Ma St OaksContinui Complex

At JO X Village

March 17 2006

Barbara Dombrowski

AHCA Program Manager272 Mahan Drive

Mail Stop 51Tallahassee FL 32308

Re Funding Agreement AFA 12

Dear Ms Dombrowski

Thank you for your prompt response to our recent request for extension ofour Validation

Therapy as a Lifestyle Project Your consideration of such a request was appreciatedand we understand that it is not possible at this time This has been an amazing project to

be a part ofand we truly hate to see it end Of course we know that simply ending our

partnership with AHCA does not mean that the growth of this program must end also

We have created our validation rooms and programs with the sole intention of makinga better life for our residents I hate to admit that the requisition ofreimbursement has

been the last thing on our minds Thank you for a last opportunity to submit our

documents to your office We are unique in our situation in that so much of our labor

was donated by our village residents and wasdone as their time and our staff s time

permitted This resulted in our being well below the initial requested funding but

ultimately delayed our implementation Our muralist endured abroken arm during this

past year and most recently a death in the family that delayed our conclusion Of the

many unusual obstacles we have faced in implementation ofthis project the most recent

came as a result of my promotion in October of last year I now serve as the Director of

Health Care Services at John Knox Village which allowed us the privilege of recruitingMary Lee Jackson as our new Administrator ofthe Skilled Nursing Facility Her first

few weeks with us were awhirlwind of information and adding our AHCA grant to the

mix would be achallenge to anyone who is new She s a real trooper

Again thank you for this wonderful opportunity to work with your organization I look

forward to your feedback with regards to the report on our program

Sincerely

1

Cathy H and NHA

Director of Health Care Services

t t rA V aj11tYII a

MAR 2 2006

BiiREAil OFf Tie1II 1 11 rrv

901 Veterans Memorial Parkway Orange City FL 32763 386 775 2008 Fax 386 775 0490

Validation Therapy as a Lifestyle

Final Report

The Validation Therapy as a Lifestyle project at John Knox Village has beena tremendous success The targeted residents on our Memory Care Unit havebenefited from the project as well as other residents in the unit Several new

residents admitted since the project began use the enhanced common areas

daily and seem to benefit from the stimulation to maintain their current

cognitive functioning or to validate their perceptions ofpast roles thatdefined their lives

The Memory Care Unit now provides a living environment that reinforces

positive memories of our resident s past The common areas are utilized byour residents to act out or recall previous roles or occupations that were

important and fulfilling to them

Overview

The Nursery is highlighted by a Winnie the Pooh mural and numerous babycribs highchairs and clothes Rocking chairs are provided and usuallyoccupied by residents rocking the life like dolls singing to them or chattingwith other residents while holding the dolls One interesting frequent user ofthe Nursery is a gentleman who according to his family was a wonderfuldad and granddad he comes to the area several times daily to sit and holdthe dolls and always has a smile on his face and rocks them to sleep

The Beauty Salon is often a bustling area where the ladies gather and enjoytrying on jewelry getting hand massages or having make up applied by staff

The School House is used often by residents who will write on the chalkboard sit in the desk or point out areas on the maps Staffuse the area forcurrent events map study and reminiscence therapy

The General s office is a favorite of our male residents The office features a

mural that gives the effect of looking out of a window onto a military base

A platoon marching a medical helicopter landing at the base hospital and a

jeep can be seen out of the window Memorabilia from all branches of the

military are on display throughout the office Many of the items on display

were provided by families of our residents which only enhance their

enjoyment of the area

The Music Room is equipped with a piano stereo system and a wide varietyof music from big band to easy listening A mural depicts a stage with a

blues theme musical notes and sheet music complete the atmosphere Thisarea is a favorite of residents in the afternoon as it is usually sunny and

inviting Soft music and impromptu sing alongs often fill the air This area

has a calming effect for several residents and they will spend time therealone

The Garage has been a favorite of the men and one resident in particular will

spend time there turning the gadgets on the work board or rearranging thetool box A mural compliments the area by depicting old signage a

mechanic and other car related items

The Sports Lounge will include team pennants shadow boxes of sportsequipment pictures and interactive games Many residents use this area

frequently and the activity staff use the area for bowling tournaments balltoss and other active events

