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“Getting to Know ME”

Applying knowledge of lifelong habits and preferences

Natalie B. Davis ACC/EDU

Kansas Activity Director’s Conference 2015

It sounds simple…but it’s not always easy

• Getting to know YOU

Objectives

• Discuss the importance of customary habits and routines to positive psychosocial outcomes

• Explain methods of collecting lifestyle assessment information

• Describe the process of implementing care approaches based on lifestyle preferences

• Discuss strategies for training staff to collect and share lifestyle preference information

• Identify tools to measure the delivery of lifestyle services

What Happens when you get to know someone?

• Resident project

Pay attention to simple pleasures….

What are YOURS?

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Thomas Moore

“The ordinary arts we practice every day at home are of more importance to the soul than their simplicity might suggest.”

LA: Find Someone Who….

“A lack of attention to lifestyle preferences or a lack of opportunity to engage in meaningful and enjoyable activities can result in: boredom, depressed mood, behavioral disturbances”

“Meaningless activity corrodes the human spirit.” The opportunity to do THINGS we find meaningful is ESSENTIAL to human health.”

Involvement in social relationships is a vital aspect of life.

“Activities are meaningful when they reflect a person’s lifestyles and interests”

“When these relationships are challenged, it can cloud other aspects of life. Decreases in a person’s social relationships may affect psychological well-being and have an impact on mood, behavior, and physical activity. “

Background

• Identify the source

• “The resident’s record should reflect comprehensive information about the person including, but not limited to: past life experiences, description of behaviors, preferences such as those for daily routines, food, music, exercise and other….”

• “Identifying to the extent possible, factors that may underlie the resident’s expressions of distress, as well as applying knowledge of lifelong patterns, preferences, and interests for daily activities to enhance quality of life and individualize routine care.”

Background

• Identify the source • “If medical causes are ruled out, the facility should

attempt to establish other root causes of behavior using individualized, holistic knowledge about the person and when possible information from the resident, family, previous caregivers, and direct care staff…..

• Boredom: lack of meaningful activity or stimulation during customary routines and activities

• Mismatch between the activities and routines selected and the resident’s cognitive and other abilities to participate in those activities/routines…”

Research

• 3 studies done using the PELI (Preferences for Everyday Living Inventory) – NH residents with and without cognitive impairment can report

their personal preferences – Preference profiles are face valid and provide useful information

about individual preferences – NH residents have a wide range in the number of strongly held

preferences – Using this comprehensive tool, 75% of strongly held preferences

are reported to be somewhat to mostly satisfied – PELI is a promising tool for comprehensive and robust

assessment of personal preference identification – https://www.nhqualitycampaign.org/files/Preference_fulfillmen

t_pilot_press.pdf

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•Important Preferences •Habits and Routines

•Care plan

•Implemented •Satisfied

•Preference Congruence

•Conversations starters •Engagement strategies

•Tools

•Lifelong patterns •Preferences

•Interests

Knowledge Skills

Communicate Assess and Measure

It sounds so simple…but it’s not always easy Applying Lifelong Patterns

Life Story

Preferences

Make introductions and greetings

Aid in communication

filling in words/thoughts

Understand behavior and reactions to

environmental triggers

Design meaningful and purposeful life

activities

Serves as a tool for reminiscing

and validation of life experiences

Understand rituals and routines

Anecdotal

• Carl is calmed by singing gospel music But he needs to hear the first lines

• Joe responds with pride when he is called Colonel But only in a specific tone of voice

• Maddie is calmed by walking outside BUT she doesn’t remember how to go out

• Frank will get in the car for the Dr. if he has his golf clubs BUT the staff need to “go along”

• Kate relaxes when she is called teacher BUT the staff needs to create the opportunities

• Ted likes to watch the Boston Red Sox BUT he needs help to turn it on and find the game

• Pat is engaged while reading the newspaper daily BUT she needs to have this task simplified

• Sue will remain focused when she has her clipboard BUT she needs to be cued

• Eunice will sit contently while looking at the garden BUT she needs cueing to look at it

• Ellie transitions to bed by reading the Bible BUT she needs a simplified format and reminding

• Jane focuses while doing crossword and jigsaw puzzles BUT she has lost the ability to get started

