We provide programs our clients use to improve:
Dementia patient quality of life & staff worklife,
Cost effectiveness of dementia care,
Without medical, polypharmacy, or economic risk.
We do this through easy to use, packaged programs of;
patient individualized behavioral interventions,
integrated staff training tools and support materials,
consulting based, downloaded & mailed programs.
WHAT WE DO
HOW WE DO IT
Each program is  a low cost, easy to use, individualized, nonpharmacological kit for individuals or groups to reduce:
unwanted dementia associated behaviors
use of neuroleptics, one on ones & survey violations
and costs of dementia care for:
Each kit includes interventions, training & support services, discussed with our consultants, appropriate to each clients needs, offered on a risk free basis and proven to be:

inexpensive, reliable and repilicable
provided in well organized & complete packages
implementable by your staff with our assistance
Each program is composed of the following five components:

      Non-pharmacological interventions you & your
       staff use to avoid or minimize unwanted behaviors.
       Self contained kits you use to train your staff
       on the use of non-pharmacological interventions.
       Well documented  tools you use to insure successful   
       program implementation.        
       Reference notebooks, interactive CDs,& research       
       used to expand non-pharmacological interventions.
       Steps including identification of your needs, program      
       design, free trial & evaluation, purchase and future
       program maintainence or expansion.


 
Nursing Homes
Nursing Departments
Traditionally we enter a realtionship with a nursing home through the DON. After a brief telephone conversation we usually provide a telephone in-service for the DON and care team members she feels might be interested in pursing non-pharmacological dementia therapy. The inservice is done in person or via the telephone and internet. Usually the presentation lasts about 30 minutes and is followed by 30 minutes of discussion.We individualize each presentation based upon our previous discussions with your and e-mail appropriate handouts and samples. The presetation provides internet graphics synched with telephone conversation. The presentaion covers the following major points:
Factors driving current & future care for residents with dementia
The problems with conventional dementia care therapies
Some new alternative approaches to dementia care
What it takes, beside money, to implement non-pharmacological dementia therapy
Three alternative ways to begin a non-pharmacological dementia at low/no cost & risk

Below are listed some benefits nursing homes can expect from using non-pharmacological dementia therapy:
Benefit
Measure
Cost Effect
Reduced Yelling
Less yelling frequency & volume  
Rent adjacent bed, reduce aide requirements
Improved Eating
Weight gain, time spent eating
Reduced labor, medical fees & violation fines
Less isolated dining
More group, less assisted eating
Reduced labor (can eat with others in room)
Less Sleep Problems
Time/nights reported out of bed
Reduced labor, improved sleep & health
Less resident stress
Less infections/comorbidities
Reduced meds titration, less violations/fines
Less unsafe wandering
Less fall reports
Reduced risk, medical costs & time out of facility
Increased sociability
# & quality of communications
Less 1 on 1, better family relations & activities
Reduced sundowning
Fewer resident sundowning
Labor use, less resident/staff stress (turnover)
Less incident reports
Reduced ER visits
Less labor, ambulance, medical/medication cost
Less neuroleptic meds
Reduced polypharmacy & ADRs
Reduced labor, staff stress, resident medical cost
Less resident isolation
More activities/communications
Less labor, better family relations, marketability
Reduced aggression
Reduced incident reports,
Reduced workers comp, residents medical costs
Improved esprit de corp
Reduced tardiness, call-offs
Reduced overtime expense & agency fees
Reduced staff turnover
Reduced staff turnover
Reduced recruit/hire/screen/training expense
Empowerment of staff
Increased # aide interventions
Fewer nurse interventions (more time managing)
More staff knowledge
Pre-post tests on dementia
Improved survey (know how to respond)
Less staff depression
Pre-post depression testing
Better job performance, reduced health claims
More staff solidarity
Pre-post employee climate test
Less agency fees or recrui/hire/screen/expense
Improved overall health
Longer average resident stay
More revenue/resident, less marketing expense
Gain innovator image
More referrals, longer waiting list
Increases occupancy/revenue, less marketing

These benefits assume clients utilize Behavior Science, Inc;  a) pre-installation, b) complete dementia training program, and c) post installation follow-up training, motivation & recognition -To see how your care team can benefit from non-pharmachological dementia therapy please call 800 734 6186                                                                                                         

