DD-4. New Innovations: Enhancing the Lives of Individuals with Developmental Disabilities Tuesday, October 9, 2007. 8:00am – 10:00 am Presented By: Marisa.

DD-4. New Innovations: Enhancing the Lives of

Individuals with Developmental Disabilities

Tuesday, October 9, 2007. 8:00am – 10:00 am Presented By: Marisa Geitner, Executive Vice President, Chief Operating Officer Ruth Benjamin RNC, CDDN, CLNC Director of Health Management and Research Heritage Christian Services, East Rochester NY

Heritage Christian Services

• Support over 1,400 children and adults with developmental disabilities in Western New York

• Provide residential and day habilitation, respite, clinical supports and service coordination

Innovations in Care

• Residential homes for seniors with disabilities

• Residential “right sizing”

• Telehealth

• Day services for seniors and medically frail

• Hospice care

Residential Settings for Individuals With Aging and Dementia

Design Elements

• Consulted experts in dementia and visual impairments

• Designed the home with a circular design for people who wander and supervision levels

• Natural lighting• Single bedrooms

Sensory Garden

• Facilitates independence in a safe environment

• Quiet and reflective atmosphere

• Sensory input from variety of colored flowers, flowing water, and scents from flowers and herbs

Safety Features

• Therapy tub and walk-in shower• Doors with subtle alarms• Windows with stops installed- only open 6 inches

Modifications that can benefit the Aging Person

• Color contrasts are important for visually impaired

• Grab bars can be added to the walls in the bedroom

• Elevated toilet seats, sometimes even a change in the color of the toilet seat is helpful

Team Approach

• The focus changes from Res Hab to meet needs and challenges that occur with aging individuals with DD

• Focus is on maintaining skills and cognitive ability

• Fulfill goals and dreams as much as possible

Residential Rightsizing

• New funding from NYS OMRDD

• Enables individuals to have their own bedroom-smaller settings

• Enhanced therapeutic services

• Additional funding for staff education

• Research component

Results

• We want to demonstrate:– Smaller environments increase quality of life– Smaller environments & improved education improve

staff retention– Blending therapies produces better individual

outcomes – Increased physical activity improves overall health

Enhanced Therapeutic Services

• Physical Therapy

• Massage Therapy

• Dance Therapy

Blending of Traditional and Expressive Therapies

• Minimizing physical deterioration that occurs with aging

• Bringing the therapy to people in the most conducive environment

• Keeping treatment diverse and interactive

Enhanced Medical Education

A 40 hour curriculum

Medical Education

• Improving the care to those with significant and complex medical needs

• Improving retention by supporting staff to be as comfortable as possible serving the elderly and those with medical challenges

• Understanding the complexity of aging with this population helps us to be more proactive in their care

DSP Credentialing

Using the College of Direct Support

Continuing Education

Staff Training on aging and DD = Staff Commitment

Participation in day conferences = Clinical Knowledge and Networking

• Networking

Health Support Professionals

A Heritage Christian designed position

Health Support Professionals

• A skilled, tenured staff that receives specialized training from our nursing staff

• Provides high quality, relaxed, care and charisma to individuals in acute medical needs

• Where and when they work is determined by the residential and nursing leadership

Tele-HealthTelemedicine and Telemonitoring

Challenges in Healthcare requiring us to consider telehealth

technology:

• An aging population increases the prevalence of chronic diseases

• Increased longevity of medically frail persons• Severe, current and projected, shortages of health

care professionals especially RN’s• Rising cost of health care• Health care disparity for underserved populations

Objectives of Tele-Health

• Telemonitoring:– Increased monitoring results in improved

care– Provide accurate, timely data to physician

• Telemedicine:– Enhances medical care, provided more

timely– Proactive– Reduce unnecessary ER visits

A More Flexible and Blended Day Habilitation Program

• Purpose:to provide Day Hab programming while meeting the medical and psychosocial needs of the aging and/or medically frail individual

Reasons for Flexible Day Habilitation

• The aging person with DD frequently has a primary diagnosis and secondary medical concerns that exaggerate the aging process and these needs cannot always be met in the traditional Day Hab setting

• As with the general population, endurance and interests change with age and these are not always addressed in traditional Day Hab settings

Benefits of Flexible and Blended Day Habilitation Program

• Offers the ability to change the day hab activities within the residential setting as the medical concerns of the person change and/or a decline in the persons functional level is observed.

