To those o f my colleagues who were unable to attend this convention and feel the power I felt, remember: "The longest journey starts with one small step."

CARMEN LIPPERT, RN Orchard ParL NY

U P D A T E O N " S H E L T E R E D F R E E D O M " I read with interest the article titled, "Sheltered Feedom: An Alzheimer's Unit in an ICF" (GN, May/June 1986).

In the summer o f 1984, a unit for 25 demented veterans was set up at Camp Hill Hospital using principles that are similar to those discussed in the arti- cle. I take it that this article was written a number o f months ago and that the authors have had opportunity to re- view their program.

I wonder if they haveany further in- formation or comments that they would be willing to share?

JOHN M. GRAY, MD Geriatric Services

Halifax, Nova Scotia, Canada

Ms. Hall replies: The Iowa City Care Center Unit was the first o f many devel- oped under the same conceptual mod- eL Currently, I am working with 50 long-term care centers to develop spe- cial care units--85 integrated units us- ing the standard care plan, 3 special care day-care centers, and 4 hospitals. I have data from 3 of the special care units so far, and it is very consistent. We continue to see elimination of all night wakening, except in one resident who was a night watchman for years before be became ill. We are seeing de- creased agitation and elimination of combativeness and wandering. We are seeing weight stabilization or gain in about two-thirds of the residents and an increase in food consumed. All units are reporting increased socialization, family satisfaction with care, and de- creased use of neuroleptics, tranquiliz- ers, and sedatives.

The older units are, o f course, report- ing increased need for staff at meal times and bath times as a result o f de- creased use of medications. However, on one unit, ADL fi~nction has in- creased in one-quarter of its residents

over a 3-month period. Residents who were being fed and helped when walk- ing became independent in these activ- ities. We attribute this to diminished stress levels. One resident had not spok- en or walked in 6 months. After 2 months on the unit he is walking by himself and giving the nursing staff his philosophy on caring for Alzheimer's residents.

Some of th e problems we have faced have been the continuing need for rein- forcement and education of staff. Spe- cial visitor training has been developed in addition to the family support groups to help families cope with envi- ronmental alterations. Turnover ofkey personnel, such as the director of nurs- ing, may change the quality of a pro- gram. The Health Department and other regulating agencies all needed education and still might pose objec- tions to the plan of care or make recom- mendations about a locking unit. The question has been raised concerning whether a home is more responsible for a resident who wanders or falls on a special uni t~than on an integrated unit. However, the biggest problems re- maining are uncertainty about when to remove a resident from the unit and the lack of funding for study and data col- lection. Developing and evaluating units have been primarily a "labor of love"for us involved, who do it--with- out pay-- in addition to our full time jobs.

We are now planning a study that compares the number of our residents admitted to acute care with a matched control group. We suspect our acute care admissions will diminish over time. I have visited several high stimu- his activity-based programs and have gained new ideas for activities pro- gramming and staff training. One pro- gram trains its nursing assistants in re- creation. Another reports increased staff and resident satisfaction using 10- hour shifts. We have also gained in- sight into when a unit is not needed.

Please let us know what you are do- ing and how you are evaluating your program so that we might all gain from each other's experience.

GERI HALL, RN, Gerontology Clinical Nursing, Specialist 1I, University of lowa, Iowa City

l 'senting The Pacific Northwest's First Regiona ! Seminar On Gerontological Nursing

March 25, 26, 27

For the first time, more than 30 of the Pacific Northwest's leading specialists in the field of geriatric care join in a symposium aimed at making nurses and other' health-care professionals more expert in caring for the elderly.

Headed by Richard W',dtman, M.D., F.A.C.P. this intensive program explores the aging process and its effect on body systems. Attendees will be eligi- ble for 15 CERP credits. For an informative brochure about the seminar, write or call:

Ilumana ~ Ilospital-Tacoma Sursing Administration E O.Box 11414 Tacoma, X~;-~ 98411-0414 (206) 572-2525, Ext. 7219

~lumana Hospital-Tacoma Bringing th6 human being in need imo the hands

o f a doc to r TM

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MAKE THE MOVE TO TEXAS! Gerontology Specialist:

Challenging opportunity for this newly created position. Self-starting individual needed to initiate a pro- gram designed with the special needs of the elderly in mind. Candi- date should be a clinical specialist with a medical/surgical background with an interest in gerontology. Pre- ferred masters prepared. Will accept BSN with appropriate experience, at least three years geriatrics. Salary commensurate with educational level.

We are a 346 bed hospital which is part of a 16 facility Medical Center located on 400 acres west of city. Excellent benefits and salary with relocation allowance available. If interested contact: Sherry Frymoyer, Coordinator/Nurse Recruitment High Plains Baptist Hospital 1600 Wallace Blvd. Amarillo, Texas 79106 (806) 358-5000

C i r c l e no. 4 o n r e a d e r s e r v i c e c a r d