The esteemed organization, i Advance Senior Care, has published a list of 10 dementia care rules to help nursing homes properly care for their residents and avoid fines and citations. I would argue that any senior facility, as well as friends and family of seniors, should keep all or most of these rules in mind as they attempt to care for our aging population. The minutiae inherent in the day-to-day care of the senior population makes a major impact on their ability to function and even thrive.

In descending order:

Rule #10: Facility sound levels
With varying stages of hearing ability, and some residents having hearing aids, do all of them have the presence of mind to recognize that the ambient noise level in their facility could be causing them undo agitation? And further, beyond causing emotional distress, it could also impair their ability to concentrate, which is already a challenge for many of these people.

A care facility’s goal should be to improve conditions to the point where they facilitate tranquility and maximum concentration to give all seniors a fighting chance at optimum functionality.

Rule #9: Facility policies and procedures
The staff needs to be trained to prevent resident abuse, neglect and just recently added – exploitation of residents with dementia. This rule calls for seven points of action: screening, training, prevention, identification, investigation, protection and reporting/response. As heartbreaking as it is that this IS a necessary rule – this rule is critical for all seniors, both in and out of facilities. People living with dementia are more vulnerable and often more trusting. They doubt their own memories (for good reason) and they don’t watch out for things like phishing scams or other BS cons directed at them. They should be able to trust those caring for them and not have to be wary of them.

Rule #8: Activities of Daily Living (ADLs)
They call it ADL decline. As in, seniors increasingly can’t do the basics of living. But part of the problem is that impatient staffers (or visiting friends and relatives) just go ahead and do it for them – which hastens the decline. Things like dressing, eating and washing up take a lot more time as we age, and it’s a whole lot easier when a nice young attendant is eager to hurry the process along by doing it for you. But the more these seniors do it themselves, the longer and better they will function. Although, trust me when I tell you that they can get very crabby when you suggest they can do it themselves.

Rule #7: Social Services
Aggressive residents should not be in a position where they are able to hurt each other, and if they do, care facilities need to find out where the aggression is coming from, intervene and then monitor the behavior and aggression moving forward. This also applies to seniors who are not yet residents anywhere. There are some cranky seniors out there.

Rule #6: Activities
This is simple; make sure the residents participate in individual and group activities, and make sure these activities are consistent with their abilities on a physical, mental and psychological sense. Translated that means: don’t sign your wheelchair bound seniors into a Flamenco Dancing class because that might be problematic physically and might cause them mental and psychological grief.

Rule #5: Proficiency of nursing assistants/staff
Senior care workers need to have some kind of formal training in working with seniors suffering from dementia, or they could cause more harm than good. Seems like it should be a blinding flash of the obvious, but you would be surprised at the lack of competency that exists in some of the most sophisticated of facilities. Yelling louder when a dementia patient doesn’t understand what someone’s saying does NOT solve the problem.

Rule #4: Dignity
There are so many opportunities for seniors, and especially seniors with dementia, to appear undignified. They may go to the bathroom and their dress gets caught in their underwear, and they’re just left sitting around when they are not properly covered. This can take a very high toll on the self-esteem of the individual, as well as those around them. Even dementia patients become disheartened when embarrassed. That said, indignities in addressing these individuals can also be humiliating. There is no reason why a person should be treated without dignity. So if a senior asks where her baby is, and we know there is no baby, the staff members should smile and tell her the baby is safely napping in a crib in the next room – or whatever else will assuage her nerves.

Rule #3: Unnecessary drugs
Mixing strong drugs, especially ones that should never be mixed, can be far more devastating to an older person. Institutions that should absolutely know what is counter indicated for the elderly may screw this up. Make an effort to know what the residents/patients are taking, what they should and what they should not be taking, and what can’t be mixed. And check frequently.

Rule #2: Quality of care
There are guidelines, learn them, embrace them.

Rule #1: Facility assessment
Assess the facility. Make sure that it is meeting the needs of all residents. Old people fall, don’t be surprised when they need help getting back up. Old people have trouble opening doors and windows, make sure they can open the ones in their rooms (especially in an emergency) or have someone there to do it for them. If the facility doesn’t meet their needs – change it. It will make everyone’s life better, too.