Assisted Living Administrator Training: Gerontology and How

it Affects Activities!

Pamela Truscott MSN, Nurse Educator, RN

Vice President of Professional Development

Nebraska Health Care Association

Aging…What does it mean?

• Demographics – life expectancy among gender, race, ethnic groups

• Caucasian 76 males, 80 females in US• Average African American 79• In Japan Average age is 79• To date…maximum lifespan of a person is 120 years

• 3 periods –• Young-old age 65-74• Old 75-90• Very Old 90+• This age group makes up fastest growing group in US• Many people in group are living below poverty level

Challenges and Changes Faced by Older Adults as it Relates to the Aging Process

• 13% of Americans are age 65 and over

• Less than 25 years people 65+ will make up at least 20% of U.S. population

• Important to remember: people of age 65 may begin to experience physical limitations, but they learn to live with them and lead happy productive lives

• Facts about Aging• Stereotypes of aging are often inaccurate

• Most older adults are independent, maintain close relationships

• Most personalities remain stable

• Depression is less prevalent than younger adults

Normal, age-related changes that affect lifestyle• Common age-related physical changes include:

• Hearing impairment

• Weakening vision

• Increasing probability of arthritis

• Increasing probability of HTN

• Increasing probability of heart disease

• Increasing probability of diabetes

• Increasing probability of osteoporosis

• Decreased speed for which information is encoded, stored, and received

• May experience memory loss

Changes in Mental Health and Mental Processes• Cognitive changes associated with mental processes occur among aging adults

• Such as: sensation, perception, memory, intelligence, language, thought, problem-solving

• Rate at which new information is learned can be slower and may have greater need for repetition

• Daily occupational/social functioning is not impaired but may take longer to input/retrieve new information

• Long-term memory substantial changes; short-term less decline

• Language ability remains strong, but word-finding ability declines as well as 3-D drawing ability

• Wisdom & creativity continue throughout life

• Prevalence of mental disorders less than any other age group

• General life satisfaction as good as if not better than other age groups

Physical Changes

• Hearing impairment is mild to moderate yet widespread• 48% men, 37% women over age 75 experience hearing difficulties

• Visual changes including problems with speed reading, seeing in dim light, reading small print, locating objects

• Time to respond to environment typically slower

• Needing assistance with everyday activities increases with age• 9% between 65-69 need personal assistance

• 50% over age 85 need personal assistance

• Top 5 causes of death among older adults include:• Heart disease, cancer, cerebrovascular disease, pneumonia, COPD

• 2/3 not living in NH report good, very good, excellent health and they learn to live with physical limitations and lead happy, productive lives

Psychological Problems of Older Adults

• Dementia afflicts 5-7% of adults over 65 and 30% over age 85

• People with dementia may also suffer depression, anxiety, paranoia

• 6% older adults suffer anxiety disorders and experience dread, apprehension, tension for at least 6 months

• Highest suicide rate is older adults that are Caucasian men who live alone

• Sexual dysfunction increases with age

• Sleep problems increase, ½ over age 80 c/o sleep difficulty

• 10-15% exhibit hypochondriasis – believe they have a medical disorder despite lack of medical findings

• Alcohol abuse & substance dependence is 2-5% men and 1% women

• Drug abuse in the form of prescription medication abuse is 25% which results from too many meds being prescribed to them

Psychological Problems Continued…

• Depression characterized by sadness, helplessness, sense of loss • Likely to have abrupt symptoms, history of psychiatric problems, decreased

motivation, tendency to c/o memory problems

• Behavior disorders can take form of physical aggression, motor over activity (wandering) & disruptive verbal outbursts

• Common causes include: delirium, depression, dementia, psychosis

• Alzheimer’s Disease is often gradual occurring over period of 8-20 years

• Unable to form new memories, marked by loss of other mental functions, inability to recall newly learned information (change in address, disorientation)

• May suffer memory loss, get lost, leading to failure to recognize other people, show childish emotions, lose ability to dress and care for themselves

The Alzheimer’s Generation• 10 million baby boomers will have AD (1 in 8) → today, 1 in 9 Americans have AD

• 13.8 million people by 2050 will have AD in U.S. alone

• 7 million people 85+

• By age 85 1 in 2 will have AD

• AD is the 6th leading cause of death – heart disease, cancer, & stroke declining

• AD kills more people than breast & prostate cancer combined

• In 2013, cost of care – 17.7 billion hours unpaid care provided by families of AD affected persons

• Estimated value 2013 - $220.2 million

• Cost of AD by 2050 - $1.078 trillion

• In 2014, cost of care = $150 billion – Medicare & Medicaid

• For every $100 spent on AD research this is $25K spent caring for a person with AD

• How are you preparing for this increase in persons with dementia?

