Setting the Stage for Dementia Care

Speaker0:
[0:15] Hi, everyone. I'm Emily.

Speaker1:
[0:17] And this is Eva.

Speaker0:
[0:19] And you're listening to Speech Talk.

Speaker1:
[0:21] We're your research-based book club so you can do evidence-based practice in practice.

Speaker0:
[0:27] Let's start talking. Eva, I want to hear all your fun things this week. What's going on?

Speaker1:
[0:34] Well, as you know, I've been working on my transition to acute care, So I've been doing onboarding and just like fully immersing myself in everything a hospital has to offer. It's been very exciting. Like the oxygen comes out of the walls. There are bed alerts for wandering patients or patients with who are fall risks. Epic is a crazy electronic medical platform. Yeah, I just I'm worried I'm out here looking dumb because I'm like, what? That's a thing. Oh, look at that button. What does that do? And everyone else was kind of like,

Speaker0:
[1:12] Yeah, don't press that.

Speaker1:
[1:14] No, this is pretty standard. Don't touch that. Please put the syringe down. So, yeah, I just feel like I'm a kid at the candy store and I just I'm trying to get up to speed as much as possible. And it's been weird not seeing patients this week. It's so weird to be at work and not be seeing folks. So I'm looking forward to finally getting my caseload. How about you, Ams? What's going on?

Speaker0:
[1:39] So I was working with one patient this week, and one of those boxes we had to tick was medication management. So we pull up the PCC and start looking at all the medication she's on. And she was like, yeah, tell me what I'm on, because I don't know what's going on, but I can't stop pooping myself. Yeah. So we start going through it. And I'm like, okay, this one looks like a blood pressure, magnesium. She goes, that's it. That's the one. They got me on that one. That one's making me poop my brains out. And I was like, well, probably not. And then we went on. And there was, I shit you not, four medications for constipation. She was like, what are they doing? Do they have a camera on my butt? I was crying, laughing in her session. And she goes, it's not funny, Emily. And I'm like, I'm so sorry. I'm not laughing at you. I'm laughing because you're so funny. And she just kept going. Like, after I said that, she kept going on about it. But I was cackling at my session this week.

Speaker1:
[2:55] This does remind me how whenever I'm sharing work stories, my friends were always like, why do your stories always have poop in them?

Speaker0:
[3:04] Well, it happens.

Speaker1:
[3:06] As you say, shit happens. Oh my gosh, I swore into the microphone. You know how nervous that makes me.

Speaker0:
[3:14] Mark this one explicit.

Speaker1:
[3:16] What are we talking about? And why are we talking about it this week?

Speaker0:
[3:20] This week we are talking dementia staging.

Speaker1:
[3:24] And just imagine like a theater stage. And this week, dementia. And then a bunch of old people come out confused.

Speaker0:
[3:35] Confused and like we're throwing like top hats at them and roses.

Speaker1:
[3:40] Yes, exactly. Bravo, bravo. Well done. Well done. Go backstage. And they're like, where's that?

Speaker0:
[3:47] Where's the bathroom? So dementia staging or placing people who have dementia on a continuum, so to say. They're mild, moderate, severely. Demented. I think that sounds weird.

Speaker1:
[4:05] Yeah, I think that is the operative verb, and it always just sounds so bad when people say it out loud. Yeah, and this is such a great concept because when we think about communicating with patients and with families about dementia, I think what's in everyone's minds typically is somebody who is truly out to see. They have no idea what's going on. They don't know where they are. They can't remember their kids' names. Sometimes they don't remember how to eat. And folks are always going, well, that's not my story. And it's important to be able to stage it. You know, what part in this process are you in? I think this topic is awesome. And in part, because you are working on a dementia staging program. And when you first told me that, I was so blown away. I was like, I don't even know what that is. So I'm really glad that we're getting into it today. And you can tell us a little bit more about that.

Speaker0:
[5:07] Yeah. And finding this article was honestly God sent. And I only found this after I have started. Isn't that how it goes? Started your program? Yeah. We only find exactly what we're looking for after we have put all of the work into whatever we were trying to do.

