Providing quality care for veterans who have experienced war is challenging enough for most nursing homes. But, what happens when dementia enters the picture, causing dementia-related behaviors to intersect with wartime flashbacks? How can caregivers learn to sort out what the behaviors mean and how best to intervene? Most importantly, how can providers amend their care protocols to serve veterans in the same quality-of-life way they serve other seniors?
The latest trends in dementia care are all about identifying triggers that can help with behavior modification within the realm of person-centered care and without the unnecessary use of medications. The problem for veteran residents is that being in a long-term care facility can be a major trigger in itself. Managing the behaviors of veterans with dementia—and even veterans in general—can require different intervention strategies and a very different levels of staff understanding compared to non-veteran residents.
About the OPTIMA Award
Since 1996, the annual Long-Term Living OPTIMA Award has honored long-term care communities that enact proactive projects to enhance resident care and resident quality of life. The OPTIMA Award winner is selected by an independent judging panel of long-term care experts using a double-blind entry-judging process and adjudicated by a third-party award coordinator. No one from Long-Term Living or its parent company, Vendome Group, is involved in the judging process.
To learn about the program and see a list of previous winners, visit the OPTIMA Award page.
The winner of the 2016 Long-Term Living OPTIMA Award decided to dig much deeper into such behavioral triggers and ended up learning a lot about how veterans’ minds and emotions work and how caregivers can best interact with them. Some of their findings will challenge everything you thought you knew about senior skilled nursing care.
Ted, an 82-year-old nursing home resident and veteran of the Korean War, is visiting the common room this afternoon, where he likes to watch TV. But suddenly, he hears the beating sound of rotors from oncoming helicopters. The jungle encroaches into his mind, and he’s sure he hears enemy gunfire pinging through the palm leaves. Next, there’s a crashing sound, and Ted is captured by an enemy soldier, who has grabbed him from behind. Flailing and screaming, he feels trapped and surely doomed to die as a prisoner of war.
What really happened: An aide wheeled Ted to the common room for his usual TV program watching, and then decided to turn on the ceiling fans to create a breeze against the Texas summer humidity. Next, a nearby aide dropped a metal dining tray onto the floor. Once Ted began his full-blown crisis episode, the aide approached him from behind and tried to comfort him by hugging him while he sat in his wheelchair.
Not all—or even the majority, some say—of current veterans have post-traumatic stress. But for those that do, they’ve probably lived most of their lives without assistance intervention or treatment. Ted’s care and quality of life could be greatly improved if the nursing home staff learned what his person-specific triggers are, why they happen and how they can be avoided.
The 2016 Long-Term Living OPTIMA Award winner, a senior veteran care chain in Texas, decided to learn more about what causes behavioral triggers and how to help veterans through them, and it’s not a program from the Department of Veterans Affairs (VA).
In 2014, John Berkely, deputy director of the Texas Land Board Veterans Homes (TLBVH), noticed a high rate of reported behaviors across the agency’s eight veteran nursing home sites, including unexplained outbursts and even violence against the staff. Deciding to do something about it, he hired Kathy Johanns, a seasoned assisted living administrator, to dig deeper into why such behaviors were happening and to develop a new training program that could help caregivers learn to handle behavioral situations better. “We realized the staff training needed to be different because these are not traditional nursing home residents,” Berkely says. Soon after Johanns came on board, Sara Rodriguez, RN, joined the team, adding years of skilled nursing experience to the program preparation.
What they’ve learned over the past three years has added an unprecedented chunk of knowledge and insight into senior veteran care and why it needs to be different from traditional skilled nursing care. The result is a new training program in veteran-specific education and care-change management, deliberately made available to any staff member, from the director of nursing to housekeeping.
Of course, the key differential between veteran residents and non-veteran residents is the potential for military-related post-traumatic stress disorder (PTSD). While many veterans return from combat zones without PTSD, some of them do—and many veterans from earlier wars were never diagnosed or treated. Those veterans are already among the current nursing home census, and many more will be coming behind them—who got to see Vietnam, Chechnya, Iraq and Afghanistan up close and personal.