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Doug Stark
Doug Stark is president of ComfortCare Homes, Inc. ComfortCare provides long-term care for the memory impaired at all levels of care and function in elegant, single-family residential homes. Born out of the Stark family's experience with Alzheimer's they have grown to 25 homes with 8 in Wichita and 17 in Nebraska and Virginia. A native of Wichita, Doug attended Wichita public schools and the University of Kansas. He served for 12 years as a Big Brother and has been a member of Wichita Rotary for 19 years. He is board member and Treasurer of Kansas Health Ethics. Doug can be contacted through his office at 7701 E. Kellogg, Suite #490, 67207, by calling (316) 685-3322, or by sending an e-mail to comfortcarehomes@aol.com
Senior Living
2003-08-01 13:57:00
Memory-impairment care is different
:  How does memory impairment care differ from normal care received in an assisted living facility or a nursing home?
Doug Stark Question:  How does memory impairment care differ from normal care received in an assisted living facility or a nursing home?Answer:  Memory impairment care, more commonly known as dementia care is very different than care found in most assisted living facilities and skilled nursing homes that cater to the cognitively intact: or at least it certainly should be.  Defining dementia explains why the care models are so different.       A person is considered to "have dementia" as a result of damage to the brain from an injury or a disease process to an extent that they can no longer survive without some assistance.  There are many causes of dementia that will be mentioned in more detail a little later.   An individual in early dementia may only be unable to recall major relevant aspects of their current lives, e.g., an address or telephone number of many years, the names of close family members (such as grandchildren), or the name of the high school or university they graduated from.     As cognitive abilities decline the person may not be able to name his or her spouse whom they are entirely dependent on for survival.  They are generally unaware of their surroundings, the year, the season, the ability to recognize and react to danger, etc.   They will require assistance with their activities of daily living as many become incontinent and require help with bathing and dressing.  Many times personality and emotional changes occur as the dementia deepens and can include delusional behavior, paranoia, obsessive symptoms like constant pacing, and anxiety symptoms including agitation and violent behavior, previously nonexistent.        Many people get Alzheimer's disease and dementia confused.  Alzheimer's disease as most know is very debilitating disease of the brain and is the leading cause of dementia, although there are many other causes.  Parkinson's disease usually also leads to dementia.  Pick's disease and multi-infarct strokes (TIAs) also are assaults to the brain that cause dementia, along with strokes, oxygen deprivation and others.     Most assisted living facilities, unless they have a separate and specialized dementia unit, generally are designed for the cognitively intact person who desires, or requires some assistance.  The typical assisted living resident resides in their own room or apartment surrounded with their own furniture and belongings.  They typically are fairly self-sufficient and are able to recognize when mealtime is and how to navigate to and from the dining room.       Assisted living facilities are ideal for the elderly looking for the autonomy of having their own space and things where they can lock the door if they want, but also enjoy the social interaction and bonding relationships of the other residents.  As wandering and elopement risks are many times a part of dementia, the lack of electronically secure entry and exit doors makes the general assisted living environment inappropriate.     Skilled nursing homes on the other hand are designed to provide a much higher level of care to those requiring much more in the way of intensive physical care, or those that have true skilled nursing needs.  Again, like the assisted living facilities, unless the nursing home has a secure dementia specific unit with dementia-trained personnel, generally a nursing homes population is fairly cognitively intact.     The bottom line is that the care needs, emotions and behaviors of individuals suffering with dementia can be substantially more difficult and taxing than caring for the lucid.   Dementia facilities need to be specially equipped designed and simplified to give appropriate care to the demented.  Care giver training for dealing with this population because of its many difficult behaviors is also very different.       In the traditional assisted living or nursing home environment, reality orientation is the key, whereas in a dementia environment, validation therapy is used to comfort  residents.   The overall theory being that due to the resident's dementia, we can no longer bring them to our reality, consequently reality orientation (clearing up their confusion) is not possible.  We must come to their reality and validate their feelings.   If, in the mind’s eye of an 85 year old dementia resident, he or she is looking for mom, validation therapy would teach one to join into the discussion about mom and help in the search, not to explain mom's absence, for if the resident were lucid they would not be looking for mom in the first place.
 
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