DD-4. New Innovations:
Enhancing the Lives of
Individuals with
Developmental Disabilities
Tuesday, October 9, 2007. 8:00am – 10:00 am
Presented By:
Marisa Geitner, Executive Vice President, Chief
Operating Officer
Ruth Benjamin RNC, CDDN, CLNC
Director of Health Management and Research
Heritage Christian Services, East Rochester NY
Heritage Christian Services
• Support over 1,400
children and adults
with developmental
disabilities in Western
New York
• Provide residential
and day habilitation,
respite, clinical
supports and service
Innovations in Care
• Residential homes for seniors with
• Residential “right sizing”
• Telehealth
• Day services for seniors and medically frail
• Hospice care
Residential Settings for
Individuals With Aging and Dementia
Design Elements
• Consulted experts in dementia and visual
• Designed the home with a circular design for
people who wander and supervision levels
• Natural lighting
• Single bedrooms
Sensory Garden
• Facilitates independence in a
safe environment
• Quiet and reflective
• Sensory input from variety of
colored flowers, flowing water,
and scents from flowers and
Safety Features
• Therapy tub and walk-in shower
• Doors with subtle alarms
• Windows with stops installed- only open 6 inches
Modifications that can
benefit the Aging Person
• Color contrasts are important for
visually impaired
• Grab bars can be added to the walls in
the bedroom
• Elevated toilet seats,
sometimes even a
change in the color of
the toilet seat is helpful
Team Approach
• The focus changes from Res Hab to meet
needs and challenges that occur with
aging individuals with DD
• Focus is on maintaining skills and
cognitive ability
• Fulfill goals and dreams as much as
Residential Rightsizing
• New funding from NYS OMRDD
• Enables individuals to have their own
bedroom-smaller settings
• Enhanced therapeutic services
• Additional funding for staff education
• Research component
• We want to demonstrate:
– Smaller environments increase quality of life
– Smaller environments & improved education improve
staff retention
– Blending therapies produces better individual
– Increased physical activity improves overall health
Enhanced Therapeutic Services
• Physical Therapy
• Massage
• Dance Therapy
Blending of Traditional and
Expressive Therapies
• Minimizing physical deterioration that
occurs with aging
• Bringing the therapy to people in the most
conducive environment
• Keeping treatment diverse and interactive
Enhanced Medical Education
A 40 hour curriculum
Medical Education
• Improving the care to those with significant
and complex medical needs
• Improving retention by supporting staff to
be as comfortable as possible serving the
elderly and those with medical challenges
• Understanding the complexity of aging
with this population helps us to be more
proactive in their care
DSP Credentialing
Using the College
of Direct Support
Continuing Education
•  Staff Training on aging and DD =  Staff
•  Participation in day conferences =  Clinical
Knowledge and  Networking
• Networking
Health Support Professionals
A Heritage Christian
designed position
Health Support Professionals
• A skilled, tenured staff that receives specialized
training from our nursing staff
• Provides high quality, relaxed, care and
charisma to individuals in acute medical needs
• Where and when they work is determined by the
residential and nursing leadership
Telemedicine and Telemonitoring
Challenges in Healthcare requiring
us to consider telehealth
• An aging population increases the prevalence of
chronic diseases
• Increased longevity of medically frail persons
• Severe, current and projected, shortages of health
care professionals especially RN’s
• Rising cost of health care
• Health care disparity for underserved populations
Objectives of Tele-Health
• Telemonitoring:
– Increased monitoring results in improved
– Provide accurate, timely data to physician
• Telemedicine:
– Enhances medical care, provided more
– Proactive
– Reduce unnecessary ER visits
A More Flexible and Blended Day
Habilitation Program
• Purpose:
to provide Day Hab programming while
meeting the medical and psychosocial needs
of the aging and/or medically frail individual
Reasons for Flexible Day
• The aging person with DD frequently has a
primary diagnosis and secondary medical
concerns that exaggerate the aging process and
these needs cannot always be met in the
traditional Day Hab setting
• As with the general population, endurance and
interests change with age and these are not
always addressed in traditional Day Hab settings
Benefits of Flexible and Blended Day
Habilitation Program
• Offers the ability to change the day hab activities within
the residential setting as the medical concerns of the
person change and/or a decline in the persons functional
level is observed.
