November 16, 2016
By Mountain-Pacific
When a nursing home resident with dementia could no longer feed himself, a Mountain-Pacific Quality Health Positive ApproachTM to Care (PAC)-certified staff member went to the facility to train staff and work with the resident. Facility staffers learned the Hand Under HandTM feeding technique and how to interact with the resident using PAC methods to improve quality of life. Eventually the resident could feed himself independently. This success story is one of many where the PAC and Hand Under Hand techniques brought successful results to facilities partnering with Mountain-Pacific.
Pamela Longmire of Mountain-Pacific, a certified PAC educator, recently worked with the Community Nursing Home of Anaconda’s staff and a resident to teach a technique designed to enable the resident to feed himself.
This interactive training empowers nursing home care partners to transform the quality of care they deliver to their residents. By applying what they learned at the PAC training, care partners are better equipped to offer care that maintains residents’ dignity and helps residents be more independent. Longmire promotes the term “care partner” over “care giver” when referencing to frontline nursing home staff, as “care partner” focuses on providing care with residents and reminds staff to focus on residents’ strengths and abilities.
“It’s all about preserving the dignity of residents and it’s about helping them maintain their skills so they can maintain their sense of self-worth,” Longmire said.
Background and staff’s first attempt
The Community Nursing Home of Anaconda is a 62-bed, long-term care facility located in western Montana. In late 2015, the facility had a resident with severe dementia who was temporarily placed in an acute, extended-care hospital. When he returned to the nursing home, he had functionally deteriorated to the point where he could no longer feed himself. After receiving the PAC training, nursing home staff helped feed him using the Hand Under Hand technique. The technique was developed to help patients with dementia regain motor memory by triggering the brain areas that prompt motor coordination skills, like picking up and moving a fork.
“During day one we attempted feeding the resident using the Hand Under Hand technique but observed no visible benefit,” said Nursing Home Director Kristi Danforth, RN.
On the second day of using the Hand Under Hand approach, the resident took the staff member’s hand and brought it to his mouth. By the end of the week, the resident was eating independently. Unfortunately, the improvement did not last long. Staff began feeding the resident to save time, once again making the resident dependent on them and unable to feed himself.
Empowering staff through in-person education
A staff member sent Longmire a picture of herself working with the resident. Longmire immediately noticed the staffer was incorrectly positioned when using the Hand Under Hand technique. Longmire traveled to the facility to conduct a second in-service training with staff. During the training, half of the staff did not believe the resident would be able to regain motor functions. Longmire was confident, however, and after the staff training she worked with the resident and his care partner during dinner to demonstrate one-on-one how to approach the resident using PAC and Hand Under Hand techniques.
Using the Hand Under Hand technique during dinner, Longmire gently guided the resident through the eating process. By correctly positioning herself and touching her palm to the resident’s hand, she comforted the resident and began to build trust. After five minutes of working with him, he was self-feeding while staffers looked on.
“Frequently, when utilizing the Hand Under Hand technique with the care partner holding the spoon with their skill fingers, the resident’s motor memory returns,” Longmire said while reflecting on the experience. “We get so busy that we forget to look at things from the resident’s point of view. We always need to be cognizant of what is best for the resident.”
When working with residents who have dementia or a decline in memory or cognitive skills, the approach has to be tailored, incorporating some key PAC techniques. “It is the subtle differences that impact the outcomes when working with someone with dementia,” Longmire said. “For instance, if a resident is sitting down, a care partner should get down on his or her level to talk to the resident without standing over him or her. Talking slower and using shorter sentences is another technique, as is being aware of a person’s dominant side and placing yourself on that side. If someone is right-handed, the preference would be to sit or stand to that person’s right side during all interactions.”
Restoring dignity while reducing costs
The in-person training conducted by Longmire gave staff a new set of skills and tools when working with their residents.
“The Hand Under Hand and Positive Approach techniques we learned from Pamela are used by several staff,” said Danforth. “The demonstrations that staff practiced during the education were so memorable, because they helped staff understand how the resident feels. I attribute the staff’s success to not only hearing, but doing.”
In addition to helping a resident gain his independence during meals, another positive outcome of his ability to feed himself are the cost savings. Staff no longer have to dedicate their time to helping him eat. If it took about five minutes per meal to help the resident, and multiplying that by three meals a day, seven days a week, staff have regained an hour and 45 minutes per week, or more than 90 hours per year. That is time that can be given back to residents in other ways.
Personal experience spurs passion
Longmire has a great interest in working with people with dementia, because the condition has personally affected her and her family.
“Years ago my father had vascular dementia,” Longmire explained. “During the course of his disease we didn’t know many things, and our lack of knowledge harmed his quality of life. I now know that there was so much we could have done to improve his quality of life. If we had known the power of PAC, music and validating him, there is not a doubt in my mind that we could have made his life so much more joyful and less heartbreaking for all of us.”
Longmire says the love and respect she has for her father’s memory are what spurred her interest in caring for people with dementia and why she pursued PAC certification.
If interested in learning about PAC and Hand Under Hand techniques, please contact Longmire: Pamela.Longmire@area-H.hcqis.org
About Mountain-Pacific—Mountain-Pacific is a 501(c)(3) nonprofit corporation and holds federal and state contracts that allow them to oversee the quality of care for Medicare and Medicaid members. Mountain-Pacific works within its region (Montana, Wyoming, Alaska, Hawaii and the U.S. Pacific Territories of Guam and American Samoa and the Commonwealth of the Northern Mariana Islands) to help improve the delivery of health care and the systems that provide it. Mountain-Pacific’s goal is to increase access to high-quality health care that is affordable, safe and of value to the patients they serve.
www.mpqhf.org