TODAY IN
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Get your local
community
involved:
Here are some
ideas of people
to contact to
help promote and
assist in special
activities:

Rockland/Bergen
County Girl scouts

Rockland / Bergen
County Boy Scouts

Rockland County
4-H Groups

The Rockland
Journal News

The Times Herald
Record
Serving Orange
and up state
counties

Town News

Local High Schools
and Clubs

Churches

Temples

Catholic Schools

Yeshiva's

Pet Therapy Groups


Local VFW

Local Government

AOH
Ideas for 2008
Reading
Roundtable
World Gossip
Animal
Adventures
Club
Art from the
Heart
Art
appreciation
Dare to Dance

Start a red Hat Society

Start a  Movie Review Club
Film your reviews

Start a animal adventures
club


Hold a music memories club

and new in stores is the
DVD version of the Price is
Right
Holidays
on the
Net
E mail us your idea,
click here
PET
THERAPY
LINK
Therapy Dogs
in New Jersey
Delta
Society-

How to
start pet
therapy
United Way of
NJ-Pet Therapy
program
Drama Groups
with your residents!
It Sounds hard, but
it will be one of
your best activities!

SMALL PLAYS


Senior Theatre


Great Fund raising
Ideas
Caring for a dying
resident
Good Endings
Enchanted
Learning
Craft Ideas
Idea Art
What is Recreation
What is Recreation
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Activity Director's Ideas  and Issues    
Over the years, the general nursing home population
has become increasingly demented in its makeup.
Some estimates indicate that 50% of all residents in
nursing homes have Alzheimer's disease. Other
studies show that Alzheimer's disease and related
disorders represent two-thirds of the nursing home
population. This trend is further complicated by the
implementation of OBRA '87 and its mandated
reforms of the nursing home industry.

OBRA represents a philosophical shift in orientation
to working with residents who have a dementing
disorder. In the past, problematic behavioral
problems associated with dementia were managed
through the use of physical and chemical restraints.
OBRA is forcing facilities to develop alternative
intervention strategies that are less intrusive and
restrictive. All in all, these forces signal a need for
facilities to reevaluate their orientation and in-service
programs related to dementia care.

Past experience has shown that an appropriate
training agenda for the future needs to incorporate
the following components:

These modules need to be offered to staff on an
ongoing basis as a way to refresh and re-enforce the
philosophical orientation that OBRA represents.

Staff tend to have an inadequate and inconsistent
understanding of dementing illnesses. In order to
develop appropriate skills in caring for those with
dementia, all staff need to be fairly knowledgeable
about the various ways that dementia presents.
Housekeeping, dietary, maintenance, laundry and
administrative staff should be trained, since these
individuals inevitably have contact with residents
who have dementia. Staff need to recognize the
various intellectual, thinking, behavioral, emotional
and physical symptoms that accompany the disease
process.

Staff need to develop an appreciation of the
uniqueness of each resident who has been diagnosed
with dementia so that an individualized plan of care
can be developed. There is a tendency to see such
residents as being "a typical Alzheimer's" which
ignores the infinite ways that dementia presents.
Since families of residents with dementia tend to be
very knowledgeable about dementia and its effects,
staff need to be equally conversant so that the family
can feel a sense of confidence about staff's
competence to provide care.

Perhaps the most crucial aspect of a comprehensive
dementia training program is assisting staff in the
development of appropriate ways of interacting with
residents. Staff have a tendency to relate to residents
in ways that tend to increase agitation or escalate
problem behaviors. Consequently, staff need to be
aware of the impact that their behavior has on the
demented resident. Training should assist staff with
understanding how their voice, body language and
distance can be used to calm residents who are
frightened. Staff also need to be trained to "read"
residents' behavior so that a preventive, proactive
approach can be developed.

Dementia interferes with communication abilities.
Often, it may take up to 30 seconds for demented
individuals to process information. If staff attempt to
communicate as they would normally, the resident
will tend to respond with resistance or
combativeness. Staff need to be taught specific,
concrete communication techniques that will
increase the likelihood that the resident will feel safe
and, therefore, free of the need for disruptive
behavior.

Behavior management training is critical since
psychotropic medications cannot be used as
indiscriminately as in the past. All staff need to be
extensively trained in this area. Training of certified
nursing assistants in behavior management is a
neglected area. If non-drug interventions are to be
effective, CNAs must be intimately involved in the
development and implementation of behavior
management plans. Specifically, it is essential that
they be informed of the need to track and count
incidents of disruptive behavior so that needed data
can be collected. Staff also need to receive
information about the appropriate use of reality
orientation, validation therapy, redirection, activities,
etc. Indeed, the role of the nursing staff needs to be
shifted more into functions that have been
traditionally performed by social work and activity
staff.

Nursing staff play a pivotal role in the decision to
prescribe or withdraw psychotropic medications.
Nurses need to receive additional training with
respect to the appropriate use of these. Though there
seems to be a dramatic shift away from prescribing
psychotropic medications to demented residents,
often resulting in dramatically improved quality of
life, in the rush to implement drug titration programs,
facilities have not always been able to determine
who is appropriate for reduction and who is not. As
a result, there are instances in which harm has been
done to those needing medications because of
underlying dementia-related psychosis.

Family care is a key training need for all staff due to
the tendency for families of demented residents to
be more intensely involved in care issues. This
involvement stems from years of caregiving in a
fashion that has been termed "the 36 hour day."
Staff need to be sensitive to the family's need for
support as they make the transition from being
primary to secondary caregivers. Staff should be
sensitive to the grief process that families undergo
when a loved one has dementia. They need to be
comfortable with addressing dysfunctional family
response to the disease and the resulting decision to
placed a loved one in a nursing home.

Finally, staff need regular training in self care. Caring
for individuals with dementia is a physically,
mentally and emotionally exhausting process.
Unpredictable behavioral outbursts, continual decline
of functioning and the demands of coping with
repetitive behaviors all cause staff inordinate
amounts of stress. Prolonged exposure to such
stressors can result in caregiver burnout. All staff
need assistance with recognizing signs of stress so
that personal plans for stress management can be
developed and maintained.

SIGNS, SYMPTOMS OF DEMENTIA,
PROGRESSION

* types of dementia, i.e. Alzheimer's disease,
multi-infarct dementia

* causes

* research

* development of a therapeutic milieu

* treatment and management strategies

* conscious use of self

* communication techniques

* behavior management programs

* psychotropic medications

* physical environment

* working with families

* stress management