Speaker1:
[5:28] That's just how the cookie crumbles.

Speaker0:
[5:30] So just a brief recap on dementia. It is a collection of symptoms that are progressive that impacts one or more areas of cognition with the most common symptom being a memory impairment.

Speaker1:
[5:43] Yeah, that's where that classic joke of not knowing where you are or who you are or who you're talking to comes from. It's because memory is so saliently impacted. And because dementia is progressive, people with dementia go through various stages of the disease, and it gradually causes a gradation in their ability to participate in ADLs, those activities of daily life, their ability to communicate. And, of course, that can impede the quality of life overall.

Speaker0:
[6:13] So the article in question is Staging and Treatment Frameworks for Dementia Management by Mary Beth, Mason Bauman, Sky Rupp, and Kristen Corman.

Speaker1:
[6:26] I think you did all those names justice.

Speaker0:
[6:29] I try my best. I'm so sorry if I ever butcher a name.

Speaker1:
[6:33] But I think the title, you know, I'm always a big fan of a straightforward title. Like, this is what it is. This is what we're working on. There's no tricks.

Speaker0:
[6:41] So the article talks about two different worlds of thought when it comes to dementia diagnoses and staging. First, the DSM-5, which denotes two dementias. Mild, where daily activities are challenging, and major, with deficits related to a specific cause, either Alzheimer's, Lewy body, vascular, etc.

Speaker1:
[7:07] You know, I really love a staging where it's just two. It's like, here's mild and here's major. It's pretty easy to follow through on. What kind of dementia do I have? Oh, you have the mild. Him on the other end? He's got the major. You got the lucky end of the stick. For now.

Speaker0:
[7:24] For now. It's a quick tip-off. There's only two.

Speaker1:
[7:30] Exactly. All right. What's the second one they're talking about?

Speaker0:
[7:33] This is one that we are more likely to use. So we split it into diagnosis related to mild, moderate, or severe. And when we say mild, we're not talking related to our previous episodes, that mild cognitive impairment diagnosis that's used as a preliminary potential stage before dementia, plug C episode 14, if you want more information on that, but more severe than that. So mild dementia would be more severe than that mild cognitive impairment.

Speaker1:
[8:10] Yeah, I just wanted to jump in there and say that's a really important distinction where we're talking about mild dementia versus a mild cognitive impairment. There's some evidence coming up that says that a mild cognitive impairment, depending on the etiology or the cause, it can be reversed.

Speaker1:
[8:26] Dementia? No. So while mild cognitive impairment can be a precursor to dementia, it might be reversible. Whereas once you're on the dementia train, there's no getting off that ride. You can slow the train down, but it's not going back to the previous station. Coming back out of the MCI discussion, tell us a little bit about the mild dementia or early stage, Emily.

Speaker0:
[8:51] So a mild dementia or early stage, depending on which frameworks you are looking at. The article says, people in early stage mild dementia demonstrate trouble sustaining attention, difficulty with episodic and working memory, and may lose orientation with time and space.

Speaker1:
[9:10] I'm constantly losing orientation with time and space. I don't know where I am. Like the space-time continuum and I'm not always friends. I think I'm somewhere. I daydream very strongly is what I'm trying to say.

Speaker0:
[9:24] I know. I always feel so awful when I'm like, what's the date? Because if it wasn't for my watch that tells me the date and the time, I wouldn't know. I forget all the time.

Speaker1:
[9:36] Relatable.

Speaker0:
[9:38] So with this stage, mostly their language is likely fine. Maybe they might have some trouble with word finding. They could have difficulties with complex tasks of daily living and relatively those simple ADLs, bathrooming, washing, maybe doing dishes, is pretty much intact.

Speaker1:
[10:04] It's that stage of dementia where people say, I think I'm just getting older. You know, they're like, I think, you know, my memory is not what it once was, but they're so functional in other things that it's almost passable. If it weren't for those pesky standardized tests that we can administer. Be like, it's not fine. All right. And one of the things that you mentioned how in the article they do so well and make it so applicable for clinicians is they go, hey, this is what defines that mild stage. Here's some treatment.

