Friday, July 25, 2014

Functional Maintenance Program for Residents with Dementia (Long Term Care Settings)

I recently attended a very informative seminar through Consultants in Dementia. I highly recommend it to those of you working in the skilled nursing environment. One of the things that has really helped me improve performance within this complex population is the establishment of a Functional Maintenance Program (FMP). In order to get this going at my facility, I had to create a proposal of the steps involved and what it would look like. I'd like to share this with you:

       Establishing A Functional Maintenance Program (FMP)

Materials needed:

Two 3 ring bingers with alphabetical tab dividers
2 large cabinets with at least 3 shelves that can fit up to 8 bins per shelf (preferably adjustable shelving for varying heights of materials)
Locks for the cabinets (key or number code)
If key locks, then a key holder similar to the restroom key for staff to retrieve at nursing station
Materials for the selected activities (to be purchased by the SLP under the FMP budget)
Either a table suitable for 4 wheelchairs at the north and south end OR at least two roll out tables next to the cabinets labeled “For FMP only”

Steps and Documentation:

Evaluation by Speech-Language Pathologist (SLP) with goals written for completion of FMP
An annual inservice for all of nursing (DON, RN, CNAs, managers) with SLP to understand the process. Paperwork will be signed by all attendees for this inservice (approximately 20 minutes)
Once FMP is established by the SLP, the Director of Nursing will sign off on the plan and the original will be placed in the resident’s medical chart with a copy going in the FMP binder 
SLP will document ongoing training with nursing for each resident within their treatment sessions
Nursing is to pass information on to CNAs for their shift until this system becomes routine
The Activities Director will add identified residents to selected activities by the SLP for both group and 1:1 sessions to be documented in their care plans
It takes 3 months of repetition and consistency for a system to be created; therefore the first 3 months will consume the most time. This is critical however for a simplistic system that will require very little maintenance once established.

How the program works once established:

The SLP will evaluate individuals that are in need of maintaining preserved skills due to dementia. Through treatment sessions the SLP will discover activities that are enjoyable to the resident and easiest for them to perform independently. This can be as basic as folding towels, arranging fake flowers, and coloring, to strategy games such as checkers or chess. The long term memory is most preserved within dementia, so finding activities that they once performed repeatedly in their lives will help maintain their preserved skills within attention, memory and problem solving. This can carry over into areas of safety. As well, residents with dementia desire to be functioning and will get restless when sitting in their wheelchairs too long, putting them at high risk for falls. Knowing their preferred activities and providing them regularly and/or when signs of restlessness appear (e.g., trying to get up from wheelchair, behavioral outbursts) can reduce negative incidents. 
Once the SLP has determined the activities best suited for the resident, a list will be created and reviewed with nursing. Brief training will take place for the primary nurse and CNAs available during that treatment time. 
The north and south end of the building will each need cabinets that can be locked, keeping the key at an identified spot in the nursing station for easy access of all staff members. In this cabinet will be a notebook that will have each identified resident’s FMP sheet which will list their preferred activities (simply look up the patient’s last name). There will be bins within this cabinet for residents on the plan with special activities unique to them as well as general bins in which the activities may be a shared interest. 
As staff becomes familiar with the preferred activities of the residents, the redirection of undesired behaviors and establishing routines should become a fairly quick transition. 
In addition to the FMP, identified residents will be placed on Activities list for 1:1 activities as well as group activities to promote socialization and more structured interactions. 

Keeping our residents with dementia engaging in activities appropriate to their skill level will decrease requests for help, attempts to get up from wheelchair and behavioral outbursts. It also has the potential to improve upon existing skills, requiring less dependence on their caregivers. 

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