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Nurse leaders improve dementia care

March 19, 2015
by Julie Thompson
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The intense, eight-hour dementia training course for the staff at Presbyterian SeniorCare’s Woodside Place might seem a little chaotic at times for anyone who walks by and peeks inside. At any given moment, there may be a staff member pacing the room, snatching up someone’s cell phone or attempting to open a pill bottle while wearing bulky gloves. There’s constant movement, noise and plenty of confusion. But for Cheryl Covelli it’s a beautiful scene. “My theme for the day is, ‘If you think it is hard for you, how do you think it is for them?’” Covelli says.

For an entire day, Covelli turns program participants into residents. She makes them incontinent, arthritic and hearing and seeing impaired. She sporadically instructs nurses to walkaround the room aimlessly, while looking for items they can take from others. The goal is to give staff an idea of what it is like for people to live with a disease yet lack the ability to communicate how it is affecting them. The result is always the same: “Staff members say that when they experience it they understand it,” Covelli says.

Eight years ago, Covelli was tapped by Presbyterian SeniorCare when it was looking to revamp its dementia training program. Creating a top-notch, effective program was extremely important for the long-term care (LTC) community to maintain its national reputation as a leader in memory care. Covelli, who started at the community as a part-time LPN, has risen to second-in-command behind the administrator. She was the person SeniorCare needed: A person with longevity, creativity and a proven track record.

“Part of the reason I have my skill set is that I have lived this for 22 years, five days a week,” says Covelli, director of nursing for Woodside Place. “I could spend hours telling you stories of how I have learned to problem solve and deal with behaviors. It’s that type of experience that is the key to helping this training program to succeed.”

One in nine people age 65 and older has Alzheimer’s disease, and according to the National Alzheimer’s Association, at least half of the residents in long-term care suffer from dementia. It’s a disease that has always existed in LTC settings, but one that is finally being given the attention it deserves. Communities are responding to the residents’ growing needs by treating dementia as a primary concern, not a secondary health issue. As a result, organizations like Presbyterian SeniorCare have birthed dementia-dedicated communities like Woodside Place that highlight holistic care for individuals struggling with the disease.

Such changes don’t come naturally or overnight, which is why nurses play such an important role in helping to foster and champion continued change. Communities can build dedicated dementia units, but it takes the proper training to make sure the staff is able to carry out the culture change needed to make it a success.

Improving dementia care

Robin Arnicar, RN, CDP, CADDCT, CDONA, FACDONA, president of the National Association of Directors of Nursing Administration in Long Term Care (NADONA), says nurses possess the expertise needed to train others in how to care for dementia patients.

“Our biggest role in memory care is to educate staff so they understand the unique needs of a memory care resident,” says Arnicar, who is also an active director of nursing for Erickson Living’s Renaissance Gardens at Charlestown Care Center. “I have learned that when you meet one person with dementia, you have met one person with dementia. They may share similar symptoms, but they are unique and different from one another.”

Nurses need to help staff understand the danger in stereotyping dementia patients, adds Arnicar. The challenge, however, is getting staff to look past an individual’s behaviors to understand his or needs.

“Behaviors are really a resident’s way of communicating with us,” she says. “Our goal has to be to help staff and even family members understand that a behavior is really their loved ones’ way of trying to tell us something.”

Common behaviors seen in dementia patients such as agitation, wandering, sundowning, depression and hoarding are all things Covelli covers in her training at Presbyterian SeniorCare. She not only has a staff member act out the behavior but then walks participants through the best way to respond. The goal is to get staff to look beyond the behavior to recognize the underlying need and find a way to solve it.

At Woodside Place, one of Covelli’s favorite examples of resolving behavioral issues involved the community’s youngest dementia patient. The 56-year-old attorney arrived at the community with an arrogant attitude and would only converse with administration. As time went on and his ability to function on his own diminished he found himself in a place where feeding himself was a struggle.

“I was watching him one day and he wore 80 percent of the food and actually ate 20 percent,” Covelli recalls. “If the staff offered to help he would become angry and throw food on the table. Inside, he knew what he wanted. I suggested that staff butter his bowl and place the hot food inside. When he lifted the bowl, the food slipped out easily. The next time I saw him he was wearing 20 percent of the food and ate 80 percent.”

Open closed-door dementia wards

Dementia care has evolved over the decades to extend beyond keeping someone safe and alive to providing what is needed to fully live the life he or she has left. “It used to be safety, safety, safety,” says Arnicar. “It’s not that safety isn’t important. In fact it is as important now as ever before, but it is just one piece of providing memory care. We are getting away from the medical model to one that allows residents to enjoy life.”