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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

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Positive Approach, LLC

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

Person-Centered

Care Planning:

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Traditional Dementia Care:

- Run by caregivers

- Based on what we can and ‘need to’ do to the person

- Work shared among 3 shifts of staff or all on one

- Safety and health care issues are top priority

- Medical model

- Organized by departments that are task specific

- You are sick and you need care for your diagnosis

- Paternalistic: father knows best

- Often driven by the givers of care

- Driven also by grief and loss and an effort to ‘help’

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

What’s Wrong with this Model?

- Who wants to live in a hospital?

- Who wants to do everything you are

‘supposed to’?

- Who wants to have someone else telling

what to do and when to do it?

- Who wants to have to talk to three different

people to get something done?

- Who wants to live in a nursing home?

- Who wants someone else running your life?

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What Does Getting Older Do To

This Whole System of Care?

- Increased risk of cognitive changes

- Increased risk of ‘losses’ that affect

emotions and life-time patterns

- Increased risk of physical changes

- Increased sense of needing to be ‘me,’ to

matter, to be respected, to count

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How Does Dementia Fit?

- Increasing numbers

- Increasing severity at admission

- Increasing ‘wait’ pre-admit

- Increasing desire for families to get more for

less

- Family desire to have person be the way they

‘used to’ or ‘should’

- Staying at ‘home’ until further along in the

journey

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So…There’s Something New

Going On:- Focused on people

- Focused on relationships

- Trying to put the person first

- Trying to honor the person’s preferences

- Trying to work as a community

- Trying to share decisions

- Trying to respect people: residents and staff

- Trying to create homes

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What is Person-Centered Care?

Combination of:

Person’s wants

Person’s needs

Still can do

Can’t do

Can do with support

Individual good

Common good

Family needs

Family wants

Balanced with:

Care partner skills

Care partner availability

Private space

Public space

People resources

Equipment resources

Safety and Security

Rules and regulations

Others needs and wants

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What Matters?

Personal history: status

Health history: status

Cognitive status: abilities

All staff: approach and assist

Environment

Schedule and flow of the day

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Personal Preferences and

Values:

- Who have you been?

- What did you value?

- Who are you now?

- What do you value now?

- Why does it matter?

- Who gets a ‘say’?

- Who gets to set the priorities?

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Know Each Person

Health Status

medical conditions,

medications,

limitations & abilities

Life History

Who the person has

been…

Personal history and

background

Cognitive Status

thinking, memory,

processing skills and

limitations

Emotional status

psychological

condition and mental

health & limitations

Routines and Habits

patterns of behavior,

daily routines, time use

& schedules

Sensory Status

sight, hearing, touch,

balance, coordination,

temperature regulation

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Life Story:Family: past, present

Living place(s)

Work history

Leisure History

Music history

People history

Plant history

Animal history

Plant history

Sensory environment preferences

Cultural history and concerns

Food likes and dislikes

Daily routines

Organizations and memberships

Roles and responsibilities

Comforts and irritants

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Personality Traits:

Who Are You?

- Introvert or Extrovert?

- Lots of Details or Big Picture Only?

- Logical or Emotional?

- Planning Ahead or Being in the Moment?

Who is the person you are trying to help?

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Introvert – Extrovert:

Introvert

Likes to be alone

Likes to think it out

Likes personal space

Needs alone time

Private

Extrovert

Think out loud

Talk it out

Seek out people

Share a lot

Not good with

boundaries

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Details - Big Picture:

Details:

Lots of facts and

figures

Wants the specifics of

what to do

Likes to get going and

doing

Big Picture

Likes to know ‘why’

Likes to think about it

before doing anything

Likes to hear the big

plan

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Logical – Emotional:

Logical:

Head First

Fair

Reasonable

Rational

Emotional:

Heart First

Nice

Kind

Empathetic

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Planning Ahead - In the

Moment:Planning Ahead:

Aware of the future

Sets priorities - plans

Likes routines

Likes a schedule

Likes to do things as planned

Needs to be in control

In the Moment

Being flexible

Go with the flow

No forward thinking

Running late

Putting other things off

Go with the flow

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What About Medical Conditions?

What is essential?

Good care is delivered

The person is receiving the

care they need and want

Conditions are assessed

Decisions are made based

on good info

There is agreement on what

to do and what not to do

Thinking/planning ahead

What is optional?

When it is done

Where it is done

Who does it

How often it is done

How strictly it is followed

It depends on the person

and their situation

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

The GEMS® Progression of

Dementia:

Sapphires – True Blue – Slower but Fine

Diamonds – Repeats and Routines, Cutting

Emeralds – Going – Time Travel – Where?

Ambers – In the Moment - Sensations

Rubies – Stop and Go – Big Movements

Pearls – Hidden in a Shell - Immobile

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Care Partners:

- Be a partner, not a boss

- Be an advocate, build a team

- Do with me, not for me or to me

- Learn the ‘So What?’ philosophy

- Learn to let go not give up

- Learn what you are good at, and what not

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Build Care Partner Skills

Environmental

Management skills

Using space &

keeping up the

place

Problem-solving

skillsFiguring out what to

do when it does not

work right

1:1 Interaction

Skills

Do you work

with your

partner(s)…

Group Leading

Skills

Getting people

together &

having fun

Customer

Relations Skills

With families,

clients,

volunteers

Documentation

Skills

Record

keeping and

reporting

Practical

Hands-on

Skills

Crafts, games,

cooking,

working…

Planning & Time

Management

Skills

What to do &

when to do it!

