Updated Arc notes
Mid Term Review ARC
Therapeutic Approach: A therapeutic approach is intended to stimulate a change in behavior. This change will be directed by one or more goals in the different areas of physical, emotional, cognitive, and social functioning.
Goal of Therapeutic Approach:
· Health promotion
· Prevention of disease, further decline
· Rehabilitation/intervention/therapy/treatment
· Provide opportunities for hobbies / programs of enjoyment unique to them – to have fun!
· Adapting the environment to support greater independence
· Teach coping through a sense of accomplishment
· Provide opportunities for growth
· Enhance social skills and personal relationships
· Promote community membership
Enhanced QOL:
· Improved health status
· Functional independence or enhanced control when functionally dependent
· A sense of well-being
· Perceptions of life satisfaction, purpose and meaning
· Increased self-esteem
· An enhanced personal / social network
Five major steps comprise the process:
· Assessment
· Activity Analysis
· Program Planning
· Program Implementation
· Documentation and Evaluation
Assessment: Assessment represents a systematic approach to identifying and describing the individual older adult’s changes in functional status. Assessment is a complex process that involves gathering information across a range of areas including the bio-psycho-social domains.
Rationale For Assessment:
· Assessment of individual health and functional status is the centerpiece of care and service delivery.
· An interdisciplinary team of professionals are involved with assessment, including allied health professionals, social workers, medical doctors, nurses, and therapists or specialists of various types.
Reason For Assessment:
· To establish a diagnosis.
· To determine the personal, social, and environmental dynamics that maintain, control, and influence behavior.
· To establish baseline measures and information from which to assess the effects of treatment or natural changes in the client’s status.
· To assess the ability to care for oneself and to function in various environments.
Goal of Assessment:
· The goal through assessment is to collect and analyze information about capabilities, problems, needs, strengths, skills, and special abilities.
· Along with individual resident assessment, the activity specialist will assess the physical and social environments in which the resident functions on a day-to-day basis.
Professional Approach for Assessment:
· Identify personal biases / stereotypes about older adults so they can be avoided.
· Be aware of age-related changes in each body system.
· Distinguish between normal and pathological changes.
· Know the presentations of illness.
· Allow time for trust to develop and gather assessment information.
· Make accommodations for any impairments to promote comfort.
· Screen for conditions common in the older adult population.
· Be alert to signs and symptoms of elder abuse and neglect.
· Always consider medications and their effects as a cause / contributor to a problem.
Activity Analysis:
· A systemic evaluation of activities for appropriateness and use in attaining individual treatment goals of the resident.
· Analyzed activities should include those that meet key psychosocial needs.
· Identity, affiliation, control, autonomy, security, self-esteem, inclusion, and meaningfulness.
· If these are considered, the personal value of the activities to the individual is more likely to be realized.
· To assure that a well-rounded, person-oriented activity program is developed.
PROGRAM PLANNING:
· Careful consideration should be given to each aspect of the plan with a focus on the individual, the environment, and the overall program.
· An individual treatment plan, plus an overall activity program, is developed in writing.
· Goals and objectives are matched with selected activities.
Goal : An Aspiration, a changing of behavior. Specific and measurable with clear outcomes.
Objectives – The nuts and bolts. We take the goal and break it down into smaller, achievable parts. We measure the progress and changes.
Planning Tasks:
1)Goals and objectives will be stated
2)Specific programs will be selected
3)Resources and concerns will be identified
4)Alternative plans of action will be outlined
5)A clear plan of action will be articulated in writing
Program Implementation:
· During implementation, the Recreation Team Member engages in the process of
· Requesting volunteers or assistance as needed.
· Supervising volunteers.
· Managing the environment where the program(s) are occurring (setting up for success.)
· Attending to Safety and Risk Management.
· Responsible management of funds supplied for the program.
Population and Aging
Life expectancy is the average number of years a person can expect to live at any given age if death rates remain constant.
Life span for the human species is fixed at about 120 years. It is the maximum potential age that a human can survive.
