Iowa Veterans Home Alzheimer's Unit
On March 2, 1987, the first resident was admitted to the north end of the newly remodeled Alzheimer's Unit. There are 20 beds on the north end for the person with Alzheimer's in an active stage and likely to wander. These persons will be ambulatory and able to function safely within a group that may be fast-paced. The south end, which opened April 15, 1987, has 17 beds and is designed for persons with a more advanced stage of the disease process. They are not as likely to be ambulatory and in many instances will be immobile. End stage total care is expected to be ultimately needed by this population. Residents will move from the north end to the south end as their symptoms progress or as it is no longer safe to be a part of the ambulatory end. Staffing on the unit is similar to other skilled care units at the Iowa Veterans Home. All nursing staff assigned to the unit were required to complete a 32-hour (4 day) training course. Many employees from other departments also took this course which was taught through interdisciplinary effort. The care philosophies of the unit were stressed throughout the class in hopes of bonding a group of staff committed to the goals of the unit.
Interdisciplinary services already offered at IVH will be available for residents of this new unit. Modifications will be made to accommodate their special needs. Dietary will serve all meals on the unit unless there is a resident who can handle the cafeteria under special conditions. The therapeutic dietitian will be on the unit a minimum of one time weekly during meals to evaluate resident needs. The clinical pharmacist has been involved in planning the unit including the writing of a drug protocol specific to the needs of these persons. Those residents able to leave the unit for activities such as recreation may do so, but it is anticipated few will be able to because of their hyperactivity and distractibility. Two groups will be provided daily on the unit for all residents able to participate. Music, crafts, social interaction, exercise and games will be part of these groups that will each meet for one-half hour. Much of the equipment, games, etc., for the care programming has been made possible through gifts from veteran organizations, interested individuals and groups. Physical Therapy, Arts and Crafts, Social Work, Occupational Therapy, and Recreation are scheduled to help with these groups with nursing staff assuming times that other clinicians are not available. Scheduled rest periods for one-half hour morning and afternoon are another unique feature of the north end. Families are encouraged to be part of the care planning. We expect they will be particularly helpful in providing information about past significant experiences. This may include what color clothes the person liked to wear, names of important persons and places, or the way a particular care routine was accomplished.
Unit Design and Aspect of Care
Although this is not a locked unit, some modifications have been made to discourage residents from leaving the north end since elopement is a frequent problem with the wandering resident. The doorknob has been removed from the door at the farthest north end with the approval of the fire marshal so that exit from this end is discouraged. There is also an attempt to camouflage this door with a solid color that may be perceived as a wall by the resident. There is an additional opening to a courtyard from the north end dayroom, but because this is not an official exit, the door can be locked when the courtyard is not in use. The main entrance to the unit features a special magnetic lock when the courtyard is not in use. The main entrance to the unit features a special magnetic closure that is mounted at a higher location and to the side of where a doorknob would be. Staff will not use this door except where there is no other choice thereby avoiding teaching residents about this closure. Food carts and other large equipment will need to be brought through these doors, but where possible these doors will be opened from the outside of the unit.
The decor of the unit has been aided by the expertise of two special groups, the Iowa State University Applied Arts students and the Central Iowa Art Association. Their suggestions have given us many unique features such as the activity boxes mounted along the walls of the hall and the aquarium that is accessible only from the non-ambulatory end. Colors on the unit are muted and deliberately without pattern. Visual misinterpretation is a major problem with this population and something like patterned drapes are adversely stimulating. Drapes of green or gold tweed fabric were selected. Walls of neutral except for burnt orange paneling in the dayroom. Pastoral scenes reminiscent of former life experiences are found in wall pictures. Families are encouraged to add items of interest that are safe and durable at their loved one's bedside. Plexiglass has been installed beside so family pictures can be displayed, yet protected. Modifications have been made to reduce the noise level on the north end. P.A. announcements will only be heard at the nursing station and in the office and not on the unit. Telephone bells have been altered so there is a quiet "ding" rather than the louder ringing noise.
Careful evaluation of the unit and its effectiveness is considered an important part of the program. Baseline data has been studied through a grant funded by the American Nurses' Foundation and Health Services and Research Development fund from Veterans Administration, continue the study now that the unit is open. Such issues as resident's functioning, falls, use of medication, restraints, family satisfaction with care, environment, staff knowledge, and job satisfaction will be measured in an attempt to evaluate the impact of a special unit for resident, their families and staff.