 
Rehab (Physical, Occupational, & Speech Therapy)
We povide tools and training to access often overlooked reimbursement for dementia patient dehab & restoration. Rehab care plans for dementia patients are are reimbursable under two conditions:

1)  If the patient has some ability to make decisions and:
requires extensive or total assistance or has dependence in 1 or more ADLs
needs no more than limited assistance in all ADL areas but exhibits potential for more self-sufficiency
 2)  no ability to make decision, no memory but
some/rare/no understanding a therapist can develop
maintenance/complication avoidance plans

If the dementia patient is resident in a nursing home, the therapists, under Medicare, may be compensated
for training aides to maintain gains above therpeutic treatments.

Using our interventions therapists should be able to provide interventions that:
1)     Decrease resident refusals for therapy there by capturing full Medicare potential  
2)     Reduce, or over time, eliminate behavior problems associated with dementia
3)     Increase efficacy or productivity of existing therapeutic interventions
4)     Increase resident independence through new therapeutic interventions
5)     Reduce psychotropic drug use & redirect resident expense to habilative therapies

Using our non-pharmacological interventions the cost of our prorams is quickly recovered 4 ways;
1)     Providing OT/ST/PT a tool to bill time formally provided by nursing without reimbursement
2)     Extend habilitation into avoidance of behavior problems improving quality of life  for all residents, improved
        quality of work life for nursing staff both of which translates into lower nursing staff turnover.
3)     Substituting behavioral for pharmacological interventions reduces drug costs, ADRs and polypharmacy  
4)     Companion inerventions to diect therapy reduces patient stress, improves outcomes & extends coverage

Specific benefits for Physical Therapy, Occupational Therapy of our interventions are provided by type of therapy below
 
Physical Therapy

Intervention
Behavioral Explanation
Prescription
Gait Training
Large muscle, depth perception losses + inactivity, poly pharmacy,psycho drugs inrease fall potential
Use implicit learning for patient to learn to tie heavily entrained beat to even gait
Range of Motion
Abbreviated conscious attention span + memory impairment make
ROM participation rates low
Same songs on graduated beat CDs increases patient pace for improved aerobics  & ROM
Neuromuscular re-education
Cognitive losses can create pseudo
losses in coordination and muscle control, need switch to implicit
Music provides background & sung instructions for patient to “learn” ADL procedurally + Montessori
Pain Management
Unexplained pain shorten attention span, distracts wounded conscious
Used to distract patient from pain generated by ROM or elevated pace
Wound Care
Chronic confusion -> stress which depresses immune system
Relaxation reduces cortisol, improves healing and immune response
Improve strength & endurance
Patient easily distracted by pain and confusion which inhibits activity & exercise participation
Music increases participation rate and extends exercise/dance/sing time as it maintains focus (graduated beat CDs)
Orthotic/prosthetic
Loss of conscious processing makes following steps difficult. Need to build procedural memory for activity
May be used as an understood cue to trigger physical exercise e.g. marching, dancing, singing
Functional mobility skills
Habilitation requires greater demands
on attention/cognition than
Patient normally can gather
Music uses entrainment to raise patient attention span, cognition and short term retrieval
Injury prevention
Loss of muscle control, judgment, & memory lead patients to do things with increased patient risk
Retrain patient to make non -conscious decisions avoiding risks using auditory & prosthetic devices  

To discuss how physical therapists can benefit from non-pharmachological therapies please call 800 734 6186                                                                                                         

Occupational Therapy

Intervention
Behavioral Explanation
Prescription
ADLs
Short/long term memory & attention span losses make sequencing through multi-step activities difficult
Patients relearn an ADL using music & or singing to cue ADL steps. Lyrics cue next steps
Adaptive equipment
Earphones may be used to focus attention, tune out other stimulation & accommodate more active patients
Use of earphones to reduce need for stimulation & dangerous activities such as wandering
Safety Management
Patient has a need to self stimulate, move toward or away from stimulation
Use of sensor triggered music to distract patient from unsafe behavior e.g. elopement
Cognition management
Patient neural/chemical deficits decrease coordination of messages and coordination of cognition
Exploit entrainment (Mozart effect) to generate short lived cognitive improvement
Upper extremity,
fine muscle control
Patient “forgets” conscious how to consciously control muscles or that extremity is in fact theirs
Use music to make it easier for patient to “learn” steps in muscle/coordination exercise
Contracture management
Some muscle contracture may be induced though chronic fear/anxiety
Use music to reduce stress induced withdrawal or contracture
Job analysis/modification
Patient retains motor memory from over practiced motions/activities but activating them can be difficult
Use music to provide a background on which the patient learns cues to ADLs or therapy routine
Bathroom safety
Fear of overlit, industrial, cold & threatening bathroom or safety tub causes patient to avoid bath/toilet
Use battery operated CD player in bathroom, to reduce confusion and avoid stress

