Strength Based Care Planning
What is Strength Based Care Planning?
People with dementia retain many valuable life-long abilities despite the significant amount of care they need by the time they enter a nursing facility. Residents with the same diagnosis, or who appear at first glance to be functioning at the same "stage" or "phase", will demonstrate a wide range of retained abilities to perform a variety of activities independently or with varying degrees of help on a daily basis. For example, a former boy scout leader will be able to facilitate a group sing-a-long and coach others to sing many songs remembered by rote even though he often loses his train of thought during social conversation.
The resident retains far more abilities than are lost over the greater part of the course of progressive dementias like Alzheimer's and related disorders, and WHO HE IS (the PERSON) exerts more influence on his behavior than what he has (a Dementia). It is important, therefore, that the resident be encouraged to perform those actions and activities which rely on retained abilities, also called STRENGTHS, for as long as possible to optimize independence.
Without addressing ways to support and develop the resident's remaining strengths, "excess disability" - the loss of ability to function due to factors other than those due to the dementia itself - may occur, increasing the amount of care required and diminishing quality of life for the resident.
Unlike the traditional maintenance or "preventing deterioration" approaches to dementia care, building on retained cognitive and daily living skills is preferable because it:
- improves life satisfaction for residents and staff
- reduces burden for already busy caregivers
- supports retained abilities leading to better adaptation to the environment
- provides an atmosphere of care geared toward successful outcomes including improved functional status
The interdisciplinary team should present an interdisciplinary, comprehensive, holistic picture of the resident's unique profile of abilities and disabilities to determine if some of his/her abilities are not being supported in daily care and then plan interventions to prevent excess disability. If excess disability is allowed to occur, staff will:
- increase the amount of time needed to care for the resident
- send the message that the resident is not expected to do for him/herself, or try to be self-sufficient at all, which is to go against normal procedure, perhaps provoking criticism from some staff
- discourage any potentially adaptive problem solving behavior or attempts to behave independently.
If we encourage residents with dementia to practice their retained skills in collaboration with us, we make them part of the "team" by giving them a voice in deciding how they will spend their time in ways that are meaningful for them. When resident preferences are included in the solution the resident joins with us to solve problems. This promotes feelings of self esteem for residents and care providers.
Problems and Strengths
While the Resident Assessment Protocol (RAP) triggers from the Minimum Data Set (MDS) assessment are stated in "problem" mode, it is helpful to identify resident strengths in the MDS which the care plan may build upon to reduce the severity, frequency or intensity of an identified problem. In so doing, our aim is to improve functioning, rather than to prevent deterioration.
This type of assessment serves as the basis of attempts to reduce problems and achieve improved function, quality of life and resident satisfaction.
This strength-based approach makes it possible to collaborate with the resident's wish to retain independence by helping the resident use his/her natural repertoire of competent behaviors to achieve mastery of the environment.