– Addresses:
• Increased fatigue
• Pain management
• Completion of necessary medical treatments
WHY Medically Frail Individuals
Do Not Attend Traditional Day Hab
• Respiratory conditions
• Compromised immune systems
• Increased exposure to illnesses
• Intolerance to cold or hot humid weather
Why Individuals with Down Syndrome &
Dementia Benefit from More Flexible Day
• Calmer and familiar environment with less stimuli
• Rest periods that address sleep cycle disturbances
• Less attention on detailed tasks
• Slower pace
More Benefits…
• Allows for staffing within the home while
focus is still community oriented
• Allows for preferred activities that are
meaningful and enjoyable
Hospice Care in the
Residential Setting
Purpose of Providing Hospice Care in the
Residential Setting
• Provides care that extends to the whole person:
• Allows the individual to maintain control and dignity
• Individual is surrounded by familiar, loving, and caring
people known as family
Purpose of Providing Hospice Care in the
Residential Setting
• Planning and decision-making directly
involves the individual, and all those
connected to him or her
• Provides for the needs of individual’s
family, friends and caregivers
• Everyone involved receives support, as
well as gives support
Team Approach
The Individual
Family and extended family of Heritage Christian
Residential Nurse
Other Agency Clinicians
Primary Physician
Hospice nurse from an outside agency
Chaplains, and spiritual care providers from
within the agency
Priorities in End of Life Care
Alleviate physical pain, and provide optimal comfort with non
medication based modalities (music, massage, distraction)
Address & alleviate when possible emotional and spiritual distress
Compose individualized plan of care that eliminates all unnecessary
medical intervention
A plan of care focusing on effective pain management, nutritional
needs, bowel management, fatigue, skin integrity, sleep
disturbances, changes in mental status, and ability to communicate
A plan of care to address the psychosocial needs and desires of the
individual. This plan must include individual involvement and be
based on individual’s culture, beliefs, interests, and wishes
Change plan as frequently as necessary when any aspect of plan is
no longer effective
Points to Consider for Hospice
• Discontinue unnecessary medications except pain meds,
bowel meds, anxiety meds
• Eliminate routine VS, I & O, weights and
Residential Habilitation plans
• Educate and support the family, caregivers, QA, and
administration as to the plan of care
• Ongoing education of family & caregivers to the changes
in the physical & cognitive processes as death nears
Your Focus is the Individual
• Cultural influences- beliefs, values, respect the individual’s needs to
die on his/her own terms
• Family members’ beliefs also need to be considered
• Assist the individual to understand what is happening when possible
• Environment- respect privacy, yet convey compassion, support and
• Meet spiritual needs
• Alleviate fear and guilt
Your Focus is the Individual
• The environment is all about who that
person is!
• Visits from family and friends are important
• Granting last wishes- don’t be afraid, these
times are often the most meaningful and
cherished not only to the person, but hold
loving memories for families, friends &
Your Focus is the Individual
Having familiar staff provide 1:1
Favorite foods
Favorite music
Let the person decide when to complete ADLs
Individual decides which med he wants
Medicate continuously – do not wait for pain or
restlessness to be present – keep sustained
level of meds in blood
Proper use of Hospice
• Utilize support systems around youcommunity hospice nurses, clergy etc.
• Work as a team
• Teach those around you
• Facilitate grieving
• Reach for support from others and realize
importance of self care
Pieters Family Life Center
• Alzheimer’s Association
• Association for the Blind and Visually
• Diagnostic and Treatment Centers
• Networking-build your own set of experts
• ANCOR and state trade associations
Contact info
Ruth Benjamin, RNC, CDDN, CLNC
Director of Health Management and
Heritage Christian Services
349 Commercial St. Ste. 2795
East Rochester, NY 14445
(585) 340-2000
[email protected]
Marisa Geitner, M.S., CCC-SLP
Executive Vice President and Chief
Operating Officer
Heritage Christian Services
349 Commercial St. Ste. 2795
East Rochester, NY 14445
(585) 340-2000
[email protected]

New Innovations: Enhancing the Lives of Individuals with