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Developing Individual- Focused Life Enrichment Care R/T New CMS

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Developing Individual- Focused Life Enrichment Care R/T New CMS 2/13/2018 Part II F679 (Was F248) Activities The facility must provide based on the comprehensive assessment and care Developing Individual- plan and the preferences of the resident, Focused Life an ongoing program to support residents in their choice of activities, both facility- Enrichment Care r/t sponsored group and individual activities and independent activities, designed to New CMS Guidance meet the interests of and support the Sarah Kneisler, RMT/NHA physical, mental and psychosocial well- [email protected] being of each resident, encouraging both independence and interaction in the community. F679 Activities (Interpretive Guidance) “Palliative Care for People with Dementia” Activity Approaches for Residents with From the section titled: “Rethinking Activities: Dementia Meaningful Engagement for People with Advanced Dementia” • All residents have a need for engagement in meaningful activities • All staff, regardless of discipline, have a crucial role in meaningful activities. • For residents with dementia, the lack of engaging activities can cause boredom, loneliness and • Activities must be customized to be meaningful. frustration, resulting in distress and agitation People with advanced dementia almost never engage in large group events. • Activities must be individualized and customized based on the resident’s previous lifestyle • Any meaningful interaction will not be judged by (occupation, family, hobbies, preferences and its duration but its quality. comforts). • National Partnership to Improve Dementia Summarized from “Palliative Care for Advanced Alzheimer’s and Care results Dementia: Guidelines and Standards for Evidenced-Based Care Sufficient & Competent (Nurse) Staffing Review CEP CEP: Behavior & Emotional Status Observations: Observations Across Various Shifts: • Are residents sitting around the nurse’s • What non-pharmacological interventions (e.g., station, in the hallways, or in front of the meaningful activities, music or art therapy, massage, aromatherapy, reminiscing, diversional television without any interaction from staff activities, consistent caregiver assignments, • Are residents displaying behavioral or adjusting the environment) does staff use and do pain concerns such as being combative, these approaches to care reflect resident choices yelling, or crying out? and preferences? • Is the resident’s distress caused by facility • Are residents who wander unsupervised practices which do not accommodate the or susceptible to, or creating issues? resident’s preferences (e.g., ADL care, daily routines, activities, etc.) 1 2/13/2018 Activity-Related Interventions Activity Related Interventions For the Resident who: For the Resident who: Exhibits unusual amounts of energy or • Exhibits usual amounts of • Goes through others’ walks without purpose energy or walking without belongings • Provides a space/environmental cues that encourages purpose • Has withdrawn from physical exercise, decreases exit-seeking behavior and • Engages in behaviors not previous activity reduces extraneous stimulation (such as seating areas conducive with a interests/customary spaced along a walking path or garden; a setting in therapeutic home-like routines and isolates self which the resident may manipulate objects; or a room environment in room/bed most of the with a calming atmosphere, for example using music, day • Exhibits behaviors that light and rocking chairs); require a less stimulating • Lacks awareness of environment to personal safety, such as… • Providing aroma(s)/aromatherapy that is/are pleasing and calming to the resident; and discontinue behaviors not • Has delusional and welcomed by others hallucinatory behavior that • Validating the resident’s feelings and words; engaging sharing their social space is stressful to her/him the resident in conversation about who or what they are seeking; using one-to-one activities, such as reading to the resident, or looking at familiar pictures/photo albums Unusual Amounts of Energy/Walking without Purpose Music: Drum Circles/Rhythm Band • Exercise Resources – Tai Chi • Book: “Drum Circle Spirit” by Arthur Hull • Music • You Tube Videos by: Kalani, Arthur Hull, Bongo Barry Bernstein, Christine Stevens – Entrainment Interactive Techniques – Drum Circles/Rhythm Band, etc. • The “basics” • Validation • “Rumble” • Aromatherapy • Call and Response: Repeat what you hear • Multi Sensory Environments • Rhythm Naming • Familiar Rhythms (Months, “Happy Birthday”, “30 days has September) Aromatherapy Essential Oils www.scentsiblesolutions.net (Loving Scents) Stimulant Properties Sedative Properties Basil Chamomile Restore Peace: a combination of pink Jasmine Bergamot grapefruit and frankincense—eases Peppermint Sandalwood nervousness, tension, depression and anxiety, Ylang-ylang True Lavender producing a calm, soothing elevated mental Neoli Sweet Marjoram state. Excellent for sun-downing issues. Angelica Lemon Balm Rosemary Hops Promote Alertness A stimulating blend of Orange Valerian Rosemary and Orange that enlivens the Lemon brain, clears and aids memory and harmonizes the physical and mental processes. 