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Deciding what you want to change and communicating that intention is the first step of the quality improvement cycle. This page describes the benefits of individualizing care for persons living with dementia, with talking points to share with your team.

Truly individualized care promotes a person’s highest practicable mental, physical, and psychosocial well-being. Adjusting care approaches to reflect day-to-day needs and abilities maximizes independence while ensuring a safe and supportive environment. Days that are comfortable and include meaningful activities help create a sense of wellbeing, improve quality of life, and support resilience to stress. This goal includes appropriate use and reduction of psychotropic medication as part of whole-person care.

The following talking points are grounded in the core themes identified in the Alzheimer’s Association’s Guide to Quality Care from the Perspectives of People Living with Dementia.

  • How Does Individualized Care Benefit Residents Living with Dementia?

    A safe and supportive environment that reflects the person’s characteristics, personality and preferences, honors the individual, and respects their personhood.

    Personalized care to meet individual needs and preferences increases comfort and reduces distress.

    Opportunities for engagement that have meaning and purpose enhance quality of life.

    Adjusting care approaches to reflect day-to-day needs and abilities supports highest levels of independence while reducing frustration.

    Avoiding inappropriate use of psychotropic medications reduces the risk of medication errors and adverse consequences. Psychotropic medications may be associated with changes such as drowsiness, decreased physical functioning, falls, heart attack, stroke, death, and hospitalizations.

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  • How Does Individualized Care Benefit Long-term Care Staff?

    Individualizing care involves knowing the resident and building a relationship. Enhanced relationships between staff and residents may increase staff satisfaction.

    Engaging residents in meaningful activity may be professionally rewarding and satisfying to staff.

    Empowering staff to individualize care demonstrates trust and affirms staff’s value.

    Providing good care is rewarding to staff.

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  • How Does Individualizing Care for Persons Living with Dementia Benefit Long-term Care Providers?

    Designing care around an individual’s preferences leads to greater resident and family satisfaction and improved resident well-being.

    A systematic approach to individualizing care through required processes supports regulatory compliance and positive survey experience.

    Understanding how residents indicate unmet need helps staff address the real need and may also support reduction of psychotropic medications. Reducing the use of psychotropic medications may improve performance on related CMS Quality Measures.

    Systematic process-based approaches paired with evidence-based tools, resources and guidance help your home provide a high standard of care. Excellent care will be reflected in resident and family satisfaction and reputation in the community.

    Staff who learn to understand signs of unmet need can address those needs or anticipate them before they occur. Being effective at one’s job increases satisfaction and may reduce turnover.

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Step 2 – Tracking Tool  >

Tracking Tool

The Campaign Tracking Tools allow you to document your work, monitor outcomes and the processes related to your outcomes. To achieve a data-driven quality improvement project, collect data for several months to establish a solid baseline and set a target for your improvement; then continue collecting data -- charts within the workbooks and trend graphs on the website provide you and your team with the feedback you need to determine if the changes you are making are being fully implemented and if they are having the expected impact on your outcomes. Keep your workbook up-to-date on a daily or weekly basis and look at data often to support a rapid cycle quality improvement project. Download the data tracking tool and collect data for a month or so to determine your starting point.


Questions? Contact the NNHQI Campaign Help Desk: Help@nhQualityCampaign.org.

Before you start, read our Tip Sheet on Testing Change & Starting Small (PDF).


Step 3 – Examine Process  >

Examine Process

Under Construction
Probing questions to identify opportunities to improve care for individuals living with dementia and reduce the use of psychotropic medications. Check back soon!
Under construction

