nhs allegheny valley school memory care program...one individual at a time nhs allegheny valley...

One Individual at a Time

NHS Allegheny Valley School

Memory Care ProgramOne Individual at a Time

Planning for Individuals with Intellectual

and Developmental Disabilities and

Alzheimer's/Dementia

avs.nhsonline.org

Confidential - NHS Human Services, Inc. - Not for Reproduction

• Ensuring that our individuals are well cared for, even when their needs change over time, is a very high priority and one that is central to the principle of “aging in place”.

Alzheimer’s/Dementia Program


Alzheimer’s/Dementia Program, continued

• Aging in place becomes more challenging when Alzheimer’s disease (AD) or another form of dementia (D) strikes.

• Rates of AD/D increase with age and the population of older adults with I/DD, which has grown thanks to earlier detection, better healthcare, and enhanced community support. It is expected to increase even more over the next 20 years.



• Those with Down syndrome (DS) are at much higher risk, with approximately 50-70% developing symptoms by the age of 60.

• The disease tends to progress more rapidly in this vulnerable group, and recent imaging studies suggest that, by middle age, virtually all adults with DS have abnormal protein deposits in the brain, which are considered a hallmark of AD.



• NHS/AVS was seeing more cases of AD/D.

• NHS/AVS was aware of the need for increased supports for clients, their families and employees.

• NHS/AVS leaders secured a grant to develop a demonstration program.

• The program continues to be overseen by a project manager and an interdisciplinary core group of senior staff members.



• Since 2012 the core group has:

▫ Surveyed employees and families

▫ Held meetings with staff

▫ Consulted experts in the field

▫ Reviewed books, DVDs, webinars and other sources of information about I/DD and AD/D



Guidelines were developed to address:

• Assessment and evaluation

• The physical environment

• Programming and interventions

• Staff training

• Supports for caregivers (family members, peers and employees)

• Leadership, advocacy and research



• These guidelines are providing the foundation for:

▫ Capital improvements

▫ Program design documents

▫ Staff training manuals.

We launched the

Alzheimer’s/Dementia Pilot Program

on our Pittsburgh Campus in Summer 2014.



• To implement the guidelines related to the physical environment, we renovated one of the existing residences on our Pittsburgh Campus (the Shingle House) to ensure the safety and well being of consumers with AD/D.



• The home is the residence and primary program area for 16 individuals with mid-level AD/D.

• The individuals residing in the home are participating in a modified program that is responsive to their changing needs.



• Enhancements to the home include new windows, doors, flooring and furnishings, as well as a secure, enclosed outdoor area to provide an outlet for consumers who are prone to wandering.


Rationale for Modifications:

Wayfinding: creating a clear pathway for moving around the facility.

• Painting the bathroom door a different color to make it easier to locate quickly.

• Place wayfinding markers near or on the floor so they are visible to individuals with dementia who often look down when they walk.

• Use older photos and mementos to help clients recognize their own bedrooms.


Rationale for Modifications (continued):

Flooring:

• Using consistent, non-patterned level flooring with a matte finish, to enhance mobility and reduce anxiety.

• Some individuals with dementia mistake high-gloss floors for pools of water and have difficulty transitioning from one kind of surface to another.



Color:

• Using paint color and contrast to create visual cues or reduce attention to specific areas.

• Use solid colors or simple patterns rather than complicated or highly unusual designs.



Lighting:

• Avoiding shadows, glare and sudden changes in lighting to reduce anxiety and confusion.

• Increasing lighting levels and keeping the home well lit in the evening to combat “sundowning” (behavioral problems that begin at dusk and last into the night).

• Removing mirrors for individuals who might be startled by their own aging faces.



Bathrooms:

• Designing to draw attention to the toilet utilizing different colors for the toilet seat.

• May also use different colors for sink, grab bars and towel bars that do not blend in with the wall.



Kitchens:

• Labeling cupboards using pictures.

• Installing shutoff switches on appliances for safety.

• Storing sharp knives, cleaning products and other hazards in discreetly locked cabinet.

• Select cups, bowls and plates that make it easier to identify food and drinks being served.



Shadow Box:

• Each individual has a personalized shadow box that is placed directly outside of their bedroom.

• The shadow box serves as a locator for each person’s room as well as a way to connect the person with their interest and past.



Exterior/grounds:

• Providing access to a safe, secure, barrier free area to direct individuals who are prone to wandering.

• Installing ramps and eliminating other barriers to entrances/ exits.

• Installing locks (with automatic release) and other wandering-prevention devices on exterior doors, and alert systems so caregivers know when someone is leaving the residence.


Sensory Processing:

• The brain interprets the information received through all of the senses.

• The brain decides what information is important.

• The body can then interact with and learn from the environment.

• Use of sensory integration activities and sensory adapted equipment is vital to programming and daily living skills.


Partnerships:

• As we developed the program we have connected to national and regional groups that are addressing the issues of individuals with I/DD and AD/D.


The National Task Group (NTG) Partnership:

• The National Task Group (NTG) on Intellectual Disabilities and Dementia Practices is a coalition of interested persons and organizations working toward ensuring that the needs and interests of adults with intellectual and developmental disabilities who are affected by AD/D– as well as their families and friends – are taken into account as part of the National Plan to Address AD.

• The NTG is supported by the American Academy of Developmental Medicine and Dentistry and the Gerontology Division of the American Association on Intellectual and Developmental Disabilities, along with the Rehabilitation Research and Training Center on Aging with Developmental Disabilities-Lifespan Health and Function at the University of Illinois at Chicago and the Center on Excellence in Aging at the University at Albany. www.aadmd.org/NTG


NTG Training:• AVS has partner with the NTG to present a two

and three day national training opportunity for health and human service providers and family care givers.

• The trainings have been well attended by many NHS staff, community providers, County providers and other leaders in the filed such as the Down Syndrome organization of Western Pa.

• National Certification is available.


What worked well: • Safe and attractive environment

• Familiar dedicated, well trained staff

• Individualized care

• Flexible, relaxed scheduling with some structure and routine

• In-home programming along with opportunities for continued participation outside of the home, as appropriate

• Enclosed yard

• Art classes

• Outings in community

• Family meetings

Staff and family survey responses:


Staff and family survey responses

(continued)Areas for improvement:

• Inconsistent staffing on off shifts and weekends

• Crowding in public areas of house

• Lack of private areas to relax, outside of bedrooms

• Clarification of end-of Life care plan


Lessons learned:

• Alarm system was not as functional as expected.

• Backyard area enclosure is beautiful but needed some modifications.

• Walk in tub presented some challenges and is costly to repair.

• Staffing patterns and training for off shift and casual staff can be challenging.

• A small separate area to relax and have time away from the group would have been of benefit to the individuals.

• Utilizing an outside consultant proved to be very beneficial to the project development.

• .


Final Thoughts:

• The NHS/AVS Alzheimer’s/Dementia Program under development will be a model that can be shared and replicated.

• Future planning is underway to create a group of community homes that can support individuals with IDD in the earlier stages of A/D so that they can remain in the community as long as possible.

.


Program Support:

• Program development and home renovations have been underwritten by:

• AVS Foundation

• Babcock Charitable Trust

• Pittsburgh Vintage Grand Prix Association

• Polk Foundation

• Other contributors to the Capital Development Fund

nhs allegheny valley school memory care program...one individual at a time nhs allegheny valley...

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