Saturday, March 24, 2012

New designs for dementia residences

Such a lovely couple.
She is so agitated, 

Architecture book lays blueprint for dementia care

This is a brilliant idea, but to my mind, misplaced.

How serious is it that those with dementia get lost? Not so serious. Most live in smaller homes or apartments, or in retirement homes, all of which are not going to do renos. Many get lost walking in a straight line outside their residence, and we send out the troops looking for them.

What is far more serious is those who cannot manage the function of things, like a stove, phone, knife or fork, or stove top cooking. Many of my clients have been forbidden from cooking.

One couple, he with COPD and she with dementia, had to move from their one-bedroom apartment. She would set fire to things when cooking. He couldn't cook (a generational thing), and didn't seem to be able to monitor her enough to prevent a fire. She didn't get lost there, she couldn't cope with the anxiety and the 4 A's of dementiaAnger, Agitation, Anxiety, Apathy.
She was irritated and irritable, she didn't get lost. 

Many clients get lost driving, rather than in their own homes. Brain research tells us that driving is a skill that gets put into the old brain, automatic centre. How many times have you driven home and forgotten the drive itself? That is because unlike new, young drivers, these skills are put into the part of the brain where you react to the familiar.

Dementia patients are likely to get into their cars, and drive to a meeting they had scheduled 20 years ago. Then, they get lost, once there, and cannot find their way home. They remember how to drive, but do not know how to process the mental map and location strategies. Driving is done in the autonomic part of the reptilian brain, where we put those familiar activities.

Like birthing centres, where room design makes a mother feel more comfortable, putting in noise-limiting wood and good design standards into a long-term care residence (LTC) is laudable, but is it going to happen?

More handrails; more central nursing stations (some days you can swing a dead cat and not hit a nurse or PSW who are run off their feet); taller windows, more light; all this is wonderful, but not where the for-profits are going to put their money. They are more concerned about tax dividends.

Healthcare is so short money. Most LTC are for-profits, about 500 of the 600 or so in Ontario.

Far more important is spending money on excellent supervision. Well-trained PSWs who can monitor residents and ensure that they are safe.
 We need better trained, regulated PSWs who are more than simple caregivers, but trained in helping clients get exercise, manage their lives, understand biopsychosocial issues our dementia patients deal with every day.
What it boils down to is ensuring that all of us pay our fair taxes (the Trouble With Billionaires), and we are able to hire quality caregivers to help us deal with the dementia, and the costs of managing those in ill-health.

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