Certified Nurses Improve Facility Quality | https://www.providermagazine.com/Issues/2015/May/Pages/Certified-Nurses-Improve-Facility-Quality.aspx | Certified Nurses Improve Facility Quality | <div>
<span>R</span><span>egistered nurse (RN) staff are in a unique position to affect quality in long term care settings at the bedside and to influence the care delivered by both individual staff members and the team as a whole.</span></div>
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RN staff in long term care settings need to have well-focused clinical assessment and judgment skills, as they are usually the primary assessor of the patient. Medical support is not always immediately accessible, so the nursing staff must analyze clinical situations and have the confidence to make decisions concerning when residents need additional care.</div>
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It makes sense that RNs should be prepared as leaders in moving quality initiatives forward. Not unexpectedly, RN staff are expressing a desire to be part of the solution in caring for elders.</div>
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Yet, nurses are already juggling many competing demands. How can they prepare themselves? Success is consistently achieved when nurses are empowered, administration is engaged, and partnerships are created and strengthened.</div>
<h2 class="ms-rteElement-H2"><span>Nurses Empowered</span></h2>
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<span>O</span><span>ne success story is Christian Health Care Center, a nonprofit organization in Wyckoff, N.J., that offers a complete continuum of care such as senior living, elder care, short-term rehabilitation, and mental health services. Chief Operating Officer Denise Ratcliffe understands that quality of care rests in the investment of nurses as not only clinicians, but as leaders who understand the complexity of the long term care landscape.</span></div>
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<div>“We as an organization continually look for ways that we can improve and recognize not only the clinical competencies of nurses at our facility, but their leadership skills as well. We left the decision of how this would take place in the hands of our nurses,” Ratcliffe says.</div>
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The nurses decided to obtain certification from the American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association. ANCC certification is a tangible representation of specialized clinical and leadership experience and is recognized as the highest representation of quality.</div>
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<p class="ms-rteElement-P">The facility purchased slots for an accredited online continuing education course to assist the RNs in achieving board certification.</p>
<p class="ms-rteElement-P">“In our environment that serves residents requiring assisted living, intermediate, skilled, and Alzheimer’s care, knowledge is power. You need to know your stuff!” says Dawnette Bredberg, director of nursing at the Eastern Nebraska Veterans’ Home in Bellevue, Neb. “The course refreshes your knowledge and brings new knowledge to the table. It helps to refine your skills.” Already a clinical expert and nursing leader, Bredberg recently completed an accredited, online course in gerontological nursing, which prepared her to become board-certified and changed her title from RN to RN-BC.</p>
<p class="ms-rteElement-P">“It was an ego boost for me to achieve board certification. It was validation for me that ‘Yes, I am an expert in this specialty.’ When you have more knowledge, it makes you more confident and engaged. I was able to use the knowledge I learned with my co-workers and patients,” she says.</p>
<p class="ms-rteElement-P">Kirsten Reile, director of nursing at Elim Rehab and Care Center in Fargo, N.D., agrees. She completed the same online course in gerontological nursing and became board-certified. Her facility serves both skilled and assisted living residents. “The more educated you are, the better the outcomes. Education and knowledge can change practice,” she says, adding that after the course, she updated her facility’s policy on when to check orthostatic blood pressure.</p>
<p class="ms-rteElement-P">Becoming an RN-BC is beneficial for all RNs, even for those with many years of experience. “You forget how great it is to learn new things when you are out in the field for awhile,” says Bredberg. “Taking an online certification test prep course is a great overall review. It encourages you to try new solutions to old problems. It makes you want to be part of the team.”</p>
<p class="ms-rteElement-P">Reile echoes that thought. For her, the course was a good refresher. “It caused me to question how things were done and to change policies. It is making us think proactively rather than reactively about patient care,” she says.</p>