Speaker0:
[10:41] So the article tells us to restore. We can try and gain back function. We can. Do they still have new learning capacity? That is normally one of my goals. Are they able to learn something over time? I'll teach them my memory strategies and I'll quiz them every time I go in. What are the six memory strategies I've taught you? That's always our first step.

Speaker1:
[11:06] And a big part of that is potentially compensation. You know, using those supports like an automatic bill pay, medication boxes, having food delivered, whether it's Meals on Wheels or an Instacart delivery that comes weekly, Being able to restore your function or your ability to complete the task is not necessarily the same thing as having the same cognitive ability as before and getting to the end goal. So my bills are still getting paid. Is it because I'm remembering or because I switched to an automatic bill pay?

Speaker0:
[11:43] We're allowing these patients to maintain their independence by teaching them new ways or having their caregivers set them up in a way that they can provide less supervision and they don't have to be as hands-on because some of those

Speaker0:
[11:57] things are automated or taken care of. So that brings us to education to those patients and caregivers.

Speaker1:
[12:05] Yeah, I was going to be like, I'm stealing Emily's catchphrase, knowledge is power. Telling people, you know, hey, this is what you're having difficulty with. See assessment results. Here are things you can do to circumvent or compensate for your impairments. Try to use a word other than impairment. People seem to find it offensive.

Speaker0:
[12:27] I actually had like a super beautiful moment in a session the other day where it was a husband and wife. Side note, I called his wife, his mother. I was like, so who are you, his mom? And she's like, I'm his wife. I was like, oh.

Speaker1:
[12:44] Well, I literally had that happen this week or last week.

Speaker0:
[12:48] I was like, give me a second to let my face return to normal color and remove my foot from my mouth anyways. So I set them up to do bill pay tasks. So we called 1-800-NUMBERS to ask him for discounts on things, and we paid, like, wrote out fake checks and did the checkbook, and then we did some simple math. And at the end of the session, his wife was like, I think I might just be doing the finances for a little bit. And I was like, aww. Like, she was just, like, it was just, like, a very incidental learning moment without having to be like, you're going to have to take away his checkbook. It was just like, I think I might help you a little bit. And it was just, it was sweet.

Speaker1:
[13:37] Oh, that is a gentle way to say it.

Speaker0:
[13:39] And I insulted her. She was beautiful. I insulted her.

Speaker1:
[13:45] Yeah. Really hard not to assume family relationships, but because when it happens, you always seem to assume people are related in a particular way at the least opportune moment. Normally I'm pretty good about asking And you are I'll let them fill in friend, family, whatever it is But every once in a while I'll be like Oh, your son's here That's my husband Awkward My bad Get it?

Speaker0:
[14:20] I'm going to walk out backwards and come back in And we're just going to redo this whole thing together Please let.

Speaker1:
[14:26] Me wipe that slate clean

Speaker0:
[14:27] I'll see you next time. All right, Eva, tell us the last treatment that we could do for our mild dementia early stage folks.

Speaker1:
[14:37] We can always set them up with some functional maintenance. So depending on your facility, you may have tasks that you can designate to a maintenance team, whether that's an RN or volunteers, activities department. Different sites have different capacity to support a retention or a maintenance program. see what you got around. A lot of times I very informally handed things off to the activities department, just letting them know what a patient is working on in terms of their memory or what their behaviors were like as a result of memory impairments, like wandering, just saying, hey, this person struggles with wandering or getting up out of their chair when they are not stable on their feet. These are the strategies we're implementing. Can you hold down the fort? And they're they were awesome about it

Speaker0:
[15:30] Yeah and it's surprising how you can find little things to do um we have bingo at our facility so they get these little bingo bucks so then they have a bingo buck store so then somebody with a mild dementia make.

Speaker1:
[15:47] It rain and bingo

Speaker0:
[15:50] Some of our people with, it's actually one lady who has a mild dementia. She will, you know, take the bingo bucks and count them out and mark down on like how many bucks they have and how many things they can pick out from the store. So it's like very functional for her and it's helpful and it kind of takes a

Speaker0:
[16:14] little bit off of the activities plate.

