The Memory Unit OT

For those of us working in a long-term care or skilled nursing setting, getting an evaluation for a resident with dementia or memory impairment may feel like a challenge. Typically the documentation systems that are used by rehab departments in these settings are highly clinical and highly rigid. They often require therapists to ask specific questions in order to obtain specific answers to fill in drop-down boxes or fill-in-the-blank narratives.

Evaluating clients living with dementia require as much flexibility and patience and treating them does. There are small, simple changes in attitude and mindset that can make evaluating persons with dementia WAY less stressful (for you and the patient).

1. Get a Clear Picture of Why You’re Evaluating this Person. Read the medical history. Get a sense of their baseline status. Review their course of hospitalization or recent decline. Talk with their families, nursing staff, and care partners about their prior levels and the changes that they are noticing in your patient. Talk with your rehab director about why this individual was referred to you. Do they have pain? Have they had a change in mood or behavior? Are they not eating as much? Are they having a hard time transferring? Get the full picture of why they are being presented to you for an evaluation so that you are as prepared as you can be.

2. Try to Offer Comfort and Consistency throughout the Evaluation. If you’re patient is comfortable in their room, do the evaluation in their room. If they’re wandering the hallways, walk and talk with them. If they’re sitting outside with their family, join them outside. Try your best not to disrupt the current environment/setting that you find them in, working to calmly redirect to something safe or productive if they are in distress.

3. Include their Families and/or Closest Care Partners in the Process. These people are going to be your allies throughout the evaluation process. Often I find that family members can help provide direction and answer questions to keep the evaluation process flowing, even if the patient themselves is having a hard time understanding what exactly we’re doing. Families and care partners are also the ones who can answer those questions about prior level of function and previous status.

4. Introduce Yourself. Keep using your own name throughout the evaluation to establish rapport. Smile. Make eye contact. Speak directly to your patient about what you’re seeing and what you’re planning to do with them. Even if they can’t remember who you are or what you recommend or advise, treat them like a human adult who has a right to know what their healthcare is expected to look like.

Bottom line, the evaluation process needs to be as flexible and client-centered as your treatments do. We’re not trying to fit these individuals into the box of drop-down menus and standardized tests that fit perfectly into a 45 minute evaluation code with 15-30 minutes of added treatment time.

Be patient. Be calm. And remember that it’s okay if you don’t get all the information on day one. Dementia often requires ongoing assessment and observation across multiple days in order to get the clear picture of what an individual needs.