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Administer Effective Dementia Treatment Interventions to Meet Goals

Strengthening, Transfers, Balance & Gait • Demonstrate long strides or high knee raises during gait training. Demonstrate side stepping for balance

training

• If patient has shuffling gait smooth soled shoes should be used.

Rationale: Shuffling gait presents itself around stage 6 GDS and cannot be corrected. Must compensate instead

Rationale: If patient is unable to follow instructions, try mimicking with exaggerated movements

• Ball toss or kick ball are effective exercises. Use ankle and wrist weights to provide resistance

Rationale: Even at stage 5 and 6 GDS, patients are still able to kick or toss a ball back to you

ADL

• Self-care training can be to determine baseline of function or return to baseline

• Environmental adaptation is a large treatment focus

• Incorporate familiar items and methods

• A white bar of soap with contrasting washcloth is more effective than liquid soap

• Bathing in the bathroom is more effective than basin or bed bath

Rationale: Nostalgia, long term memories, familiarity is calming

• When a bed bath is necessary, cover patient with a warm blanket and offer a massage. When patient

agrees, bathe patient underneath the blanket

Rationale: You are a stranger and no one wants to be nude in front of a stranger. And, who doesn’t like a massage?!

• For dressing, offer patient 2 appropriate clothing options. Ask patient to help you

• Ask patient, “would you like to get dressed now or at 9am?”

Rationale: provides a sense of autonomy and most people love being helpful to others

Cruise Dining/Feeding

• Sit across from patient during feeding instead of adjacent

Rationale: patients with Alzheimer’s lose peripheral vision by stage 6 GDS and can’t see you at their side

• Ask patient to taste food for you and let you know if it needs any seasoning

Rationale: Patients with Dementia love being helpful

• Put food in ice cream cones

Rationale: who doesn’t love ice cream cones?!

• Sweeten up all food. If patient is Diabetic, use artificial sweetener or stevia

Rationale: By stage 6 on the GDS, patients with Alzheimer’s lose sense of taste except sweet and bitter so adding

salt and pepper is useless. Savory flavors cannot be detected

Medication Administration

• A patient at GDS 4 can sometimes manage meds if a caregiver places them in an organized pill box. Visual

and/or auditory reminders may be necessary

• GDS 5 or higher needs more assistance with meds.

• When patients refuse meds, ask patient to try your recipe and give you’re their honest opinion

Rationale: They enjoy being of assistance to you but they don’t enjoy taking orders from you

Aggression

• Use good guy/bad guy routine – When patient becomes agitated, a 2nd caregiver can be the patient rescuer.

Rationale: It immediately establishes trust with a stranger

• If the patient and others are not in immediate danger, step away and allow the mood to past.

Rationale: They will forget about it soon

Toileting

• Attempt toileting 30 minutes after meals. Wait 90 seconds and patient will void

Rationale: It just works! The physiology of the air is involved

• Allow patient to tear toilet paper and attempt hygiene

Rationale: familiarity

Wandering, Packing & Hoarding

• Keeping patient busy with meaningful activities can reduce wandering. Folding, wiping/cleaning, child care,

drawing, music, gardening and “repairing” with safety tools, and sorting are good examples if activities are

supervised properly

• If possible, create a safe environment for patient to wander outdoors

Rationale: Prevents boredom, creates nostalgia

• When patients begin packing in preparation to leave, create a reasonable explanation for why they

shouldn’t leave now. I.E. storm coming. Assure them that the room is paid for and that they can leave in

the morning after the storm passes.

Rationale: By GDS mid to late stage 5 patients with Dementia can no longer be oriented back to reality.

• If patient attempts to enter a room or area that is off limits, inform them that the floor is wet, there are

repair men working and the lights, water or heat will be turned off temporarily. Assure him or her that you

will inform them when the area is safe again.

Rationale: By GDS mid to late stage 5 patients with Dementia can no longer be oriented back to reality. Also, you

are establishing trust as a stranger.

• If vision is intact, signs written in simple language can be effective for achieving desired behavior

Rationale: Patients can read through GDS late stage 6. However, abstract thinking no longer exists.

• If utilizing a sign to prevent entering a restricted area, use a “Dead End” sign instead of a “Stop Sign”.