Speaker1:
[16:16] That's great. And that wraps up for mild. let's get into moderate dementia or middle stage. If I say it like this, it could sound like a vacation. Welcome to moderate dementia.

Speaker0:
[16:32] And that's where I hope your moderate dementia is. I hope your moderate dementia is somewhere on a beach.

Speaker1:
[16:40] On a remote island where it doesn't matter what time it is, where you don't have responsibilities because you don't know what they are.

Speaker0:
[16:49] So this middle stage these people can typically follow like a two-step command but maybe their verbal comprehension is declining relating to language their word finding difficulties are more prevalent content is often described as empty but when they're presented with a tangible item people with a moderate dementia can make on-topic statements yeah.

Speaker1:
[17:16] That's where we see a lot of the visual and tactile cueing being particularly helpful, giving somebody a complex series of directions for, say, hygiene or grooming tasks. They're beginning to have trouble processing what you told them, but when you put the toothpaste and the toothbrush in front of them, they're perfectly fine.

Speaker0:
[17:37] At this stage, their ADLs, like brushing teeth, getting dressed, is needing those cues. So maybe setting them up with a visual schedule in their bathroom or making sure the aides know, They might be talking with you just fine, but they will not brush their teeth when given the opportunity they'll forget. So still providing additional setup and cues, even though they might be presenting like they have no problem doing those things.

Speaker1:
[18:13] Yeah. And just a quick aside, this is where we're starting to see more types of memory impairments. So it's not just that immediate recall, but we're also starting to see more deficits in long-term recall, which I think is more often when family members begin to notice and think it's a problem. When you're saying, oh, hey, your mom or grandma has difficulty with remembering directions, they're like, she's 80. You know, of course she does, but she can always remember people's birthdays or that her husband passed, what have you. and all of a sudden she's asking where her husband is, that's when people are going, oh no.

Speaker0:
[18:54] And that's always like the hardest part too, when you're only just now having these conversations when it's at this part, wherein the extra compensations are actually needed when your education is prevalent, that there has to be something to make sure they're still getting the most out of conversations. And it just takes until this point that people are like, wait a second, grandma is not the same.

Speaker1:
[19:25] And unfortunately, that conversation is so much better had at the mild stage and then transitioning into the moderate. But for most folks, it seems like they're most accepting of the conversation or they're more likely to go, oh, we need to address this once they've already reached a moderate stage. And really, those memory strategies are best learned while there's still better learning capacity.

Speaker0:
[19:48] Yeah, I found that too, especially in having these conversations with the patient themselves, when they're at that moderate stage and they are forgetting personal details about themselves because they've always prided themselves on that long-term memory. Once they start forgetting those memories that that was their golden ticket. I can't have dementia because I still remember XYZ. Now they don't remember it and they, you know, have that limited recognition of, oh, no, I'm forgetting this. I need to fix it fast.

Speaker1:
[20:22] When I get old, I'm not going to be defensive about it because I already don't remember things. Yeah, I don't know what I did when I was 17. I don't even know where I was.

Speaker0:
[20:35] No one knew where I was when I was 17.

Speaker1:
[20:39] You hoodlum.

Speaker0:
[20:40] I think there was like two boys who might have known exactly where I was when I was 17, and that's it.

Speaker0:
[20:48] Terrible life choices. So treatment. Eva, what are we doing? How are we helping?

Speaker1:
[20:56] There are some fun treatment suggestions. Some of these I've never had time for, like memory wallets, memory stations. I've definitely tried to set up memory supports for people at different places within their rooms or their current environment Like look, there's a toilet sign on this door Because all of a sudden the doors in an unfamiliar environment don't mean anything to them The door outside of their room The door to their closet and the door to their new bathroom are all just the same door to them so Yeah labeling. This is your bathroom door. This is, let's look at something on the outside of your room door that you can identify. In your bathroom, we've put up that daily hygiene routine. And I usually just use icons for folks with more severe memory impairments so they can see, there's a big picture of a toothbrush, a hairbrush, and the toilet. So we're looking at briefs, teeth, and, I don't know, something else that could potentially rhyme there. I felt like briefs and teeth really came off well, and then I kind of faltered.