Older Adults & Heterogeneity:
Although older adults are stereotyped as all the same (homogeneous), nothing could be further from the truth.Older adults are the most heterogeneous age group in the population. Older people vary greatly from one another in their bio-psycho-social functioning.
Chronological Age Subgroups:
Young-old: 65-74 years of age
Old-old: 75-84 years of age
Oldest of old: 85 and above
Centenarians: people 100 and above
Supercentenarians: people 110 and older
Chronological vs Functional Age:
Two people can be age 70 chronologically but differ remarkably in their functioning.
Functional age is determined by: an individual’s ability to carry out activities of daily living (ADLs) and to live independently.
-One’s lifestyle will be the major contributor to chronic disease and functional losses.
Health & Functional Status:
· Older adults are high consumers of healthcare services and chronic disease management is a contributing source of high healthcare costs nationally.
· Chronic disease is the main reason for disability and impairment among older adults.
Impairment follows a process of pathology -> impairment -> functional limitation -> disability.
Process of Impairment:
Pathology-direct result of changes in tissue and cells of the human organism that are produced by injury, infection, disease, birth defect, or other agents.
In older people, pathological states involve either acute or chronic conditions
Acute vs Chronic Conditions:
Acute-is rapid or abrupt in onset, caused by infection(bacterial or viral), is treatable, is short-term in duration, and curable
Chronic-is progressive onset, caused by multiple lifestyle factors, lasts a lifetime, is irreversible, progressive, and managed through medical and rehabilitative care.
Impairment:
Occurs when there is a loss of mental or physical function that results from the specific condition of an organ or organ system
Functional Limitation:
Effects that are present in the person’s capacity to perform as a whole as well as independently or with some assistance.
All functional limitations result from impairments
Disability:
An outcome that moves pathology, impairment, and functional limitation beyond the individual into the context of the social and physical environment.
A limitation in the individuals inability to perform roles and tasks that are socially defined and expected.
Health and Functional status:
Service settings and scope of care
Institutional Care
Nursing Home, LTC Facilities
Assisted Living Facilities
Acute Care Hospitals
Residential Rehabilitation Centers
Continuum of Care Model
Long Term Care (LTC) is not the only system in place for healthcare services for seniors
Non-Institutional Care
Adult day health service programs
Adult day activity services programs
Other community-based service models
Retirement communities with full service & a la carte services
Health and Functional status: Intervention Through Prevention
Primary prevention:
Education, immunizations, information distribution
Secondary prevention:
Screening and early detection
Tertiary prevention: Pro-Active. Reducing further impairment, management of disease
The aging Process
two perspectives to studying aging :Gerontology and Geriatrics
Gerontology: The scientific study of old age, the process of aging, and the particular problems of the elderly.
Geriatrics: The branch of medicine or social science dealing with the health and care of the elderly.
Physical Changes to Sensory System:
Vision:
Age Related Macular Degeneration: Leading cause of loss of vision in those over 65. Degeneration of the Macula, the area of the retina that gives us our central vision. Blurred vision, image distortion, difficulty reading.
Glaucoma : Damage to the optic nerve. 76% of people over 65 who have glaucoma are legally blind. Visual Field loss and blurred vision.
Cataract :Most common cause of vision impairment in older adults, and the most common cause of blindness in the world. Prevalence increases with age. Exposure to UV light can contribute to the progression of cataracts. Blurred vision and glare. Availability of surgery to correct reduces these numbers.
Diabetic Retinopathy: Significant cause of vision loss in the elderly. Prevalence increases with the duration of the Diabetes. Blurred vision, visual field loss, floaters and poor night vision.
Hearing: Hearing loss is common and affects 1 in 2 adults over the age of 65.
Hearing loss is not life threatening, but can impact quality of life.
Causes: changes in blood flow to the ear, changes in the structure of the inner ear, impairment of the nerves.
Other causes: Diabetes, poor circulation, medications, family history.
High pitched sounds are the first to be lost. Difficulty hearing in noisy areas.