Physiological Needs

• All people need most basic requirement met (food, shelter, drink, sleep, treatment of illness and injury) to survive

• Most caregivers focus on this area

• Providing the basics with focus on health for frail and disabled takes bulk of caregiver’s time/energy

• It is essential, but…

• Meeting physiological needs is more about survival

• Does not necessarily ensure quality of life for aging

Security Needs

• Often source of conflict between generations → adult children fearful that parents safety is in jeopardy

• Aging adults desire sense of security, especially those who are vulnerable d/t injury or illness

• Often elders will react with anger at being treated like child especially from their own children

• Sensitivity needed when discussion security concerns

• Security concerns include: driving, maintaining the house, being alone at home

• May react strongly to the loss of independence

• May want to replace loss with other alternatives such as: transportation services, respite care, in-home care, adult day care, ect.

Social Needs

• Being connected socially is important to all people

• Social connectedness for aging population is key quality of life concern

• Health issues or lack of ability to get out can cause social opportunities to decrease

• Often end up spending more time alone

• Need opportunities to be involved with family, friends, community

• Attending functions can help older adults feel like they are contributing members of society

• Ideas for social interaction include: senior centers, volunteering, connecting through social media

Self-Esteem Needs• Want to feel recognized and appreciated for ideas, abilities, talents

• Often lose their sense of worth

• Illness, disability, frailty limits their sense of worth

• Loss of self-worth is devastating to their well-being

• Can be linked to depression and increased mortality

• Boost their self-esteem by working with older adults on projects that add worth and thereby enhance quality of life

• Ideas to elevate self-esteem include: hobbies, writing memoirs, constructing legacy album, recording family stories

Self-Actualization Needs• Highest rung, according to Maslow is self-actualization

• Reached by relatively few people

• People who do reach this stage tend to concentrate on reality of life rather than wishful thinking

• Are problem-solvers not complainers

• Have viewpoint that life’s journey is as important as final destination

• Misconception is that with all their life experience and maturity this should be an easy stage to accomplish

• Process of aging often strips older adults of higher levels of self-actualization, self-esteem, social connection, leaving our aging adults clinging on to the lower levels of survival

Quality Improvement Programs in Assisted Living• Facilities are now being forced into how they are improving their

facilities through quality

• NCAL Quality Awards applications to prove quality

• How are you able to incorporate new ways of improving quality care

INTERACT. What is it?• INTERACT (Interventions to Reduce Acute Care Transfers) is a quality

improvement program that focuses on the management of acute change in resident condition. It includes clinical and educational tools and strategies for use in every day practice in long-term care facilities.

• INTERACT is a quality improvement program designed to improve the early identification, assessment, documentation, and communication about changes in the status of residents in facilities. The goal of INTERACT is to improve care and reduce the frequency of potentially avoidable transfers to the acute hospital. Such transfers can result in numerous complications of hospitalization, and billions of dollars in unnecessary health care expenditures.

INTERACT IS A FREE QUALITY IMPROVEMENT PROGRAM AVAILABLE AT:

INTERACT2.NET

Activities in Assisted Living and how they benefit this population• Assisted Living facilities are based on the social model

• Social model is highly engaged in activities

• Activities must provide purpose and joy

• If activities only fill time they will not be successful

Activities

• Activity is –• The state of being active; behavior or actions of a particular kind

• Recreation is –• Something people do to relax or have fun

• Pleasure is –• Activity that is done for enjoyment

• COMBINATION is KEY

Activities

• Key areas to consider…

• Who is on your team

• What is your department’s goals?

Administrator involvement in Activities

• Administrator can be as involved as a formal Activities Director

• Strive to be in the moment with each individual, at all times, while maximizing their abilities and minimizing their frustrations.

• Build off their abilities, don’t focus on what they can’t do.

Reflection

• Can you answer the question, “Who am I? without making reference to your:

• Job

• Possessions

• Gender

• Nationality

• Health Situation

• Role in life

• Personal appearance

How to accomplish activities• Keep the individual focused

• Anticipate their needs

• Maintain function and life skills

• Target procedural memories

• Individualization of the daily routine

• Have FUN…Laughter is good for the heart and good for the soul

When working with Dementia remember…

• Engagement and Stimulation are the primary goals, not doing it correctly according to what YOUR standards does not equal success

• Don’t hide them away, rather involve them, adapt the activity and help them achieve success

• Utilize their hard learned skills, cooking, cleaning, spelling even

• HAVE PATIENCE

• BE FLEXIBLE

Team Member Education

• Memorize activity calendar just like restaurants do the menu

• How much input do residents have into designing the calendar

• Right care at the right place at the right time

• Be “in the moment” with the resident – whatever their reality consists of, not necessarily your reality