Speaker0:
[22:06] Briefs, teeth, and cheeks.

Speaker1:
[22:08] Yeah, something like that. Somebody come up with a fun slogan to get back to us. Or, you know, I'll have one by their bed so that when they wake up, they roll over, they see that they need to be getting up during the day. They need to I usually try to put an item from the activities department on the wall for them we go through we look at the week together and we select something that they want to do for the next day and I put it up on a very large note in their room and I remind nursing and we try and make sure they're getting up and participating as much as possible because as we know the stimulation and interaction are very positive.

Speaker0:
[22:47] More specifically for those memory stations, this is something that I just recently learned about too. So outside of just like, outside of labeling, maybe the walls or putting up signage, a memory station might be a little area on a table next to their bed that has, an adapted phone that has like one button calling a large clock with the day the time the weather and like you were saying a short list of things to do so as soon as they wake up it's, in their face, reorienting them to the date all the time. So whenever they're looking around, they're, okay, what is today? It's here, right within reach. So that's a memory station. Something else that is awesome to have around are picture storybooks. So I actually have one right next to me. Have you ever read this book Tuesday, Eva?

Speaker1:
[23:50] No.

Speaker0:
[23:51] I don't know if any of you guys have read this book, but it's a book with, you know, maybe 10 words in the whole thing. And it's just a book with all these crazy pictures of something that happened on a Tuesday. It's called Tuesday. And these pigs are flying and nobody knows why.

Speaker1:
[24:09] It's kind of like an adult comic book.

Speaker0:
[24:11] Yeah. There's nothing to read. You fill in the book completely yourself. There's almost no words. So in that, it's something fun to look at. It's something...

Speaker1:
[24:23] Wait, speaking of fun to look at, listeners, Emily's wearing a Bob Ross shirt. It's awesome. Just happy little accidents.

Speaker0:
[24:34] No, can I, a little throwback to how me and Eva became friends for our listeners who care. This is the, I always wear, whenever I wear this shirt, I think about you because in our class at NYU, our very first time meeting, you messaged me in the chat and you said, hey, I like your shirt. And I was like, we're going to be friends forever.

Speaker1:
[24:56] I have no long-term memory. I have no recollection. As far as I knew, this is the first time I've seen this shirt. It's so special. It's like it's new every time.

Speaker0:
[25:07] Eva, I have a test for you.

Speaker1:
[25:10] You want to draw a clock? I'm so scared of early onset dementia. Can you draw a clock? Anybody comes at me with a clock, I'm going to be like, oh, God.

Speaker0:
[25:18] Trump says it's a very hard test.

Speaker1:
[25:24] Man, I have actually had people refuse the MOCA because they heard the president talk about it. They were like, that's that test that Trump took. I don't want anything to do with him. And I was like, well, how you're behaving right now is actually telling me a lot about how you'd probably do on this test.

Speaker0:
[25:42] So, lose-lose for you.

Speaker1:
[25:48] Okay. What else are we talking about for moderate dementia treatment strategies? We're getting aides involved for ADLs. We're calling in our PTOT colleagues to see if there's anything we can do to help support them in their performance of daily tasks.

Speaker0:
[26:10] Yeah, we're looking to preserve whatever's there. So if reading is still a strength, we're trying to keep them reading, doing a book club kind of thing. Any skills that they currently have, we want to challenge them. So this is very person focused. What are their interests? What is that teetering line for them between what is challenging and fun and too hard? Like, how can we be supportive and making sure they're still able to do leisure activities and keep them not frustrating?

Speaker1:
[26:49] Yeah, and I'm going to put a bookmark in the Montessori discussion because I

Speaker1:
[26:54] know that's coming up for severe dementia, but can't wait to talk about it. Let's transfer over to severe dementia so we can talk about Montessori programs.

Speaker0:
[27:03] So a severe dementia, or a late stage, is defined as a person who is disoriented in person, place, and time. Typically will have an incontinence of bladder and bowel. Their language ability may range from being completely mute, palalelia, echolalia, jargon, to even being able to state their own name and maybe even just some crystallized vocabulary. So core words that they might say all the time, like bathroom or help.