Treatment: Hearing aides, assistive devices (amplifiers)
Taste & Smell:
Taste buds are replaced every few weeks, however, over age 50, they begin to lose sensitivity and the ability to regenerate.
As we age, we start to lose our sense of smell, and the ability to tell the difference between scents.
Olfactory nerves and mucus production in the nose also decline.
75% of people over 80 have severe olfactory impairment.
When taste and smell are impaired, a person may change their eating habits.
Physical Changes in Other Systems:
Integumentary System
Musculoskeletal System
Cardiovascular & Respiratory Systems
Gastrointestinal & Urinary Systems
Lymphatic System
Nervous System
Endocrine System
Reproductive System
The Aging Process Cognitive Functioning:
Cognitive functioning consists of : intelligence, learning, and memory
Without normal cognitive functioning: many of life’s tasks are more challenging and this may present added stress for the individual.
Intelligence, learning, and memory have shown very small decline with age.
Intelligence- Two Categories of Abilities
Fluid intelligence: skills that are biologically determined, abilities / skills not learned through experience.
Fluid declines: from early adulthood onward.
Crystallized intelligence: accumulated knowledge or abilities learned
Crystallized intelligence increases: throughout adulthood.
The aging Process: Memory
Memory: is the process of retrieving learned information and contains all the information learned across life
3 types of memory that are involved in learning:
1. Sensory Memory
-when new information is received by the senses
-two primary types of sensory memory: Visual and Auditory: passes this information to either to Short Term or Long Term Memory
2. Short Term Memory(primary):
-where information is organized and temporarily held for storage
-limited capacity, effected by declines
Short-term memory may need supports:
Vocabulary, information, and comprehension remain strong.
3. Long Term Memory(secondary):
-where information is stored for long periods of time
-rehearsal, memorization, and repetition
-unlimited in its capacity
The aging Process: Memory and Learning
With use, long-term memory stays.
Short-term memory may need supports.
Vocabulary, information, and comprehension remain strong.
Processing information may need supports.
Learning Involves the processing and storing of new information
Takes place when information in received, encoded, and stored.
The Aging Process: Cognitive Learning
Processing information may need supports:
Learning Involves the processing and storing of new information, Takes place when information in received, encoded, and stored. Older adults may take longer to learn.
Risk for brain damage that affects cognitive functioning increases with age.
Implications = use it or lose it, exercise the mind for mental fitness.
Activation and Restoritive Care
Every Resident: Bill of Rights for people who live in Ontario long-term care homes.
CLEO :Community Legal Education Ontario.
ACE :Advocacy Center for the Elderly.
Resident Rights: Are guaranteed by law (Long Term Care Homes Act.) Must be displayed in the home. Reminds people that this is your home and you have the right to be respected in your home. You are a valued member of the community. Must be followed. Every home must have a way for Residents to express concerns.
27 Residence Rights:
1. Respect and Dignity
2. No Abuse
3. No Neglect
4. Proper Care
5. Safe and Clean Home
6. Citizens’ Rights: Every Resident has the right to exercise the rights of a citizen.
As a citizen it is also expected that Residents will respect others rights and freedoms and obey Canada’s laws.
7. Knowing your Caregivers
8. Privacy
9. Participation in Decisions:
· Every Resident has the right to have his or her participation in decision–making respected”
10. Personal Belongings:
· Every Resident has the right to keep and display personal possessions, pictures and furnishings in his or her room, subject to safety requirements and the rights of other residents.”
11. Plan of Care (a-d)
A. Plan of Care “Every Resident has the right to participate fully in the development, implementation, review and revision of his or her plan of care.”
B. Consent to Treatment “Every Resident has the right to give or refuse consent to any treatment, care or services for which his or her consent is required by law, and to be informed of the consequences of giving or refusing consent.”
C. Care Decisions “Every Resident has the right to participate fully in making any decision concerning any aspect of his or her care, including any decision concerning, his or her admission, discharge or transfer to or from a LTC home or a secured unit and to obtain an independent opinion with regard to any of those matters.”
