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Aging in Place - A Strategy for Caring for People with Intellectual Disability and Dementia. Partners in Care… Living in the Moment March 6, 2007. Leslie Udell Program Co-ordinator Winnserv Inc. Degree of Commitment to Supporting Individuals. Educating Board of Directors
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Aging in Place -A Strategy for Caring for People with Intellectual Disability and Dementia Partners in Care… Living in the Moment March 6, 2007 Leslie Udell Program Co-ordinator Winnserv Inc.
Degree of Commitment to Supporting Individuals • Educating Board of Directors • Development of agency policies • Recruitment and education of new board members
Accessible/Dementia Friendly Housing • Environmental considerations • Evaluating current housing • Considerations for people living in apartments or on their own
Admission and Discharge Criteria • Dealing with individual’s actions and reactions to the symptoms of Alzheimer’s disease • The impact of significant health concerns • Supporting people who have the need to wander • Supporting people who are living independently • Considerations for a death at home
End of Life Care Policies • Benefits and steps to planning ahead • Planned death at home • Advanced Care Directives, DNR orders • Funeral planning • Bereavement support
Assessment • Documentation of decline • Gradual onset and continuing cognitive decline • Atypical actions and reactions • Late onset seizure activity
Diagnosis and Misdiagnosis • Detailed medical history • Thorough physical and neurological exams • Psychiatric examination • Pharmacological review
Assessment Tools • Videotaping • Vineland Adapative Behavior Scales • Inventory for Client and Agency Planning (ICAP) • Scales of Independent Behavior • Adaptive Behavior Scale – Residential and Community
Specialized Dementia Scales • Dementia Scale for Down Syndrome (DSDS) -Gedye • Dementia Questionnaire for Mentally Retarded (DMR) – Evenhuis et al. • Assessment for Adults with Developmental Disabilities (A.A.D.S.) – McQuilliams, Kalsy, Oliver & Hall & • Generic Tools - Mini Mental
Change in Focus of Supports Provided • Maintaining skills • Stabilizing the environment • Minimizing choices • Giving reassurance • Personal care • Assessing and meetings medical needs • Meaningful activities
Supporting Families • Provision of information • Planning and directing care plans • End of life decisions • After the death
Staff Levels and Training • Appropriate levels of staffing • Dementia specific training • Maintaining and preserving skills vs. learning new skill • Pain recognition and management • Addressing concerns about reactions and actions related to the disease • End of life care, the dying process and grieving for themselves and roommates
Provision of Personal Care • Body mechanics • Use of equipment • Assistance for eating and drinking • Issues of incontinence
Support for Grieving and End of Life Care • Support teams for staff and roommates • Pastoral care for families, staff and roommates • Staff discussions around their beliefs and concerns • Families values and beliefs around death and dying • Utilizing hospice and palliative care • Arrangements for final farewells
Disclosure of Diagnosis • Do you tell the person that they have dementia? • Consideration of policies on disclosure • Do you tell roommates about the diagnosis?
Understanding the Disease • How do you explain Alzheimer’s disease to the individual and their friends and roommates? • Fostering acceptance and addressing concerns
Death, Dying and Grieving • Rituals • Repeated grieving • The many faces of grief