<p class="ms-rteElement-P">Nurses need not only the clinical expertise, but the confidence to continually move the quality bar. Obtaining certification injects a confidence boost in nurses, one of the necessary elements for facilitating quality of care, participants say.</p>
<div><span style="font-family:georgia, palatino, serif;font-size:1.3em;background-color:initial;">Administration Engagement</span></div>
<p class="ms-rteElement-P"><span>An engaged administration views nursing staff as partners, as crucial links between policy and action at the bedside. The simple act of inviting RN staff into this partnership is a powerful indicator of engaged leadership. It also recognizes the resources needed to achieve facility goals.</span></p>
<p class="ms-rteElement-P">“We wanted to remove as many of the barriers to obtaining certification as we could at our facility,” Ratcliffe says. “So we sought funding from our local foundation for both the certification prep course and for the examination fee for our nurses. We were overwhelmed at the response our invitation elicited from our nurses.”</p>
<p class="ms-rteElement-P">In fact, a domino effect occurred.</p>
<p class="ms-rteElement-P">“I’d thought about certification for a long time,” Bredberg says. “So when my administrator not only found the online training course but offered to pay for both the preparation and certification test, of course I took the opportunity.” Bredberg then continued to engage administration to utilize internal funding to support additional nurses.</p>
<p class="ms-rteElement-P"><span>Financial support was influential for Reile as well. Scholarship funds for certification preparation and testing were made available for nurses in her facility from a state-level quality grant. She not only took the opportunity herself, but also purchased the course for four of her unit managers.</span><span style="font-size:13.6000003814697px;background-color:initial;"> </span></p>
<h2 class="ms-rteElement-H2"><span></span><span>Supp</span><span>ort, Recognition Vital</span></h2>
<p class="ms-rteElement-P">But almost as important as financial backing is the act of showing support for education and those who take the challenge.</p>
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“Prior to starting the certification prep course, my administrator looked at me and said, ‘I think you should do this. I know you will do well,’” Bredberg says. “When I completed the course and passed the certification exam, my administrator wanted to throw a party. He put it in the newsletter and told our clients about my educational success.”</div>
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Recognition of success was part of the plan for Ratcliffe as well. “When our nurses achieved certification, we hosted a really nice dinner for the newly certified nurses. We invited board members, family, and media. Each nurse was given a leadership book and a nice award,” she says. “Two of the nurses gave powerful testimonials about their journey.”</div>
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Administrators who show confidence and interest in their nursing staff are an amazing influence on nursing and subsequently quality success. This investment in nurses causes a rebound interest and investment by the nurses in the facility. They become part of the change, participants say.</div>
<h2 class="ms-rteElement-H2"><span>Partnerships Strengthened</span></h2>
<p class="ms-rteElement-P"><span></span><span>A valuable feature of selecting an online certification course provided by faculty experts in nursing education is the true partnership that is established among the educators, administrators, and nurses. </span></p>
<p class="ms-rteElement-P">These educational partners ensure that gerontological content is updated, that learner progress in the course is tracked, and that support is given to both administration and nurses alike if there are any technological or educational issues.</p>
<p class="ms-rteElement-P">When thinking about this partnership, Bredberg says, “I was nervous at first—my administrator was going to get emails about my progress. But as you succeed in the course, you gain confidence.”</p>
<p class="ms-rteElement-P">The partnership with educational experts benefits the RNs who are enrolled as well as the facility administrators. Comprehensive gerontological content is organized and presented systematically in small, easy-to-absorb pieces. All of the continuing education credit needed to take the certification exam is awarded. Also, tips are provided to make sure nurses are prepared to take the certification exam.</p>
<p class="ms-rteElement-P">“I liked the fact that there is a course that is all online and self-paced. It allows for flexibility, but still requires you to learn the material before moving on. It is set up to keep you on task and focused on the exam,” says Bredberg.</p>
