Excellence in Action: LEVELING UP! Addressing Post-COVID Cognitive Changes Utilizing a Level-Specific Approach.

A LTC resident, living in the secure memory care area in one of our Shreveport, LA, facilities, demonstrated a decrease in socialization, communication, attention, and ADLs, as both direct and indirect results of COVID-19.  Prior to the pandemic, the patient was able to make simple decisions in the facility, such as which table to sit at for meals, simple conversational speech with her peers, and she was able to feed herself without assistance.  She also participated in facility activities if monitored and reminded by facility staff.

When the COVID-19 pandemic hit, the patient began to decline as a direct effect of the precautions put in place to slow the spread of the virus, including limited social activities and social isolation.  Following the patient’s own contraction and recovery from the virus, her physical and cognitive declines were even more noticeable.  As a result, all three disciplines (Physical, Occupational, and Speech Therapies) placed the patient on caseload to address her physical, ADL, cognitive, and communication-related deficits.

SLP, Kelsey, and SLP Student, Brooke, incorporated level-specific activity boxes, including the concepts and initiatives they learned in Dementia Capable Care training.   The patient received aCognitive-Based Leveling assessment, which determined that she was functioning in the lower end of ACL 3, Middle Stage Dementia.  (TMC Color Code:  Yellow.)  The SLPs presented the patient with a variety of textures during therapy sessions to work on manual actions of tactile stimulation, as well as sensory stimulation, to improve the patient’s interaction with the world around her and to maintain current function.  They incorporated  soft materials, hard puzzle pieces, slick pieces of paper, and colored paper, which allowed the patient to experience different textures. 

Initially, the therapists would explain to the patient what each texture was as she was feeling them.  This encouraged not only the sensory stimulation, but also resulted in the patient verbalizing and naming the different sensations of each material.  This was a significant improvement for this patient, as she was not vocalizing much at all following her recent COVID illness.  She also improved her self-feeding abilities and now has the ability to attend to tasks during meals!

In addition to working directly with the patient, the SLP team has developed a Functional Maintenance Plan (FMP) including the CNA staff and the Activities Director for Memory Care, to encourage them to provide level-specific activities and cueing to help the patient feel included and social during facility activities.  

The Activities Director for Memory Care, as well as facility CNAs and Nursing staff, have commented on the patient’s improved level of alertness during activities.  They noted that the patient is consuming more of her meals, is feeding herself again, and they commented that the patient occasionally initiates simple words and phrases to start a conversation, which she had not done in several months.

Since the implementation of their formal Dementia Treatment program, including level-specific care activities, this facility has noticed improvements in several of their CASPER numbers, including a decrease in falls with injury, a decrease in ADL loss, and a decrease in weight loss.

Providing care that is tailored to the individual needs of our residents is a major part of TMC’s “Why”.  Determining a patient’s cognitive functional level enables all care partners to identify their remaining abilities at each level and allows our interdisciplinary team to provide care in a manner that best supports the needs and abilities of the patient.

In Shreveport, LA, we are ALL IN for making a positive difference in the lives of EVERYONE we serve!