The model of Attention in our Day Care Centres is based on our interdisciplinary teams’ conduct, which is the result of their professional training, research and experience. It is also based on the shared idea of how we must deal with any particular case.
ATENDO model is the combination of a kind of geriatric assistance and a method which combines traditional programmes with the use of the new technologies to improve stimulation. All actions are based on the individual. They are also examined regarding all their dimensions (geriatric assistance centres which are focussed on people), as well as families or carers’ support, and all this is always carried out in a rehabilitating and preventive environment.
Approach and objectives
En los centros atendo se presta atención integral a personas mayores en situación de dificultad, bien sea por causas médicas (como consecuencia de enfermedades crónicas fundamentalmente), por merma de su autonomía personal (pérdidas funcionales), por algún grado de deterioro cognitivo o patología psicogeriátrica (demencias, síntomas conductuales) y/o por problemática social sobrevenida (dificultad familiar para la atención y cuidados).
Ante este perfil de persona usuaria y en el entorno asistencial de los centros de día, proponemos un método de trabajo propio que a modo de herramienta nos permita ofrecer una atención integral y de calidad a nuestros usuarios y cumplir los objetivos de actuación planteados.
Nuestros objetivos asistenciales son:
- Promover en los usuarios el mayor grado de autonomía posible.
- Mantener y mejorar sus capacidades residuales.
- Favorecer su permanencia en el entorno familiar en las mejores condiciones y el mayor tiempo posible.
- Evitar o retrasar la institucionalización.
- Formar, informar y apoyar a las familias y cuidadores.
- Ofrecer a familiares y usuarios una referencia que mejore su calidad de vida.
Concepts and definitions
INITIAL GERIATRIC ASSESSMENT (henceforth IGA)
It constitutes the key tool for old people’s assessment in both primary health care and specialised assistance (where it is used as a basic element for geriatrics). It consists of a global and multidimensional assessment of the patient from the physical, functional, mental and social points of view, and in an integrated way.
The IGA identifies old people’s problems, ability and needs in order to treat them and monitoring the changes.
Our proposal includes integrating the IGA as a basic part of geriatric assistance so that each one of the professionals in our interdisciplinary team (both medical and non-medical staff) can be able to adapt it to their own discipline and to the team’s work. In other words, each problem or evaluation of a user will be revised from a quadruple views standard: physical-medical, functional, mental and social. Every professional will know and use the IGA as a system to deal with old people specific assistance.
We think that our interdisciplinary staff can and must be trained to use the IGA as the key tool for evaluation and control, by adapting it to each professional competence (psychologist, doctor, speech therapist, physiotherapist, social worker, geriatrician, social trainer, etc.)
THE PERSON AS THE CENTRE OF ATTENTION FROM RESPECT
Our day care centres can be defined as geriatric assistance centres, which are orientated towards the care of the elderly and their family and carers’ support.
The diagnoses, assessments and professional criteria we apply to our staff’s training and status help us to improve assessment when dealing with problems and to plan and to give the most appropriate treatments to our users. However, old people suffering from cognitive, sensory or emotional impairment might not always come to terms with that good will.
It so happens that those patients do not often tolerate reorientation or the shock of a reality that is beyond their control. It is precisely at this point when the intervention becomes an imposition. We realize that the word ‘intervention’ might sound as an action invading a person’s private life. In other words, as if we were interfering in their life or trying to curtail their freedom.
Those circumstances make organization, schedules, rotations and resources optimization clash with the individual’s will of doing another thing or simply “not doing what you tell me”. It is at these moments –which are so common in our daily practice – when we must foster individual respect and adjust our programmes and organization to our users’ personal preferences and their ability to make decisions.We think that many people suffering from dementia can express their needs by means of that behaviour, in much the same way as we use spoken language. Therefore, we shall treat them respectfully. We must also fulfil our professional criteria, but suiting them to each person.
We work with human people in all their dimensions: moral, physical, mental, social and cultural. Above all, we pay special attention to the fact that every person is unique and they must be treated as individuals because they are valuable in themselves.
Respecting people is more important than our professional considerations, diagnoses and assessments. It is even more important than our organizational aspects or our resources arrangement.
INTERDISCIPLINARY TEAMWORK. OUR STAFF
Teamwork is characterised by having a common objective and interdependence among the actions of its members. It is also characterised by accepting and assuming the existence of the existing working rules. Performance and responsibility are shared. Besides, there is a feeling of belonging and cohesion. .
Our team compositionis multidisciplinary in order to assist our users in an integrated way.
