Transitioning to LTC, Part 2
People who are experiencing obvious deficits related dementia or other conditions require more assistance during even simple changes in daily routines, so it is vital to either prepare ahead of time, or to start putting strategies in place as soon as the new resident arrives.
Initial contact and discussion with the family and the resident will allow the treating SLP to develop cognitive-linguistic and communication strategies that will help to increase integration and participation in the new environment, and decrease catastrophic reactions to events and negative behaviors.
Imagine that you always put your reading glasses by your bedside lamp before bed, and put your dentures in a cup in the bathroom. Then you put your slippers under the bed, and set your bathrobe on the bedside chair. You have done this habitually, without thinking, for more years than you can remember!
Imagine now that you are in a new environment - you can't quite remember the name or location, but you know you are in a nursing home. There are strangers handling your things. A CNA puts your reading glasses on the dresser across the room and your dentures in a cup on the nightstand. Your slippers and robe are put in a closet, also across the room, and you still cannot quite recall which closet is actually yours - they all look the same, and sometimes you confuse the bathroom door with the closet door.
When you wake up in the morning, you need to use the toilet, but you can't find your glasses, and the floor is cold under your feet. When you get up to find your slippers and robe, your roommate becomes upset because you have opened her closet and are "getting into her things" again! By now, you are quite upset, and then several staff members come in and "fuss" at you for getting into someone else's closet. You forget that you even had to use the toilet, and are directed to sit down in your chair and wait for staff to help you get dressed, when you have never needed assistance dressing before.
In order to help residents with dementia acclimate to the new environment and routine, the team of therapists, nursing staff, CNAs, and family must be involved. Families and staff should be reminded that it may take 3 weeks or more for a resident with dementia to learn a new task or routine.
Considering what a frightening experience a move can be to anybody, it is no wonder that patients with dementia often display negative behaviors and catastrophic reactions as their whole routine is changed, and they are no longer in control.
Next week: Specific tips for transitions with the more confused resident.