The Best Friends Staff Building a Culture of Care in Alzheimer's Programs By Virginia Bell, M.S.W., and David Troxel, M.P.H.

Training Tool Kits (Contents)
Acknowledgments
Dedication
Introduction

1. The Best Friends Model
   
   Staff with Knack: Being Well Informed
   Having Empathy
   Respecting the Basic Rights of the Person
   Maintaining Caregiver Integrity
   Employing Finesse
   Knowing It Is Easier to Get Forgiveness than to Get Permission
   Using Common Sense
   Communicating Skillfully
   Maintaining Optimism
   Setting Realistic Expectations
   Using Humor
   Employing Spontaneity
   Practicing Patience
   Developing Flexibility
   Staying Focused
   Remaining Nonjudgmental
   Valuing the Moment
   Maintaining Self-Confidence
   Using Cues that Are Tied to the Life Story
   Taking Care of Oneself
   Conclusion
   
   
2. Staff Recruiting, Training, & Development
   
   A Day in the Life of A Skilled Nursing Facility Administrator
   Recruitment and Hiring: Potential Employees
   When Staff Fail
   Training and Retention: Training Programs that Do Not Work — The Old Idea Care Center
   Training Programs that Work — The New Idea Care Center
   Ideas for Training Programs that Work
   Conclusion
   Training Tool Kit
   
   
3. Medical & Scientific Basics
   
   What Does the Word Dementia Mean? Is It the Same as Senility?
   What Is Alzheimer’s Disease?
   What Is the Difference Between Alzheimer’s Disease and Normal Age-Associated Memory Loss?
   What Are the Related Irreversible Dementias?
   What Are the Most Common Irreversible Dementias in Older Adults?
   What Are the Related Reversible Dementias?
   Should Everyone Who Has Symptoms Get a Thorough Diagnosis?
   Are All Persons with Alzheimer’s Disease Alike?
   Can Alzheimer’s Disease Be Inherited?
   Can Alzheimer’s Disease Be Prevented?
   How Can Excess Disabilities Be Prevented?
   Do Sudden Changes Suggest Problems Other than Alzheimer’s Disease?
   What Is the Role of Psychotropic and Other Drugs?
   Resources for the Best Friends Staff
   Conclusion
   Training Tool Kit
   
   
4. The Experience of Alzheimer’s Disease
   
   When Staff Don’t Get It
   The Best Friends Way
   To Know Someone, You Must Walk a Mile in His or Her Shoes
   Person-Centered Care Is Central
   Losses Caused by Dementia Can Evoke a Wide Range of Distressing Feelings and Emotions
   Persons with Dementia Can Experience Joy, Love, and Happiness
   The Feelings of Persons with Dementia Are as Real as Yours and Mine
   Behaviors that Seem Out of Place Are Not
   Feelings and Behaviors Can Be Changed by Meeting the Needs of the Person
   Conclusion
   Training Tool Kit
   
   
5. Assessment & Expectations
   
   Why Existing Assessments Often Fail
   The Best Friends Assessment: Review Physical and Mental Health
   Review Cognitive Health
   Assess Who the Person Is
   Assess the Care Environment
   Emphasize Remaining Strengths
   Do Not Overemphasize Stages
   Individualize Care Plans
   Assess Frequently as a Caregiving Team—Persons Vary from Day to Day
   Assess Combative Behavior Carefully
   Set Realistic Expectations
   Share Information with Families or Other Visitors
   Conclusion
   Training Tool Kit
   
   
6. Friendship
   
   Friends Know Each Other’s History and Personality
   Friends Do Things Together
   Friends Communicate
   Friends Build Self-Esteem
   Friends Laugh Together Often
   Friends Are Equals
   Friends Work at the Relationship
   Friends Show Love and Affection
   Friends Can Overcome Social Barriers
   Conclusion
   Training Tool Kit
   