Speaker1:
[27:40] Yeah, I've had some interesting, I haven't heard that phrase before, actually crystallized vocabulary. I had a patient, not to always bring up poop, but her only phrase she said was, I need to poop. No matter what you said to her, she'd just be in bed saying, I need to poop. And sometimes you just had to read her facial expression to see, was this like a playful one? Like, oh, I'm in a good mood. I need to poop. Or like, I'm really struggling today. I need to poop. And it was just kind of like funny tragic that she was stuck on that phrase. I did an evaluation for a family friend whose mother had dementia and a recent stroke. She had a lot of really funny crystallized phrases, overall very jargony, fluent aphasia, but they gave her a glass of, I don't remember if it was juice or wine, but they were having dinner and they wanted her to, they put it in a wine glass, that's all I remember. It was in a wine glass because she wanted to have dinner with wine. And they got that through a lot of gesturing and pointing. And her granddaughter passed her the cup and she goes, oh, you won. Like, out of nowhere. A lot of just complete nonsense. And then, oh, you won. I love that.

Speaker0:
[29:04] That's so cute.

Speaker1:
[29:06] Yeah. Okay. So as you were saying, Emily, this is where things are getting much more serious. This stage is where sensory things and managing emotions are going to be our primary goal.

Speaker0:
[29:19] Eva, keep going. Let's talk about our treatment. How are we managing? Talk about your Montessori.

Speaker1:
[29:26] The Montessori. So I learned about this from an OT colleague who used to run a dementia program at an old SNF, like a specifically an old Jewish SNF. It was like, they did Shabbat. That's where I learned about Shabbat. There were a lot of old Ethels there and Shirley's.

Speaker1:
[29:46] And they had a Montessori church.

Speaker1:
[29:50] Dementia program, Montessori style. Now, I know if you're like me and you heard that and you went, isn't Montessori for kids? Well, a similar concept is very activity-based for engagement. And so a lot of what people do is the rote tasks they've done their whole lives. And so he described how that little garden path that was circular, no matter where you came into the path, You could only go in a circle. Then they also had little stations and one was like a pile of unfolded towels and then an empty bench and people would just stop and fold the towels and put them back on the bench. So there were all these sort of like little ADL tasks throughout the department so that as people came across them, it was an activity for them to do. They didn't have to be able to communicate about it. It was very visually obvious. And I thought that was truly wonderful. What a wonderful way to make people feel like they're doing something useful for the community, because they're participating in something everyone needs, like napkins for lunch, you know? And so they're sitting there folding napkins or putting envelopes and cards for the holiday party.

Speaker1:
[31:10] And yet it didn't require a lot of directions, sort of low overall maintenance by the staff facilitating it, but very functional and very participatory.

Speaker0:
[31:23] Oh, I love that. Yeah, I get me too. I think about Montessori when it comes to kids, but it is just being able to do something with your hands, doing,

Speaker0:
[31:36] something sensory and functional like it's a real life task. So our next treatment is caregiver education. So this one is always really hard for me especially when it comes to the caregiver education to the aids in the SNF when it is like how how to treat someone with severe dementia because I feel like they are already experiencing some of their worst behaviors that I really don't see, right? Like I am not changing a brief and I am not forcing them to get dressed. I am not forcing them into the shower. I'm not like doing these really hard things with them. And sometimes people with severe dementia can be combative or agitated quickly.

Speaker0:
[32:28] So they can have more behaviors in these times. And I'm just like, hey, let's put on some videos about cats. And it calms them down. And they're like, what? Like, I can't take that into the shower. What are you talking about? So that it always feels like, you know, I'm trying to be really helpful when it comes to their mood and behavior. But at the same time, it doesn't, I mean, And I don't know if it's just me or

Speaker0:
[32:56] if you have experienced that too, Eva. It just doesn't always feel like it translates really well.

Speaker1:
[33:01] Yeah. And again, this is so location specific, right? So for places that have the resources and that place may just be home.

