Question
What are evidence-based OT interventions to reduce unwanted behaviors in clients with dementia?
Answer
If you have your folks using the elevator and you still want your visitors to be able to use the elevator, I think you need to communicate that. Oftentimes, you can have a sign on the outside of the facility that indicates that the elevator is in fact in working order despite the signage that is there. Maybe it is something that you send home with your families.
You would have to check with each of your state-specific guidelines related to that. I have not seen anything specific. Most of the states will be on board with your signage, with your camouflage, what have you, providing that number one, you are not violating HIPAA, and also, that you have it appropriately care planned. I have not seen too many issues with that.
Change the facility. I say that facetiously, but I mean that. If nothing else, every nursing home is now required to meet a whole new host of regulations related to participation, and those new rules just came out the end of November. We have three years to comply with all of those rules. If you read through them, they are resident-directed care and person-directed care. It talks about flexibility of the schedule, flexibility of what we provide to our residents, and that it is the residents' schedule, and not ours. That is really a learning curve that we have to get around in our facilities. Obviously all things cannot be flexible, I get that, but some things certainly can be. Meal time, bath time, bed time, and therapy times can be flexible.
I generally go back to the occupational profile, but I have to be honest with you, they are pretty old school. However, I still use my interest and roles checklist, and those have been around for a long time with OTs. I also use another tool that you may or may not have heard of, the PELI. The MDS is actually based on it, and it goes through every activity you could imagine for that person so that we can try to get an idea of what they like, and I really do like my COPM as well. I think you can kind of use anything there, I think, as long as it hits on all of the questions that are in the profile.
The vast majority of our facilities do not have that kind of money, do they? I think what you can do is create an area. Would I do it in a client's room? Probably not, because I do not think you want all of that sensory stuff going on at all times in the client's room. You can certainly find cost effective sensory equipment. Some of those fiber optics and tactile things can be frabricated. I think you can certainly do that cost effectively. I will tell you, a good friend of mine has done some really great research on Snoezelen. She created it herself and did get a lot of the same types of benefits from it.
