| The Current Caregivers Corner | Caregivers Corner Archives |
2003: | January | February | March | April | May | June |
2002: | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep/Oct | Nov | Dec |
2001: | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep/Oct | Nov | Dec |
2000: | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec |

Caregivers Corner

January, 2001

A Montessori-based System of Quality Care for Individuals with Dementia

One of the greatest challenges facing any Alzheimer's disease or other related dementia care operation - whether adult day care, assisted living or nursing home based - is establishing a methodology for the program structure. Most programs have a well-meaning mission statement and philosophy but lack a methodology. Such programs can become mired in confusion and inconsistent care because there is no clearly defined program structure. Even with clear and consistent leadership and staff training, it is difficult to maintain the integrity of a quality program that is lacking in structure.

A Montessori-based system is an excellent methodology for providing quality program structure. This system can be used equally well for staff assisting individuals with their activities of daily living (ADL) care and stimulating activities throughout the day. The original education model developed by Maria Montessori, MD in the early 1900s for multi-aged children was based on her desire to enhance capabilities for each child, promote stimulating educational development, and to assist the children in meaningfully engaging with their environments. Dr. Montessori wisely used a positive presentation focusing on the "can do's" rather than the "cannot do's." These same goals and approaches are supportive for individuals with dementia.

The Montessori-based system uses the following simple steps:

	Observe the resident/participant for clues as to what appeals/works bet for them individually
	Focus on an individual's success
	Keep instructions simple, pleasant and clear
	Provide resident/participant with immediate positive feedback
	Build on individual's skills and capabilities
	Use repetition of task steps to bolster intuitive knowledge
	Use the environment to cue the resident/participant
	Use physical activities to help individuals retain skills and capabilities
	Maintain uniformity in the environment to assist residents/participants to recognize and know their environment
	Share successes in care giving with your co-workers to extend the sphere of knowledge

Once these basic steps are mastered by staff, the system can be integrated into all aspects of the resident's/participant's daily life. For example, the technique of orderly and repeatedly storing personal care items in the same place will assist an individual in cueing for their morning or evening grooming care. By adding the techniques of task breakdown and successful task mastery, the individual gains some independence in maintaining parts of their grooming care while also adding to feelings of self worth.

The Montessori-based system has the added benefit of increasing staff's feelings of success and self-confidence since they are able to tangibly and quickly see positive results of their care. The following is a recent example of this that incorporates many of the Montessori-based steps:

A daytime caregiver was experiencing great difficulty helping an individual in advanced stages of Alzheimer's disease who was non-ambulatory and non-verbally communicative brush his teeth. The individual had serious gum disease and needed the daily dental care to prevent infections. Each morning became a battle to provide the dental care, leaving both the caregiver and the individual spent and unhappy. The caregiver had recently been introduced to the Montessori-based system of care. She decided one morning to implement several of the steps. First she began by carefully observing the resident and his environment. Second, she focused on an approach that would work successfully for the man. Finally, the caregiver rethought how she was communicating to the man and decided she was not being clear or pleasant. Armed with a new understanding and a willingness to a attempt a "trial and error" approach, the caregiver began her task differently. She began by sitting the individual in his wheelchair and taking him to his bathroom sink to do the dental care rather than doing this in his bed. She found he reacted more positively to an environment he as used to being in for dental care. Next. the caregiver placed one toothbrush in the man's dominant hand, and prepared another toothbrush for her use. Last, she spoke clearly and gently to the man indicating that she understood his discomfort with brushing his teeth, and that they would work slowly and carefully together. The combined approaches worked wonders, and by the end of the week they could successfully brush his teeth with both individuals content with the outcome.

Above is just one example of how a Montessori-based system can be instrumental to quality care. This system provides a person-centered system of care that is resourceful, easy-to-implement, affordable, and flexible. By virtue of a positively focused system of care, the outcomes become positive as well. This article was contributed by Karen Love of Falls Church, VA. who is with Pathways to Care, an organization dedicated to excellence in Alzheimer's disease care.

Go to the Caregivers Corner archives.