Dementia Care in a Nursing Home

More than 50 percent of residents in assisted living and nursing homes have some form of dementia or cognitive impairment, and that number is increasing every day.

The dementia care recommendations define goals for each care area and present strategies for achieving them.

Food and Fluid Consumption Inadequate consumption or inappropriate food and fluid choices can contribute directly to a decline in a resident’s health and well-being.

Recommendations are based on these goals:
• Provide good screening and preventive systems for nutritional care.
• Assure proper nutrition and hydration, given resident preferences and life circumstances.
• Promote mealtimes as pleasant and enjoyable activities where staff have an opportunity to
observe and interact with residents.

Pain Management
Pain is under-recognized and undertreated among people with dementia, primarily because they can have difficulty communicating. Poorly managed pain can result in behavioral symptoms and lead to unnecessary use of psychotropic medications.

Our care recommendations are based on the following goals:
• Ease the distress associated with pain and help residents enjoy an improved quality of life.
• Treat pain as the “fifth vital sign” by routinely assessing and treating it in a formal, systematic way, as one would treat blood pressure, pulse, respiration and temperature.
• Tailor pain management techniques to each resident’s needs, circumstances, conditions and risks.

Social Engagement
Engagement in meaningful activities is one of the critical elements of good dementia care. Activities help residents maintain their functional abilities and can enhance quality of life.

Recommendations are based on these goals:
• Offer many opportunities each day for providing a context with personal meaning, a sense of community, choices and fun.
• Design interactions to do with — not to or for — the resident.
• Respect resident preferences, even if the resident
prefers solitude.

When nursing homes and assisted living residences are considering changes to care or to the environment of the residence, they should ensure that these changes comply with relevant state and federal regulations.

Goals for Effective Dementia Care
• To ensure that staff provide person-centered dementia care based on thorough knowledge of residents and their abilities and needs.
• To help staff and available family act as “care partners” with residents, working with residents to achieve optimal resident functioning and a high quality of life.

Fragment to the book: Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes/Jane Tilly, Dr.P.H.; Peter Reed, Ph.D.; Elizabeth Gould, M.S.W.; and Abel Fok/August 2007