<p class="ms-rteElement-P">Ratcliffe agrees that the partnerships among facility administration, RN staff, and educational experts providing online gerontogical training are another key to success. “Christian Health Care Center’s nurse leaders decided on the certification initiative, and they worked together to make it happen,” she says. </p>
<p class="ms-rteElement-P">“Our certified nurses are now able to speak the quality language and have an understanding of the patient satisfaction pieces and the finances that need to come together to make high-quality outcomes; they are able to ‘connect the dots’ and feel like they are part of the quality initiatives. We are now building on that achievement.”</p>
<p class="ms-rteElement-P">Charge nurse Sawsan Lahoud, who directly benefited from Christian Health Care Center’s nurse leadership initiative, reflects on the opportunity provided by her facility.</p>
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“I am so happy and grateful that my facility recognized my potential and supported me in my effort to become board-certified in gerontological nursing,” she says. “Everyone has potential, if given the opportunity.” </div>
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<em>Heidi Keeler, PhD, RN, is an assistant professor and nurse planner for continuing nursing education at the University of Nebraska Medical Center in Omaha, Neb. She can be reached at (402) 559-4524 or </em><a href="mailto:hkeeler@unmc.edu" target="_blank"><em>hkeeler@unmc.edu</em></a><em>.</em></div>
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</em> | RN staff in long term care settings need to have well-focused clinical assessment and judgment skills, as they are usually the primary assessor of the patient. Medical support is not always immediately accessible, so the nursing staff must analyze clinical situations and have the confidence to make decisions concerning when residents need additional care. | 2015-05-01T04:00:00Z | <img alt="" src="/Issues/2015/May/PublishingImages/caregiving_t.jpg" style="BORDER:0px solid;" /> | Caregiving | Column |
Technology Merges REITs And Senior Living Communities | https://www.providermagazine.com/Issues/2015/May/Pages/Technology-Merges-REITs-And.aspx | Technology Merges REITs And Senior Living Communities | <div><span lang="EN"><div> </div>
<div>Hardly a day goes by without another story of new Real Estate Investment Trust (REIT) activity in the senior living market. REITs have evolved greatly since they were created by Congress in 1960.</div></span></div>
<h2 class="ms-rteElement-H2">Entering New Markets</h2>
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A REIT can choose to invest in many categories of real estate such as office spaces, hotels, shopping malls, apartments, and, increasingly, senior living. Whatever the underlying investment, it needs efficiency and effectiveness to operate at a profit and yield the desired returns. </div>
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<div>Typically, a REIT focuses on one segment and leverages its expertise in that segment to drive maximum returns for its investors.</div>
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<div>As noted, many REITs are now focused on senior living because it has become a very attractive and profitable market. With the number of Americans 65 and older growing at a rate four times faster than the general population, the demand for senior living is undisputed. </div>
<h2 class="ms-rteElement-H2">Software Used By REITs</h2>
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REITs with expertise in apartments or other rental properties tend to leverage facility management software to ensure their properties are being run efficiently. </div>
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<div>Without a doubt, the software does help operate rental properties more efficiently by ensuring maintenance and other administrative duties are performed adequately.</div>
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In addition, while skilled nursing has been the dominant market for long term/ post-acute care electronic health record solutions, the number of skilled nursing centers is now declining, while senior living care settings are increasing in volume. As a result, many electronic health records originally designed for skilled nursing are taking a run at the senior living market. But, are these solutions optimal for senior living communities? In a word, no.</div>
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<div>Any REIT needs to maximize “funds from operations.” However, the way to widen funds is significantly different for a senior living community than it is for a traditional rental property because of the service delivery aspect of the business. Also, the potential for legal liability in a senior living community can be significant and must be mitigated. Substandard care, noncompliance with governmental regulations, and a host of other concerns must be closely monitored.</div>