To discuss how occupational therapists can benefit from non-pharmachological therapies please call 800 734 6186                                                                                                         

Speech Therapy

Intervention
Behavioral Explanation
Prescription
Verbal/written expression
Questioning, testing or any activity with fear/failure potential inhibits remaining cognitive/memory ablities
Use type of music for mood management and to reduced “performance” stress
Auditory comprehension
Attention/memory deficits make expressing/understanding verbal communications increasingly difficult
Use music to sing instructions for improved communications and comprehension
Reading comprehension
See above
Use music to reinforce read lyrics  sing along
Cognition management
Over stimulation, environment or schedule change create confusion stress & diminish remaining ability
Use entrainment to improve attention span and temporary cognitive
Alternative communications
See above (auditory & reading comprehension) which can cause emotional liability or profanity
Use sung communications to improve patient comprehension and participation
Swallowing/dysphasia
Confusion generated by wounded conscious processing of swallowing process inhibits swallowing process
Engineered music hijacks wounded consciousness processing; frees procedural swallowing memory
Sensory Integration
Reduced conscious attention span decreases ability of patient to integrate multiple sources of sensory stimulation
Engineered music may be used to facilitate the introduction of other sensory stimulation and prolong patient exploration and enjoyment
Dysarthia
Muscle atrophy and/or aphasia (e.g. DFL) make speaking difficult or impossible
Use song lyrics for exercise and for regaining speech ability for problems not associated with neural loss
Apraxia
Inability to follow instructions may, relearn/learn new activities actions particularly in Parkinson's or LBD
Some relearning can take place through Montessori techniques or in relation to engineered music

 
Recreation therapists
fTAG 248  Requires "The facility must provide for an ongoing program of activities designed to meet, in accordance with the comprehensive assessment, the interests and the physical, mental and psychosocial well-being of each resident"

Research shows nursing home residents with dementia spend 65% of their time doing "little or nothing" and only 12% of their time engaged in social activities. It has been hypothozied that they may be at a higher risk for understimulation because they lack the initiative to begin or sustain leisure activities.

Additionally residents diagnosed with dementia and related disorders often exhibit behaviors including physical aggression, wandering, handling objects inappropriately, repetitive vocalizing, cursing, and screaming.

These dual behavior patterns makes residents with demetnia difficult to engage in activities and also disruptive to the activities of others. However, RTs can learn to provide prompts & individualized environments to increase engagement as well as recognize pre-cursors to behavior problems thereby allowing them to create and manage individual activity plans for most dementia reasidents. Behavior Science, Inc. provides the tools for RT's to rapidly diagnose behavior problems and indentify individualized, pro-active activity requirements for residents with dementia e.g. Engineered Music, sensory stimulation & sensory rooms, NPO programs.    

 
Hospitals
n a recent study, 95% of the hospitalized patients with dementia were reported to have at least one agitated behavior, 75% had at least one moderately disruptive behavior and 11% experienced 17 or more disruptive behaviors. The frequency of most behaviors did not vary significantly by shift or length of stay but increased significantlywith the use of psychotropic medications. The number of behaviors, their frequency, and levelof disruptiveness were all significantly correlated with staff burden. The study concluded: "The prevalence of agitated behaviors in patients with dementia in long-term-care beds at an acute care hospital is similar to that reported in long-term-care facilities. These behaviors are associated with staff burden".
McCusker, Cole, Abrahamowicz; Agitation in demented patients in an acute care hospital: prevalence,       
        disruptiveness, and staff burden; Int Psychogeriatr. 2001 Jun;13(2):183-97.        




 
Assisted Living SCUs


 
PACE Sites & Adult day centers