NHS Allegheny Valley School Memory Care Program One Individual at a Time One Individual at a Time Planning for Individuals with Intellectual and Developmental Disabilities and Alzheimer's/Dementia avs.nhsonline.org
Alzheimer’s/Dementia Program • 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”. Confidential - NHS Human Services, Inc. - Not for Reproduction
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. Confidential - NHS Human Services, Inc. - Not for Reproduction
Alzheimer’s/Dementia Program, continued • 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. Confidential - NHS Human Services, Inc. - Not for Reproduction
Alzheimer’s/Dementia Program, continued • 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. Confidential - NHS Human Services, Inc. - Not for Reproduction
Alzheimer’s/Dementia Program, continued • 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 Confidential - NHS Human Services, Inc. - Not for Reproduction
Alzheimer’s/Dementia Program, continued Guidelines were developed to address: • Staff training • Assessment and • Supports for caregivers evaluation (family members, peers and employees) • The physical environment • Leadership, advocacy and research • Programming and interventions Confidential - NHS Human Services, Inc. - Not for Reproduction
Alzheimer’s/Dementia Program, continued • 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. Confidential - NHS Human Services, Inc. - Not for Reproduction
Alzheimer’s/Dementia Program, continued • 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. Confidential - NHS Human Services, Inc. - Not for Reproduction
Alzheimer’s/Dementia Program, continued • 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. Confidential - NHS Human Services, Inc. - Not for Reproduction
Confidential - NHS Human Services, Inc. - Not for Reproduction
Alzheimer’s/Dementia Program, continued • 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. Confidential - NHS Human Services, Inc. - Not for Reproduction
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. Confidential - NHS Human Services, Inc. - Not for Reproduction
Confidential - NHS Human Services, Inc. - Not for Reproduction
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. Confidential - NHS Human Services, Inc. - Not for Reproduction
Confidential - NHS Human Services, Inc. - Not for Reproduction
Rationale for Modifications (continued): 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. Confidential - NHS Human Services, Inc. - Not for Reproduction
Rationale for Modifications (continued): 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. Confidential - NHS Human Services, Inc. - Not for Reproduction
Confidential - NHS Human Services, Inc. - Not for Reproduction
Rationale for Modifications (continued): 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. Confidential - NHS Human Services, Inc. - Not for Reproduction
Confidential - NHS Human Services, Inc. - Not for Reproduction
Confidential - NHS Human Services, Inc. - Not for Reproduction
Rationale for Modifications (continued): 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. Confidential - NHS Human Services, Inc. - Not for Reproduction
Confidential - NHS Human Services, Inc. - Not for Reproduction
Confidential - NHS Human Services, Inc. - Not for Reproduction
Rationale for Modifications (continued): 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. Confidential - NHS Human Services, Inc. - Not for Reproduction
Confidential - NHS Human Services, Inc. - Not for Reproduction
Rationale for Modifications (continued): 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. Confidential - NHS Human Services, Inc. - Not for Reproduction
Confidential - NHS Human Services, Inc. - Not for Reproduction
Confidential - NHS Human Services, Inc. - Not for Reproduction
Confidential - NHS Human Services, Inc. - Not for Reproduction
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. Confidential - NHS Human Services, Inc. - Not for Reproduction
Confidential - NHS Human Services, Inc. - Not for Reproduction
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. Confidential - NHS Human Services, Inc. - Not for Reproduction
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