Thursday, December 19, 2013

Four ways for assisted living operators to facilitate transitions

(Originally titled, "Four Ways for ALFs to Facilitate Transitions for Dementia Residents.")

My wife, Clare, who has Alzheimer’s disease, recently entered the “Reflections” unit for residents with dementia in an Assisted Living Facility (ALF).  Clare’s transition from home to ALF was about as good as I could have hoped for.  However, there are four steps that our ALF could have taken to make this transition much easier for both of us. 
1.  Issue a staff list to caregivers.  When we visited the ALF where Clare was eventually placed, we received a folder with lots of helpful information.  However, not even after Clare became a resident did I ever receive a list of personnel responsible for Clare’s welfare.  I was introduced to the Director of her “Reflections” unit when he conducted the intake assessment, and I had already met the person responsible for relations with caregivers.  But I was never given a list of the aides on the three shifts responsible for Clare during each 24 hour period. 
I could have familiarized myself much more quickly and easily with the names of the many aides who help Clare had I been provided a staff list.  The list should also have included names/titles/areas of responsibility of all administrators and supervisors responsible for Clare’s care.  In addition, the direct line telephone numbers and email addresses for all administrators and supervisors should have been provided.  I eventually obtained all of this information during the first few weeks, but had that information been given to me upon Clare’s admittance it would have saved me a lot of time and effort.
2.  Provide easily readable name badges for personnel.  The ALF we selected provides name badges for its personnel that are the exact opposite of what is helpful to residents and caregivers.  The name of the ALF is very prominent and in large size lettering on a metallic badge.  The name of the employee is in much smaller size lettering.  And the employee’s title is in even smaller size lettering.  Except for the administrative personnel, the names and titles of employees are typed in 10 or 12 point font on a piece of white tape on the bottom of the badge.  I have 20/20 vision, but in order to read a person’s name and title clearly I must get very close to that person, almost violating their “personal space.”  I know that the ALF is proud of its name and wants to market its name, but for caregivers who shave already placed their loved ones in that facility, what is important is the name and title of the people working with their loved ones, not the name of the facility.  
3.  Provide removable name badges for residents.  When Clare attended day care programs, each morning she and all the other participants were given name badges upon arrival with names printed in very large 36 point font size, easily readable from a distance.  When participants left at the end of the day, the name badges were collected to be used the following day.  This was very helpful for Clare because she cannot remember names anymore.  I think that ALFs should consider a similar practice for residents in their dementia units.  Even after several weeks of being with her fellow residents 24/7, Clare is still unable to remember the names of most of her new friends.   If every dementia resident wore a name badge, identification would be a lot easier.  Needless to say, it would also make it easier for caregivers to identify a resident’s friends when they come to visit.
4.  Establish formal meeting schedule with caregivers to discuss resident care.
Dementia unit administrators in ALFs should schedule meetings with the primary caregiver of a dementia resident on a regular basis.  These meetings would provide a formal opportunity for facility administrators to provide primary caregivers with a status update on how their loved ones are faring, and offer an opportunity for primary caregivers to ask questions and offer suggestions with respect to activities, medication protocols, etc.  Too often the observations and perceptions of caregivers are not thoroughly considered, and that is wrong.  Even with a dementia resident no longer living at home with a 24/7 caregiver, that caregiver has important history and insights that should be considered on an ongoing basis after admittance.  Meetings could be modeled along the lines of federally mandated school district Committee on Special Education (CSE) meetings for classified special education students.  For CSE meetings, parents are invited to attend so district administrators can provide a status update on how their children are doing, and so parents have an opportunity to ask questions and offer suggestions on any perceived needs for improvement. 
I would advocate that such meetings be offered to caregivers of dementia residents one month after resident admission, and then once every three months after that date.  As a retired principal, I can understand the reluctance of ALF administrators to add yet more meetings to their schedule.  However, as a caregiver whose wife is in such a facility, I can attest to the difficulty of finding the people I need to speak with on any given day due to different work shifts.  At least if I knew a meeting was scheduled in a given week, I could maintain a list of questions knowing that the administrators will all be there to respond to my questions at our scheduled meeting. 
Although these four suggestions are based upon my own personal experience with one ALF, I know from many others in my support groups that I would probably be making one or more of these same suggestions had Clare been placed elsewhere.  ALFs should be issuing staff lists to caregivers upon admission of their loved ones, providing personnel with easily readable name badges, providing dementia residents with easily readable name badges so they can readily identify each other, and scheduling formal meetings with caregivers to discuss resident progress.
Published as guest blog column in McKnight's Long-Term Care News. December 20, 2013.  Access online only at