- Director / Coordinator / Neuropsychologist
- A doctor having a diploma in Geriatrics
- Social worker
- Speech Therapist
- Social integration specialist
- Occupational Therapist
- Geriatrician assistants
- Others: driver, chiropodist, hairdresser, carer assistant, students…
Attitude towards the team members and to the organization of the centre:
- Responsibility for fulfilling the own competences as well as the team’s labour.
- Respect for the organization and the different professionals.
- Honesty and sincerity.
- Cooperation and trust in interdisciplinary work.
- Facilitating attitude which is based on finding solutions.
- Reaching a consensus.
- Conflict resolution.
- Readiness to innovate and get new perspectives.
- Initiative and proactiveness.
- Flexibility and ability to adapt to change(s).
- More and better decisions
- More elaborated actions
- Higher innovation and creation capacity
- Stimulus to make progress individually.
HELPING NON-VERBAL COMMUNICATION.
There are two basic types of communication which are fundamental to human interaction. Non-verbal communication is the most important regarding our users, especially those suffering from cognitive impairment or having sensory deficits.
Non-verbal Communications refers to body language, gestures, facial expression, posture, movements, sign language, tone, etc. This is how they transmit their emotional state or mood to the rest of people.
The more advanced the dementia and affected comprehension and expression, the bigger the disparity between spoken language and non-verbal communication. In these cases, our reference will be body language (“we will pay more attention to the music than to the lyrics”).
In all the cases, we must match our non-verbal communication (by means of spoken language) with the person’s cognitive and sensory state. There comes a moment when cognitive impairment is so serious that “how we tell them” becomes more important than “what we tell them”.
Next, you can see some of the techniques that we use in order to increase our user’s motivation and to foster positive communication in our centres:
General rules for verbal language:
- Treating the person respectfully and in a good mood.
- Speaking precisely and slowly.
- Uttering short sentences. Adjusting the pace of dialogues.
- Giving enough time to understand and answer.
- Asking simple questions, which are easy to answer.
- Avoiding excessive correction.
- Help to find the word log on or pick up the thread.
- Paraphrasing: retelling words or phrases to the person.
Regarding non-verbal communication:
We must always have an appropriate and positive attitude and/or mood; we shall smile and be very descriptive, i.e.: using sign language; we must keep eye contact as well as behave appropriately –by means of gestures-. Our posture should have a relaxed appearance and we shall be close to our patients, but never invade their personal space. Our tone must be kind and our volume should be appropriate. We must never scold or correct them excessively and/or systematically. Our attitude must be assertive and we must not behave as if we were punishing or reproaching them for something.
We must never forget that, when dealing with the degenerative process of any kind of dementia, emotional memory is the last one to be lost. Therefore, the aforementioned techniques to help communication are essential.
“When you can heal someone, look after them”
The users in our day care centres are very varied depending on their general, physical and mental conditions. Therefore, we must not only look after [according to Collins Dictionary, “if you look after someone or something, you do what is necessary to keep them healthy, safe, or in good condition”] them, but they should also felt well cared for. In other words, it is important for us that they feel both they are in safe hands and well cared for.
In order to do so, it is necessary to meet our patients’ basic needs as well as helping whenever necessary: from personal hygiene, feeding and mobilization to helping them cope with feelings of loneliness and/or fear of what might happen.
Similarly, apart from looking after the user and make them feel cared for, it is also essential to be even closer to their family and make them feel they can trust us regarding both our professionalism and services. Besides, we want them to know that we will be there for them when the hardest times arise. It is vital to grant care continuity (at other care levels, if necessary), as well as cutting the level of anxiety down so that doubts or uncertainty about an incorrect diagnosis may disappear: “when they get worse, when they cannot move, when they do not eat…”
ASSITANCE BEFORE DIAGNOSIS
We use this care principle in order to highlight the importance of assisting the elderly.
The advance in technological medicine is overwhelming and it is parallel to the decrease in the amount of time devoted to each patient: talking and listening to them. Both a personal interview and personalized attention are, nowadays, a luxury that only a few can afford. So much so that, even if the elderly undergo a great variety of tests carried out by devices and machines, they feel that nobody tells them what is going on or listens to them or touches them (they aren’t even seen, since doctors might be watching our for the screens). In a word, they feel unattended. The elderly do not link diagnosis to devices, but to the moment when they have been examined, consulted and assisted.