D. Privacy of Health Information “Every Resident has the right to have his or her personal health information within the meaning of the Personal Health Information Protection Act, 2004 kept confidential in accordance with that Act, and to have access to his or her records of personal health information, including his or her plan of care in accordance with that Act.”
12. Independence: allowing them to do as much as they can without interferance
13. Restraints:
· Every Resident has the right not to be restrained, except in the limited circumstances under this Act, and is subject to the requirements provided for under the Act.”
· If someone is mentally capable, no one can restrain them if they do not agree.
· After all other options are exhausted, sometimes a restraint is needed for safety. It must be ordered by a doctor and checked on at regular intervals.
· The doctor must explain the restraint, and let the resident know the consequences of agreeing or not agreeing.
· The only time a person can be restrained without consent is in an emergency. If there is immediate harm to the person or others, a person can be restrained.
· Medications may only be used, no physical restraints.
What are some examples of restraints?:
Seat belts, trays they can't remove off wheelchair, confining them, medical restraints (medications), putting bed against 1 wall.
14. Communication and Visit in Private.
15. Visitors during Critical Illness:
· “Every Resident who is dying or who is very ill has the right to have family and friends present 24 hours per day.”
16. Designated Contact Person:
· “Every Resident has the right to designate a person to receive information concerning any transfer or any hospitalization of the resident, and to have that person receive that information immediately.”
17. Raising Concerns:
· Every Resident has the right to raise concerns or recommend changes in policies and services on behalf of him or herself or others to the following persons (anyone) and organizations (licensee) without interference and without fear of coercion, discrimination or reprisal, whether directed at the resident or anyone else.”
18. Friendships
19. Lifestyle and Choices:
· Every Resident has the right to have his or her lifestyle and choices respected.”
20. Residents’ Council:
· “Every Resident has the right to participate in the Residents’ Council.”
21. Intimacy:
· Every Resident has the right to meet privately with his or her spouse or another person in a room that assures privacy.”
22. Sharing a Room:
· Every Resident has the right to share a room with another resident according to their mutual wishes, if appropriate accommodation is available.”
· Could be a spouse or just a friend.
23. Personal Interests:
· Every Resident has the right to pursue social, cultural, religious, spiritual or other interests, to develop his or her potential and to be given reasonable assistance by the licensee to pursue these interstress and to develop his or her potential.”
24. Written Policies:
· “Every Resident has the right to be informed in writing of any law, rule or policy affecting services provided to the resident and of the procedures for initiating complaints.”
25. Your Money:
· “Every Resident has the right to manage his or her own financial affairs unless the resident lacks the legal capacity to do so.”
26. Going Outside:
· Every Resident has the right to be given access to protected outdoor areas in order to enjoy outdoor activity, unless the physical setting makes this impossible.”
27. Bringing People to Meetings:
· Every Resident has the right to have any friend, family member, or other person of importance to the resident attend any meeting with the licensee or the staff of the home.”
· What is the one exception?: Residence counsel
What Residents can do if their Rights are Violated? ,Four avenues that Residents can take:
1. Submit a concern to the LTC home.
· You have the right to submit a concern regarding your care or rights.
· Ask the home for a copy of the complaint process.
· You can voice your concern, or submit it in writing. If in writing, the home must submit it to the MOHLTC.
· You must receive a response within 10 business days. With an explanation of what the home will be doing.
· If the concern regards harm or risk of harm, the home must contact the ministry & investigate immediately.
· If it is a possible criminal offence, the police must be notified.
· Keep personal notes during this process.
2. Submit a concern to the Ministry of Health and Long Term Care.
· You may contact the Ministry at any time regarding a concern, even if you have already started this process within the home.
· Provide as much information as possible regarding your concern.
· You may submit in writing or by calling the toll free number. Calling is best for immediate concerns.
3. Sue the long term care home for breaking the contract.
· If Residents rights under the Bill of Rights have been violated, in means the home has not followed the contract.
