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DD-4. New Innovations: Enhancing the Lives of Individuals with Developmental Disabilities. Tuesday, October 9, 2007. 8:00am – 10:00 am Presented By: Marisa Geitner, Executive Vice President, Chief Operating Officer Ruth Benjamin RNC, CDDN, CLNC

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dd 4 new innovations enhancing the lives of individuals with developmental disabilities

DD-4. New Innovations: Enhancing the Lives of Individuals with Developmental Disabilities

Tuesday, October 9, 2007. 8:00am – 10:00 am

Presented By:

Marisa Geitner, Executive Vice President, Chief

Operating Officer

Ruth Benjamin RNC, CDDN, CLNC

Director of Health Management and Research

Heritage Christian Services, East Rochester NY

heritage christian services
Heritage Christian Services
  • Support over 1,400 children and adults with developmental disabilities in Western New York
  • Provide residential and day habilitation, respite, clinical supports and service coordination
innovations in care
Innovations in Care
  • Residential homes for seniors with disabilities
  • Residential “right sizing”
  • Telehealth
  • Day services for seniors and medically frail
  • Hospice care
design elements
Design Elements
  • Consulted experts in dementia and visual impairments
  • Designed the home with a circular design for people who wander and supervision levels
  • Natural lighting
  • Single bedrooms
sensory garden
Sensory Garden
  • Facilitates independence in a safe environment
  • Quiet and reflective atmosphere
  • Sensory input from variety of colored flowers, flowing water, and scents from flowers and herbs
safety features
Safety Features
  • Therapy tub and walk-in shower
  • Doors with subtle alarms
  • Windows with stops installed- only open 6 inches
modifications that can benefit the aging person
Modifications that can benefit the Aging Person
  • Color contrasts are important for visually impaired
  • Grab bars can be added to the walls in the bedroom
  • Elevated toilet seats, sometimes even a change in the color of the toilet seat is helpful
team approach
Team Approach
  • The focus changes from Res Hab to meet needs and challenges that occur with aging individuals with DD
  • Focus is on maintaining skills and cognitive ability
  • Fulfill goals and dreams as much as possible
residential rightsizing
Residential Rightsizing
  • New funding from NYS OMRDD
  • Enables individuals to have their own bedroom-smaller settings
  • Enhanced therapeutic services
  • Additional funding for staff education
  • Research component
results
Results
  • We want to demonstrate:
    • Smaller environments increase quality of life
    • Smaller environments & improved education improve staff retention
    • Blending therapies produces better individual outcomes
    • Increased physical activity improves overall health
blending of traditional and expressive therapies
Blending of Traditional and Expressive Therapies
  • Minimizing physical deterioration that occurs with aging
  • Bringing the therapy to people in the most conducive environment
  • Keeping treatment diverse and interactive
enhanced medical education

Enhanced Medical Education

A 40 hour curriculum

medical education
Medical Education
  • Improving the care to those with significant and complex medical needs
  • Improving retention by supporting staff to be as comfortable as possible serving the elderly and those with medical challenges
  • Understanding the complexity of aging with this population helps us to be more proactive in their care
dsp credentialing

DSP Credentialing

Using the College of Direct Support

continuing education
Continuing Education
  •  Staff Training on aging and DD =  Staff Commitment
  •  Participation in day conferences =  Clinical Knowledge and  Networking
  • Networking
health support professionals

Health Support Professionals

A Heritage Christian designed position

health support professionals1
Health Support Professionals
  • A skilled, tenured staff that receives specialized training from our nursing staff
  • Provides high quality, relaxed, care and charisma to individuals in acute medical needs
  • Where and when they work is determined by the residential and nursing leadership
tele health

Tele-Health

Telemedicine and Telemonitoring

challenges in healthcare requiring us to consider telehealth technology
Challenges in Healthcare requiring us to consider telehealth technology:
  • An aging population increases the prevalence of chronic diseases
  • Increased longevity of medically frail persons
  • Severe, current and projected, shortages of health care professionals especially RN’s
  • Rising cost of health care
  • Health care disparity for underserved populations
objectives of tele health
Telemonitoring:

Increased monitoring results in improved care

Provide accurate, timely data to physician

Telemedicine:

Enhances medical care, provided more timely

Proactive

Reduce unnecessary ER visits

Objectives of Tele-Health
a more flexible and blended day habilitation program
A More Flexible and Blended Day Habilitation Program
  • Purpose:

to provide Day Hab programming while meeting the medical and psychosocial needs of the aging and/or medically frail individual

reasons for flexible day habilitation
Reasons for Flexible Day Habilitation
  • The aging person with DD frequently has a primary diagnosis and secondary medical concerns that exaggerate the aging process and these needs cannot always be met in the traditional Day Hab setting
  • As with the general population, endurance and interests change with age and these are not always addressed in traditional Day Hab settings
benefits of flexible and blended day habilitation program
Benefits of Flexible and Blended Day Habilitation Program
  • Offers the ability to change the day hab activities within the residential setting as the medical concerns of the person change and/or a decline in the persons functional level is observed.
    • Addresses:
      • Increased fatigue
      • Pain management
      • Completion of necessary medical treatments
why medically frail individuals do not attend traditional day hab
WHY Medically Frail Individuals Do Not Attend Traditional Day Hab
  • Respiratory conditions
  • Compromised immune systems
  • Increased exposure to illnesses
  • Intolerance to cold or hot humid weather
why individuals with down syndrome dementia benefit from more flexible day hab
Why Individuals with Down Syndrome & Dementia Benefit from More Flexible Day Hab
  • Calmer and familiar environment with less stimuli
  • Rest periods that address sleep cycle disturbances
  • Less attention on detailed tasks
  • Slower pace
more benefits
More Benefits…
  • Allows for staffing within the home while focus is still community oriented
  • Allows for preferred activities that are meaningful and enjoyable
purpose of providing hospice care in the residential setting
Purpose of Providing Hospice Care in the Residential Setting
  • Provides care that extends to the whole person:
      • Physically
      • Socially
      • Emotionally
      • Psychologically
      • Spiritually
  • Allows the individual to maintain control and dignity
  • Individual is surrounded by familiar, loving, and caring people known as family
purpose of providing hospice care in the residential setting1
Purpose of Providing Hospice Care in the Residential Setting
  • Planning and decision-making directly involves the individual, and all those connected to him or her
  • Provides for the needs of individual’s family, friends and caregivers
  • Everyone involved receives support, as well as gives support
team approach1
Team Approach
  • The Individual
  • Family and extended family of Heritage Christian
  • Friends
  • Residential Nurse
  • Other Agency Clinicians
  • Staff
  • Primary Physician
  • Hospice nurse from an outside agency
  • Chaplains, and spiritual care providers from within the agency
priorities in end of life care
Priorities in End of Life Care
  • Alleviate physical pain, and provide optimal comfort with non medication based modalities (music, massage, distraction)
  • Address & alleviate when possible emotional and spiritual distress
  • Compose individualized plan of care that eliminates all unnecessary medical intervention
  • A plan of care focusing on effective pain management, nutritional needs, bowel management, fatigue, skin integrity, sleep disturbances, changes in mental status, and ability to communicate
  • A plan of care to address the psychosocial needs and desires of the individual. This plan must include individual involvement and be based on individual’s culture, beliefs, interests, and wishes
  • Change plan as frequently as necessary when any aspect of plan is no longer effective
points to consider for hospice plan
Points to Consider for Hospice Plan
  • Discontinue unnecessary medications except pain meds, bowel meds, anxiety meds
  • Eliminate routine VS, I & O, weights andResidential Habilitation plans
  • Educate and support the family, caregivers, QA, and administration as to the plan of care
  • Ongoing education of family & caregivers to the changes in the physical & cognitive processes as death nears
your focus is the individual
Your Focus is the Individual
  • Cultural influences- beliefs, values, respect the individual’s needs to die on his/her own terms
  • Family members’ beliefs also need to be considered
  • Assist the individual to understand what is happening when possible
  • Environment- respect privacy, yet convey compassion, support and presence
  • Meet spiritual needs
  • Alleviate fear and guilt
your focus is the individual con t
Your Focus is the Individual Con’t…
  • The environment is all about who that person is!
  • Visits from family and friends are important
  • Granting last wishes- don’t be afraid, these times are often the most meaningful and cherished not only to the person, but hold loving memories for families, friends & caregivers
your focus is the individual con t1
Your Focus is the Individual Con’t
  • Having familiar staff provide 1:1
  • Favorite foods
  • Favorite music
  • Let the person decide when to complete ADLs
  • Scrapbook
  • Individual decides which med he wants
  • Medicate continuously – do not wait for pain or restlessness to be present – keep sustained level of meds in blood
proper use of hospice
Proper use of Hospice
  • Utilize support systems around you- community hospice nurses, clergy etc.
  • Work as a team
  • Teach those around you
  • Facilitate grieving
  • Reach for support from others and realize importance of self care
resources
Resources
  • Alzheimer’s Association
  • Association for the Blind and Visually Impaired
  • Diagnostic and Treatment Centers
  • Networking-build your own set of experts
  • ANCOR and state trade associations
contact info
Ruth Benjamin, RNC, CDDN, CLNC

Director of Health Management and Research

Heritage Christian Services

349 Commercial St. Ste. 2795

East Rochester, NY 14445

(585) 340-2000

rbenjamin@heritagechristianservices.org

Marisa Geitner, M.S., CCC-SLP

Executive Vice President and Chief Operating Officer

Heritage Christian Services

349 Commercial St. Ste. 2795

East Rochester, NY 14445

(585) 340-2000

mgeitner@heritagechristianservices.org

Contact info
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