• Encourage independence

• Promote Dignity and Respect

Outings

• Be careful outside of their home (unknown areas, may cause anxiety)

• Do you have defined ratios (staff vs resident)

• Pictures (of each resident you are taking)

• Outings bag (extra briefs/disposable garments, clothes)

• Plan around busy times and times that are appropriate

• Communicate constantly

• Realize there may be delays

Returning from outings

• Increased pacing/wandering may occur

• head count as soon as bus leaves and as soon as it returns

Assisted Living Regulations

4-006.08 Activities: The assisted living facility must plan and provide activities designed to meet the interests and promote the physical, mental, and psychosocial well-being of residents. Such activities must be on-going and all residents informed of the opportunity to participate. Information about activities must be posted and made available to residents.

Survey Protocols

There is evidence (ex. Observation of activities in progress, activities calendars, etc.) that an activity program exists and sampled residents have access to meaningful activities that are appropriate to their interests.

75 % of sampled residents/authorized representatives interviewed affirmed satisfaction with activities.

Facility posts information about activities and residents are aware of activities that are available.

When setting up an activities program in your assisted living facility, think about meeting the following needs of your residents:

Physical

Intellectual

Spiritual

Social

Creative

Community

Physical Programs

• A daily exercise program with range of motion and light physical movements that all residents can attend.

• Example: Exercise Stretching or Fun N Fitness

• A walking club to get residents out and walking. Map out a “trail” inside and outside your facility and provide the distance for residents to keep track of.

• Example: Walk Across Nebraska

• Competitive games and sports to get residents active.• Example: Bowling, golf, balloon volleyball, horseshoes,

shuffleboard, croquet, golf ball toss

Intellectual StimulationResidents who utilize their minds keep their thinking processes sharp and may even help prevent dementia

• Lecture series – get speakers in on topics that interest them. Utilize local hospitals, community colleges, extension agents. Your local ombudsman, agency on aging, and other local agencies are great resources and are usually free.

• Start your own current events groups, a book of the month club, political science club to get residents thinking.

• Local librarian to come in the facility and deliver and pick up books for those that can’t make the trip to the library.

• Trips to museums and exhibits.

SPIRITUAL NEEDS

• Chapel services within the facility

• Bible study groups in and out of the facility

• Church services

• Prayer groups

• Spiritual counselor

• Taped services and bulletins from local churches

Meeting your residents spiritual needs at this time of their life is one need that should not be overlooked.

Creative & Artistic Needs

• Crafts, painting, woodworking, quilting• Painting backdrops for plays, fleece blankets, cutting scrap paper, dyeing

Easter eggs

• Music of all kinds. Starting your own kitchen band, local high school, college, grade school kids in the facility to performs, or taking to community concerts.

• Writing club, poetry readings, or a drama club to perform to other residents.

Your activity program should jumpstart residents need to be creative and use the right side of their brain.

SOCIAL NEEDS

• Social Clubs• Bridge club, card clubs, Red hat Society, extension

clubs, cooking clubs, and Romeo club (Retired Old Men Eat Out)

• Games• Bingo, black jack, pitch parties, Wheel of Fortune, Deal

or No Deal

Social interaction with others is a very important need of residents living in assisted living. Depression and loneliness is prevalent in senior citizens across the nation. Your programs should meet all your residents’ social expectations. Do a survey and information sheet and you or your activities director will know how to keep them socially active.

◼ Social Get Together

– Movies, happy hours, shopping excursions, football & baseball games on TV, special occasion functions. (Examples: Husker games, world series parties, New Year’s Eve, happy hour, movie and popcorn)

◼ Trips

– Weekly shopping trips, casino trips, monthly evening out to eat, dinner and a movie at the theater.

◼Sense of Community

– Welcome coffees, baby showers, family potluck dinners, hall parties, men’s coffee clutch, women’s beauty hour.

◼Facility News

– Community bulletin board, newsletter

SENSE OF COMMUNITY

• Senior citizen center activities• Meals, cards, etc.

• Service Club Organizations• Rotary, Lions Club, Chamber of Commerce

• School Functions• Local games, plays, grade schools

• Charitable organizations• Relay for Life, Red Cross, United Way

• Figure out tasks residents can do to help someone else• Mints for graduations, chocolate strawberries for prom

Keep your residents involved in the community they lived in, worked in, and developed.

TRANSPORTATION NEEDS

• Self Transportation• Own vehicle, family

• Public Transportation• Taxi cab, handy-bus, city bus service

• Facility Transportation• Vehicle owned by facility, scheduled and unscheduled

trips, van with lift or car

• Community Transportation• Churches, hospital

Mode of transportation is an important function of an assisted living facility. Residents lose their sense of independence when they are no longer capable of driving themselves. Offering transportation flexibility offers them their independence back.

