MAP-IT: Enhancing The Lives of Alzheimer’s Patients in Skilled Nursing Facilities

Alzheimer’s/Dementia Statistics

Dementia refers to a decline in mental ability severe enough to impair one’s daily life and safety. Memory loss is an example. Alzheimer's is the most common type of dementia.

Over 5 million Americans are currently living with Alzheimer’s, and it is estimated that as many as 16 million will have the disease in 2050.

The cost of caring for those with Alzheimer’s and other dementias is estimated to total $226 billion in 2015, increasing to $1.1 trillion (in today’s dollars) by mid-century.

Nearly one in every three seniors who dies each year has Alzheimer’s or another dementia.

Florida’s Statistics

Number of people aged 65 and older with Alzheimer’s by age

Year	65-74	75-84	85+	TOTAL
2015	69,000	200,000	220,000	500,000
2020	93,000	240,000	240,000	580,000
2025	120,000	330,000	280,000	720,000

 

When Living at Home is No Longer an Option: Residential Communities

Many families turn to skilled nursing or long term care facilities to provide 24-7 nursing care where patients will be safe. Some facilities have specialized memory care or Alzheimer's units.

According to a 2011 survey bt MetLife Mature Market Institute, the national average cost for basic services in an assisted living facility is $41,724 per year and in a nursing home, it's $78,110 per year for a semi-private room and $87, 235 per year for a private room.

Most families are self-pay and defray t the care costs out of their own pockets. Types of benefits that may cover nursing care include long-term care insurance Veterans benefits and Medicaid.

Medicare does not cover the cost of long-term care in a care facility. Medicare only covers short-term skilled care after a hospital stay.

The community of choice was residents in a skilled nursing facility. The population of choice within this community is Alzheimer's residents residing in a Memory Care Unit. Residents meet the admission criteria for this unit based on their mental status or inclination to wandering or fleeing.

Alzheimer’s disease leads to cognitive, physical, and mental decline throughout its progression. These residents are at greater risk for neglect, failure to thrive, and lack of purposeful meaning as their disease progresses.

I chose to volunteer with this population in order to enhance their quality of life. This is congruent with the Healthy People 2020 goal to improve the health, function, and quality of life of older adults.

Stake holders of this community include: the residents, nurses, patient care assistants, physical therapists/assistants, patient family members, friends or loved ones, the activities associates, community members, clergy, and corporation affiliates.

 

Source: http://www.healthypeople.gov/2020/topics-objectives/topic/older-adultsd

MAP-IT Volunteer Site : Diamond Ridge
Diais a 120 bed facility that offers both semi-private and private rooms with a wide range of resources from comprehensive rehabilitation to memory care. Resources are available to not only the patients, but to their family and loved ones through grief counseling an support. 7 days a week speech, occupational, and physical therapies with state of the art equipment are offered.

• Specialty programs consist of Vital Stim, to treat swallowing difficulties; Anodyne Therapy for pain management; Low Vision, a program for Occupational Therapy to treat visual deficits; and Nu-Step, for a new level of Physical Therapy. 
• Able to accommodate different religious and/or cultural practices.
• Transportation is free of charge to patients and residents.
• Grief counseling.
• Financial counseling and assistance with application for medicaid/ medicare services.
• Daily individualized care plans are discussed and address patients/residents needs, concerns, and plan of care.
• Pet therapy and patient/residents pets are allowed and welcome to visit.
• 24 hour nursing services provided

–Long-term care

–Wound care

–Pain management

–End of life care

–Alzheimer’s and memory care

• Diamond Ridge Health and Rehab

Memory Care Demographics

Male vs Females: 4 Male to 24 Females

Ages within this community range from 70 to 90 years of age. 

Race/Ethnicity: 27 Caucasian and 1 African American

Financial Status/Class: The financial status varies for each member for each member within the community; however, most are self pay or have long term insurance or Veterans insurance assisting with the expense of skilled nursing care.

Religion: Primarily Christian

Length of Time: Many reside permanently in this unit, some residents have been there 4 years plus, while others are newly admitted based on their altered mental status while in comprehensive rehab and will only be residing their while they complete their physical therapy.

Florida State Demographics

• According to the U.S. Census Bureau, as of 2014 Florida had a population of 19,893,297
• As of 2013, 18.7% of the population is over the age of 65 years of age.

–Race/Ethnicity: 

• 78.1% of the population  is White alone.
• 56.4 % of the population is White alone, non Hispanic or Latino.
• 23.6% of the population is Hispanic or Lat1no.
• 6.7% of the population is African Americans.
• 0.5% of the population is American Indian/ Alaskan Native.
• 2.7% of the population is Asian.
• 0.1% of the population is Native Hawaiian/Pacific Islander represent.
• 2 or more races make up 1.9% of the population.

–Females account for 51.1% or the population and 48.9% are males.