In a world where technological health advances are the order of the day and technical medicine is the paradigm in any health field, we want to highlight that, in many occasions, assistance is more important that diagnosis when dealing with old people. Feeling well cared for in order to reach a diagnosis is an essential step without which, the treatment or medical prescription would be less reliable or adhered than when dealing with primary health care attention. Therefore, emphasizing both human contact and the affectionate link between professionals and their patients is essential.
FUNCTION BEFORE RECOVERY
Maintaining our users’ functional capacity is they main aim after our work. Nowadays, it is common that the health care programmes for the elderly are some kind of extension of those used when treating younger people. They aim at recovering processes.
When dealing with geriatric assistance, it so happens that illnesses tend to be multi-pathological, chronicle and disabling. On the other hand, the way they appear and their clinical expression are different. In the case of the elderly, they need both consistent assistance and rehabilitation.
The current medicine can control that load of chronicle symptoms, but it cannot heal them. In many occasions, keeping functionality is more important than finding non-viable recovery.
It is very common to see cases of therapeutic fierceness in order to find the recovery of an old person’s serious health problems. Consequently, they end up loosing their left ability to preserve functionality, which was enough to keep both a certain degree of autonomy and quality of life.
AN INTERVENTION METHOD
The programmes to assist our users are the result of a combination of cognitive stimulation and rehabilitation traditional programmes and new technologies programs.
TRADITIONAL OR “PENCIL-AND-PAPER” PROGRAMMES
1. Functional Therapies
- Gerontogymnastics Functional Rehabilitation Mobilization programme Programme to train/improve daily life activities (DLA) Psychomotricity
2. Cognitive Therapies
- Reality orientation Reminiscence programme Psychostimulants Specific neuropsychological rehabilitation Programme for sensory stimulation Interactive minds (programmed dialogues)
3. Psycho-affective Therapies
- Therapeutic groups (group therapy)
4. Socializing Therapies
- Ergotherapy. Music Therapy Communication and social skills groups Conversation groups Activity programmes for special days
NEW TECHNOLOGIES PROGRAMS
The introduction of the new technologies improves intervention, creates new skills and fosters refined work.
This model is based on the “therapeutic surprise”:
- Unexpected, but with a rehabilitating aim.
- It produces higher interest and creates expectation.
- It makes the learning of new concepts possible.
- It stimulates imagination.
- It breaks the supposed old people’s convenience.
- It allows a better control of the session on the part of the therapist.
- It is more focussed on the person’s undamaged part than in the deficit.
Interventions are specific and planned.
They are integrated in all our activity plans dealing with technology.
Activities can be individual or in groups (tournaments and competitions using WII and Play Station + Eye Toy Consoles) .
- Prelingua Program in order to increase lung capacity, as well as voice tone and pitch.
- Functional Rehabilitation Programs: WII Sports, Eye Toy, Balance (individual and in groups). Balance board.
- Cognitive Stimulation Programs: JClic, Sebran, Presentations, Internet, Photos and Videos, Riddles, Hangman, Blocks, Trivia, etc.
WII Console Program Aims:
- Improving the psychomotor coordination of upper limbs.
- Getting more and better mobility of upper limbs.
- Improving visuospatial perception.
- Cognitive stimulation by playing board games such as Trivia or Cranium.
- Increasing self-esteem by carrying out activities which deal with the new technologies.
- Entertaining through games and social activities which have rehabilitating purposes.
Evaluation, Planning, Intervention and Proactive Revaluation
As it can be seen in the chart, our model follows a working outline that is based on the next structure:
There is an integrated evaluation from the interdisciplinary staff. We use both the IGA tool as well as the ancillary principles as a guide in order to identify both an old person and their family’s problems and needs.
Planning a made-to-measure intervention, including both attention and care plans. We also design objectives during this phase.
During the intervention phase, we apply the programmes which have been adapted to the person. They combine both traditional methods and new technologies programs and they also use the therapeutic surprise. Matching attention and follow-up gives way to the staff’s knowledge, professionalism and poise.
Finally, there is a proactive revaluation which pursues changes, either daily ones or those coming from our staff meetings regarding the protocol. Changes will be introduced according to the result of the revision.
At the same time, other processes take place: the new user(s) welcome, their period of adaptation and integration, together with that of their carer(s) and/or relatives, who are individually supported. They also receive a periodic planned training in groups.
Internally, our team carries out a research (studies, essays collaboration, etc.), innovation and development (intervention programmes, projects, techniques, strategic changes, etc.). Both continuous teaching (courses, seminars, guiding, etc.) and training foster feed-back and promote a constant development of innovation.