   
7. The Life Story
   
   Every Program Should Obtain a Person’s Life Story Before Admission
   The Life Story Should Be Accessible to Staff and Volunteers
   Every Dementia Care Program Should Have on File a Written Life Story on Each Staff Member or Volunteer
   Use the Life Story to Greet the Person and Improve Recognition
   Use the Life Story to Introduce and Reintroduce Residents to Individuals Around Them
   Use the Life Story to Reminisce About the Person’s Life
   Use the Life Story to Provide One-to-One Comforting Care
   Use the Life Story to Improve Communication Through Clues and Cues
   Use the Life Story to Improve Activities
   Use the Life Story to Point Out Accomplishments
   Use the Life Story to Prevent Challenging Behaviors
   Use the Life Story to Incorporate Past Daily Rituals
   Use the Life Story to Broaden the Caregiving Network with Volunteers
   Conclusion
   Training Tool Kit
   
   
8. Communication
   
   Check the Environment
   Remember the Basics of Good Communication
   Use the Person’s Preferred Name
   Make A Good First Impression
   Keep Language Simple
   Ask Questions Using Discretion
   Employ Good Timing
   Be Conscious of Nonverbal Communication
   Do Not Argue With or Confront the Person
   Remember that Behaviors Communicate a Message
   Treat the Person as an Adult
   Use the Life Story Often
   Maintain Caregiving Integrity
   Respond to the Person’s Emotional Needs
   Screen Out Troubling Messages or News
   Speak Using Positive Language
   Employ Humor
   Turn "No" into "Yes"
   Do Most of the Work
   Conclusion
   Training Tool Kit
   
   
9. Being Together Using Best Friends Activities
   
   An Activity Philosophy
   Purpose of Activities
   The Art of Activities Is Not in What Is Done; It Is in the Doing
   Activities Should Be Individualized and Tap into a Person’s Past Interests and Skills
   Activities Should Be Adult in Nature
   Activities Should Include Pets and Other Animals
   Activities Should Recall a Person’s Work-Related Past
   Activities Should Stimulate the Five Senses
   Doing Nothing Is Actually Doing Something
   Activities Should Tap into Remaining Physical Skills
   Activities Usually Are Initiated by Others
   Activities Should Be Voluntary
   Everyone Can Still Engage in Some Form of Activity
   Intergenerational Activities Are Especially Desirable
   Activities that We Think Will Never Work Sometimes Do
   Activities Should Appeal to the Staff as Well as to the Person
   Personal Care Is an Activity
   Activities Can Be Short in Duration
   Activities Can Happen Day or Night
   Activities Can Fill a Spiritual Need
   Activities Are Everywhere
   Conclusion
   Training Tool Kit
   
   
10. Caregivers as Members of the Best Friends Team
    
    The No-Clue Day Center
    The Best Friends Way
    Understand that the Definition of “Family” Is Changing
    Remember that Each Family’s Response to Alzheimer’s Disease Is Unique
    Realize that Placement Does Not Always Make Things Easier, Only Different
    Share a Defined Philosophy of Care with Families
    Believe that Most Families Are On Your Side
    Create a Care Plan for Families
    Never Give Advice
    Involve Families in Care Decisions and in the Program
    Develop Honest, Effective Dialogue
    Handle Conflict Appropriately
    Encourage Use of Services
    Help Families Recast Relationships
    Conclusion
    Training Tool Kit
    
    Conclusion
    
    Invest in Staff
    Treat Staff with the Same Respect that Good Programs Give Their Residents or Participants
    Recognize that Staff Have a Desire to Be Part of a Caring Community
    Give Staff the Tools that They Need to Build Effective Job and Life Skills
    Involve Staff in Decision Making
    Recognize that Leadership Is Vital to a Program’s Success
    Encourage Staff to Be Involved with Residents and Participants Through Group and Individual Activities
    Assign a Best Friend to Each Staff Member
    The Best Friends Model as a Tool for Change

Notes and References
Appendix A: Programs Featured in The Best Friends Staff
Appendix B: Professionals Featured in The Best Friends Staff
Appendix C: Suggested Resources for Trainers
Index