· A lawyer is able to give advice on suing for breech of contract.
· Resource: CLEO’s “Steps to Justice” is a website that gives information about legal problems.
4. Consider other options
· Depending on your concern, you may want to:
· Contact the Police
· Contact a Professional College (if your concern regards a doctor, nurse, physiotherapist, social worker etc.)
What is Residents’ Council?: A Residents’ Council is made up of a group of residents in the LTC home. This group represents all residents living in the home.
· According to the LTCA in section 56, “Every Licensee of a long term care home shall ensure that a Residents’ Council is established in the home.” 2007, c.8,s.56 (1),
· Only residents living in the home are permitted to be a member of the Residents’ Council.
· In Ontario, specific rights are given to Councils in homes regulated by the province.
· It is being a member of Residents’ Council that allows the residents to work with the leadership of the home to maintain some control over their lives.
· All Residents’ Councils are different, however, most have the same goals.
Goals of the Residents’ Council:
· To protect the rights of the Residents.
· To promote quality of life within the home.
· to help Residents communicate with Leadership in a positive, ongoing way.
· to establish as sense of community and friendship among the Residents.
· To encourage Residents to use their skills and talents toward a common goal.
· To encourage residents to have a voice in their daily lives.
· Provide a safe place where everyone can be heard.
· To gather information of interest about things that may affect them.
All Residents’ Councils must have: by-laws, policies and procedures as to how the council should be run; including Guidelines, Membership, Principles, Officers etc.
Officers:
· The Licensee must provide the council with a Liaison that is acceptable to the council. The Council must vote annually to continue with the current Liaison. (go to between council and residence)
President: This is an elected position. If no one is interested in this position, the Liaison will run the meeting until a time when a Resident is interested in the position.
· the President presides over all meetings.
· the President ensures that all Residents’ Council concerns are registered.
· the President ensures that the follow up from any concerns submitted is satisfactory to the Council Members.
Restorative Care: Focuses on the restoration and/or maintenance of physical function, and helps the elder to perform their own activities of daily living (ADL's),
About Restorative care:
Prior to regulations being put into place: decline was seen as a normal part of aging.
After the implementation of regulations in LTC: the emphasis has been on eliminating the Medical Model of care, and now looks at rehabilitation, restoration and holistic care.
When delivering restorative care: we look at the whole person, a complex being with strengths and needs both physical and mental. Each resident is an individual, part of a family and a community. No two people are alike.
Based on belief in the dignity and worth of each person.
Each person is unique and services are designed to attain (rehabilitation) and maintain (restorative) the highest level of functioning possible.
A residents physical condition can affect self esteem and quality of life.
Restorative care is given 24/7 and can be given in any setting.
Benefits of Restorative Care:
Promotes functional performance and prevents disability
Improves & maintains physical and psychological health
Allows elders to function as independently as possible
Promotes dignity and well-being
Psychological benefits
Physical Benefits
Goals Of Restorative Care:
Decrease falls and injuries
Increase muscle strength and balance
Decrease incontinence
Prevent frozen bones and pressure sores
Promote increased involvement with others and decreased depression
Decrease disability
Disabilities and Principles of Restorative:
The Person with a Disability:
Disabilities for the elderly come in many forms: language, speech, hearing, physical, cognitive. Elders with disabilities are just like us with the same wants and needs.
We need to adapt the environment to meet their needs. Meeting a residents needs: is called “making reasonable accommodations.”
A “restorative environment” :encourages and enables residents to be as independent as possible. elders with disabilities want to be treated like everyone else. Many are self-sufficient and lead productive lives.
Our responsibility is to :emphasize the uniqueness and value of all people.
Elders with disabilities perform tasks differently that we do, but the outcome is the same.
Communicating and Interacting with Elders who have a Disability:
Be polite.
Avoid referring to the resident as their disability.
Always emphasize the person over the condition.
Converse with the resident like you would anyone else.
Some disabilities are not visible.
Avoid assuming that an elder with a disability needs help. Always ask before assisting.