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All that said, key measures such as occupancy and days sales outstanding (the average number of days that a company takes to collect revenue after a sale has been made) must also be managed to ensure a profitable business. If the senior living organization does not make money, it may not have the ability to pay its lease obligations, and the performance of the REIT will suffer.</div>
<h2 class="ms-rteElement-H2">Why Software Matters</h2>
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So a true, complete solution for a senior living community will provide greater benefit to REITs by augmenting both the profitability and reliability of its tenants. A comprehensive solution, purpose-built for senior living, helps maximize return and minimize risk in the following ways:</div>
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<div><div><div>■ Reduces the potential for litigation by having accurate and timely documentation of services delivered;</div></div></div>
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<div><div><div>■ Improves the ability to buy/sell an asset with market-leading software in place to demonstrate, monitor, and manage performance;</div></div></div>
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<div><div><div>■ Increases the ability to partner with managed care providers and quickly determine how well they are performing both operationally and financially;</div></div></div>
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<div><div><div>■ Allows new buyers to quickly gauge the quality of the investment, making it more liquid in the case of a need to sell; and </div>
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<div><div><div>■ Handles the increasing acuity of residents in senior living communities. (Facility management-oriented solutions typically have gaps in their clinical functionality.)</div></div></div>
<h2 class="ms-rteElement-H2">Quid Pro Quo</h2>
<p class="ms-rteElement-P">A purpose-built senior living solution implemented across all investment communities helps REITs maximize return by:</p>
<div><div><div>■Helping the “partner” maximize its earnings and make it a good customer via</div></div></div>
<div><div>--Maintaining census, delivering greater returns;</div>
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--Maximizing revenue by capturing and billing for ad hoc services provided; and</div></div>
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--Automating tasks, thus requiring less administrative overhead and providing more flexibility.</div>
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<div><div><div>■ Standardizing across all communities for common reporting and improved analysis of portfolio performance.<br><br><img width="100" height="124" class="ms-rtePosition-1" alt="James Evans" src="/Issues/2015/May/PublishingImages/JamesEvans.jpg" style="margin:5px 15px;" />REITs can benefit greatly from standardizing the systems used in their investment properties. Senior living communities can demonstrate their value to their REIT partners by implementing systems purpose-built to maximize occupancy, ensure the quality of care delivered, optimize the efficiency of operations, and report results on a timely basis to drive decision making. </div></div></div>
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<span lang="EN"><div><em>James Evans is chief financial officer of MatrixCare. He can be reached at (952) 995-9800 or </em><a href="mailto:James.Evans@MatrixCare.com" target="_blank"><em>James.Evans@MatrixCare.com</em></a><em>.</em></div></span><div> </div>
| Many REITs are now focused on senior living because it has become a very attractive and profitable market. With the number of Americans 65 and older growing at a rate four times faster than the general population, the demand for senior living is undisputed.
| 2015-05-01T04:00:00Z | <img alt="" src="/Issues/2015/May/PublishingImages/tech_t.jpg" style="BORDER:0px solid;" /> | Technology | Column |
The Joy Of Rementia | https://www.providermagazine.com/Issues/2015/May/Pages/The-Joy-Of-Rementia-.aspx | The Joy Of Rementia | <div id="__publishingReusableFragmentIdSection"><a href="/ReusableContent/4_.000">a</a></div><p class="ms-rteElement-P"><span><img width="232" height="274" class="ms-rtePosition-1" alt="Kassandra King" src="/Issues/2015/May/PublishingImages/KassandraKing.jpg" style="margin:5px 10px;width:157px;height:184px;" /><br>P</span>icture this: Nine residents of a memory care community are sitting around the kitchen table, holding conversations, laughing here and there, munching on finger sandwiches they just made.</p>
<p class="ms-rteElement-P">“Cucumbers, yuck!” “Mine doesn’t taste like cucumbers. It tastes like tomatoes.” “I don’t know what you’re talking about.” “Well, I don’t like cucumbers or cream cheese!” “This is the best sandwich I’ve ever had.” “I think it’s peanut butter. But it’s sweet, too.” “Well, you better not eat any more or you’ll spoil your dinner!” </p>
