Case Management of Dementia Residents—

1 case Management of Dementia Residents . A Tool to Optimize Outcomes and Quality of Life Anne Ellett, NP, MSN. A s the population in the United States ages the first baby boomers cele- brated their 60th birthday in 2006 . the social and economic implica- or cognitive Looking ahead, the increase in Alzheimer's disease (AD) and other dementias will soar as the 85-plus population grows; as there is an almost 50%. risk of developing some form of tions are likely to be profound for case Example society in general and the senior housing industry in particular. Myra is a 78-year-old woman who lives with her 85-year-old husband, Stan, The changes have been coming in a two-room suite in an assisted living residence.

2 Myra and Stan moved in for some time. Today's nursing fa- three months ago at their son's urging. Due to Stan's decreasing vision, he cilities look much different than was no longer able to drive; and they both needed assistance. However, they did 10 or 20 years ago. The they reported no history of significant problems with ADLs. When the acuity of residents has increased couple moved into the ALF, staff noted that Myra often was absent for significantly, and subacute care, re- meals in the dining room and didn't participate in most social gatherings. hab, and special units (such as At times, her clothing appeared mismatched, and she occasionally would those for Alzheimer's disease) are come to the dining room with her dress on over her nightgown.

3 Becoming mainstays of the industry. The ALF's nurse consultant began to use case Management with Myra At the same time, assisted living is because she was concerned that the elderly woman may have Dementia . seeing more residents with chronic The nurse made a recommendation for a physician visit to assess for illnesses such as Dementia that re- possible Dementia . The physician diagnosed a vascular Dementia , and the quire varying levels of medical nurse completed the FAST to begin her case Management of Myra. Myra's care; and many experts agree that FAST score was Stage 5, showing decreased organization abilities, inability providing good care for residents to perform complex tasks, and needing assistance in choosing appropriate with Dementia is the future for the clothing.

4 AL industry. If ALFs are to effectively care for By identifying the stage of Myra's Dementia , the staff was better able to the growing number of demented meet Myra's and Stan's needs in the AL environment. Stan had been residents they are seeing, they need providing a lot of the support to help maintain Myra's ADLs, and the staff case Management tools that not on- was able to offer him more assistance in getting Myra groomed and to the ly ensure excellent care but also dining room for meals. Many aspects of Myra's health and socialization optimize outcomes and maximize were monitored, and staff was better prepared to engage her in social quality of life.

5 Activities. Stan had more time to develop friendships and participate in areas of his own interest. The couple's son was involved in a care plan ALFs and Dementia meeting and appreciated the proactive approach and the regular case Recent studies show that over 50% Management of his mother to help ensure her quality of experience in the of residents living in assisted living AL residence. may have some form of Dementia May/June 2006 Assisted Living Consult 7. Dementia for people 85 and older. Figure 1 shows the projection for the Figure 1. Number of Alzheimer's Disease Cases prevalence of AD in this country.

6 Providing adequate care for de- 16M. mentia residents living in assisted 14M. living settings can be a challenge for Alzheimer's disease is the staff. The needs of Dementia res- 12M expected to grow to an idents for supervision, engagement, estimated 16 million by and clinical oversight may be greater 10M. 2050. than for other cognitively intact resi- 8M At this time there are under dents, yet residents with Dementia 70,000 centurions in the often are unable to adequately com- 6M Researchers predict by municate their needs to staff. the year 2050 there will be As health care providers and 4M.

7 700,000. consumers become more sophisti- 2M. cated and demanding regarding their expectations for residential 0M. care for demented individuals, ALFs 2004 2050. will be expected to develop effec- Sources: USA Today; New York Times Magazine tive programs to manage residents with Dementia , while delivering a good quality of life experience. In case Management of Dementia resi- an effort to set standards of care for dents is to help plan the successful people with Dementia , the Alzheim- transition of a demented person er's Association (AA) already has Regular assessment when they move into an assisted published initial Dementia care and intervention of living environment from a higher This tool addresses the Dementia residents level of issues globally and focuses on the An example of a case manage- specific areas of social engagement, avoids crisis ment tool for Dementia residents is food and fluid consumption, and Management .

8 Included in Table 1, with a case ex- pain Management . ample of how it can benefit demen- tia residents' experience in assisted Study Fuels Guidelines living. The Alzheimer's Association based Why is case Management so im- As part of the case Management , its guidelines on the results of a portant for ALF residents? Effective- many areas of Dementia residents'. study examining the quality of care ly caring for this population of resi- well-being is tracked and moni- for Dementia residents in long term dents can be very labor intensive tored. The stage and progression of care facilities. This study found that and complex.

9 A monthly case man- the Dementia is tracked through the over 50% of residents with demen- agement program for Dementia resi- resident's Functional Assessment tia had low food and fluid intake dents monitors both clinical and Staging (FAST) scale The during meals, 40% of residents with social outcomes. An organized ap- FAST scale (Table 2), a commonly recognized pain received no pain proach of regular assessment and accepted scoring tool, follows the medication, and unrecognized de- intervention of Dementia residents progression of Dementia from mild pression was avoids crisis Management , and it memory impairment on through A system of case Management of improves the quality of the resi- moderate to severe Dementia .

10 A. Dementia residents, which includes dent's experience in the AL envi- FAST score of seven or greater is regular intervals of assessment, is ronment. required for a person with demen- an excellent method for AL com- case Management also allows AL tia to receive Medicare-certified munities to meet the Alzheimer's staff to recognize the number of hospice services. Association's guidelines and can residents with Dementia in the facil- There are several other areas help optimize positive health out- ity; and it can help focus staff train- that need to be tracked as part of comes and quality of life for de- ing on important topics such as Dementia case Management , in- mented residents.