Step 4 – Create Improvement  >

Create Improvement

The Science of Change

Guidelines & Recommendations
Website A Letter to Caregivers from National Alzheimer's Association Early-Stage Advisory Council
What is important to individuals living with dementia? This letter summarizes key themes from the Guide to Quality Care, below.
Website A Guide to Quality Care from the Perspectives of People Living with Dementia
Recommendations from the National Alzheimer's Association Early-Stage Advisory Council, rich with quotes from individuals living with dementia.
Website Dementia Care Practice Recommendations
Alzheimer's Association 2018 Dementia Care Practice Recommendations were developed to better define quality care across all care settings and throughout the disease course. They are intended for professional care providers who work with individuals living with dementia and their families in residential and community-based care settings.
Designing Your Improvement Project
Adobe PDF 5 Point Bundle for Avoiding Unnecessary Antipsychotic Medications
This three page change bundle from the National Nursing Home Quality Care Collaborative shares successful practices of high performing communities. The bundle includes specific actions for addressing the underlying causes of distress, enhancing our communications, establishing sound practices, and optimizing quality of life through relationships and meaningful activities.
Adobe PDF STAR-VA Manual
STAR-VA is an interdisciplinary approach including background information, practical resources, and training materials. The manual covers details involved in designating project coordinator and champion; staff education in identifying and interpreting signs of distress, positive communication, and incorporating pleasant events and meaningful activities; and creating a supportive physical environment. Rooted in the Staff Training in Assisted Living Residences (STAR) intervention, STAR-VA has demonstrated success across multiple implementations. Though developed by the VA, this resource is not specific to veteran populations.
Self-Assessment & Prioritization
Adobe PDF Resident Questions Worksheet 2018
Facility Questions Worksheet 2018
Originally developed for CMS's Focused Dementia Care Survey process, these tools have been released to the public with the intent that long-term care communities will use them to assess their own practices in providing resident care.
MS Word Dementia Care Critical Element Pathway
Critical Elements Pathways are used by state survey. Use Pathways to identify your strengths and your opportunities for improvement, and to plan your next steps. Routine review of Pathways supports your continuous readiness.
Individualizing Care
Adobe PDF Survey Guidance on Individualizing Care
Excerpt from State Operations Manual Guidance for Surveyors: Examples of individualized, non-pharmacological interventions.
First, Know the Person
Understanding and Responding to Unmet Needs
Adobe PDF Using the Unmet Needs Model
This info sheet provides a brief summary of the unmet needs approach, including assessment tips, responses and resources.
Website Positive Approach with Hand-under-Hand
This video includes four scenarios (5 minutes each), with demonstration and commentary. Created by the VA, it is equally applicable to all individuals living with dementia and their care partners.
Video We are Detectives 4:38 min
From the Appropriate Use of Antipsychotics in Long-Term Care Toolkit.
Video Brain Changes 13:35 min
Meaningful Activities 15:15 min | Music 14:49 min
From Challenge to Success 6:36 min
Educational videos from Teepa Snow.
Adobe PDF Identifying and Promoting Pleasant Events (begins on page 69)
From the STAR-VA program, this section includes introduction and tools for identifying and implementing pleasant events specific to each person.
Video Agitation v. aggression, and what do they mean? 5:08 min
Geriatric psychiatrist Susan Wehry, MD, explains the difference between agitation and aggression and how interpreting those communications correctly can help us best meet the individual's needs.
Adobe PDF How to Respond When Dementia Causes Unpredictable Behaviors
This brochure includes information on common expressions of unmet need and distress, tips for responding, and strategies to proactively address resident needs.
Website Curbside Consults
Individual case studies cover topics such as intrusive wandering, insomnia, repetitive vocalizations, and resisting care. From the Alberta AUA Toolkit.
Nonpharmacological Approaches
Website Evidence-Based Nonpharmacological Practices to Address Behavioral and Psychological Symptoms of Dementia
From the Alzheimer's Association 2018 Dementia Care Practice Recommendations.
Website Encouraging Comfort Care: A Guide for Families of People with Dementia Living in Care Facilities
From Alzheimer's Association-Greater Illinois Chapter, this resource provides information for families and staff, with particular attention to care issues related to the late and final stages.
Adobe PDF Recommendations for Assisted Living Residences and Nursing Homes - Phase 1 & 2
The recommendations cover fundamentals of dementia care for areas such as preventing falls, family support, pain management, food and fluid consumption, and resident wandering. From the Alzheimer's Association.
Adobe PDF Recommendations for Assisted Living Residences and Nursing Homes - Phase 3
Phase 3 of the recommendation focuses on end-of-life care with topics such as decision making, psychosocial and spiritual support, and coordination of care. From the Alzheimer's Association.
Deprescribing & Monitoring
Website Accurately Diagnosing Mental Health Disorders (webinar, 23 minutes)
Appropriate assessment and evaluation for the accurate diagnosis of schizophrenia and other mental disorders. National Partnership to Improve Dementia Care, Medicare Learning Network call & slides.
Website Deprescribing Guidelines for Antipsychotic Medications
Deprescribing is the planned and supervised process of dose reduction or stopping of medication that might be causing harm or no longer provides benefit. This link takes you to the Antipsychotic Deprescribing Guideline, Algorithm, and 10-minute whiteboard video on using the Algorithm.
Website Prioritization Tool for Antipsychotic Reduction
A case-by-case review of individuals receiving psychotropic medications will help your multidisciplinary team identify and prioritize candidates for medication reduction.
Website MedStopper
This web-based deprescribing tool was developed by a team of health professionals to help doctors and their patients look at a list of medications to decide if some should be stopped or changed. The medications are ranked in order with those least safe or effective at the top (consider stopping first) and color coded.
Website A Practical Guide to Stopping Medicines in Older People
From the Best Practice Journal.
Adobe PDF Monitoring with Assessment Cues
Detailed tracking may be used to prompt discussion, notice patterns, interpret unmet needs, and look for person-centered and non-pharmacologic interventions.
Website INTERACT Stop and Watch Early Warning Tool
INTERACT Stop and Watch, designed for use by all staff and family members provides a way recognize early warning signs of changes in resident condition that need clinical follow-up. Combine with education on signs of adverse medication consequences.
Website IA-ADAPT Program
From the Iowa Geriatric Education Center, this website includes lectures, reference guides, and other information on appropriateness, risks, and benefits of antipsychotic medications for individuals living with dementia.
Adobe PDF Antipsychotic Medication Reference
This chart lists indications, off-label uses, and adverse/side effects for antipsychotic medications.
Consumer Awareness Tools
Adobe PDF What You Need to Know About Antipsychotic Drugs for Persons Living with Dementia
Fact sheet from the AHCA/NCAL Quality Initiative.
Website Encouraging Comfort Care: A Guide for Families of People with Dementia Living in Care Facilities
Equip yourself to ask good questions aimed at obtaining the best care for your loved ones, including a handy checklist of comfort care measures to be discussed with staff members at your long-term care community.
Adobe PDF How to Respond When Dementia Causes Unpredictable Behaviors
This brochure includes information on common expressions of unmet need and distress, tips for responding, and strategies to proactively address resident needs.
Adobe PDF Assessment and Care Planning Fact Sheet
This fact sheet explains the concepts of resident assessments and care planning and offers advice on how to increase resident and family involvement. From Consumer Voice.
Adobe PDF Individualized Assessment with Behavior Symptoms Fact Sheet
This fact sheet provides background and guidance for a constructive care plan conference. From Consumer Voice.
Adobe PDF Recommendations for Assisted Living Residences and Nursing Homes - Phase 1 & 2
Recommendations cover fundamentals of dementia care for areas such as preventing falls, family support, pain management, food and fluid consumption, and wandering. From the Alzheimer's Association.
Adobe PDF Recommendations for Assisted Living Residences and Nursing Homes - Phase 3
Phase 3 of the recommendation focuses on end-of-life care with topics such as decision making, psychosocial and spiritual support, and coordination of care. From the Alzheimer's Association.
Website Alzheimer's Association Daily Care Topics
The page contains a comprehensive list of resources targeted towards caregivers with information about respite care, stress reduction, and techniques to improve care.
Website Nursing Home 411
This site includes numerous resources for care of individuals living with dementia, with a focus on avoiding the use of antipsychotic medications.