– Addresses:• Increased fatigue• Pain management• Completion of necessary medical treatments

WHY Medically Frail Individuals Do Not Attend Traditional Day Hab

• Respiratory conditions

• Compromised immune systems

• Increased exposure to illnesses

• Intolerance to cold or hot humid weather

Why Individuals with Down Syndrome & Dementia Benefit from More Flexible Day

Hab

• Calmer and familiar environment with less stimuli

• Rest periods that address sleep cycle disturbances

• Less attention on detailed tasks

• Slower pace

More Benefits…

• Allows for staffing within the home while focus is still community oriented

• Allows for preferred activities that are meaningful and enjoyable

Hospice Care in the Residential Setting

Purpose of Providing Hospice Care in the Residential Setting

• Provides care that extends to the whole person:• Physically• Socially• Emotionally• Psychologically• Spiritually

• Allows the individual to maintain control and dignity

• Individual is surrounded by familiar, loving, and caring people known as family

Purpose of Providing Hospice Care in the Residential Setting

• Planning and decision-making directly involves the individual, and all those connected to him or her

• Provides for the needs of individual’s family, friends and caregivers

• Everyone involved receives support, as well as gives support

Team Approach

• The Individual • Family and extended family of Heritage Christian• Friends• Residential Nurse• Other Agency Clinicians• Staff• Primary Physician• Hospice nurse from an outside agency• Chaplains, and spiritual care providers from

within the agency

Priorities in End of Life Care

• Alleviate physical pain, and provide optimal comfort with non medication based modalities (music, massage, distraction)

• Address & alleviate when possible emotional and spiritual distress

• Compose individualized plan of care that eliminates all unnecessary medical intervention

• A plan of care focusing on effective pain management, nutritional needs, bowel management, fatigue, skin integrity, sleep disturbances, changes in mental status, and ability to communicate

• A plan of care to address the psychosocial needs and desires of the individual. This plan must include individual involvement and be based on individual’s culture, beliefs, interests, and wishes

• Change plan as frequently as necessary when any aspect of plan is no longer effective

Points to Consider for Hospice Plan

• Discontinue unnecessary medications except pain meds, bowel meds, anxiety meds

• Eliminate routine VS, I & O, weights andResidential Habilitation plans

• Educate and support the family, caregivers, QA, and administration as to the plan of care

• Ongoing education of family & caregivers to the changes in the physical & cognitive processes as death nears

Your Focus is the Individual• Cultural influences- beliefs, values, respect the individual’s needs to

die on his/her own terms

• Family members’ beliefs also need to be considered

• Assist the individual to understand what is happening when possible

• Environment- respect privacy, yet convey compassion, support and presence

• Meet spiritual needs

• Alleviate fear and guilt

Your Focus is the Individual Con’t…

• The environment is all about who that person is!

• Visits from family and friends are important

• Granting last wishes- don’t be afraid, these times are often the most meaningful and cherished not only to the person, but hold loving memories for families, friends & caregivers

Your Focus is the Individual Con’t

• Having familiar staff provide 1:1• Favorite foods• Favorite music• Let the person decide when to complete ADLs• Scrapbook• Individual decides which med he wants • Medicate continuously – do not wait for pain or

restlessness to be present – keep sustained level of meds in blood

Proper use of Hospice

• Utilize support systems around you- community hospice nurses, clergy etc.

• Work as a team

• Teach those around you

• Facilitate grieving

• Reach for support from others and realize importance of self care

Pieters Family Life Center

Resources

• Alzheimer’s Association

• Association for the Blind and Visually Impaired

• Diagnostic and Treatment Centers

• Networking-build your own set of experts

• ANCOR and state trade associations

Questions?

Contact infoRuth Benjamin, RNC, CDDN, CLNCDirector of Health Management and

ResearchHeritage Christian Services349 Commercial St. Ste. 2795East Rochester, NY 14445(585) [email protected]

Marisa Geitner, M.S., CCC-SLP Executive Vice President and Chief

Operating OfficerHeritage Christian Services349 Commercial St. Ste. 2795East Rochester, NY 14445(585) [email protected]