2 2/13/2018 Multi Sensory/Snoezelen™ Multi Sensory Techniques Stimulation versus relaxation Bubble tubes Restraint free/facilitated sleep/reduced Fiber optic lighting falls and wandering/nonpharmacologic approach for target behaviors Massage techniques Variety of equipment appealing to all of Aromatherapy the senses Comfortable furnishings Purposeful activity suited to individual Projected images needs Music Multi-Sensory Room Ideas Familiar Areas for Stimulation Sensory Considerations Film/Video Considerations • Room vs. Open Space • Personal video recordings to encourage reminiscence • “Old films and feature movies with simpler plots could be used to help prompt memories. Other sensory components could be used • Room vs. Portable in conjunction with the movie to help enrich the sensory experience e.g. provision of stuffed toys such as a cat when the • Multi Sensory Equipment included film features a cat, actual dancing when the actors are dancing, throughout snacks replicating foods being shown on the film.” • “Films showing natural themes and simple life scenes such as Great Resource: “How to Make a playing children accompanied with familiar music or music written specifically for the movie – contain no or minimal narration, do not Sensory Room for People Living require undivided attention.” • “Scenes from nature can include: landscapes, water and sea, with Dementia: A Guide Book” by forests, flowers, fish swimming underwater, animals, and glowing Anke Jakob and Leslie Collier fire” • Films featuring abstract, calming, non-memory provoking images (e.g. slowly animated shapes and colors and music promoting relaxation 3 2/13/2018 Stimulating Vs. Relaxing Activity Interventions Stimulating Relaxing Engages in behaviors not conducive with a therapeutic home like environment • Sights: Bright Lights/Red • Sights: Low lights/Slowly • Sounds: Loud and percussive changing lights/Pastels • Providing a calm, non-rushed environment, with music, Music faster than the • Sounds: Music slower than the structured, familiar activities such as folding, heart beat, Abstract sounds heart rate, continuous music, sorting, matching, using one-to-one activities • Touch: Textured or spiky balls, sounds of nature or small group activities that comfort the rougher textures, random • Touch: Massage, stroking soft resident, such as preferred music, walking touch fabrics quietly with the staff, a family member or friend; • Taste: “Smooth foods” • Taste: Citrus, Peppermint, eating a favorite snack; looking at familiar • Smells: Aromas Sour/spicy foods pictures; • Movement: Sudden, random, • Smells: Aromas, baking smells spinning • Movement: Linear (rocking), • Engaging in exercise and movement activities rocking to music • Exchanging self-stimulatory activity for a more socially-appropriate activity that uses the hands if in a public space Music and the Decades: Ages 15-30 What Musicians were Popular? 1940s: Jazz/Big Band: Bing Crosby, Frank Sinatra, Perry 100: 1933 -1948 95: 1938 -1953 Como, Ella Fitzgerald, Louis Armstrong, Benny Goodman, The Andrews Sisters, Nat King Cole 90: 1943 -1958 85: 1948 -1963 1950s Rock and Roll: Elvis Presley, Chuck Berry, Jerry 80: 1953 -1968 75: 1958 -1973 Lee Lewis, Little Richard, Chubby Checker, Billy Haley & 70: 1963 - 1978 the Comets, Buddy Holly, Carl Perkins, The Coasters, Bobby Darin, Ritchie Valens, Roy Orbison, Gene Vincent 1950s Traditional Pop: Nat King Cole, Rosemary Clooney, Perry Como, Dean Martin, Tony Bennett, Peggy Lee, Ella Fitzgerald, Johnny Mathis, Andy Williams, Frank Sinatra, Frankie Laine, Patti Page, Teresa Brewer, Ames Brothers, Andrews Sisters, The Four Aces, Doris Day, Pat Boone What Musicians were Popular? What Musicians were Popular? 1950s Country: Johnny Cash, Gene Autry, Hank Williams, 1960s Surf and Psychedelic Rock: The Beach Boys, The Conway Twitty, Patsy Cline, The Everly Brothers, June Carter Ventures, The Champs, The Doors, The Grateful Dead, Cash, Les Paul & Mary Ford The Jimi Hendrix Experience, Jefferson Airplane, Jan 1950s Rhythm and Blues: Little Richard, Frankie Lymon & the and Dean, The Kingsmen, The Trashmen Teenagers, Sam Cooke, The Orioles, Ray Charles, Fats 1960s Roots and Hard Rock: Janis Joplin, Creedence Domino, The Ravens, The Penguins, The Crows, The Platters, Billy Ward & his Dominoes, James Brown, Lloyd Price, Bobby Clearwater Revival, Steppenwolf, Roy Orbison, Procol Day Harum, The Rolling Stones, The Who, The Animals,
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