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Memory Care Nursing: What's New

Memory care is a euphemism, right, a sugar-coated term for facilities that care for people who suffer from dementia? In many cases, no. There are some very exciting advances in dementia care, and many nursing homes and assisted living facilities are putting them into action. The best facilities are providing supportive environments and also activities that actually enhance cognitive function.

Reaching People with Music

Research has demonstrated that music aids cognition and memory, and that people respond to it even after many cognitive functions have been lost. It can also be very soothing – this is in itself, a plus as it’s agitation, not just memory loss itself, that makes dementia so challenging. Elder Options of Texas notes that music from a person's young adult years often has the most capacity to engage elders (https://www.elderoptionsoftexas.com/article-music-therapy-and-dementia.htm).

Music and Memory is built around personalized music: iPods, downloads, and also excellent training. The organization offers a certification program for elder care facilities. Many have it (https://musicandmemory.org/about/certified-music-and-memory-nursing-homes/). This program has gained quite a reputation and is supported in state policy in nearly half the nation. One of the things that's driving this: the pressing need to reduce antipsychotic medication in nursing homes. Medication has often been utilized when agitated behavior makes it difficult to house and care for people. Antipsychotic medication doesn't help memory or cognitive function and may well reduce it – quite a contrast with music! The Music and Memory organization reports that 24 states have Music and Memory initiatives (https://musicandmemory.org/wp-content/uploads/2018/03/MM_ImpactReport_3.26.18.pdf). States are using federal funding.

Touch Screens and Apps Changing Lives

Technology is changing lives. People are often amazed at what their little ones can do with a touchscreen technology. It's the same with elders who have significant cognitive decline. Here, though, the action may not take place on a small device that can be tucked away into a caregiver’s handbag. There may instead be a large computer screen mounted on the wall; this encourages social contact as well as motor skills.

It's Never 2 Late (iN2L) makes a suite of programs specifically for people with dementia. Some are designed to be mentally stimulating: There are games, puzzles, art. In a video, one can see an elderly woman, immersed and ‘grooving’ as she colors with her finger on a giant screen (https://in2l.com/benefits/memory-care/). Some apps connect people to things from the distant past that they still remember. They can take a virtual trip back to the place they grew up: zooming in on a neighborhood and sliding their finger to travel through it (https://vimeo.com/111224068). Their own mementos can be swipes away, too.

The Music and Memory organization has also expanded their focus beyond just music to other ways that digital technologies can connect. One of the successes: An elder who remembers pow-wows may now have the opportunity to attend a virtual one.

Organizing Living Environments for Success

Facilities are restructuring living environments to enhance functioning. Even eating can be a source of frustration as skills decline, but it doesn’t necessarily have to be. People with dementia may have success feeding themselves -- and avoid embarrassing situations – if there’s careful planning. The Thrive Dining program has gone beyond merely serving traditional finger foods. They utilize chef expertise to create nutritious and tasty foods and remake them as hors d’oeuvres that can be eaten in a bite or two.

Some programs utilize Montessori principles: creating an environment that cues the person for success, providing activities that stimulate and engage the senses, and breaking them down step by step. Programs can be organized in different ways. A DC project carried out in adult day services utilized kits in clear plastic shoeboxes that were designed to suit the backgrounds and interests of particular participants as well as support skills across domains. Participants arranged flowers, rolled dice, massaged their hands with hand lotion, swept, folded yarn, and worked with tongs (https://www.alz.org/national/documents/aoagrant_tools_montessori.pdf ). A person can experience some pleasure using a slotted spoon to dig through rice looking for treasure; he or she simultaneously re-acquire motor skills needed to eat independently (https://www.alzheimers.net/2014-05-27/montessori-method-dementia/).

Multiple senior living organizations now offer Montessori-based dementia programming. The Center for Applied Research in Dementia is a resource for Montessori tools (https://www.alz.org/national/documents/aoagrant_tools_montessori.pdf). One can find print materials for reading, matching, and sparking discussion.

Individualized planning, too, is a tool. An LPN who is serving as Director of Nursing at an Assisted Living with Memory Care reported that at her facility, the art projects that are used with one participant may be completely different than those used with another (https://www.newschannel5.com/plus/openline/openline-creekside-assisted-living-august). This is because different elders have different goals.

People with Alzheimer’s will eventually lose the most basic functions, if they don’t die of some other cause in the interim years. But there can be a surprising amount of life – and joy – remaining. The emotional climate also creates a sense of engagement, and this, too, can maximize skill. Action Pact, an organization devoted to person-centered care, has described how putting elders into a more homelike environment and offering choice can create transformation.

Becoming a Memory Care Nurse and a Memory Care Advocate

Not all facilities are at the same stage of success. In some parts of the country, there is little regulation of the term memory care, and yes, some memory care facilities may be doing little more than providing a an environment where residents are unlikely to wander off. Passionate nurses may want to shop around for their ideal workplace. But those with the experience and leadership drive may instead work to facilitate change from within. The 2017 Music and Memory report notes that their program works best when there's interdisciplinary effort with a team committed to truly infusing the program into resident life. It stands to reason that this is also the case with other powerful programs!

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