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Section 27
Making Time for Alzheimer's & Low-Functioning...
with Sample Care Plans to Save you "Documentation Time"
Table of Contents | NCCAP/NCTRC CE Booklet
Small Specific Obtainable Goals
Do you feel you spend a lot of your time doing documentation? Part II of this Manual should save you some time in documentation. I feel the key to success in writing Care Plan Goals for Low Functioning and Alzheimer's residents is to find a goal that is so small and so specific that when you revise your Care Plan in thirty to ninety days, you can show some type of change for the resident either improving or declining.
In Volume Two of this series, we discussed "Vocalization - Noise, Sound, and Word." Based on the information from that section, you may write a Goal for an extremely disoriented resident, "To name a picture…" However, if the resident does not even vocalize, nor does the resident have eye contact with the picture, the Goal "to name the picture" will always stay the same, because it’s too high or too complicated for the resident who cannot even say word. Thus, the key to writing Care Plan Goals that are appropriate for your resident, becomes writing small, obtainable goals. For example, for the resident just described regarding "naming a picture," like saying the word "tree" or "daughter," breaking the Goal into smaller part, the Goal revisions might encompass the following sequence:
Goal: To make noises in relationship to the picture…
Goal: To name the picture…
However, due to the nature of Alzheimer’s disease, dementia, delirium, and so on, many residents progress downward. So perhaps your goals would go in reverse order:
Goal: To make noises in relationship to the picture…
Goal: To have eye contact with the picture…
Goals obviously always need to be realistic. If you have unrealistic goals, CMS Surveyors will probably feel that you do not know your resident's capabilities and/or limitations. Chances are you will receive a deficiency in Activities if you have a goal for a resident to name a picture, and that resident is usually in a semi-comatose state. Therefore do you agree that you need to avoid the temptation of setting pie-in-the-sky, unrealistic goals in hopes of accomplishing the impossible, but sounding "good" on paper?
Simplify your Documentation with a “Resident’s Notes Folder”!!
If you already haven't done so, consider creating a "Resident Notes Folder" for notes, in the format suggested below. You might use a 3-ring folder with one page for specific low functioning and Alzheimer’s residents you are targeting as Priority Residents as described on the DVD, as well as others you select whose program may need some additional attention. Keep this Resident Notes Folder next to your Volunteer Sign-in Book. Computer documents are great but by keeping this next to your Volunteer Sign-in Book you can encourage your staff and volunteers to make entries after each visit they have with your Low Functioning and Alzheimer's residents.
In this Resident Notes Folder, anyone working with the resident can revise a Goal,
revise an Approach, or make a progress note-- even a volunteer!
The format of this Resident Notes Folder intentionally parallels that of your required documentation for Care Plan Conferences. Can you see how this Resident Notes Folder will serve to facilitate your knowledgeable discussion of the resident at your next Care Plan Conference, as well as act as a reference when you are updating your Goals, Approaches, and Progress Notes? In short, volunteers are not allowed behind the nurse's station to pull resident's charts and make entries. But why cut yourself off from this valuable source of knowledge? You may say, "But how do I get them to record in this Resident Notes Folder when they haven't done so in the past?" With your activity staff, you merely tell them that you have expanded their job description, and they are now required to make brief reports in the Folder which can include Goal revisions, Approaches and/or Progress Notes. With volunteers, of course, such an authoritarian approach will cause them to quit. A few may be flexible. But I have found the only way in many cases to implement such a change is to include this in the initial training of your new volunteers as being SOP, standard operating procedure. Don’t have many volunteers? Our Management Series of courses include a DVD course with a Manual entitled, "Recruiting Volunteers, Ideas that Work!"
Behavioral means "Observable"
Behavioral Goals: The following Goals are behavioral. A test as to whether a Goal is "behavioral" or not is whether the Goal is observable or not. In short if you can see it, it is behavioral. For example to "To enjoy the Sing-a-Long..." is not observable. Thus, "To enjoy the Sing-a-Long…" is not a starter phrase for a behavioral Goal. However, "To attend the Sing-a-Long..." is observable. Thus the goal "To attend the Sing-a-Long..." is a behavioral starter phrase for a Care Plan Goal.
Measurable can mean "Numbers"
Measurable Goals: In order to make Goals measurable, phrases containing numbers such as the following might be added: __ out of __ times; for __ ft, __inches, __cm.; to do (activity name) __ times a week; within __ months. Talk to your corporate consultant for the specific requirements in your State based upon your CMS Surveyors interpretation regarding what wording qualifies a goal as being obtainable and measurable. Of course, follow your corporation's guidelines in this and in any other area above what is in our Courses. Our Courses provide generic suggestions that may not be applicable to your situation. Remember the “Residents’ Notes Folder” from above?
Duplicate the Charts…
below and distribute to Staff and Volunteers for their assistance in creating programs and/or making entries in your “Resident’s Notes Folder”. Do you see what a documentation time-saver this is for you?