Always ask before providing care. Never assume that someone can or cannot do something.
When communicating with someone in a wheelchair, always get to the persons level. Avoid standing in front of them, and excuse yourself when crossing in front of them.
Avoid leaning or hanging on a persons wheelchair. This is often an extension of their body and can be an invasion of personal space.
Language is Important:
Institutional:
Disabled Person
Blind / Deaf Person
The Disabled
Confined to a wheelchair
Diapers / bibs
Social Model:
Person with a disability
Person with a visual or hearing impairment
People who are disabled / the Disabled Community
A person who uses a wheelchair
Briefs / clothing protector
Other terms to avoid:
Abnormal, Afflicted, Burden, Sufferer, Deformity, Demented
Principals of Restoritive Care:
Treat the whole person
Begin treatment early ~ starting early will improve the outcome
Activity strengthens, Inactivity weakens ~ keep the resident as active as possible
Prevent further disability ~ prevent injury /practice safety
Stress the ability, not the disability
Maintenance Programs:
If residents do not progress in a rehabilitation therapy program, the therapy is discontinued, and the resident is referred to a restorative program.
The Therapist will continue to act as a consultant.
The restorative maintenance program provides repetition to maintain what he or she has learned.
Objectives are:
· Maximize current level of functioning
· Maintain the resident at this level preventing decline
· Keep the resident as safe as possible
Restorative Care Approaches:
Set Up: Preparing equipment and supplies for the program.
Verbal Cues : a brief and clear direction (may need to be repeated.)
Demonstration: Showing the resident how to do the skill, giving simple verbal directions. Some resident will require a demonstration of each individual step.
Hand Over Hand : Placing your hand over the residents hand assisting them to perform the task.
Monitor Responses
Basic Guidelines for Restorative Care:
· Follow instructions in the Care Plan
· Provide privacy
· Eliminate distractions
· Modify the environment as needed
· Practice good body mechanics and safety
· Be patient, avoid rushing
· Be encouraging, provide frequent positive feedback
· Report observations
· Document care directly after your session
· To be successful, the whole team must be aware of each individuals unique restorative programs.
· Goals and approaches are created by the interdisciplinary team.
Keys to success are:
· Consistency
· Continuity
· Communication
· Care Plan
Example of Restorative Programs:
All Teams: Restorative Dining, Reality orientation / Cognitive stimulation / Engagement
Communication programs ie. Aphasia
Nursing Focused: Bowl and Bladder maintenance, Bathing, dressing and grooming
Positioning
Rehabilitation Focused: Ambulation, Range of motion and Wheelchair mobility (Rehabilitation)
Transfers and Mobility:
· A progressive mobility program increases a residents activity level gradually.
· Bed Mobility
· Transfer Training
· Strengthening
· Weight bearing: FWB, PWB, WBAT, NWB
· Self-propelling in wheelchair
· Ambulating with walker
Transfer belt contraindications:
· An ostomy
· A gastrostomy tube
· Recent abdominal surgery or fresh incision
· Severe cardiac or respiratory disease
· Fractured ribs
· Independent- no help or oversight, provided help or oversight only one or two times during the past seven days.
· Set Up- providing minimal assistance
· Supervision- oversight, encouragement, cueing 3 or more times over 7 days
· Limited Assistance- received physical help in guided maneuvering of limbs or other non weight bearing assistance 3 or more times over 7 days
· Extensive Assistance- help with weight bearing support 3 or more times. Full team performance of activity 3 or more times(but not all) of last 7 days
· Total Dependence- Full team performance of activity for entire 7 days. Complete non-participation by the resident in all aspects of the activity
Ambulation and Assistive devices:
· Provide support during ambulation
· Redistribute the balance of weight
· Shifts center of gravity over a wider area
· Enable resident to be independent with ambulation
Types:
Canes:
· Good for residents with one good arm, lateral instability, or balance conditions.
