Moving Beyond Person-Centered Care to Resident-Driven Communities

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Dr. Cameron Camp

Cameron Camp, Center for Applied Research in Dementia, Michelle Hilgeman, PhD, Principal Investigator, MAP-VA, Lynn Snow, PhD, Co-Investigator, MAP-VA, Jennie Keleher, Implementation Coordinator, MAP-VA, Tuscaloosa VA Medical Center, Christine Hartmann, PhD, Co-Investigator, MAP-VA.

How do residents drive the daily life and changes in your community? In some communities, residents participate in community service projects. They greet new neighbors with welcome baskets when they move in. They have opportunities to teach younger generations. How do you create such a community? Applying Montessori principles can guide you toward the answer.

Montessori 12 Key Principles

The activity should have a sense of purpose and capture interest.

Invite the person to participate.

Offer choice whenever possible.

Demonstrate more. Talk less.

Physical skills. Focus on what the person can do.

Match your speed to theirs. Slow done!

Use visual hints, cues or templates.

Give the person something to hold.

Go from simple to more complex.

Break a task down into steps.

To end, ask: “Did you enjoy doing this?” and “Would you like to do this again?”

There is no right and wrong. Think engagement.

©Cameron J Camp III & Associates, LLC. Used with permission.

Montessori-inspired communities are resident-directed communities. They emphasize enabling independence and meaningful resident involvement in the decision-making and day-to-day life of a nursing home or assisted living community. Knowing each individual and offering choice are the foundations. Building and sustaining a true resident-directed community challenges us to move beyond the basics of person-centered care by enacting resident direction.

Montessori-inspired communities, as promoted by the founder of the Original Montessori for Dementia

Training®, Dr. Cameron Camp, are built on the belief that Alzheimer’s and dementia are not insurmountable obstacles to a fulfilling quality of life. The person-centered pillars of respect, dignity, and equality form the foundation of these communities.

These pillars are nurtured through the consistent application of the Montessori principles (see box). Residents of Montessori-inspired communities are supported to be as independent as possible through a deliberately prepared environment that uses visual cues, templates, and interesting activity stations. Residents are given the opportunity to harness procedural memory to learn to find places, complete tasks, or access information important to them. Relationships are developed through the use of name tags (calling people by name enables feelings of connection), resident committees (groups coming together helps explore shared interests), and resident- led activities (including welcoming newcomers, reading groups, coffee hour, poker games).

Nursing home or assisted living staff who want to implement the Montessori approach often struggle with exactly how to do these things. The Montessori Organizational Self-Assessment Tool® (MOST) was created by Alzheimer’s Australia (now Dementia Australia) based on the work of Dr. Camp. This tool encompasses five general areas using 30 items related to the principles of Montessori. Each item offers examples of how it is implemented at different times in a community’s journey (Not There Yet, On the Way, and In Action). These examples offer a road map of sorts for programs as they advance in implementing resident-directed community. A numerical scoring system enables staff to rate themselves on progress and identify areas of need. In the Department of Veterans Affairs (VA) Community Living Centers (nursing homes), scores on this tool have been correlated with positive resident- and neighborhood-level outcomes, such as decreased falls, decreases in depressive symptoms, increased food intake, and decreased use of psychotropic medications.

Montessori-Inspired Lifestyle® Pledge

I will:

Work to create a place where I would want to live.

Remember that I am a guest in the home of my residents.

Treat everyone I meet with respect, dignity and equality.

Remember that I must earn the trust of others, and that they must learn to trust me.

Apply the Montessori principles in everything that I do.

Treat everyone I meet the way they wish to be treated.

©Cameron J Camp III & Associates, LLC. Used with permission.

With support from the VA Health Services Research & Development Service (IIR-16-018, Hilgeman, PI) Dr. Camp and researchers at the VA are adapting the Montessori approach to be most effective with its unique population of Veterans (e.g., Veterans with severe mental illness). The MOST will also be adapted to reflect items of greatest relevance to the growth and spread of Montessori-inspired communities within the VA system.

For more information, or for resources you may wish to use in establishing Montessori in your own care community, please contact Jennie Keleher at virginia.keleher@va.gov or visit www.cen4ard.com.

 

 

 

 

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