Our Ageless Abilities clinical framework is designed to address the needs of those diagnosed with dementia and are determined to be functioning at a level 4-7 on the Global Deterioration Scale.  The Ageless Abilities clinical framework provides the treating therapist a comprehensive approach that includes the evaluation, staging, treatment and development of effective strategies to routinely implement to ensure the quality of life of the patients/residents we are privileged to serve. The purpose of this program is to assist the therapist in evaluating and developing an appropriate plan of care for the person with dementia, which in turn will help to maximize their daily performance and lessen the risk for excessive disability. This program, which utilizes information from the Allen Cognitive Disabilities Theory and the Global Deterioration Scale model, focuses on caregiver education, family training, and environmental safety.

An appropriate plan of care for a person with dementia:

*Maximizes their daily performance

*Promotes acceptable behaviors and interactions

*Decreases development of excessive disability/learned helplessness

*Enhances quality of life

Many residents of long-term care facilities and other residential settings have some degree of dementia. Dementia causes a range of behavioral, cognitive, functional, and mood impairments that can significantly affect patient-centered outcomes and quality of life.
Ageless Abilities Target Population:
Residents who are at a stage 4 through 7 of dementia are candidates for this program. There are several sub-types of dementia, each of which require different treatment approaches. These types of dementia include:

Alzheimer’s disease

Dementia of the Parkinson’s Type

Lewy Body Dementia

Frontal Lobe and Picks Disease

Vascular Dementia / Multi-Infarct Dementia

Creutzfeldt-Jakob Disease

HealthPRO Heritage is our full service therapy partner and consultant on clinical initiatives. We are dedicated to embrace a paradigm shift from looking at individuals with dementia as having cognitive disabilities to one of identifying their continued cognitive abilities. The Ageless Abilities framework facilitates just that! This program is designed to focus on the abilities of the resident rather than their disabilities. Through specific evaluation, functional treatment techniques and the establishment of individualized programs, the therapist can train caregivers to support a resident in maintaining independence and self-help skills late into the disease process.

Our Safe Transitions clinical framework focuses on one thing: getting our short-term rehabilitation patients home in a timely manner, functioning as safely and independently as possible. Our Safe Transitions program embraces the philosophy that discharge planning begins on admission and focuses on a patient-driven model which offers:

-Clinical programs that support the needs and goals of the patient

-Processes to define collaboration and timelines to meet length of stay expectations (defined by network partners/insurances and other health providers).

-Enhances coordination of services by promoting best practices and optimizing outcomes, fortifying partnerships with referral sources.

There are 5 components to Safe Transitions:

1. Discharge Readiness Checklist

Provides a structured means of identifying the specific areas each individual patient needs to address in order to achieve his/her specific goals.

2. Home Survey

Includes the therapist, patient and family member going to the home to assess performance in areas required in order to safely return to the home environment. This would include such things as entering/exiting the home, getting in/out of bed, in/out of a favorite chair and in/out of the bathroom and kitchen. Attention is given to detail in assessing for home modifications or equipment that may be needed to promote safe and independent functioning of the patient and the caregiver.

3. Cognition Assessment

A cognition assessment is completed when indicated to identify areas of need and implement treatment strategies to promote patient safety and independence.

4. Medication Management

Addresses the patient and/or caregivers ability to safely and independently manage their prescribed medications once they are in home environment.

5. Health Literacy Training

Health Literacy Training includes specific educational information to the patient and their family regarding the individual health needs of the patient, such as diabetes management, COPD management etc…to promote a good understanding of what is going on in their body and how they can proactively manage their health, thus decreasing the risk of future illness and possibly hospitalization.

 

HealthPro Heritage is our full service therapy partner and consultant on clinical initiatives.  The Safe Transitions framework facilitates:

A multidisciplinary admission process to ensure immediate review and evaluation of patient conditions, needs and discharge plans.

Risk Assessment Process to identify risk factors for readmission or rehospitalization

Post-discharge communication to ensure safety, services and to mitigate transitions to skilled care facilities verses acute care.