• Betty relaxes when looking at baby pictures BUT someone needs to hand it to her

• Harry stops pacing and trying to leave when focused on a card game BUT someone needs to play

Challenges

• Lack of time

• Lack of importance

• Communication impairments

• Cognitive Impairments

• Untrained interviewers

• Cultural barriers

• Access to “informed significant others”

Benefits of Digging Deeper

• Benefits of structured life review with Alzheimer’s (Tabourne, 1995) – Improved social interaction and self-esteem

• Webster (1999) documented 8 outcomes from reminiscing/life stories – Alleviate boredom – Reinforce identity – Increase problem solving – Increase conversation

• Benefits of structured life review (Haight, Micheal, Hendrix 2000)

– Impact on depressed mood in new nursing home residents – Prevented depression and despair

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KNOWLEDGE Components of a Preference Assessment

LINKS

• L ife skills are identified

• I nterests and involvement patterns are understood

• N ow becomes meaningful by a link to the past

• K ey to successful interventions is a connection to lifelong habits and values

I have DEMENTIA. The more you know about my life,

my past, my goals,

my history, The easier it will be to care for me.

Ellen Belk, Keep in Mind

Attributes of a Psychosocial Assessment

University of Pittsburg Preferences for Everyday Living-58

Life Story Circles

1. Personality Traits

2. Habits and Rituals

3. Values

4. Needs-Maslow’s Hierarchy

1. Social relationships-10

2. Growth-personal development-14

3. Diversionary activities-leisure-8

4. Self-dominion-living environment-16

5. Care patterns and daily routine-10

1. The lifelong patterns of social involvement and engagement (introvert, extrovert, family, leader)

2. The unique “moments” and experiences that have made an emotional impact (stories to share)

3. A statement of VALUES that defines the person’s actions (beliefs, what is important)

4. A set of interests and preferences that form one’s IDENTITY (who they ARE)

5. A portrait of one’s habits and routines (simple pleasures and daily routines for comfort and security)

6. A collection of special accomplishments that reinforce one’s worth (things to be proud of, skills and strengths

7. A description of relationships that provide rootedness and connectivity to others (who provides support and security)

“Becoming WHO they WERE…”

TED

Normalization of Life Patterns

Things I like to do on

a daily basis (food,

drink, personal habits, spirituality,

pursuits)

Things I like to do

occasionally

(weekly or monthly)

Things I like to do

for special

occasions (once in a while)

Relationships

that are

important to me (type of

socialization)

Other things I have

enjoyed/lifetime

experiences

Stories I like to share

What could be a possible cause of agitated behavior? What “trigger” could we use to stimulate a positive emotion? What approach could you use to get him to shower? What communication approach would you use to engage him? What meaningful activities could he do both in his room and in a group? What stories can we remind him of while providing care?

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Birth 18-25 26-45 45-65 65-75 75-82

1923 1941-1948 1949-1962 1962-1988 1989-1998 1998-2005

Arlington MA English Writing Music (classical) Flute School Strict upbringing Work and Order Cleanliness No toys Unhappy childhood

College-Tufts-Elephant English Music (Big Bands) Football Navy World War II Baseball RED SOX

Marriage 3 kids Personnel Work English/books Community service Church work Camping Choir Sports (Hockey, Baseball, Football) Move to Texas

Personnel Work Church Board and service Community Boards and service Choir Grandkids/ BOOKS Flute Sports

School Mentoring Non-profit boards Flute Walking Senior Olympics Church service Retirement

Time Line of Life Stories

Rowland-Junie-Ted

Use objects of special value to trigger positive emotion memories

Relationship Mrs. Adams did not feel adjusted to the new nursing home even after three months. The QoL.SRI revealed a low score in the relationship domain. The QoL.CP (care plan) prompted the staff to engage the resident in conversation about her preferred routine in an effort to create a more positive relationship between the resident and staff members. Mrs. Adam's relationship score increased from baseline to 90 and remained stable at 180 day.

Individuality Mr. Peters served in WWII and was recently admitted to the local nursing home. The QoL.SRI identified a low score in the individuality domain due in part to the fact that Mr. Peters felt that the staff took little interest in his military service and life prior to coming to the nursing home. The QoL.CP prompted the staff social worker to meet with the resident and talk about his military experience.

