DCC Training Overview

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Quality Dementia Care is Rooted in Strength-Based & Person-Centered Care.

I. Principles of Best Practice: Person Centered Care Components

1. The person is the focal point of care.

2. Assess to Identify-Cognitive Level or Dementia Stage

3. Habilitate & Compensate- Adapt the Activity and Environmental Demand.

4. Abilities remain at every stage/cognitive level

The key to effective intervention with a person with cognitive challenges it to equalize the

activity and environmental demands to the person’s capabilities.

II. Models of Care

1. Restoration Care—For pts with acute problems and good potential for learning. There is a realistic

expectation for recovery to a prior functional level and discharge to a least restrictive environment

2. Compensation Care-For treatment of patients with more complex medical conditions and with

limited potential for learning. Complete independence is not expected, but with supervision and setup,

the pt may be able to perform certain functional tasks.

3. Adaptation Care-For treatment of patients with chronic and multiple medical conditions and with poor

potential for new learning. Pt needs are identified and caregivers are taught to provide support in a

safer, more efficient, and cost effective manner, thus reducing the burden of care.

III. Positive Outcomes Focused Care

Optimize and maintain functional level

Optimize and maintain health, safety, and quality of life

Prevent avoidable medical events

Facilitate positive behaviors, de-escalate negative behavior and manage a behavior crisis.

IV. Required: Optimize functional level, promote highest practicable physical, mental, and psychosocial well-

being. To achieve this requirement, we must emphasize cognitive assessment.

1. Cognition underlies all areas of function, mobility, decision making, problem solving, learning, etc.

2. Cognition is the primary determinant of level of function potential.

3. Cognitive level/stage knowledge is needed to be able to convert to best ability to function, care

approaches, risk management.

V. Cognitive Assessment Tools

Best Practice: Add strength –based, Functional Cognitive Assessments:

1. Screens: Global Deterioration Scale (GDS), Functional Assessment Staging Tool (FAST)- used by IDT.

2. Evidence Based Assessments: Allen Battier, a strength-based approach, based on evidence within the

Cognitive Disabilities Model- used by therapists.

Cognitive Disabilities Model Developed by Claudia Allen.

DCC Training Overview

© Copyright Synergy Care, Inc. 2019. CONFIDENTIAL – Synergy Care, Inc. Proprietary Document

VI. A Strength-Based Approach: Identify and facilitate use of remaining abilities.

“We must circumvent cognitive losses and facilitate use of retained capacities to facilitate functional

potential and engagement in meaningful daily activities, at every dementia stage. Planning and care delivery

centers around the person and their interests, preferences, habits, roles, supports, etc.

Therefore, we must:

Identify preferences and routines and accommodate.

Provide Habilitation or Compensatory Care

Use activity analysis to create just right challenge (OT) to meet the person where they are today.”

(Re: Kim Warchol, CPI, Dementia care specialist; How to Deliver Strength Based Dementia Care that

Supports Quality Initiatives)

VII. Goals/Treatment Approaches

1. Must have a clear understanding of what level the patient is functioning at and then determine what

their Best Ability to Function remains and can be carried out to avoid Excess Disability.

2. Goals are written towards remaining best ability; what you want the patient to continue to be allowed

to do.

Ex. “Pt will dress with intermittent v/c to maximize function and decrease excess disability.”

Ex. “Pt will feed self with spoon to maximize their function and decrease excess ability.”

Ex. “Caregiver will exhibit competence in allowing pt. to function with self-feeding to allow their BATF.”

3. Goals are geared toward:

-Teaching/Training Caregivers

-Adaptation

-Compensation

-Motivating the patient to perform remaining abilities

-Improved quality of life and decreased burden of care

VIII. Reason for Referral

1. Is also based on remaining BATF

2. Can be based on common risk factors that can be caused at each Level of Dementia.

3. “Pt. isn’t performing at their BATF; therefore, pt is at risk for increased contractures, increased risk of

aspiration, increased dependent quality of life, etc.

References:

Warchol, Kim, OTR/L, Founder and President of Dementia Care Specialists, a CPI specialized offering, (2017) How to Deliver Strength

Based Dementia Care that Supports Quality Initiatives.

Quick Guide for DCC Treatment Plans

© Copyright Synergy Care, Inc. 2019. CONFIDENTIAL – Synergy Care, Inc. Proprietary Document

ACL 1 End Stage: Most likely bed bound, mute and requires total care.

Treatment Plan:

1. Prevent contractures

2. Prevent skin breakdown

3. Prevent aspiration pneumonia

4. Prevent Loss of quality of life

5. Prevent weight loss

6. Prevent unmanaged pain

Examples: diet change, sensory stimulation (smells, sound etc), AAROM, activities to increase interaction, teaching care giver.

ACL 2

Late Stage: Mostly focused on postural ability to overcome gravity, self feeding, and limited mobility

Treatment Plan:

1. Prevent of falls with ambulation

2. Compensate self-feeding (finger foods and safe swallowing)

3. Maximize receptive and expressive communication

4. Promote gross motor aspects of activities

Examples: only use passive adaptive equipment, modify environment, move slowly allowing patient to process, use music to promote movement, teach care giver not the patient

ACL 3

Middle Stage: Mostly manual actions such as grasping an object, some self feeding, ambulation in highly familiar areas Treatment Plan:

1. Prevent falls

2. Prevent contractures

3. Prevent weight loss

4. Prevent elopement

5. Promote max ability to perform ADLs, mobility and communication

Examples: teaching caregiver, break activities into single steps, use of familiar objects, wait for response, reduce distractions, use functional activities, exercise with cues, sensory and music

Quick Guide for DCC Treatment Plans

© Copyright Synergy Care, Inc. 2019. CONFIDENTIAL – Synergy Care, Inc. Proprietary Document

ACL 4

Early Stage: Minimal cognitive assistance for all ADLs except self feeding, has trouble with change or complex tasks, poor judgment Treatment Plan:

1. Prevent falls or other accidents

2. Prevent UTI's

3. Prevent depression/anxiety

4. Prevent elopement

5. Maximize ADL performance, mobility and communication

6. Modify environment

7. Train caregivers

Examples: teach caregivers, maintain familiar routines, minimize change, enhance recall and memory ex: turn at end of hall where the clock is

ACL 5

Mild Cognitive Impairment: Stand by cognitive assist, may require supervision depending on familiarity or complexity of task, learn through trial and error Treatment Plan:

1. Focus on promoting IADL's and work situations

2. Promote ADLs

3. Promote mobility

4. Promote training and use of equipment

Examples: provide situation specific training, provide strategies for organization and planning, practice socially acceptable behaviors

ACL 6

Normal

Reference: Basis of Knowledge from Dementia Capable Care Foundations Course