Residents’ |
Activity "Involvement" Care Plan Goals for |
Simple "Crafts/Art" |
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Arrange objects into categories… |
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Classify objects or pictures by appearance, color, size, or function… |
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Color remaining within lines… |
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Complete three, four, five, six… piece puzzle with assistance… |
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Copy a circle… |
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Copy a square… |
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Copy triangle on request… |
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Cut along 8 inch straight line within 1/4 inch of line… |
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Cut along curved line… |
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Cut on lines… |
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Cut out and paste simple shapes… |
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Cut picture from magazine or catalog without being more then 1/4 inch from edge… |
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Draw a line following a path on paper… |
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Draw a line from left to right… |
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Draw a line from top to bottom… |
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Draw circle, square, triangle, and rectangle… |
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Draw simple recognizable pictures such as house, man, tree… |
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Fold paper diagonally (decoration making)… |
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Hold and examine offered object for at least a minute… |
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Hug and carry doll or soft toy… |
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Identify basic colors… |
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Identify basic shapes… |
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Make a choice when asked… |
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Match three colors… |
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Match basic colors… |
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Match basic shapes… |
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Match similar forms of geometric shapes… |
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Match similar objects/symbols… |
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Match similar pictures… |
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Paste paper… |
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Put halves of picture together… |
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Put together four part nesting toy… |
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Sort by color, shape, and/or size… |
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Stack three blocks on request… |
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Tear simple shapes from paper… |
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Tell what’s missing when one object is removed from a group of three (game)… |
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Trace circle, square, triangle, and rectangle… |
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Trace horizontal lines… |
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Trace pattern (holiday)… |
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Trace vertical lines… |
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Use crayons or pencil to draw pictures… |
Residents’ Names |
"Memory Recall Ability" |
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Anticipate events (soap opera quiz)… |
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Demonstrate understanding of concepts yesterday, tomorrow, tomorrow night as evidenced by... |
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Discriminate time as A.M. or P.M… |
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Identify activities associated with seasons, days of the week and times of the day… |
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Identify day after tomorrow… |
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Identify next month, this month, and last month… |
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Identify next week, this week, and last week... |
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Identify the hour hand on a clock face… |
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Identify the minute hand on a clock face… |
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Identify tomorrow, identify day before yesterday… |
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Identify yesterday… |
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Locate on a calendar today, tomorrow, this week, last week, and next week… |
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Name a major holiday in each season (in an informal conversational, not a test setting)… |
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Name days of week in order (this is appropriate only if in early stages of Dementia)… |
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Name the months of the year in order… |
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Name times of day associated with various activities… |
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Recall 4 objects seen in a picture (use magazine pictures)… |
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Recall details of a story presented orally… |
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State age… |
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State birthdate… |
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State the current date… |
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State the current season… |
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State the current year… |
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State the difference between morning, afternoon, and night… |
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State the months in which major holidays occur… |
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State the months of the year… |
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State the number of months in the year… |
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State the number of seasons in the year… |
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State the seasons of the year… |
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State time durations of common activities… |
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State time to the nearest hour… |
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State understanding of concepts: yesterday, tomorrow, tomorrow night… |
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State what happened before and after an event (going to PT, Activities...)… |
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Tell whether it is morning, afternoon, or night… |
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Write from memory the correct date… |
Residents’ |
"Making Self Understood" and Increasing "Modes of Expression" |
a. "Talking and Conversing" and "Speech Clarity" |
|
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Answer question “What’s this?” with object name… |
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Answer questions beginning with when… |
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Answer questions beginning with where, why… |
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Answer questions beginning with who, what… |
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Answer questions beginning with who, what, where, why, when… |
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Answer simple “how questions” (“How did you sleep last night?”)… |
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Answer yes/no questions… |
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Articulate correctly all speech sounds… |
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Combine noun and verb in two word phrases (go home)… |
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Combine two different syllables in vocal play (la-ba)… |
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Describe a picture in simple words or phrases… |
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Give oral instructions… |
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Greets residents and relatives when reminded/independently… |
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Greets familiar people without reminder… |
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Identify sounds in the nursing home… |
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Imitate voice intonation patterns of others… |
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Increase expressive vocabulary by words each __ week, month… |
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Increase speaking vocabulary by __ words each week, month… |
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Increase volume of voice / Decrease volume of voice upon request… |
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Indicate refusal by saying "no"… |
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Maintain eye contact when speaking… |
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Make contributions to discussions which are clear and to the point… |
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Name action pictures… |
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Name children, spouse, siblings, etc… |
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Name familiar sounds in the nursing home… |
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Name objects in a picture… |
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Orally express own ideas… |
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Repeat same syllable 2-3 times (ma, ma, ma)… |
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Repeat sound made by others… |
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Respond to a question in a complete sentence… |
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Respond verbally when spoken to as evidenced by __... |
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Repeat own sound “___” upon request… |