Rationale: What do you do after you stop at a stop sign?

Visual Changes

• Paint walls florescent green

• Use florescent lighting

• Place signs and televisions 45° below eye level

Rationale: By GDS Stage 6, patients with Alzheimer’s typically lose peripheral vision and their field of vision lowers.

They also lose the ability to see color. Florescent green is easy to see and calming

Effective Discharge Planning to Avoid Hospital Re-admissions

DME

ADL: Medicare pays for no DME used for bathing, dressing or feeding

Toileting: BSC is only covered if patient is room confined and cannot access bathroom

Mobility: One mobility device is covered every 5 years

Mobility Criteria

1. Mobility limitation that significantly impairs one or more mobility related ADL

2. The deficit must entirely prevent participation and mobility related to the ADL or place the

patient at heightened risk

3. Patient must be able to safely use device

4. Mobility deficit can be resolved with the use of the device

Patient qualifies for a w/c if mobility deficit cannot be sufficiently resolved with use of a cane or walker

and:

1. Home must provide adequate access

2. w/c will significantly improve patient’s mobility

3. Patient will use w/c on a regular basis inside the home during ADL (not covered for community

use or long distances)

4. A lightweight w/c is covered if patient cannot propel a standard w/c in the home but can propel

a lightweight chair

Hospital Bed

• A fixed height hospital bed is covered if 1 or more criteria are met:

1. Patient has a medical condition that requires positioning of the body in ways that are not

feasible with an ordinary bed. I.E. HOB >30°

2. Patient requires positioning on the body in ways that are not feasible in an ordinary bed for pain

3. Patient requires HOB > 30° due to CHF, COPD or aspiration. Pillows and wedges must have been

attempted and ruled out

• Patient can qualify for a semi-electric bed if 1 of the above criteria is met AND also needs

frequent repositioning by an available caregiver

• A full electric bed will not be authorized for convenience. Patient must require frequent

positioning and care provided by an available caregiver.

Functional Maintenance Program Last Name, First Name: ______________________________ Room # ______ Effective Date: ________

Ambulation Device

no device front wheel walker 4-wheel rolling walker rollator

hemi-walker L platform walker R platform walker single point cane

crutches wide base quad cane narrow base quad cane non-ambulatory Ambulation Assist

independent supervision limited assist extensive assist total assist

Wheelchair

Wheelchair: Yes No If yes, size: _____ style (select one): standard High back one arm Other specific details (dycem, lap tray, forearm trough, etc.): _________________________________

independent supervision limited assist extensive assist total assist

Bed Mobility

independent supervision limited assist extensive assist total assist

Transfers

stand pivot sit pivot Mechanical Stand Mechanical lift Slide Board

independent supervision limited assist extensive assist total assist

ADL Bathing: UB ______ LB ______ Dressing: UB ______LB ______ Grooming: _______ Feeding: _______ Toileting: transfer _______, hygiene ______, clothing mgmt.______ ADL set up: ______

Legend: I = Independent, S = Supervision, LIM = Limited Assist, EXT = Extensive Assist, TOT = Total Assist

Adaptive Equipment (select all that apply)

reacher long handled shoe horn sock aide long handled sponge

scoop plate weighted utensils spill proof cup built up utensils

none Other _________________ Feeding/Swallowing Instructions (select all that apply)

use straw no straw alternate bites with sips

small sips (¼ or ½ tsp) small bites (1/4 or ½) check for pocketing

head of bed to 90° cut food into bite size pieces dentures (upper/lower/both)

monitor feed resident none Other _______________

Food Texture: regular mech soft puree Liquid Texture: thin nectar honey pudding

Special Cognitive or Communication Instructions: ___________________ See attached handout

Splinting/Orthotics (select all that apply)

hand wrist elbow shoulder knee ankle foot left Right Both

back neck none other ___________________________________________________

Instructions: _________________________________________________ or See attached handout

Exercise Protocol (select all that apply)

Upper Extremity: strengthening AROM PROM AAROM - Right Left Both

Lower Extremity: strengthening AROM PROM AAROM - Right Left Both

Exercise Protocol: Walk-to-Dine or See Attached handout

Please notify the rehab department of any changes in functional status of residents Therapy Strategies Plus © Form: 10117. May Reproduce.