failure to thrive  Increased risk pressure ulcers  Diminished quality of life

39. DOCTORS NURSES SURVEYORS DIRECT CARE STAFF

41.  Data shows antipsychotics cause harm  Data shows they are of limited use  The side effects negatively effect quality of life  Regulators require we be concerned as do elder rights

43. After a break See you in 15 minutes

46. I don’t know what to do!

47. Underlying principles

48. Those who care for them

49.  Ways of knowing  Ways of processing  Ways of learning

50. Well-being, strengths, personhood

51. In their shoes Loss exercise

53. PERSON with Dementia

54.  The process and manner by which carers maintain the personhood of those who receive services The Bradford Group

55. All behavior communicates All behavior has meaning

56. All behavior expresses core human needs

57. Behavior

58. MEANING ESTEEM & SELF RESPECT BELONGING & AFFECTION SAFETY AND SECURITY PHYSIOLOGIC INTEGRITY With or without dementia

59. DIGNITY MEANING RESPECT

60. What is this person trying to tell us?

63. + ENGAGE Model Respect CARING

64.  4 Modules/8-10 hours learning activities  Who’s Who  Person-Centered (Dementia) Care and Recovery  All About Behavior (2)  Interventions  Learning outside the classroom

65.  Training Manual  Resource Guide  DVD  Video clips  Power points  Podcasts

67. Behavioral and Psychological Symptoms of Dementia

68.  Brain-behavior relationships of 5 As  Medical approach to symptom control

69.  Memories

70.  Regulate emotions  Fear  Anger

72. WHO a person is, is as important as WHAT he or she has

74. PatienthoodPersonhood What causes behavioral and psychological symptoms? What is this person trying to tell me?

75. Shifts primary perspective person rather than disease abilities rather than inabilities relationships rather than task

78.  Old paradigm:  Behavioral symptoms common  Goal is elimination  New paradigm:  Not all behaviors are symptoms  Behaviors are efforts to communicate Need, desire  Goal is interpretation, addressing need, preventing

79. Current (old) model Emerging model  Loss of ability to modulate  Lump together  Explaining  Intervention  Unmet human need  More precision  Understanding  Prevention

80.  Slapping thighs  Clapping  Yelling  Screaming  Self-referred  Something is wrong with me  Do something!

82.  Hitting out  Kicking  Pinching  Biting  Threatening  Swearing

83.  Common triggers  Fear  Anxiety  Frustration  Medications  Sensory loss  Crowded or noisy environments  Abrupt, tense or impatient staff

84. FEAR

85. STOP LEAVE ME ALONE!

86. WHERE AM I?

87. I can’t get away! I have to fight!

88.  Is there a history?  NOT a green light for dismissal  Is there a pattern?  What works/what doesn't  What do we know?  How can we  Create sense of safety  How can we change our behavior?

90. DAY 2

91.  Environment  Eden Alternative  (loneliness, helplessness, boredom)  Music www.musicandmemory.orgwww.musicandmemory.org  (Massage)  Recreation  (Aromatherapy) http://www.alz.org