Clean Dementia Care

In the effort to think, feel, treat, and heal clean, how does this apply to dementia care. It's pretty typical that as part of the disease process, those with dementia will display a number of behavioral symptoms as a way to communicate. These behavioral symptoms mean something. The individual may be hungry, thirsty, tired, in pain, or needs to use the bathroom. Or the individual might be anxious, sad, angry, scared, or bored. However, sometimes these behavioral symptoms put the individual and their care partners at risk for injury. It's important as care providers that we help to anticipate what the individuals in our care need so they don't have to act out to show us they need something. However, when the individual with dementia does act out we need to recognize what's happening and intervene.

Unfortunately, often times an as needed psychotropic medication is used immediately at hopes to stop the behavior. Essentially it slows down the individual and sometimes even makes them sleep. There are all kinds of risks of doing this - falls, increased confused and agitation when it wears off, diarrhea or constipation, and so on. When the medication is done having it's wanted affect, the individual with dementia will likely display the same behavior again when they are needing or wanting what they were trying to communicate about in the first place. For example, if the person with dementia was acting out because they are hungry, they will still be hungry when they are out of their stupor caused by the medication. If they were scared when they are left alone in their room and they are shouting out repeatedly, when the medication affects wear off and still left in their room, they will continue to scream out repeatedly. These medications are not solutions but band-aids.

The best approach to handling new or worsening behavioral symptoms is a 5-step approach:

  1. First, have a medical evaluation completed that includes blood work and an urinalysis. Often with dementia, infections aren't caught right away because the individual can't express their ailments and therefore come out as behavioral symptoms that let the care provider know that something is wrong.
  2. Second, if all checks out medically, then complete a root-cause analysis of the behavioral symptoms. When do they occur, identifying triggers so the care partner can learn when these symptoms may occur. This will help them plan to be proactive in preventing these symptoms by setting up better routines for the person with dementia.
  3. Third, use non-pharmacological tools and approaches to care - music, art, essential oils, reminiscing, dolls, pets, weighted blankets, and more. Trial to see what works with the person you are caring for. Build that toolbox so you have many to choose from! If you can calm or satisfy them, then you'll feel great about the care you are providing. We call this the "Win, Win!" Care providers or companies, remember, CMS requires that you do this.
  4. Fourth, if the individual you are caring for needs a higher level of intervention, then they may benefit from psychological, speech,  occupational, or physical therapy.
  5. Fifth, if none of these work, and the behavioral symptoms are still happening, then a psychiatric evaluation and the introduction or increase of psychotropic medication may be needed. But this is a last resort! 

Implementing this 5-step approach will help you as a care provider, company, or caregiver to avoid the overuse of psychotropic medications in your care. This will help minimize negative side effects and sometimes long-lasting problems for the person with dementia. For care providers and companies, this will help lower your prescriptions in your facility, boosting your Quality Measures and 5-Star Rating, and increase your CMI because you'll be able to do gradual dose reductions.

Win, Win!

 

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