4-006.11E REQUIREMENTS FOR FACILITIES OR SPECIAL CARE UNITS FOR PERSONS WITH ALZHEIMER’S DISEASE OR DEMENTIA

• Care and services must be provided in accordance with the resident service agreement and the stated mission and philosophy of the facility.

• Prior to admission, the facility must inform the resident or designee in wiring of the facility’s criteria for admission, discharge, transfer, resident conduct and responsibilities.

• The facility or unit must maintain a sufficient number of direct care staff with the required training and skills necessary to meet the resident population’s requirements for assistance or provision of personal care, activities of daily living, health maintenance activities, supervision and other supportive services. Such staff must remain awake, fully dressed and be available in the facility or unit at all times to provide supervision and care for residents.

• Direct care staff must be trained in:

• The facility or unit’s philosophy and approaches to providing care and supervision for persons with Alzheimer’s disease.

• The Alzheimer’s disease process; and

• The skills necessary to care for and intervene and direct residents who are unable to perform activities of daily living, personal care, or health maintenance and who may exemplify behavior problems or wandering tendencies.

Each assisted living facility or special care unit that specializes in providing care for persons who have Alzheimer’s disease, dementia or a related disorder must meet the following requirements:

SURVEY PROTOCOLS

• All sampled special population residents have written evidence that abilities and special needs were evaluated and identified.

• There is written documentation verifying the administrator and direct care staff assigned to care for special populations received appropriate training from an individual qualified by experience and knowledge in the area of special services being provided.

• All resident service agreement reviewed for sampled special population residents addressed individual resident’s special needs.

• Observations during survey and resident/family/authorized representative interviews indicate the facility’s physical environment is maintained to assure safety and dignity of residents and accommodates special needs such as physical limitation or visual and cognitive impairments.

4-006.11E REQUIREMENTS FOR FACILITIES FOR PERSONS WITH ALZHEIMER’S DISEASE OR DEMENTIA

• 73% of residents sampled receive care and services as negotiated in the resident service agreement and in accordance with stated facility mission and philosophy.

• There is evidence that 100% of sampled residents’ authorized representative received written information regarding facility’s criteria for admission discharge, transfer, resident behavior and related responsibilities prior to admission of the resident.

• Review of staff schedules and interviews of staff, residents/authorized representative reveal direct care staff are awake and available at all times to provide care to residents.

• 75% of sampled direct care staff and administrator training records contain evidence training was completed for:

• Alzheimer’s Disease process

• Facility philosophy

• Approaches to providing care and supervision for residents• Resident’s authorized representative interviews and observation of care indicate staff use skills necessary

to provide care to residents unable to perform activities of daily living and personal care or have behavior problems and wandering.

• Doing activities with special populations may require special training for the staff responsible doing the activities.

• Many of the activities, even those designated for dementia residents, may or may not work with residents. The activities should be structured based on the residents themselves. What works for one resident may not work for the whole group and may not work for that same resident the next time you offer it.

• Learning and getting to know each resident, interviewing the family about the resident’s likes, dislikes, job history, etc. are ways to provide meaningful activities to special populations.

• In dealing with dementia/special populations, communication with the authorized representative of the residents is key. The activity staff should have a good way of communicating what is going on in the activity program and the daily activities of each resident to the authorized representatives of residents.

THINK OUTSIDE THE BOX

Your activities program can set you apart from your competition. Keeping all the various needs of your residents in mind and meeting and exceeding their expectations makes for happy customers. Happy customers stay where they are and the work spreads to their families and friends. Here are some ideas to get that right side of your brain working!

Instead of always finding entertainment to come in, utilize your staff and their talents.

Stimulate your residents memories and senses with all kinds of stuff.

Pay attention to what is going on in your community. If it interests you, it will them too.

You, the leader, should be involved in the activities also.

Resource Guide

• Learning from Hannah-Secrets for a Life Worth Living• William H. Thomas, M.D. VanderWyk & Burnham

• Creative Forecasting, a monthly publication• P.O. Box 7789, Colorado Springs, CO 80933

• (719) 633-3174 Fax 719-632-4721

• www.creativeforecasting.net

• Family Fun• www.familyfun.go.com

• Kool Aid – purses, wallets, and other items• www.koolaid.com

• Activity Director Newsletter• www.activitydirector.net

Questions?Contact Information

Pamela Truscott MSN, Nurse Educator, RN

Director of Professional Development

Nebraska Health Care Association

1200 Libra Drive, Suite 100

Lincoln, NE 68512

Phone: (402) 435-3551 ext. 301

Email: PamT@nehca.org

Thank You!