Creating Successful Dementia Care Settings (Calkins)

Excerpted from the User’s Guide for Creating Successful Dementia Care Settings, developed by Margaret P. Calkins.

The authors’ goal in writing this four-volume series was to create an easy-to-use reference to help care providers understand and more appropriately manage, through the environment, the broad array of behaviors and changing abilities that occur with dementia. One must first recognize the importance of accommodating the basic needs of all people, and then one must consider that most people with dementia are older, and therefore, experience the world through sensory modalities that are changing or that have been altered by aging. Vision, hearing, touch, taste, and smell all change with age, and sensory changes often affect behavior. For example, it may not be dementia but simply poor vision that hinders a person’s ability to read signs or an activity calendar. Volume 1, Understanding the Environment Through Aging Senses helps caregivers to be more sensitive to how these sensory changes can affect a person’s basic functioning.

Only after the needs of the resident as a person like anyone else and as an older person with changing sensory experiences have been acknowledged can one consider the unique needs of the individual as an older person with dementia. There is no denying that the neuropathological changes that occur in the brain of a person with dementia affect his or her ability to perceive, make sense of, and operate effectively in the surrounding environment. Basic tasks, such as dressing and eating, that once were easy become increasingly difficult. The inability to interpret what someone is saying, to identify faces or objects, or to understand his or her current location can easily lead to fear and resistance to care. Volumes 2 and 3, Maximizing Cognitive and Functional Abilities and Minimizing Disruptive Behaviors, respectively, focus on these issues.

Enhancing Identity and Sense of Home, Volume 4, addresses issues that are primarily related to basic human needs such as privacy, autonomy, identity, and personal space. Much of the information is appropriate not only for people with dementia but also for cognitively alert individuals in long-term care settings.

The more that you, as a caregiver, understand all of the factors that affect the person or people whose care is entrusted to you, the better able you are to see the world as they do. Thus, the beginning of each chapter in all of the volumes presents the individual topic from the residents’ perspective, including contributing factors and influences on specific behaviors or issues. In addition, these sections offer ideas for assessing problems and implementing interventions. This level of information is particularly useful for staff members who manage and/or train direct care staff. The authors hope that this information will broaden staff’s knowledge on the topic, and that they will pass the information along to others who care for residents.

The residents’ perspective section is followed by “What Staff Can Do,” which provides information on social interactions between staff and residents and ideas for structured and spontaneous activities on the same unit. Some interventions focus on teaching direct care staff to take a different approach to particular situations, whereas other interventions are provided for staff who plan structured activities and programs.

The third main section of each chapter, “What the Environment Can Do,” offers suggestions for modifications or changes that can be made to the physical environment so that your facility becomes more supportive of the residents, particularly those with dementia. Many of the suggested changes cost nothing and involve only a different use of the environment or a small modification using materials you probably already have on hand. Other changes are low in cost, requiring the purchase of a few additional products or materials. Finally, if your facility is able to upgrade or replace some of its furnishings or equipment, we have provided practical advice in “What the Environment Can Do” on what to consider when purchasing a product. Many of the modifications suggested in this section explain how these modifications benefit the residents and the staff who care for them.

The final section of each chapter, “Where to Find Products,” lists specific manufacturers and distributors of the products mentioned in the text. There is some repetition in these sections across the four volumes so that you do not have to refer to a separate volume for the information. Many of the manufacturers and catalogs also carry more products than those highlighted in our lists. This section is followed by a summary sheet, which boils down the chapter text into an easy-to-remember, quick overview. We have also provided an area for you to make notes about your own staff and facility. Managerial staff may wish to use the summary sheets as handouts to accompany direct care staff training, or to post them by the time clock or nurses’ station or include them in staff’s pay envelopes. All staff, including business office, social services, dietary, and housekeeping, may appreciate this quick overview of issues because they likely interact with residents daily.

At the conclusion of each volume, a detailed bibliography and suggested readings help you learn more about issues in the individual volumes. The Behavior Tracking Form and Sensory Stimulation Assessment appendixes appear at the end of Volume 3. Staff can use these forms to examine the occurrence of behaviors and aspects of the environment more closely. Each blank form is accompanied by explanatory information and a sample completed form. Volume 4 includes three appendixes, all designed to help residents feel more at home in the facility and to protect their safety.