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Maximizing Cognitive Abilities Through Occupational Therapy at Emerald Crest

March 29, 2018

Playing-cards-DSC_2554_2.jpgWhen you walk into any of the homes of the four Emerald Crest by Augustana Care locations, it’s not obvious that they have an Occupational Therapy (OT) unit. Occupational Therapy is integrated into everything they do. By integrating the Occupational Therapy philosophy into our program, we can better identify our resident’s needs and develop the best strategy and technique for their success. These strategies are shared with family members and caregivers allowing them to partner with the resident to maximize their abilities, promoting an ongoing sense of purpose and pride.

Emerald Crest by Augustana Care’s Occupational Therapy is focused on dementia care. Emerald Crest is a home-like care setting for people living with dementia. Dementia is condition that causes changes in a person’s brain that affects their thinking skills, or cognition. At Emerald Crest the occupational therapists start by assessing each new resident’s cognition based on the Allen Cognitive scale. Developed by Claudia Allen, this 6-point scale details what stage of dementia a person is functioning at. Level 6 describes someone that does NOT have any cognitive challenges, someone like you or I that lives independently. When someone is at Level 5 they begin to show early signs of cognitive change such as disorganization, trouble with finances and trouble with driving. An individual at Level 5 on the cognitive scale may get lost, be involved in minor accidents and traffic violations, but would still be able to meet their personal care needs and live at home with minimal assistance. When people progress to Level 4, they begin to struggle with meeting their personal needs consistently. Showering, changing clothing, eating regular meals and taking medications appropriately become difficult for their brain to orchestrate. Emerald Crest by Augustana Care specializes in the middle, late and end stage (Levels 4 and below) when a person can’t manage living at home and needs help with bathing, grooming, administering medication, etc. The Emerald Crest homes are staged as early/middle, middle and late stage. Each house has daily activities and programs geared towards their level to engage & keep each day purposeful for the residents.

Once assessed, the occupational therapists begin to identify not only a person’s disabilities, but they also work to identify their abilities. Instead of therapy sessions that are scheduled periodically, often in a different therapy room, the OTs develop approaches that help fill the gaps in each resident’s daily activities. They coach their care team on approaches and communication so that each person can function at their highest level of independence. For instance, a person at Level 4 might need assistance simply picking out their clothes. At Level 3, caregivers are coached that they will need to stay with the resident and hand them clothes one item at a time and give them step by step directions with demonstrations throughout. When a resident is Level 3/Level 2, they struggle to understand how to use objects. For instance, if you are helping a person at this level brush their teeth, after handing them the toothbrush they may not know what to do with it and may put it down or use it as a hairbrush instead. But if you hand it to them and use your hand to guide the toothbrush to their mouth and get them started, it will make sense.  

When a resident exhibits behavior issues an occupational therapist is consulted on what need is not being met and strategies that can help. 98% of behaviors are caused by the person with dementia’s lack of understanding of the world around them and fear. When working with an individual with dementia who has behavior issues we must remember that the behaviors are not done on purpose or intended to hurt anyone. Instead, the person with dementia is trying to communicate a need and trying to tell us something. The OTs play an important role in providing guidance with behaviors based on that individual’s cognitive level. For instance, a caregiver might say, “I have a resident who is having bathing difficulties and that’s changed. What should we do?” An OT might first assist that resident with their shower, develop a care approach based on their cognitive level and demonstrate their techniques to the caregiver. If a person with dementia is picking at their food or losing weight, a regular plate of food might be too overwhelming. Servings can be broken down using a divided plate, a smaller plate, or even separate courses. In one instance, “Rose” was trying to leave her Emerald Crest home every day at 3:00 pm. We learned at one point in her life she picked up the kids from the bus stop at 3:00pm. Understanding the meaning behind “Rose’s” behavior helped the caregivers know what to say to comfort her and what to do to redirect her. 

Activities are a huge part of the Occupational Therapy program at Emerald Crest by Augustana Care. When engaged at their cognitive level, residents exhibit less behaviors and even sleep better. Some activities such as puzzles and adult coloring books are offered at other Augustana Care communities but might need to be simplified for those with dementia. At late stage homes, OTs plan “friends visits”. This is when baby dolls, animated cats & stuffed animals are brought in to remind residents of a time when their live counterparts gave them purpose. One woman who, in her life had 8 children, lit up when she was handed a doll. She immediately began rocking & caring for the “baby”. These are moments when you realize that even though they’re not going to get better, the goal is to help them attain the highest ability for as long as possible and simple is always better. These are words echoed by Jenny LaVoi who has been an OT for 15 years. As the Director of Cognitive Care Program at Emerald Crest by Augustana Care, LaVoi says, “I love what I do because it can take little effort or time to change their day or improve overall quality of life.”

Families play a big part in each resident’s occupational therapy. Some need guidance on what to talk about with their loved one or what types of activities do to. Yet others need communication techniques or guidance on managing a visit outside the Emerald Crest home. In addition, OTs coach physical therapists, doctors and other health care staff. If you’re in the Minneapolis area, they periodically provide community presentations.

Hopefully you have a clearer picture of what occupational therapy means in this unique memory care, residential care home setting. It surrounds their day and is based on their cognitive ability. We guide residents throughout the day through their cares and activities which is their treatment. This is why OT it’s included in their monthly fees and not billed separately. The goal is to help each resident thrive by maintaining their abilities & function for as long as possible.