<p class="ms-rteElement-P">These same residents sit in proximity of each other for every meal every day and hardly say a word.</p>
<p class="ms-rteElement-P">What’s the difference between now and lunch earlier? They are experiencing rementia now, returning to full personhood as a result of meaningful engagement—otherwise known as an “activity.</p>
<p class="ms-rteElement-P">The word rementia is not common in the United States, though it is used in a sense akin to “rehabilitated” in the United Kingdom. Thomas Kitwood, PhD, uses it throughout his masterpiece, “Dementia Reconsidered: The Person Comes First.</p>
<h2 class="ms-rteElement-H2">Purposeful Engagement</h2>
<p class="ms-rteElement-P">With two kinds of bread and sandwich ingredients such as peanut butter, jelly, cream cheese, tomato, and cucumber, the participants are free to choose sandwich content.</p>
<p class="ms-rteElement-P">“Remember, food handler regulations require that we all wear gloves,” says the Alzheimer’s care consultant. “If you don’t wear gloves, you touch it, you eat it. You are volunteering to make sandwiches for others in the community who didn’t leave their rooms at lunch, and maybe they didn’t eat enough. Some people here need more calories. This is a nutrition program. And, you can eat some of what you make, but not until after we finish!”</p>
<p class="ms-rteElement-P">Heads nod, a few comment, and one or two look slightly at a loss. The jar of peanut butter and bread are in front of Ruth, who asks, “What do you want me to do?” “Looks like you have the ingredients to make sandwiches,” the consultant says. “Oh, right.” She doesn’t need any further direction and hits it like an assembly line worker. Next to her, the only male volunteer is slathering on the jam. Letting them figure it out, and watching them match their halves, is a sweet, sweet sight. </p>
<p class="ms-rteElement-P">At another seat, a woman cuts the sandwiches into quarters. It doesn’t matter that some sandwiches are half raisin bread and half whole wheat or oddly arranged. The point of engagement isn’t to achieve perfect results.</p>
<h2 class="ms-rteElement-H2">Breaking and Revisiting Habits</h2>
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As the care assistants observe the activity, they are gently reminded not to jump in, especially during clean-up. “Let the residents do as much as possible,” they are told. They step back and continue to watch, peripheral to the recreation, not in control. Throughout the hour, hand gestures are used to remind the caregivers of Summer House at Wesley Palms Retirement Community in San Diego, Calif., who are learning how to do rementia engagement, not to fix, interfere, or exclaim “Oh, no!” or “Not like that, like this.” Those are hard habits to break. The caregivers at this planned recreational session are being trained on progressive approaches that require rewiring the urge to correct unless someone is truly in harm’s way.</div>
<p class="p3">Resident Dorothy, who has emerged as the natural leader of the project, starts to gather the empty ingredient bowls: “Should I throw these away?” Now is the time to offer a little guidance. “There’s the trash bin,” says a caregiver as she points toward a waste can. This caregiver is getting the hang of this new method.</p>
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Following Dorothy’s actions, others begin to gather the miscellaneous items on the table. The knives, yes knives, are coated with cream cheese, peanut butter, and jams.</div>
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<p class="p3">“Ugh, washing those utensils is going to be a pain.” “Wipe them off with a napkin first,” says resident Nel as she demonstrates, “then you don’t have to dirty all of the dishwater.” Common sense from her long-term memory.</p>
<h2 class="ms-rteElement-H2">A Carry-Over Effect</h2>
<p class="p2">The importance of purposeful activities has been terribly underrated in organized care settings. A difference exists between activities and engagement: During the former, actions are being done toward or at residents, while with the latter, residents are contributing with an objective. When residents are given the opportunity to use skills still intact, their met psychosocial needs have a carry-over effect. Difficult “behaviors” are reduced, staff members experience greater satisfaction, and the overall environment is elevated. The outcomes can be astounding.</p>
<p class="p3">Measurable results show up in a reduction of reportable incidences and decrease in 911 calls due to “harm to self or others.” Most importantly, many residents who are consumed with wanting to go home become comfortable in their new communities. </p>
<p class="p3">The shift comes from education that emphasizes a new form of interaction between caregiver and care receiver. The biggest component is resident choice, free will, and accountability.</p>
