Sunday, November 15, 2015

Dementia Unit: Hiding Reality Behind Closed/Locked Doors?

How long have there been "Dementia Units" in Skilled Nursing Centers/Nursing Homes?

Earliest reference I've found on line is to one in Maine in 1983. If anyone knows of specialized units, those separated from the general population, a self contained unit, with special requirements for entry, prior to this date, please add a comment below.

Here's a click through  to reference more information.

"Fundamental principles of care for a resident with dementia include an interdisciplinary approach that focuses on the needs of the resident as well as the needs of the other residents in the nursing home." as quoted from Sections 1819 and 1919 of the Social Security Act (the Act).

A revised CMS guidance and surveyor training highlight and re-emphasize a number of key principles, including:

1. Person–Centered Care. CMS requires nursing homes to provide a supportive environment that promotes comfort and recognizes individual needs and preferences.

2. Quality and Quantity of Staff. The nursing home must provide staff, both in terms of quantity (direct care as well as supervisory staff) and quality to meet the needs of the residents as determined by resident assessments and individual plans of care.

3. Thorough Evaluation of New or Worsening Behaviors. Residents who exhibit new or worsening BPSD should have an evaluation by the interdisciplinary team, including the physician, in order to identify and address treatable medical, physical, emotional, psychiatric, psychological...

IMPORTANT TO REALIZE:  Current laws, regulations, standards, etc by the highest government departments are broad statements of generalized requirements allowing each State to interpret and legislate INDIVIDUAL STANDARDS without having a regulated and specific across the board set of standards and measurements.

Current evaluations are being done by staff members that can be “appointed” to positions in facilties that DO NOT have Medicare or Medicaid beds.

Many facilities are trying to move away from accepting Medicare of Medicaid and into the "private pay" sector. They're riding the coat tails of the Insurance industry who's sold a lot of policies on Elder Care Insurance and on current statistics of the average stay in a facility of three years or thereabouts.

A growing and current practice is to "secure" our older population with Dementia/Alzheimers behind closed and even locked doors in special units.

In our area, you don't need to be formally diagnosed at many facilities, only exhibit symptoms, and, of course, either have the ability to pay or can get Elder Care Ins to pay.

Mom's last facility has a place; there's a mural of tree's and blossoms painted on the wall surrounding the door. It's always closed. The people behind the door don't come onto the "regular" floor leading to the "regular" dining room, the reception area for guests and the front desk. 

On rare occassions, I've seen one or another "resident' of this special "Place" walk through the door with a family member and into the light of day, the reality of the facility beyond the area behind the closed doors.

A tall fence surrounds the outside of the unit. Supposedly there's a garden, places to sit where residents of this "Place" can move into the "outside world" but only when allowed, when the door is "open".

Isolation. Setting aside. For their own good, their best interests. 

For some, this is a good alternative. A dear friend living in a facility and my own mother have had the experience of living with roommates who were well into the advanced stages of Dementia and whose actions and activities warranted more supervision and separation.

But how much can you really do to "remove" someone from an environment to change that environment?  Sometimes, what's needed for our elderly just as for our youth is more individualized supervision, more guidance, more time from someone who cares to supervise and guide their lives.

In reality, there's no difference between care for our aging population and care for our children. The difference is in our society's priorities and what investment we choose to make.

If we believe there is no benefit, no "long term" receipt of return on investment, there will be none.

 As long as we see the older population as "terminal" and "just waiting to die" and don't realize the benefits their wisdom, experience and ability to learn and grow provide for even the youngest of our society, we will continue to lose the benefit of one of our greatest national assets -- those who have learned, those who have taught and those who continue to teach.

I witnessed the benefits Mom had when she was in an Adult Day Care next door to a children's pre school unit. The children were sometimes integrated into the activities of the older adults and when they played outside, the two "yards" were visible to one another. 

Think about it:  we move from childhood into adolescence and adulthood. We're told one of the greatest steps we can take is creating a family. We celebrate life coming into the world and families become "extended" with grandparents, aunts and uncles,  cousins and friends.

Then we grow to a certain age and we separate and segment. We believe growing older is reaching a point of being cared for more than cared about.

We separate, isolate and eventually only occasionally connect with or contact by the most convenient way for those who are mobile, those who are active, those who have "lives to lead" outside the walls of closed and often locked doors.

Is this how you see your life? Neither do they and neither did they. 

It's time to rethink, reassess and replan our "Platinum Years".

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