Speaker1:
[33:12] I think a lot of the recommendations for low stimulation, low intensity are much more easy to accommodate. We keep clear counters, quiet or very soft music.

Speaker1:
[33:27] You know, we're really keeping things as simple as possible so that we don't have the visual distraction, tendency towards anxiety because of feeling overstimulated or confused. When you're in a SNF, you don't necessarily have the luxury of providing that. And so I think your comment about feeling that it's difficult to explain to aides or CNAs, nursing staff, what have you, is in part because you're trying to tell them what best practice is in an environment that is almost literally opposite of best practice for folks with advanced dementia, right? Right. So what I a lot of times will try to do is remind people, if possible, room them with someone who's quiet. If you've got a very quiet bed bound patient, that may be the right room for them. If we maybe have a room without somebody else in it, somebody else who has dementia so that we can kind of co-create the environment for them, just go in and turn the TV off. You know, there's so many loud sounds, and while it may seem callous, they may not even notice you turned it off, you know? And so doing as much of that external enforcement as possible

Speaker1:
[34:51] I worked in a dementia unit very briefly that did have more resources than most places I've worked. It was very quiet, very calm. And even so, I was brought down to try and help with communication goals for a woman who was very combative around meals and brief changes.

Speaker1:
[35:13] And I don't know how everybody else feels about it. You know, don't be upset with me if you don't feel the way I do. But if someone's being combative, they want to be left alone and you're trying to change their brief, if you have tried verbal approach where you let them know that, hey, we're going to come in and change your brief in 15 minutes, we're providing signs, we're providing visual cues, we're trying to do everything as consent oriented as possible. And they're very upset, I say leave them be. I am not for healthcare professionals burning themselves out because they're experiencing physical abuse from their patients. And if you don't think a 70-year-old woman can hit hard, you got another thing coming because they do not hold back, right? They're willing to pull hair, claw, grab, push, bite. They are not fighting fair. So I know that, you know, sitting in a wet brief can lead to skin breakdown, deterioration, sepsis, you know, the whole nine yards. This is the complicated aspect of end-of-life care. I'm not saying it's easy. I'm saying if they're okay and we want to maintain the safety of healthcare workers, then, you know, I say let it sit for a while until they're in a better place.

Speaker0:
[36:36] And to that, there's this really cool TED Talker influencer. If you haven't followed her, she's really knowledgeable in dementia. That's her wheelhouse. Her name is Adria Thompson. She's an SLP. And she gives really specific ways on how to approach somebody who has dementia when it comes to getting dressed or changing, just to make sure that they're comfortable and it gives you a more tangible way. So if you haven't seen any of her stuff, it's a good follow.

Speaker1:
[37:11] Definitely know how I'm going to spend 30 plus minutes computer time later this week. I'm just going to go on to look at this one thing. And that's why I don't have a smartphone at all, because I have no self-restraint. Okay, so we have done a lot of talking about the various stages. We have talked about what characterizes them, potential treatment approaches. And finally, we're just going to quickly wrap up with saying another fantastic

Speaker1:
[37:45] aspect of this article is they talk about testing. They have all these different cognitive tests you can conduct, and then they show what scores you get on each of those tests and what stage of dementia it corresponds with. So, seriously, we will link the article. Check it out because this chart is pretty legit.

Speaker0:
[38:06] I love a good chart. And this one, mouthwatering. I love this chart. This is making like... The dementia staging process so easily, so easily done because you do the test. It's on there. It's exactly where it should be. I'm like, ah, another like golden awe moment. Again, after you start the program, you find all the amazing things. Drives me nuts.

Speaker1:
[38:35] And I think we should just take a second to ask you, Emily, how is your program going? What got you to start it, and how's it going?

Speaker0:
[38:47] What brought me to start it? Billing brought me to start it.

Speaker1:
[38:53] The silver lining of billing.

