Today, tomorrow

Abstract

An interesting thing happened to long term care during the past two decades-persons with dementia replaced physically frail but cognitively intact residents as the majority population in our facilities. Current estimates are 65 to 75 percent of all nursing home residents have a dementia diagnosis. While this statistic went relatively unnoticed, the challenge of caring for these dementia residents did not, particularly with the advent of the OBRA regulations (Nursing Home Reform Act, 1987) requiring significant reductions in restraint use. Under OBRA, our dementia residents made it known very quickly that they could not function well within our conventional medical-model style of caregiving once they were untethered and undrugged.We caregivers were not fairing much better either, frantically struggling to "manage" the "difficult/disruptive" behaviors of this seemingly perplexing population. Frustrated, we began chiding our activity and recreational professions with what was to become a universal mantra: "Do something with these people! They are driving us crazy!" My experiences with this national scenario were not much different, but they occurred much earlier. As the administrator of Florida's first restraint-free nursing facility in 1983 (well before OBRA), I, too, took a single-minded, single-discipline approach to keep our dementia residents out of trouble by tasking the activity department with "entertaining" them all day. Unfortunately, the beleaguered activity staff pointed out that their traditional activity approaches were no more successful than the traditional caregiving approaches the other disciplines were using. Thus began my odyssey in finding more appropriate ways to give care to residents with dementia.Many of my fellow professional caregivers soon began questioning the traditional medical-model approaches and care practices as well, that were clearly setting both residents and staff up for failure, constant confrontation, and tremendous frustration and stress. One of the first books raising the issue of the inappropriateness of medical-model practices with dementia residents, because of their irreversible and progressive brain damage, was published in the mid-1980s. 1 It called for use of the more appropriate, realistic, and compassionate psychosocial model of care. Nurse researchers also began to publish articles addressing a phenomenon referred to as "excess disability," where dementia residents' disabilities were increased or enhanced by using traditional medicalmodel nursing care practices. 2,3 Fortunately, as research expanded, our knowledge regarding the pathopsychology of Alzheimer's disease