The Challenges of Dementia

The Challenges of DementiaDementia… When presented with that diagnosis for you or for a loved one, the word can frighten and sadden those close to the patient. Despite the years of education by healthcare professionals and associations who specialize in specific types of dementia, the general public knows little about the signs, symptoms, or progression of the disease until it affects one of their loved ones. However, most are aware that at some point memory is gone.

Symptoms of dementia vary depending on the cause and the area of the brain that is affected. Symptoms may include:

  • Memory loss. This is usually the earliest and most noticeable symptom.
  • Trouble recalling recent events or recognizing people and places.
  • Trouble finding the right words.
  • Wandering and other unsafe behaviors.
  • Problems planning and carrying out tasks, such as balancing a checkbook, following a recipe, or writing a letter.
  • Trouble exercising judgment, such as knowing what to do in an emergency. Showing impulse behaviors.
  • Trouble controlling moods or behaviors. Depression is common, and agitation or aggression often occurs.
  • Not keeping up personal care such as grooming or bathing.
  • Gait and balance disturbance.

Behaviors are often progressively troublesome and hard for the family to handle and can lead to nursing home or residential care facility or assisted living placement. According to the Alzheimer’s Society, the elderly have had endemic growth of the dementia diagnosis. At this time 20 percent of the elderly population over 80 years of age has dementia, 2/3 of elderly in nursing homes have dementia, and baby boomers will significantly elevate the numbers of seniors with Dementia to 14 million in the near future.

For nursing homes and residential care facilities, there are numerous regulatory issues surfacing based on admitting residents involved in a resident-to-resident altercation with or without obvious injury. Categories include abuse and/or neglect, hitting, shoving, biting, and spitting when perceives others are encroaching on their space, or removing one of their belongings, to name a few.

To maintain certification and/or licensure in good standing, the resident medical record must contain a description of behaviors, availability of behavioral plan of care development team, including: community resources; behavior management program, medication management process; non-medication strategies; discharge plan and preparation; responsible party and relationship;  availability of therapy staff; contact with psychiatrist, and  local mental health hospital admission source; staffing ratios, secured unit, facility security; staff training methods, and linked interventions to avoid further behavior.

The Center for Medicare and Medicaid recently developed the Critical Elements for Behavioral and Emotional Status to assist those communities who are housing dementia residents exhibiting physically or verbally abusive behaviors; socially inappropriate or disruptive behaviors, including: resistive to care, psychosocial adjustments difficulties post admission, and symptoms of depression. Each facility admitting residents with dementia needs to review and comply as soon as possible.

A quality behavior program begins before admission and continues until discharge in nursing homes and residential care facilities/assisted living facilities. If you’re interested in developing a behavioral program, or having problems with implementing a behavioral program at your health care facility, the AssuredPartners NL CORE Solutions team can help. To learn more, visit: AssuredPartners NL Clinical Risk Management.

Sources: Alzheimer Society, CMS form # 20067 from the Center of Medicare and Medicaid
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