Speaker0:
[38:55] The MDS nurse said, we are charting a lot of people who have an undiagnosed dementia as their primary diagnosis code. This is not what we should be doing. How do we fix it? Because I guess treating under a specific dementia code gives your facility better reimbursement rates. It's all a money grab. It's all a money grab. So that's how it started. How is it going? slow. So I was in a, a petty battle with my facility because I wanted to provide, you know, a good general education to the staff. Like, how are we going to make sure follow through is there? And they're like, no state. If state comes in and sees any labels on anything, then we'll get dinged for not following those. And I'm like.

Speaker0:
[39:57] You know, here's a thought. We could like follow the advice I'm providing instead of saying no. So there was a big pause. Currently, I have two people on my dementia group. I have one severe and one mild. Mild is a lot more fun. I will say that this article mentioned something that hit home for me in that saying that about less than half, 45%, reported not being told about their dementia diagnosis from a healthcare provider. And in starting this dementia group, I sat my first client down and I was like, all right, girl, we're in this dementia group. I want to do some testing. And she was like, wait a second, what? I have dementia? And I was like, no, this is not the first time you're hearing this. So then, yeah, so... Again, lesson learned, pulling foot out of mouth. Make sure that you're talking with your nursing on, you know, who all has had that conversation. Like if this diagnosis code is on their chart, you know, testing those waters about their brain and about their diagnosis code so that, you know,

Speaker0:
[41:22] you are not the one taking the fall for it.

Speaker1:
[41:25] A real casual, hey, did you know you had dementia? And where do you hope this program goes? How do you want this to shape up?

Speaker0:
[41:36] What I would really hope for the program, I mean, because like to be a billable program, even though it's a maintenance program and maintenance programs are approved by CMS, you can't have a program that is forever on your caseload. There should always be a goal that it's transferable to somebody else. So the goal is that, one, we'll be able to train enough people naturalistically on how to maintain dementia levels. Going through the facility and providing ample education when we're having these groups on some of the activities these patients like or they don't like or what they could be encouraged on doing to provide that handoff for the maintenance process. And then rechecking in, like we'll have them on caseload for, you know, four weeks. And I've been starting off my dementia program patients for 60 days, actually, to do a lot of fun activities, see what they enjoy. I just, the other day we did a planting activity and my patient was like, how did you know I used to like doing this? I was like, girl, I didn't.

Speaker1:
[43:01] I did not.

Speaker0:
[43:03] I did not. We were just trying things out. So next week we're going to be making snow globes. So right now we're just, you know, doing fun things, challenging, you know, what can they do? What should they keep doing? The goal. I mean, the goal is transference. It's always transference, always to have more people educated on how we can help or maintain or include and not make it feel like more work.

Speaker1:
[43:33] There you go. So if you work at a site and you have a significant dementia caseload, maybe you got a part B's to get turned over, maybe you are just realizing there's not a lot of resources for dementia support, consider reading this article, listening to us some more, and trying to group your patients by their dementia stages and seeing if that helps with education, organization in the facility, and let us know how it goes. So until next time, keep your sights on those long-term goals, y'all.

Speaker0:
[44:05] Thanks, guys. You've been listening to Speech Talk.

Speaker1:
[44:10] Thank you, everyone, for coming to listen to our research book club. Until next time, keep learning and leading with research.

Speaker0:
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Speaker1:
[44:28] If you have a research topic you want us to cover or you have episode comments, clinical experience you want to share, or just want to send us some love letters, Send us an email at hello at speech talk pod dot com.

Speaker0:
[44:41] If you want even more speech talk content, check out our website at speech talk pod dot com, where you can find all of our resources we made for you, copies of articles covered and Eva's blog following these topics and more.

Speaker1:
[44:54] We're your hosts, Eva Johnson and Emily Brady.

Speaker0:
[44:57] Our editor and engineer is Andrew Sims.

Speaker1:
[45:00] Our music is by Omar Benzvi.

Speaker0:
[45:01] Our executive producers are Aaron Corney, Rob Goldman, and Shanti Brooke.

Speaker1:
[45:06] To learn about Speech Talk's program disclaimer and ethics policy, verification and licensing terms, and HIPAA release terms, you can go to speechtalkpod.com slash disclaimers.

Speaker0:
[45:18] Speech Talk is a proud member of the Human Content Podcast Network.