Collages

• “A little Bit of This and a Little Bit of That”

SKILLS

Tools for Understanding lifestyle Preferences

And habits

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Interview Strategies

• It is important to LISTEN to what the resident is saying.

• What is most important to the resident?

• What is the resident saying about important aspects of their life?

• What does the resident want to happen?

• What habits and routines does the resident prefer to continue?

Interview Strategies

• Conversation Starters for habits and routines

– Fill in the blank

– Forced choice

– Yes/no

• Preference cards

• Lifestyle Preferences

– “Have you ever enjoyed

• Relational activities and interactions

Relational Interactions

• Name discussions

• Collages

• “I have-have you?”

• If I could, I would…

• What would you do?

• Pleasant events, “have you ever enjoyed?”

• Patterns and legacies

• Picture “talk”

• Scripts and stories

• What’s in my pocket?

• Singing and dancing

• “Cold hands”

• Kitchen wisdom

• Recipe talk/smells like

• Share and visit

• Penny Ante

COMMUNICATION Integrating preferences into care plans

Example Care Plans

• “SHAWN”

• http://www.improvingqol.pitt.edu/program-materials/examples-care-plans

– Paper

– Kiosk

– Voice activated

Case Study-Cna interview

• How are you informed of a resident’s personal activity interests and preferences?

• What training did you receive about your role in providing in-room activities of resident choice?

• How are in-room activities incorporated into daily routine?

• Are adequate supplies available? – 2 of 5 cna s could identify resident specific interests – Staff did not communicate preferences, interests, hobbies – Current in room “activities” did not meet resident

choice/lack of supplies – 7 of 10 residents said cna was unaware of personal choices

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ASSESS AND MEASURE Strategies to measure Preference Congruence

What is Preference Congruent Care?

• “Preference Congruent” care is care that fulfills important resident preferences for personal care and recreational activities. – Utilizes MDS 3.0 Section F items that staff ask on a routine basis – Interviews resident to discover:

• which preferences are “very” or “somewhat” important to him/her • how satisfied s/he is with each of the important preferences being fulfilled

– Provides critical visual feedback to staff: • which preferences are being fully met and which require further follow up for

each individual resident’s care plan • which preference gaps may be affecting many persons residing together in a

household, floor or unit • overall measure of quality that can be benchmarked and tracked over time • http://www.polisherresearchinstitute.org/#!preference-congruence/c17bj

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Nursing home information:

– Review areas of importance and satisfaction within entire nursing home.

– Assists with program and service planning and evaluation.

How “Preference Congruent” is your Care for each Type of Preference?

University of Pittsburg Quality of Life Structured Interview

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Steps…

• Spend time to REALLY get to know the person “ME” – Use a tool that captures the essence of the person

– Be prepared with follow up questions

• Determine a process to communicate the information – Care plan preferences

– Report “wins”

• Train care staff and give them the tools to implement the interventions

• Track discrepancies between important preferences and involvement in those preferences

Resources

• https://www.nhqualitycampaign.org/ Person Centered Interview Tools

• http://www.polisherresearchinstitute.org/#!advancing-excellence/co71 Polisher Research Institute PCC tools

• https://www.nhqualitycampaign.org/files/AE_Detailed_Preference_Interview_v1.10.pdf tracking tool

• http://www.improvingqol.pitt.edu/ Improving Quality of Life

• http://www.he.k-state.edu/aging/outreach/peak20/

resources

• Van Haitsma, Kimberly Ph.D. Resident Choice Made Easier. Provider Magazine, February 2013.

• Power, Allen G. M.D. Dementia Beyond Drugs. Health Professions Press, Inc. 2010

• Zeisel, John Ph.D. I’m Still Here-A New Philosophy of Alzheimer’s Care. Penguin Group. 2010

• Brenner, Tom and Karen. You Say Goodbye and We Say Hello-The Montessori Method for Positive Dementia Care. Brenner Pathways. 2012

• Basting, Anne Davis. Forget Memory-Creating Better Lives for People with Dementia. John Hopkins Press.2009

• Gibson, Faith. The Past in the Present. Health Professions Press. 2004

Additional Information

• Natalie B. Davis ACC

– natalieteach@aol.com