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<h2 class="ms-rteElement-H2">Rementia Defined</h2>
<p class="ms-rteElement-P">The word dementia, broken into syllables, literally means “out of the mind.” Not many people take that description as a compliment. Rementia, on the other hand, is to be “returned to the mind.” The only condition in which someone’s living essence is factually away from the mind is postmortem. </p>
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The goal of rementia is not to cure Alzheimer’s disease or restore a person to his or her level of function prior to the onset. Rementia care restores personhood and recreates a person’s experience of life. </div>
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For someone who is lost, confused, and searching for what has been lost, rementia care reinforces a person as whole and complete as they are today, where they are today. For rementia to evolve, residents must have a sense of purpose where they live. Caregivers who incorporate methods from Kitwood’s book, such as recognition; negotiation; collaboration; play; stimulation; celebration; relaxation; holding; and, most important of all, validation, will find their responsibilities become less strenuous and more satisfying.</div>
<h2 class="ms-rteElement-H2">Revisiting Validation</h2>
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The concept of validation was brought to the forefront in Naomi Feil’s groundbreaking book, “The Validation Breakthrough.” Validation is a huge component of rementia care training that requires an acute shift in caregiver communication. </div>
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<p class="p3">In class, validation statements are practiced through role playing. “I want to go home,” requires an acknowledgement of the feeling, not the response, “You are home,” or “You can’t go home,” or “You live here now.”</p>
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An example of the validation technique is, “You must miss your home. Tell me about that house. Where is it?” Now caregivers are exploring personhood, the history aspect of one’s life, and having a meaningful conversation rather than doing battle. Often, just reminiscing about that home brings a sense of comfort.</div>
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<p class="p3">Talk about feelings, and don’t argue the facts. For seasoned readers of this article, this is not a new idea. But even the most experienced and educated can fall into the trap of attempting to distract before connecting to the emotion behind the outward expression.</p>
<h2 class="ms-rteElement-H2">Beware of Malcaregiving</h2>
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Kitwood also describes malcaregiving, equally important to expose and reprogram. Caregivers do not intentionally provide bad care. Poor habits such as interruption, objectification, disempowerment, infantilization, outpacing, ignoring, imposition, and invalidation come about from the overburdening, overwhelming expectations placed on direct caregivers. Actions such as outpacing stem from the need to be efficient.</div>
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<p class="p3">Unfortunately, the lack of attention to the emotional well-being of residents, that is, ignoring, leads to increased resistance with activities of daily living care, weight loss, outbursts, and searching episodes, also known as wandering or attempting to elope.</p>
<p class="p3">Meaningful engagement, which requires residents to participate in the process, is the cornerstone of rementia care. Experimentation, exploration, flexibility, creativity, and a willingness to branch out into unexplored territory will create new pathways in resident lives. </p>
<p class="p3">The paradigm shift necessary to achieve stellar results simply stated is: Dementia says, “HE CANNOT!” Rementia says, “HE CAN!”</p>
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<p class="p1"><em>Kassandra A. King, BA, NHA, RCFE, is owner of Alzheimer’s Connection, http://alzconnectlamesa.com/, a care consulting/placement company in San Diego, Calif., that also offers Alzheimer’s disease education for professional staff, family members, and the general public. She is the author of “Getting REAL About Alzheimer’s: Rementia through Engagement, Assistance, and Love,” Plain View Press, Austin, Texas, September 2014. King can be contacted at (619) 777-0724 or <a href="mailto:kakingalzconnect@gmail.com">kakingalzconnect@gmail.com</a>.</em></p> | The word dementia, broken into syllables, literally means “out of the mind.” Not many people take that description as a compliment. Rementia, on the other hand, is to be “returned to the mind.” The only condition in which someone’s living essence is factually away from the mind is postmortem.
| 2015-05-01T04:00:00Z | <img alt="" src="/Issues/2015/May/PublishingImages/rementia-_t.jpg" style="BORDER:0px solid;" /> | Management;Caregiving | Column |