I Already Told You. . . Don T You Remember?

“I Already Told You. . . Don’t You Remember?”

A Train-the-Trainer’s Guide to Excellence in Dementia Communication & Behavior Prevention

Erin Bonitto, M.S., A.D.C. — Christopher Bonitto, L.N.H.A.

Gemini Consulting, Inc. New Contact Info – October 2007: Cold Spring, MN 56320 www.Gemini-Consulting.org (320) 685-7265 [email protected] [email protected]

1 “The front-line staff work with dementia every day. . . don’t they already know what it is?”

Teaching that Sticks: Using a Common Visual

. Age-Associated Memory Impairment (A.A.M.I.)

. Dementia

Teaching that Sticks: Using Your Real-Life Stories & Examples

. Alzheimer’s Disease (continued next page)

2 Erin Bonitto, M.S., A.D.C. – Gemini Consulting , Inc. – (320) 685-7265 www.Gemini-Consulting.org – [email protected] ©2007. Gemini Consulting, Inc. Alzheimer’s Disease or Age-Associated Memory Impairment?

The Alzheimer’s Association says that when difficulties go beyond simple lapses in memory – when there are problems severe enough to impact family life, social activities, work – look to a diagnosis of Alzheimer’s. Ten Warning Signs:

1. Memory loss. While it is normal to forget appts, names, telephone numbers – people w/ dementia will forget these things more often and not remember them later.

2. Difficulty performing familiar tasks. People with dementia will often find it hard to complete every day tasks – things so familiar that we don’t even think about how to do them. For example, the steps for preparing a meal, using a household appliance, putting keys into the ignition, etc.

3. Problems with language. A person with Alzheimer’s disease often forgets simple words or substitutes unusual words. For example, instead of referring to “toothbrush,” the person may ask for, “that thing for my mouth.”

4. Disorientation to time & place. People with Alzheimer’s Disease can become lost on their own street, forget where they are or how they got there, and not know how to get back home.

5. Poor or decreased judgment. Examples: Dressing without regard to the weather, wearing several shirts on a warm day; giving away large amounts of money to telemarketers, etc.

6. Problems with abstract thinking. Example: Forgetting what numbers are for and how they are used.

7. Misplacing things. Anyone can temporarily misplace a wallet or keys. A person with Alzheimer’s disease may put things in unusual places: an iron in the freezer or a wristwatch in the sugar bowl.

8. Changes in mood or behavior. Someone with Alzheimer’s Disease can show rapid mood swings – from calm to tears to anger – for no apparent reason.

9. Changes in personality. A person with Alzheimer’s Disease can change a lot, becoming extremely confused, suspicious, fearful, or dependent on a family member.

10. Loss of initiative. It’s normal to tire of housework, business activities, or social obligations at times. The person with Alzheimer’s Disease may become very passive, sitting in front of the television for hours, sleeping more than usual, or not wanting to do normal activities.

Source: Alzheimer’s Association, www.alz.org 10 Warning Signs: www.alz.org/alzheimers_disease_symptoms_of_alzheimers.asp

3 Erin Bonitto, M.S., A.D.C. – Gemini Consulting , Inc. – (320) 685-7265 www.Gemini-Consulting.org – [email protected] ©2007. Gemini Consulting, Inc. “The staff have already seen pictures of the brain. . . this is too much info. . .”

Teaching that Sticks: . Creating Easy-to-Understand “Brain Names” . Connect-the-Dots Between Common “Behaviors” and “The Brain” . Using a Real-Life Example: Preventing Out-of-Character Sexual Behaviors

4 Erin Bonitto, M.S., A.D.C. – Gemini Consulting , Inc. – (320) 685-7265 www.Gemini-Consulting.org – [email protected] ©2007. Gemini Consulting, Inc. “We already cover Dementia Communication during orientation & the yearly in-service. . .”

Sample “10-Minute Trainers” for Dementia Communication:

. “Treat every interaction as if it is your first”: Coaching a basic 4-step introduction

. “Simply describe what you will be doing”: Coaching simple statements

. “Use the language of dementia”: Coaching facial expression and gestures

Hands-On Coaching that Sticks: “10-Minute Trainers” . Establishing easy-to-understand competencies . Quick classroom practice . On-the-floor teachable moments . Using shift-change, the time clock, and mandatory meetings . Handling the objection: “We don’t have time”

5 Erin Bonitto, M.S., A.D.C. – Gemini Consulting , Inc. – (320) 685-7265 www.Gemini-Consulting.org – [email protected] ©2007. Gemini Consulting, Inc. “The front-line staff don’t have time to do ‘activities’. . .”

