Positive Changes in Long Term Care

Meaningful pastimes in the nursing homes

One of my job requirements is to put together the activity programming on the memory care wing. I have earned a few certifications from the National Council for the Certification of Dementia Professionals , but felt I was lacking in the activity aspect of the job. Though I had led activities in memory care for over thirteen years and had created some of the programming, I didn’t feel completely qualified. I also wanted to better serve readers of this website.

To solve that problem I signed up for a program to earn my Activity Director Certification. And, Wow! What an education I’m getting! I highly recommend the programming to anyone who wishes to enter the field. I am currently working through Activity Director Certification Services program facilitated by Theresa Thorland, CTRS/ACC/MS/MA. One part of the program that captured my imagination is the culture change movement.

Positive Changes in Long Term Care

Although most of you are caring for loved ones at home, I wanted to share some of the positive changes in long term care. The focus has been moving from merely providing health care to enhancing quality of life. Therefore, we are no longer simply housing and doctoring people. Now, the industry is focused on providing person-centered individualized care in an effort to make living in a nursing home more satisfying. What a much needed change!

The change has been occurring since the 1970’s, but is now driven by the Pioneer Network. I strongly suggest you visit their website. They share a wealth of information covering the span of in-home care to long-term care. This page shares information about these choices while this page provides more detail about person-centered care and culture change. I hope you check them out.

More Choices….

Basically, the change is reflected in offering and providing more choices for those we serve. Residents are no longer expected to follow the schedule and routine of the facility. Instead, they are now encouraged to maintain the routine they followed at home. Some residents rise in the early hours and others may sleep until eleven. Likewise, they go to bed when they would like. Some nap or watch television in the afternoon, some go to bed shortly after dinner. Therefore, the individual routines within a facility now resembles those on the ‘outside,’ instead of a ‘one size fits all’ schedule.

No one is required to have breakfast or bedtime snacks, though they are offered to all. There are more choices in meals. Don’t like the eggs and bacon for breakfast? Oatmeal, fruit, yogurt, even ice cream are available. Beverage choices are also varied and available.

Some choose to have a beer or a glass of wine after dinner. Also, fine – unless the doctor deems it unsafe. Medical professionals weigh benefits and risks while focusing on the individual and what is best for them – physically and mentally. Additionally, the meal times are longer, allowing people to come and go as they please.

More Activity Choices

Gardening is another activity choice for positive change in long term care! Sowing seeds, tending to plants, and eating the produce! Share stories about making end of the garden soup here!

There are more activity choices as well. Though most homes still offer bingo, there are now classes for painting, crafts, cooking and baking, spiritual and cultural topics, game shows, and other games. Sensory and exercise segments are also available. Clubs pop up as the clientele changes. People are engaged in technology through use of laptops, tablets, and smart phones. Volunteers engage in sharing their talents and skills by assisting in gardening, singing and entertainment, helping with group activities, and assisting on trips.

Additionally, residents venture outside the facility more often. Trips are planned to visit restaurants, wineries, shopping malls and stores, concerts and plays, as well as scenic drives to parks and to enjoy fall foliage or Christmas lights. Residents choose the destinations; activity staff handle the logistics.

Getting the community involved….

Intergenerational activities abound. The youngsters in the community help by becoming make-up artists and dates for proms, by helping to create crafts with residents, by reminiscing and learning with them, and by entertaining. Student ‘shadowing’ opportunities are more available as well, enabling students to ‘try out’ working in healthcare before committing to a specific field or track of education. Everyone benefits. The students gain valuable experience. The facility gets extra help. The residents interact and bond with the next generation.

Animal visitors

Therapy animals and family pets are welcomed into the homes to visit and provide engagement opportunities for those who love animals. Some facilities house large bird environments, fish tanks, and other shared animals with residents choosing to feed or care for the animals…. or not.

We had a large, sleepy dog visit the memory care wing a few days per week. The dog would lay on the floor, occasionally moving enough to lick up a crumb from snacks being served. She would lazily wander from person to person for pats and pets. The smiles she left behind were priceless!

Getting to know you

Really getting to know the new arrivals has been another positive change in long term care. Please do not misunderstand. The front line staff members – the nurse aides in particular – have always made an effort to make real connections with residents. They truly know those they serve! They learned by talking with the person and their loved ones. . . by becoming friends.

With the culture change, this process is more structured and includes everyone who will be working with the new person – from nurse aides, to therapists, to doctors. It begins with staff asking the right questions to discover individual preferences, strengths, and abilities right from the beginning. Questions are asked of everyone in the resident’s life in an effort to capture a vivid picture of the person. Ideally, everyone is part of the care team.

Everyone benefits…

By listening and responding, the facility benefits by providing the resources necessary to keep the resident happy and fulfilled. The family gains peace of mind. And, the person living in the facility benefits by getting what they need to have meaning, purpose, and quality of life.

Another positive change! Getting to know you… and your preferences… Which would YOU prefer? One of these? All of these? NONE? Using their music – check it out here!

Personal identity is stressed. People are no longer ‘the resident in room 212’ or ‘Mrs. Smith.’ Instead, they are spoken to using their preferred name or nickname. Though some may still prefer being called Mr. or Mrs., some ask to be called by their nickname or even referred to as ‘Mom’ or ‘Sis.’ This information is readily available to the staff who honor those in their care by using their preferred name. What a blessing!

A Focus on Friendship

Sharing the bounty with friends…. Meaningful relationships with family, friends, and staff…

People living in long term care now have a larger network of friends – staff and other residents become family. Using their preferred name, as well as honoring their individuality and their choices, enhances the creation and building of friendships. The focus changes from ‘taking care of’ people to becoming partners in care. The staff serves those in their care by helping them do what they want to do when they want to do it! It gives me hope that, if I end up in long term care some day, I will still be able to live my life out loud -as I do now!

How do these positive changes in long term care affect those with dementia?

I know it’s difficult to think of the day when you may have to take your loved one to a facility to live. It’s a heart-wrenching decision to leave your loved one with strangers and hope for the best. But, these positive changes have made life for those with dementia much easier in facilities. When we take the time to really get to know the resident and their families, we can embrace them as they are. And, we can meet their needs in meaningful ways.

Perhaps the best aspect of the focus on individuals and their uniqueness is the ease of transition for the person with dementia. Though the environment is different from what they are used to, the use of their preferred name, the flexibility of the schedule to follow their routine, the opportunity to do what they want to do, and the variety of choices provides security and comfort. It provides the framework for familiarity and friendship with the staff. Hopefully, these positive changes in long term care give the resident true quality of life.

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