C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

Definition of Dementia:  A usually progressive condition (such as Alzheimer's disease) marked by the development of multiple cognitive deficits (such as memory impairment, aphasia, and the inability to plan and initiate complex behavior). 

• Dementia is diagnosed only when both memory and another cognitive function are each affected severely enough to interfere with a person's ability to carry out routine daily activities. 

Source:  The Journal of the American Medical Association 

As an Occupational Therapist who provided direct care in the early 90s, I recall treating patients with dementia on the locked unit of a Massachusetts’s Nursing Home.  I will never forget the glares, snickers and micro aggressive comments intended to discourage this practice.  Viscerally, I knew that the interventions were beneficial despite the social pressure and commentary, such as: 

“the resident cannot remember what you say”
“the resident cannot learn new things”
“the resident cannot follow one step commands” 

This decision to treat was simple.   I put myself in the position of the resident and considered how I would want to be treated if my cognitive capacities deteriorated. 

I treated, I cared, and I documented.  Why? To improve the quality of care and quality of life of the residents.  

The signs and symptoms of dementia include: 

• Memory Loss
  Asking the same questions repeatedly
  Telling the same story
  Forgetting the location of items (which may lead to paranoia of theft)

• Language Loss
  Word finding difficulty
  For example, a shirt may be called “that thing I put on my body”

• Difficulty with ADLs
  Driving, housekeeping, bathing and dressing, eating and walking

• Personality Changes
• Emotional Involvement
  Decreased involvement in Activities

• Decline in Judgment
• Mood Swings
  Including depression and euphoria
• Behavior Disorders
  Paranoia, delusions, generalized suspicion. 

The goals of Occupational Therapy vary by patient, but all encompass the overarching theme to provide the support necessary to maintain or increase overall functional performance.  

Omnibus Reconciliation Act 1987 

OBRA ’87 regulations require facilities to provide services to 

“attain and maintain highest practicable physical, mental and psychosocial well-being”

of every resident. The medical regimen must be consistent with the resident's assessment (performed according to the uniform instrument known as the MDS) and Interdisciplinary Care Plan. Any decline in the resident's physical, mental or psychological well-being must be demonstrably unavoidable. (483.25). 

In other words, it is not acceptable to arrive at a skilled nursing facility and decline in function six months later.  

OBRA ’87 applies to dementia residents.  

Occupational Therapy helps to: 

• Decrease physical restraints
• Decrease falls and resultant serious injuries
• Increase communication
• Increase purposeful activity
• Decrease agitation
• Increase functionality with (ADL’s) Activities of Daily Living i.e., bathing, dressing, toileting, transferring
• Decrease dependence on incontinence devices
• Identify psychosocial person-centered needs
• Improve sleeping patterns
• Decrease chemical restraints for unassessed agitation 

How are the above areas accomplished? 

The answer to this question is Skilled Care, i.e., Skilled Occupational Therapy.  

It takes the skills, knowledge and judgment of an Occupational Therapist to identify and develop a sustainable, person-centered treatment plan that promote and enhance the overall environment, caregiver/resident interaction and clinically appropriate sensory stimulation. 

Stay tuned for our next blog post: Part II – Treatment Techniques for Dementia.