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Say “Hello” in response… |
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Say five different words (may use the same word to refer to different objects)… |
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Say own name… |
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Speak slowly and clearly… |
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Speak with appropriate intonation… |
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Speak with appropriate phrasing… |
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Speak with appropriate voice projection… |
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Speak with appropriate volume… |
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State own name… |
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Summarize the main idea of a reminiscence story… |
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Tell a story or relate a personal experience in sequence (reminiscence)… |
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Tell about an object or picture using words that describe it (family photo album)… |
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Tell full name when requested… |
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Tell how common objects are used… |
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Use two word phrase (my bed)… |
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Use complete sentences to tell a story… |
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Use complex sentences (My Doctor wants me to walk because...) |
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Use familiar greetings… |
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Use nouns in speech… |
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Use single words meaningfully to label object or person… |
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Verbally express complete thoughts in understandable speech… |
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Verbally express immediate needs (bathroom, drink...)… |
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Ask questions… |
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Vocalize to gain attention… |
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b. Increasing ability to "Write" and "Write to communicate needs" |
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Choose own name cards from group of name cards… |
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Copy any word written in cursive or manuscript… |
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Copy experience charts in manuscript or cursive… |
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Copy lower case letters of the alphabet in manuscript or cursive form… |
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Copy name from sample made by staff… |
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Copy personal data words… |
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Copy the correct date… |
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Copy upper case letters of the alphabet in manuscript or cursive form… |
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Discriminate upper and lower case letters… |
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Draw a diagonal line from corner to corner of 4 inch square of paper… |
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Draw a V stroke in imitation… |
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Identify letters in the alphabet in manuscript… |
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Identify letters in the alphabet in cursive… |
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Identify letters in first name… |
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Identity letters in last name… |
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Print complete name on large line paper… |
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Print first and last name… |
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Print or write first name … |
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Print the letters of first and last name… |
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Read the cursive writing of others… |
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Recognize first name printed or written … |
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Scribble… |
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Trace name through thin paper… |
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Write name in cursive… |
Residents’ Names |
Exhibit "Ability to Understand Others" |
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Answer simple questions with non-verbal response (head nod)… |
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Attend for five minutes while story is read or during conversation… |
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Attend to music or conversation 3-5 minutes… |
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Carry out a series of three directions… |
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Carry out a series of two related commands (pick up brush and brush hair)… |
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Carry out a series of two unrelated commands (brush hair, go to activity)… |
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Carry out simple directions when accompanied by gestures… |
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Choose an object from a group based on verbal description (game)… |
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Control voice volume __% of the time upon request… |
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Extend object to staff and release… |
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Find a pair of objects/pictures on request (use magazine pictures)… |
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Follow an object, visually, moved past midline of body… |
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Follow an oral four-step direction in sequence… |
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Follow an oral three-step direction in sequence… |
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Follow an oral two-step direction in sequence (Slide up in the bed, then lay back)… |
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Follow moving object (give example) with eyes __ out of __ times… |
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Follow sound, moving head… |
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Group pictures into categories… |
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Imitate staff in simple task… |
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Individually take out 6 objects from container… |
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Laughs as an indicator of positive feeling in relation to... |
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Look at person attempting to gain attention by talking or movement… |
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Look in direction of sound or change body movement in response to sound… |
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Maintain eye contact for ___ seconds… |
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Manipulate object in hand when object is placed in hand for __ seconds… |
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Match pictures with corresponding words… |
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Match similar words… |
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Match textures… |
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Nod for “yes” or “no”... |
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Follow three different one step directions without gestures… |
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Open mouth when resident sees spoonful of food… |
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Perform simple gestures on request… |
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Place object in container in imitation… |
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Place object in container on verbal request… |
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Place objects in, on, and under upon request… |
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Point to named picture… |
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Put three objects into a container… |
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Empty container… |
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Quiet or change body movement in response to presence of person… |
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Reach for familiar persons… |
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Reach for object and attempt to grasp it… |
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Reach for offered object… |
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Remove object from open container by reaching into container… |
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Repeat actions that produce laughter and attention… |
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Respond behaviorally to spatial relationship direction: down, up, in, out, etc… |
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Respond to gestures with gestures (friendly wave)… |
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Respond to own name as evidenced by __... |
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Search for sound by turning head in direction of sound… |
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Show response to voice by body movements… |
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Shows response to own name by looking or reaching… |
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Smile in relation to... |
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Shows recognition of (family/staff) by smiles or cessation of “noise”… |
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Smile in response to attention by staff… |
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Smile in response to facial expression of others… |
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Vocalize in response to speech of other person… |
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Watch person moving directly in line of vision… |
Permission is granted to duplicate the preceding charts for staff use. Keep in a visible place for easy continual reference.
NCCAP/NCTRC CE Booklet
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