· Used for more severe conditions, requires balance and upper body strength in one arm
Walkers
· Standard- Adjustable, rubber tips
· Rolling- Legs have wheels, sometimes all 4 or sometimes 2 in front
· Requires upper body strength, excellent for older adults and good for those who need balance not support
Wheelchairs
· Transfer Chairs- good for short distance and quick use
· Tilt Chair- major seating chair, tilt good for relieving pressure and positioning
· Broda- more difficult seating needs. Good for multiple sclerosis, Alzheimer’s, kyphosis, and brain and neck injuries
· Power Chair- best for distance, great for independence
Personal Expressions
Personal Expressions imply: a change in normal or baseline behavior; a new behavior or an existing but worsening behavior.
These expressions may be due to: a trigger, an unmet need or a perceived threat.
They are the result of: changes in the brain affecting memory, judgement, orientation, mood and behavior. One thing to remember is that “All expressions have meaning.”
Expressions or behaviors can be: a persons only way to communicate to others.
Understanding Personal Expressions: Expressions can be someone’s words, gestures, actions and reactions.
Everyone has good days and bad days.
Every Human being has expressions.
They are unique to each person.
Examples of Personal Expressions:
· Agitation
· Exit Seeking
· Hoarding / Rummaging
· Physical Expressions
· Refuses care
· Suicidal Expressions
· Suspicion / Paranoia
Coping and Defense Mechanisms Common in Seniors:
· Denial, refusing to admit there is a problem.
· Rationalization, providing an acceptable but untrue reason for a problem.
· Projection, blaming someone or something else.
· Not everyone is able to use coping or defense mechanisms ie. a person living with dementia.
Escalation of Personal Expressions: Usually begins with signs of anxiety or distress.
What might this look like?
· May become a verbal expression.
· What might a verbal expression sound like?
· May escalate into a physical expression.
Supporting Personal Expressions:
Step 1: Attempt to learn the cause or trigger of the expression. Ask
· Are there environment conditions present?
· What times of day is it?
· Is it during specific activities? Ie. personal care, programming, meals?
· Is it in the presence or absence of others? Ie. other residents, or family members?
Step 2: Eliminate the cause of the personal expression.
· Identifying and removing the trigger or cause will stop the expression.
· It may not be immediate, but it will get better over time. Step 3: Examine the consequences of the personal expression
· Something in their routine may have to be eliminated or changed
· Document, document, document!
4 Keys to Personal Expressions:
1.Understand: Search for the meaning, know the person so you can try to understand the cause.
2. Plan: Involve family. Schedule Multi Disciplinary Care Conferences with family. Make a plan and share with all care providers.
3. Manipulate the Environment: Remove hazards and stimuli. Provide diversion.
4. Limit Restraints and Psychotropics: Be mindful of their negative effects.
Physical Restraint: defined as any mechanical or physical material, device, or equipment that is attached to or adjacent to a resident’s body. It cannot be easily removed by the resident.
Chemical Restraint: drugs that are used for discipline or convenience instead of medical purposes. Most often, chemical restraints are used in nursing facilities to sedate and pacify residents whose behavior is too aggressive or unruly for the staff.
Behavioral Supports Ontario (BSO):
The Behavioral Supports Ontario initiative was created to: enhance health care services for older adults in Ontario with complex and responsive behaviors, associated with dementia, mental health, and other neurological conditions. Also provides enhanced family caregiver support in the community, long term care or wherever the resident resides.
Specialized Social Therapist: was a role created within the Lead BSO Team, because there was a piece missing to the Team , Recreation.
The SST:
· provides support to the Internal BSO team (our PERT team), all team members and recreation.
· An SST “thinks outside of the box” to create person centered programs for residents with personal expressions.
· The SST connects with families for additional information regarding the residents past life, interests and passions.
· the SST visits with the resident and observes the resident in programs and throughout the day.
· They will then work with the neighborhood team in trialing different and possible new ideas or programs for the resident. The SST will trial multiple programs, mentor and support the team while supporting the Recreation team member with new ideas.
· The SST follows up with supporting documentation and follow up visits.