Namaste: Honoring the spirit within

Winchester Rehabilitation and Nursing Center, Winchester, Mass., has a diverse dementia population in varying stages of the devastating disease, but no designated Alzheimer’s unit. Our journey into a Namaste experience began with our desire to address the sadness, isolation and loneliness of our advanced dementia residents.

This frail population was the incentive and driving force for us to explore alternatives to reach these residents. Dr. Susan Wehry, geriatric psychiatrist and advocate for seniors and persons with disabilities, notes that enriched environments can impact individuals in meaningful ways. Different parts of the brain respond to aromatherapy, music and emotions and touch, for example. Conversely, isolation inhibits and slows down the aging brain.

The Centers for Medicare and Medicaid Services’ (CMS) ongoing focus on reducing unnecessary use of antipsychotics asks us to find new, innovative approaches to dementia care. The intent is not to wipe out the use of needed medications, but to ”Rethink, Reconnect with patient individualized care and Restore good health and quality of life,” explains Alice Bonner, RN, PhD, director, Division of Nursing Homes, Survey and Certification at the Massachusetts American Medical Directors Association.

CHANGING APPROACHES TO DEMENTIA CARE

In the 1990s, Dr. Bill Thomas started Eden Alternative, a program based on the fundamental belief that we must change the way we organize and operate long-term care facilities. He wanted to provide new solutions to old problems. At the heart of those problems, he saw three plagues: loneliness, helplessness and boredom. The foundation of Eden Alternative emphasizes relationships, community and surroundings that include living things such as plants and animals, as well as empowerment of all who participate in the community.

The culture change movement in long-term care strives to change the way frail and disabled people interact with their surroundings. Namaste programs also are focused on individualized engagement and the embrace of each resident’s needs and preferences.

We had a strong need to expand the options for our dementia residents. Our first initiative was to move residents out of the standard “lineup” in the hallways and into the living spaces.

Next, we examined our activity programming, which included music, dance, art therapy, improvisional theater, cooking, discussion groups and laughter yoga. We realized that a group of our residents could not relate to the activity program that was in place for the general population in our facility. Although programs offered a wide range of choices, they were not reaching the needs of our “lost” patients.

INTRODUCING NAMASTE

Joyce Simmard, MSW, created the original Namaste program. Her energizing book, Namaste, became a virtual recipe for success in advanced dementia care. The program reaches “the spirit within” each resident through an involvement with and attunement to the multiple sensory modalities. Our activity director enthusiastically embraced the new ideas.

Assigned staff members were required to read Simmard’s book. The assignment alone would weed out the faint of heart. We appointed a Namaste specialist and a point person for families and staff.

Instead of passive activities or large-group programs, small groups and individual interactions were offered using sensory programming. Current scientific evidence supports the concept that mind/body connections can reach the dementia patient. Somatic experiencing works with the body where the disease exists, reaching that part of the brain that still responds to touch/hand massage, music, movement (or the “kinesthetic sense”), and aromas from essential oils.

CREATING THE NAMASTE ROOM

We looked at our facility’s spaces and considered the ongoing schedules for the rooms that were available. We learned that

Mrs. L was non-verbal and had very little reaction to her surroundings. Soon after her time in the Namaste room, she was engaging in short conversations, answering questions appropriately and telling her caretaker how she felt about things, ranging from having her face washed ("it felt good"), to seeing pictures of Elvis and letting staff know "she wasn’t crazy for Elvis like she was for Frank Sinatra."

the success of the program was not about the ideal spot, but about creating opportunities with what we had to work with. What defines the Namaste Room is the philosophy of nurturing, individualized attention through loving touch and meaningful interactions while “being in the presence of others.” The mind, body and soul of the person are the focus; therefore, quality of life can be at the forefront of the program.

So, we carved out our spaces, and selected our residents based on the criteria outlined by Simmard. We chose residents with a diagnosis of advanced irreversible dementia who were unable to participate meaningfully in routine activity programs. The target Mini-Mental Exam score was 0-7. Participants had challenges in communicating, needed total assistance with personal care and were nonambulatory.

Although space constraints limited the number of participants at first, the resulting behavioral changes for those few were noticed by staff and families alike. The selection of caregivers involves looking for “anyone who can express love, offer a gentle touch, and be present for people.” Namaste caregivers need to research the residents’ social history, speak to family members and friends and learn the residents’ likes and dislikes. We developed a core group of caretakers for the Namaste Room, because relationships are key in building trust. The environment lent itself to a balance, or “feng shui” (an Asian practice meaning harmonious surroundings).

Mr. B enjoyed interacting with a stuffed animal dog in the Namaste room. He named the dog “Buttons” and would blow on him in an affectionate manner. On another day, he chose to paint, asked for the color purple. When he was finished with his art work he named it "the man selling clothes."

The program started in our library from 3-8 p.m., five days a week. The library morphed into a different world at 3 p.m. We moved tables around to suit the needs, added a tabletop waterfall and an essential oil diffuser, and used soft lights and music. The staff was trained with essential oil use and hand massage techniques. A small refrigerator held cool sensory tastes such as ice cream, fruit slices and drinks. A flat-screen TV was added for the purpose of showing streaming video aquariums, slides of babies and other soothing triggers of long-term memory. The door was kept closed and extraneous traffic was not permitted. Other tactile textures include soft cuddly stuffed animals and baby dolls, which brought a great deal of comfort to residents.

After we documented our observed changes (through photos, comments and written observations), we gave a presentation for the families and explained the changes in their loved ones. The presentation was met with a great deal of emotion and gratitude. They saw their loved ones smile, raise their hands to gesture and even paint. No one had seen such possibilities for these residents prior to this program.

The families’ satisfaction is like a burden lifted from their shoulders. They see peace and tranquility and a way to

Everyone in the Namaste room enjoyed the smells of the bread maker. The sensory smorgasbord prompted some residents to request some bread, while others showed increased appetites and less resistance to eating even when outside the room.

communicate with their family member. They see a renewed joy for their family member through the use of music and touch. The program provides opportunity for staff to form an alliance with families as well.

We all age differently, so providers need to understand how having individualized plans for residents can change their late-life pictures. No matter how old or “hidden away” a person seems to be, discovery and light can be found. The Namaste program and the others like it look toward improving resident quality of life while decreasing reliance on medications and shifting our focus to non-pharmacological interventions.

Shelley Silverman King, R.N., is certified in gerontology and holistic nursing. She can be reached at shelsilverman2002@yahoo.com.

 Learn more about designing spaces for memory care at the Environments for Aging conference, April 6-9, 2013.

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Topics: Activities , Alzheimer's/Dementia , Articles , Clinical , Executive Leadership