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Y O U R D A I L Y
L O N G -T E R M C A R E N E W S S O U R C E
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Results
reflect focus in dementia care When Len Fabiano started working in long-term care 34 years ago as an orderly, people with dementia were most often heavily sedated and restrained. Staff were doing the best job they could dealing with dementia, but for residents, staff and family members, the situation was a deteriorating one, he says. “I knew there had to be a solution,” he told OMNIway in a recent interview. “I’ve spent the last 34 years trying to open doors to find solutions.” His research to find better ways of dealing with dementia goes beyond academic study. Len has lived in countless long-term care homes, experiencing first-hand the life of residents, from eating with them in dining rooms to having staff put him in the tub. “I’ve been described as a zealot,” he says. “Certainly, my work has gone beyond a career to become a passion.” Len has been delivering training for 20 years, with people progressing through behaviour care and management to become specialist leaders. Len is founder and president of FCS International, which has provided three years of training work in dementia care for OMNI staff. In December he begins providing expanded three-day training for OMNI staff in dementia care. “Our job is to show staff the tools,” he says. “But you can have all the tools and they won’t be effective unless staff understands the tools and you have specialist leaders to keep programs going.” If we know what triggers aggressive behaviour by residents with Alzheimer’s or other forms of dementia, we can prevent those triggers from firing, Len said. This is not a hypothetical theory, he said. “Our research is well-defined and well documented.” He cites one recent report from a home where there was an 87 per cent decrease in the use of psychotropic medicine after staff training in behaviour management through the use of supportive measures. Len’s approach is based on the philosophic approach that there are two ways of dealing with dementia aggression. The first is reactive, waiting until the behaviour happens before intervening. The second is proactive, addressing the issues from the moment the resident enters the home. That approach includes a functional assessment of the person, he said. “It is not a diagnostic tool because the person has already been diagnosed but it involves the direction of care,” he says. “If we can eliminate the triggers or stressors that fire the aggressive behaviour, we won’t have that behaviour.” There is a pattern to what happens to trigger dementia aggression, Len said “The client teaches you by their behaviour.” While the ideal is to have all staff using the tools he introduces, the reality in is that there are two types of staff, those who provide resident-centred care and those who are task-focussed, Len said. “The problem is that when the two types of staff work together in a home, they don’t get along and it can be disastrous.” Measurable results in homes can help identify those unwilling to change, he said. “People start to stand out in measurable results such as the amounts of medication used,” he says. With dementia, proactive care begins with a study of a family questionnaire that should be filled out for every resident who enters a home. The disease changes and circumstances change so the behaviour must be managed to prevent the triggers from firing, he says. “If the dementia reaches a point where a person’s behaviour risks the safety of themselves and others, crisis management comes into play with severe physical and chemical interventions often needed.” “We don’t want to get to that stage,” he says. “That is why training and leadership is so important.” According to Len, OMNI is well placed to be in the forefront in behavioural management through supportive measures. The company has already made a strong commitment to supportive measures. OMNI has taken an aggressive stance on training, setting guidelines expected to be met. The aim is to ensure that if you walk into any OMNI home and you will see the same effective behaviour care and management tools in use, from the simple to the complex, says Len. |
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