Some Common Dementia Strengths:

1. ______memories. Examples:

2. ______-- ______memory. Examples:

3. ______responses. Examples:

4. ______rituals. Examples:

5. ______contact. Examples:

6. Sense of ______. Examples:

7. Other Strengths: Examples:

Teaching that Sticks: . Eliminating the word “activities” . Hands-on demonstration for common dementia strengths . Handling the objection: “We don’t have time”

6 Erin Bonitto, M.S., A.D.C. – Gemini Consulting , Inc. – (320) 685-7265 www.Gemini-Consulting.org – [email protected] ©2007. Gemini Consulting, Inc. “There’s nothing you can do about ‘behaviors’. . . they’re just a normal part of dementia. . .”

Eliminating the word “behavior”:

. ‘Looping’ and ‘Triggers’

. Using dementia strengths to prevent ‘looping’ (or “picking the channel”)

. The ‘pre-agitation’ window (or “the calm before the storm”)

Real-World Examples:

. Nursery: Falls

. Factory – Work Program: Combative Outbursts

. Lounge-Style Program: Wandering, Exit-Seeking, Repetitive Questions, & Falls

Teaching that Sticks: . Use real-life words & constructs . Connecting-the-dots between “dementia strengths” and behavior prevention

7 Erin Bonitto, M.S., A.D.C. – Gemini Consulting , Inc. – (320) 685-7265 www.Gemini-Consulting.org – [email protected] ©2007. Gemini Consulting, Inc. “You can’t teach “dementia approach.” Some staff members just have it and some never will. . .

Practice: ‘Frustration-Reducing’ Strategies

Bathing: . Other: . Basic introduction Housekeeping or Maintenance Visit: . Simple statements & concrete language . Basic introduction . Simple statements & concrete language . Gestures & non-verbal techniques . Gestures & non-verbal techniques . Authentic props & environmental cues . Props . Other: . Other:

Meals: Inviting to an Activity: . Basic Introduction . Basic introduction . Simple statements & concrete language . Simple statements & concrete language . Gestures & non-verbal techniques . Gestures & non-verbal techniques . Meal-time conversation . Interesting props . Other: . Other:

Dressing: Meeting in the Hall . Basic introduction . Basic introduction . Simple statements & concrete language . Simple statements & concrete language . Gestures & non-verbal techniques . Gestures & non-verbal techniques . Other:

Hands-On Coaching that Sticks: . Quick classroom practice . On-the-floor teachable moments . Be a fly-on-the-wall 8 Erin Bonitto, M.S., A.D.C. – Gemini Consulting , Inc. – (320) 685-7265 www.Gemini-Consulting.org – [email protected] ©2007. Gemini Consulting, Inc. . Establishing easy-to-understand competencies

“There’s not enough time. . .”

Discussion: Use of Existing Labor Hours

. Re-assuring & re-directing anxious residents,

. Re-approaching residents who resist caregiving,

. Documenting resident-to-resident incidents,

. Documenting resident-to-staff incidents,

. Caregiver burnout (recruitment & retention),

. Unnecessary discharge due to “unmanageable behaviors.”

For more information. . .

Erin Bonitto, M.S., A.D.C. About the Presenter: A nationally-recognized dementia and long- Founder, Gemini Consulting, term care educator whose career sprang from the kitchen of her Inc. small-town nursing home, Erin Bonitto is an Activity Director with an 1218 5th Street South M.S. in Gerontology. Since 1999, Bonitto has presented at Cold Spring, MN 56320 hundreds of conferences nationwide – including many A.H.C.A. (320) 685-7265 state affiliates. Additionally, she is a sought-after consultant and [email protected] coach, serving providers nationwide. Her “Life Enrichment” dementia system is being studied by the N.Y. State Department of New Contact Info – October Health, which has worked with Bonitto for two years to implement 2007: the system in three NY nursing homes. The department recognized www.Gemini-Consulting.org Bonitto’s “Alzheimer’s-Dementia Lounge” with a 2005 Safety [email protected] Award, when it showed a 50% fall reduction. Long-term care professionals in more than 45 states have praised Erin’s story- telling style and “do-able” systems approach to dementia training. 9 Erin Bonitto, M.S., A.D.C. – Gemini Consulting , Inc. – (320) 685-7265 www.Gemini-Consulting.org – [email protected] ©2007. Gemini Consulting, Inc.