Step 5 – Engage  >

Engage

Engaging stakeholders creates a robust and successful quality improvement project. Use these fact sheets to start the conversation and encourage everyone to be involved. A story board is a wonderful, visual way to engage your community in the project, keep everyone in the know about new changes that are being tested, and share your challenges and successes along the way.

Storyboard Guide
Adobe PDF Storyboard guide from QAPI
Use this guide to create a compelling poster to keep your community engaged in your project, monitor your progress, and celebrate your success. Print outcome trend graphs from your Campaign account to document your change!
Staff Handouts
Adobe PDF Staff Fact Sheet: Addressing unmet needs in individuals living with dementia
Adobe PDF How to Respond When Dementia Causes Unpredictable Behaviors
This brochure includes information on common expressions of unmet need and distress, tips for responding, and strategies to proactively address resident needs.
Adobe PDF Find mini-videos in the Understanding and Responding to Unmet Needs section of our Create Improvement Page
Consumer Handouts
Adobe PDF Consumer Fact Sheet: Avoiding unnecessary use of antipsychotic medications
Adobe PDF What You Need to Know About Antipsychotic Drugs for Persons Living with Dementia
Fact sheet from the AHCA/NCAL Quality Initiative.
Adobe PDF More useful resources in the Consumer Awareness Tools section of our Create Improvement Page

Step 6 – Monitor & Sustain  >

Monitor & Sustain

Once you make a change or an improvement, it’s important that you continue to collect and submit your data to ensure your improvements are working.

Step 7 – Celebrate Success  >

Celebrate Success

Too often we let accomplishments pass by without notice because we are already moving on to the next step. But, it's important to take a moment to celebrate accomplishments, big and small.

A celebration program can create a spirit of community in your nursing home. Use visible awards such as certificates, plaques and other tangible rewards that can be proudly displayed. Try giving a spontaneous award from time to time to acknowledge people who are going the extra mile.

More resources on their way. Please check back soon.

Back to Goals  >

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