Promoting Function & Maintaining Independence in the Face of Dementia – Jane Yakel

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Sooner or later, it will touch us all: our patients, family members or someone else close to us is diagnosed with dementia. With our population aging, we are continually being swept into a flurry of daunting tasks to teach the demented patient skills that are hard to come by, including; locking wheelchair brakes for safety; drinking liquid to prevent dehydration; increase functional independence in toileting, and most importantly, assisting with training the caregiver. As we enter the world of dementia and see the paradigm of service delivery shift to the caregiver, it is increasingly important to increase our knowledge and skill levels, not only for our patients but also for our ability to train caregivers and family members.

Knowing how the diseases of dementia unfold is an invaluable tool for success. Knowing how, when, and what to do for the patient depends on understanding that our professional, and ethical, responsibility is to assist the patient to achieve and maintain their highest level of functioning; therefore, we must know what they need – and this knowing begins with the ability to accurately “stage” a patient’s dementia. Once a patient is staged, the needs of the patient can be more easily seen.

This innovative recording presents staging tools that clearly outline, at each distinct stage, the patient’s remaining abilities and the patient’s lost abilities; this is the insight that drives intervention. Discuss and demonstrate the top evidence-based communication techniques in the field for dementia via role play. Complete this dynamic and collaborative recording with the confidence and skills to develop structured, systematic, and highly individualized therapy programs, and with the abilities to justify their practice.

1. Accurately stage the patient with dementia or other cognitive impairments
2. Utilize patient staging levels to design appropriate treatment interventions
3. Demonstrate successful intervention of Errorless Learning Techniques, Spaced Retrieval, Montessori-Based Dementia Programming, Reminiscence Therapy, and The Ability-Based Approach
4. Implement Validation Therapy, Reflective Listening, and Re-Direction to increase communication between you, the patient, and the caregiver
5. Document patient-centered goals, measure progress, and justify necessity through utilizing Medicare documentation guidelines
6. Distinguish the differential diagnosis of degenerative neurological diseases and detect how dementia symptoms vary among the diseases

DEMENTIA AND DISEASES

• Differential diagnosis of degenerative neurological diseases
  • Detect how dementia symptoms vary among the diseases

ASSESSING OR STAGING? WHAT DO THEY TELL US AND WHICH DO WE DO?

• Standardized assessments
• Patient-centered assessments
• “Staging Tools”
• What patient skills to expect at each stage
• Chronological ages that go with the stages

DOCUMENTING DEMENTIA SKILLED INTERVENTIONS

• Write patient-centered goals
• Measure progress and justify medical necessity
• Making daily documentation “skilled”
• Key words that reflect functional outcomes in dementia therapy

APPROACHES TO THE MEMORY SYSTEM

• Memory system to use for new learning/conscious memory
• Memory system for procedural learning unconscious memory
• Documenting memory systems per medical diagnosis

EVIDENCE-BASED THERAPEUTIC INTERVENTIONS

• Errorless Learning
  • Error vs. Errorless learning
  • Directions for successful use of errorless learning
  • Interactive lab/case discussion
• Spaced Retrieval
  • Specific timing and directions of spaced retrieval for the dementia population
  • Designing a “prompt question”
  • Discipline-specific demonstrations using Spaced
  • Retrieval
  • Written goals and skilled documentation
• Montessori-based Dementia Programming
  • Translate Montessori teaching into successful therapy intervention
  • Retrogenesis: Understanding First In – Last Out Theory
  • Create structured stimulating activities appropriate to individual cognitive levels
  • Written goals & skilled documentation specific for
  • Montessori techniques
• Ability-Based Approach
  • Design successful therapeutic interventions according to patient abilities
  • Determine the patients best ability to function
  • Written goals & skilled documentation specific for ability-based techniques
  • Examples and case studies provided
• Reminiscence Therapy
  • Powerful use of the “senses” designed to awaken the soul
  • Know the patient is “alive inside”
  • Design individual and/or group Reminiscing Therapy sessions
  • Select activities and create reminiscing themes and kits
  • Written goals and skilled documentation
• Memory Books/Aids
  • Proven methods in presenting functional & factual information in written & picture format
  • Idea suggestions for individual stages of life/ “stages” of dementia

COMMUNCATION SKILLS: THE KEYS TO BEHAVIOR

• Reflective Listening
  • Listening from a position of empathy & emotional intelligence
  • Practice multiple verbal formulas proven for success
  • Client-centered communication – Reflection of Feeling
  • Avoiding pitfalls all listeners fall into
  • Interactive lab/case examples and discussion
• Validation Therapy: A Powerful Communication Tool
  • Principles and pointers for dismantling power struggles and resolving arguments
  • Accepting values, beliefs, and reality regardless of accuracy
  • Handling hallucination, delusions, hoarding, blamers, and accusers
  • Interactive lab/case examples and discussion
• Re-direction
  • Learn the key to “agree” with what the patients wants/needs through conversation
  • Case study for safety, ambulation, hallucinations, and delusions
  • Interactive lab/case examples and discussion

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