Measurement of Goals

Our five targeted residents who exhibited problematic behavior have been

assessed throughout this project The assessments consisted of a Brief

Cognitive Rating Scale and a Psychological Evaluation detailing thebehaviors of the residents and how the behavior adversely affects their

quality of life Care Plans have been developed and updated as needed as

their behaviors improve or deteriorate

Education

The staff that works the Memory Care Unit has been trained in theValidation Therapy approaches to dementia the use ofNaomi Feil s

approach to dementia care and other ongoing training in related dementias

and Alzheimer s The ongoing training serves to boost staffs confidence and

generate creative thinking

Financial Impact

Due to the fact that our mural painter was out of the state for an extended

period oftime due to the death of his father we were unable to complete allof the areas outlined in the original funding agreement nor did we spend theentire amount of the agreement Our total amount spent was 5 906 71

Copies of receipts are attached

Five Chosen Residents for Validation Theraov

This paper will give a brief update on how the five residents in our

validation sample set have utilized the validation and activity programsprovided as of February 2006 Update will include information as the

whether programming has been effective

Resident 1 Resident one has had a decline in her physical and cognitivefunctions She had a recent fall and is now utilizing a wheelchair for hercontinued desire to wander She presents with very poor safety awareness

and remains impulsive Her tendency to become argumentative duringactivities has declined significantly due to her cognitive decline Residentone has made a turn around as far as the activities she benefits from In the

past arts and crafts were her weak spot and now she enjoys that opposed to

the validation rooms During the validation room activities her attention spanis that of very short Activities dealing with questions quizzing and verbal

input is where she has declined which coincides with her decreased

cognitive skills This resident is showing more signs and symptoms of a

depressed mood from the possibility that she understands her decline

subconsciously

Resident 2 Resident has responded well to the validation rooms She getsmost stimulation from the nursery and can be observed engaging with the

baby dolls She gives the dolls extensive care like changing their clothes

talking to them rocking them to sleep and putting them to bed She is

receptive to spending time out ofher room in this environment and will also

participate during validation programming in the schoolroom Still she ismore of a passive observer during any other group activity Resident has an

improved affect and will smile at others and briefly engage in one on one

conversation with staffwhen initiated Larger groups cause her to be over

stimulated and anxious Staff is aware of this and will choose appropriateactivities

Resident 3 Resident continues to follow previous pattern of resisting care

She very rarely seeks to be outside the unit and Ive witnessed her and her

spouse refer to their room as their home Resident is content in current

environment throughout the day as along as her spouse is at her side Shewill attend group activities mostly in the morning as long as he is with her

Occasionally she can be encouraged to attend validation programming in

the beauty shop Staff is trying to increase her participation in this area

because it will not only increase her social stimulation but also aid us in

improving on her hygiene issues Resident at this point is more receptive to

time in the nurturing room and schoolroom with spouse This is not

surprising as she has a strong attachment to her previous role as a mother

Resident 4 Resident has shown a decline in his attempts to fiddle with andfix items around the building Staff finds he is more receptive to one on one

activity programming Resident shows no interest in group activities

Activity staff takes residet to the garage area where he does seem to enjoygiving tips on what tools to use during a project This validation area tapsinto resident s previous interests He does seem to enjoy giving tips on whattools to use during a project This is embraced Attendance in activities forthis resident is minimal He spends time wandering throughout the MemoryCare Unit and sitting alone in either the schoolroom or in the outside

courtyards Efforts are being made to increase his participation andtolerance of activities and utilization of validation rooms

Resident 5 Resident did have a decline in physical functioning for a shorttime She demonstrated episodes of crying spells and increased isolationDue to her cognitive abilities a psychologist has also been added to her planof care along with the validation therapy She had worked with therapy andis now back to her usual self She continues to demonstrate a need to be

busy She attends group activities in addition to validation programmingActivity staff has been trying to utilize the beauty shop with her to increasebetter self image and self confidence This is a slow process and staff has

just started with this She has been less irritable and anxious but willcontinue to seek out something to do when not occupied

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