Transitioning to LTC, Part 3
Here are some final ideas help with the transitioning patient with more severe dementia into a new living environment: Depending on the patient's level of function, all of the suggestions previously given for higher level patients should be considered and attempted.
Avoid letting families and visitors say they are "coming right back" if they are really leaving. Some of the most difficult transitions I have seen occur when families tell a person they are "just going to see a doctor," or are just staying "for a little while."
Mark doors to room, closet and bathroom clearly with a written label or a picture. Put these at eye-level to the patient; consider if the patient is in a wheelchair or ambulates! Mark the patient's dresser and side table, as well.
Have a basic list of frequent contacts. Teach the resident to use a simple cell phone, if possible, to stay in touch.
Have photo albums and other items available for memory tasks and to help the patient feel secure. Start a memory book and keep it simple; complicated scrapbooks can be too busy and distracting.
Set up the patient's toiletries and other items in as similar way to at home as possible, and keep them in the same place.
Maintain schedules and visitation plans as much as possible. Write down any cancellations or changes.
Expect behaviors and emotions including fear, sadness, anger and frustration.
Remind the patient where she is and why she there as often as needed. Help her to make call home, when appropriate, or set up a schedule for calls with patients who want to call loved ones when they are work or throughout the day.
Bring the resident to social activities, and assist as much as needed.
Explain clearly and honestly where the person is and why. Write this information down and place it in a notebook that the patient will keep. However, if the person becomes agitated to denies this information, then...
Determine whether reorientation works for the confused patient, or if validation is a better approach. For example, if the patient insists he is living in an apartment in San Diego instead of a nursing home in New Jersey, figure out early on if he becomes agitated and angry when re-oriented, or if he can still understand that his situation has changed. Do not constantly correct the confused patient, but guide them and redirect them toward different topics and appropriate activities.
Let the patient do as much for himself as he possibly can! If he was toileting and self-feeding before the admission, do not let staff start to feed him just because he is slow, uncoordinated, or "seems a little slow."
Read part 1 and part 2 of Jennifer's blog series on helping new residents adjust to long-term care.