–Religion: The highest percentage of Floridians are Christian. 

–83.7% of population has lived in same household 1 year or over  

Missing Resources at Diamond Ridge

1)Dedicated Volunteers: to date there is only one dedicated regular volunteer per the Activities Director.

2)Cognitive and Physical Stimulation for this population. The Memory Care Unit has one assigned activities employee who implements and initiates activities and stimulation for the residents. She is a CNA by training and assists with ADLs, but her primary roles is to promote activity participation and coordinate meals. She is the only employee that works 5 days a week for 10 hour shifts; while the rest of the workers work 8 hours shifts.

Top Problem Areas:

1)Staffing/Volunteers

2)Dedication/Variety of Activities

3)Quality of Life Assessment

4) Level of Functioning Assessment

5)Family/Caregiver Communication Resource Promotion

Plan

Increase the number of volunteers by advertising in the community. Hanging flyers in community locations that promote volunteering. Having an ad in the local newspapers or community guides solicitng volunteers.

Staffing issues need to be addressed by administration with a consideration to acuity and EBR. Providing the leaders of the facility with the education into these issues is key in improving staffing rations.

Evidence Based Research to promote current finding and developments in Alzheimer’s LOF and QOL promotion through adequate assessment tools.

Empowering the families, caregivers, and healthcare workers through communication, EBR, and cogntive/physical stimulation activities.

Plan Time Line

Phase One ( 1-2 months): Obtaining permission from facility supervisors; design flyers for volunteers, post flyers, reach out to community guides, newspapers, radio asking for advertisement space for the good purpose of promoting Alzeimer’s well being. Introduce the plan to staff members and existing volunteers.

Phase two (3-4 months): Training of new volunteers, introduction of QOL of LOF tools for better individualized plan of care. Matching volunteers with certain residents based on their skills, likes, and needs. Promoting family involvement with volunteer program.

Phase three(5-6 months): Fine tuning of QOL and LOF tools and volunteer participation. Introducing EBR to all employees and volunteers to gain better insight into the disease process.

Phase Four(7-9 months): Promotion of improvement of staffing ratios and continuing educaiton, introduciton of leading EBR to change staffing issues and promote better outcomes of QOL and LOF.

Phase Five (Months 10-12): Evaluation of program outcomes based on initial QOL and LOF to current QOL and LOF for residents still available to assess. Restructuring parts of program that survey indicate are not working.

Plan Tracking

Surveys to determine employee, community, volunteer perceptions before and after implementation of program.

QOL of LOF forms before and after of patients.

Volunteer and employee retention numbers.

Employee and Volunteer Satisfaction Surveys.

References

Dementia Specific Health Related Quality of Life Measures (n.d.) Retrieved from http://www.dementia-assessment.com.au/quality/

Department of Disease Prevention and Health Promotion.(2o15). Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/older-adults

Diamond Ridge Health & Rehabilitation Center. (2013). Retrieved from http://diamondridgehealthandrehab.com/

Help End Alzheimer's. (2015). Retrieved from http://www.alz.org/

Kemoun, G., Thibaud, M., Roumagne, N., Carette, P., Albinet, C., Toussaint, L., & ... Dugué, B. (2010). Effects of a physical training programme on cognitive function and walking efficiency in elderly persons with dementia. Dementia And Geriatric Cognitive Disorders, 29(2), 109-114. doi:10.1159/000272435

Orrell, M., Spector, A., & Woods, B. (2008). Cognitive stimulation for the treatment of Alzheimer's disease. Expert Review of Neurotherapeutics, 8(5), 751+. Retrieved from http://db04.linccweb.org/login?url=http://go.galegroup.com.db04.linccweb.org/ps/i.do?id=GALE%7CA224272720&v=2.1&u=lincclin_cfcc&it=r&p=AONE&sw=w&asid=b862838d94547280f3497f505c118d8d

Tools for Early Identification, Assessment, and Treatment of People with Alzheimer’s Disease and Dementia (2000.) Retrieved from https://www.alz.org/national/documents/brochure_toolsforidassesstreat.pdf

United States Census Bureau (2015). Retrieved from http://quickfacts.census.gov/qfd/states/12000.html

Vance, D. E. (2012). Potential factors that may promote successful cognitive aging. Nursing: Research and Reviews, 2, 27+. Retrieved from http://db04.linccweb.org/login?url=http://go.galegroup.com.db04.linccweb.org/ps/i.do?id=GALE%7CA345989349&v=2.1&u=lincclin_cfcc&it=r&p=AONE&sw=w&asid=c7c6484ddd203a0e6ebc94a23b1bdb61

Yi-Xuan, N., Ji-Ping, T., Jin-Qun, G., Zeng-Qiang, Z., & Lu-Ning, W. (2010). Cognitive stimulation therapy in the treatment of neuropsychiatric