Dealing with Dementia in a Long-Term Care Environment
Jeannine LeCompte, Compliance Research Specialist
The Centers for Medicare and Medicaid (CMS) has a high standard of expectations and a number of regulatory demands for facilities providing care for those diagnosed with dementia, so it is worthwhile to ensure that staff have a clear understanding of the medical condition and the demands of competency required of all personnel.
Dementia refers to a group of symptoms that together affect the memory, normal thinking, communication, and reasoning ability of a person. Dementia can make it difficult to perform even simple tasks such as eating or bathing. Dementia is usually caused by degeneration in the part of the brain responsible for thoughts, memories, actions, and personality. Death of brain cells in this region leads to the cognitive impairments that characterize dementia.
According to CMS, 47.8 percent of the population of residents living in nursing homes in the US have officially been diagnosed with dementia of varying degrees. The most common type is Alzheimer’s disease, currently affecting more than 5 million Americans. Treatment options for dementia are currently limited to four medications that may slow progression, but the condition is not curable.
Many people with dementia eventually die from other conditions such as heart disease, cancer, or stroke. In the absence of one of these life-threatening conditions, dementia ultimately causes death. Today, Alzheimer’s disease is the fourth leading cause of death among older Americans. Among those who survive to the advanced stages of dementia and require full-time care, the vast majority live in nursing homes.
Symptoms of dementia vary from person to person, although forgetfulness about recent events is the hallmark symptom. It is helpful to know the typical course of dementia to be better prepared to face the challenges ahead. For the sake of simplicity, the course of dementia can be divided among four stages: early, middle, late, and final.
Early Stage:
- Need help with household affairs such as cooking and paying bills
- Trouble managing money and medications
- May get lost or confused when driving
Middle Stage:
- Need reminders or practical help with personal care
- Walking and reaction times will be slow
- No longer able to safely drive vehicles
Late Stage:
- Needs constant reminders or practical help with personal care
- Loss of control of bowel and bladder functions
- Trouble with balance and coordination
- Sleep often
Final Stage:
- Require total assistance with personal care
- Unable to walk and little movement
- Poor appetite and swallowing problems
- Sleep most of time
CMS has specific rules and regulations regarding treatment and staff competency. Failure to meet these standards will result in substandard quality of care for the resident, and the facility may also face potential fraud charges when billing for a level of care which does not meet the minimum CMS requirements.