Peer

Relationship

Skills

Helping each

other

Observation

skills

What you see,

hear, sense…

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Learn How To:- Do something new

- Learn a new type of exercise or activity

- Simplify a dance

- Re-look at a old skill and make it easier

- Share a tasks

- Do something without touching things

- Get someone to do something without words

- Give positive feedback and say “thanks”

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Take a Look, Listen, Feel:- Lighting: enough, non-glare, focused

- Sounds: background, distracting, volume

-Temperature

-Space: how crowded; intimate, personal,

or public

-Work surface

-Seating surface

-Walking surface

-Familiar? Friendly? Fun? Forgiving?

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What Do People with

Dementia Need?- Daily routine!

- Help to fill their day with meaning

- Balance of:

- Productive activity: feeling valued

- Leisure activity: having fun

- Self-care activity: wellness, health, personal care

- Restorative activity: sleep, rest, and re-energizing

- A match-up for preferences: large group, small group, 1:1, alone

-Active versus passive activities

-Sensory options: visual, auditory, tactile, olfactory, gustatory

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

What Does It Take

To Make a Day Have

Meaning and Joy?

Know each

PERSON!

Understand

ACTIVITIES!

Make & Use a

SCHEDULE!

Build staff

SKILLS!

Manage the

ENVIRONMENT!

Resources to

succeed

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Two Examples:

Paying Bills:

Do it independently

Together – use a calculator

Together – do all of them

Together – do one at a time

You do most, they sign and put in envelopes

You do all but the signature

They put on stamps

Both take them to the mail box

Washing Dishes:

Do it independently only after meals

Do it independently –when needed to fill time

Together – one wash one dry

Do parts

Watch and guide

Carry dishes to/from sink

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Two Options:

DOING:

Filling socks: rice, beans, corn

Adding herbs: lavender, citrus, eucalyptus, mint

Putting a sock inside another sock

Heating the socks

Rubbing the socks over muscles

Emptying socks out

MAKING:

Fruit salad from fresh fruit

Fruit salad from canned fruit

Fruit salad from pre-cut fruit

Fruit salad: one fruit and yogurt

Fruit salad: dried fruit, granola, yogurt

Putting the fruit salad in small cups or bowls

Serving the fruit salad

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Key Activities to Consider:

Productive - Work

Enjoyment - Leisure

Wellness - Personal Care

Restorative - Rest

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Productive Activities:Helping another person

Helping family members

or caregivers

Completing community

tasks

Making something

Sorting things

Fixing things

Building things

Creating something

Caring for things

Counting things

Folding things

Marking things

Cleaning things

Taking things apart

Moving things

Cooking/baking

Setting up/breaking down

Other ideas….

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Active: Passive:

Socials

Sports

Games

Dancing

Singing

Visiting

Hobbies

Doing, Talking, Looking

Entertainers

Sport program/event

Presenters

Living room or lobby

sitting

TV programs – watching

Activity watchers

Being done to

Leisure Activities:

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Cognitive: Physical:

Tabletop tasks:

• Matching, sorting, organizing, playing

Tabletop games:

• Cards, board games, puzzles

Group games:

• Categories, crosswords, word play, old memories

Exercise

Walking

Strengthening tasks

Coordination tasks

Balance tasks

Flexibility tasks

Aerobic tasks

Personal care tasks

Self-Care and Wellness

Activities:

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Rest and Restorative Activities:Sleep/naps

Listen to quiet music with lights dimmed

Look at the newspaper

Look at a calm video on TV screen

Rock in a chair

Swing in a porch swing

Walk outside

Listen to reading from a book of faith

Listen to poetry or stories

Listen to or attend a worship service

Stroke a pet or animal

Stroke fabric

Get a hand or shoulder massage

Get a foot soak and rub

Listen to wind chimes

Aromatherapy

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

Good Activities

Are Ones That Involve:

- Plants

- Animals

- People

- Music

- Objects

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To move from traditional to

person-centered care

requires:

Culture Change!

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The Goal:

Build a plan of care that helps the person:

-Be the way they want to

-Do what they are able

-Feel good about themselves

-Feel okay about where they are

-Enjoy the people who are there to help them

-Get what they need

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

So What Do We Need From

You?

- Awareness of the process

- Participation in planning

- Sharing about the past

- Time to learn and try something new

- Willingness to listen

- Willingness to advocate and negotiate

- Flexibility as we figure this out

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Key Steps:

- Connect

- Gather Information

- Share Information

- Use Information

- Review Information

- Make Changes

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

The content contained in this presentation is strictly for informational purposes. Therefore, if you wish to apply concepts or ideas

contained from this presentation you are taking full responsibility for your actions. Neither the creators, nor the copyright

holder shall in any event be held liable to any party for any direct, indirect, implied, punitive, special, incidental or other

consequential damages arising directly or indirectly from any use of this material, which is provided as is, and without

warranties.

Any links are for information purposes only and are not warranted for content, accuracy or any other implied or explicit purpose.

This presentation is copyrighted by Positive Approach to Care and is protected under the US Copyright Act of 1976 and all other

applicable international, federal, state and local laws, with ALL rights reserved. No part of this may be copied, or changed in any

format, sold, or used in any way other than what is outlined within this under any circumstances without express permission

from Positive Approach to Care.

Copyright 2017, All Rights Reserved

Teepa Snow and Positive Approach to Care

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