Skilled Nursing Facility

Tips for dementia resident care

Caring for residents with dementia can be a difficult task, but taking an interdisciplinary approach while caring for residents can go a long way. The following tips on how to approach dementia care are from Caring for the Dementia Resident by Frosini Rubertino, RN, BSN, C-NE, CDONA/LTC, available for purchase here.

  1. Person-centered care. CMS requires nursing homes to provide a supportive environment that promotes comfort and recognizes individual needs and preferences.
  2. Quality and quantity of staff. The nursing home must provide staff, both in terms of quantity (direct care as well as supervisory staff) and quality to meet the needs of the residents as determined by resident assessments and individual plans of care.
  3. Thorough evaluation of new or worsening behaviors. Residents who exhibit new or worsening BPSD should have an evaluation by the interdisciplinary team, including the physician, in order to identify and address treatable medical, physical, emotional, psychiatric, psychological, functional, social, and environmental factors that may be contributing to behaviors.
  4. Individualized approaches to care. Current guidelines from the United States, United Kingdom, Canada, and other countries recommend use of individualized approaches as a first-line intervention (except in documented emergency situations or if clinically contraindicated) for BPSD. Utilize a consistent process that focuses on a resident’s individual needs and tries to understand behavior as a form of communication to reduce behavioral expressions of distress.
  5. Critical thinking related to antipsychotic drug use. In certain cases, residents may benefit from the use of medications. The resident should only be given medication if clinically indicated and as necessary to treat a specific condition and to target symptoms as diagnosed and documented in the record. Residents who use antipsychotic drugs must receive gradual dose reductions and behavioral interventions, unless clinically contraindicated, in an effort discontinue these drugs.
  6. Interviews with prescribers. The prescribers must validate the reason for using a psychopharmacological agent or any other interventions. The survey team will conduct interviews with the physician, other primary provider (nurse practitioner, physician assistant), behavioral health specialist, pharmacist, and other team members to evaluate the process of care.
  7. Engagement of resident and/or representative in decision-making. Residents and/or their family or representative must be involved in the discussion of potential approaches to address the behavioral symptoms. These discussions should be documented in the medical record.