Monday, August 20, 2012


I asked a colleague of mine if occupational therapy could be utilized to improve the lives of residents with dementia, she quickly and loudly answered “YES!”  Lynn Dennie, COTA, was kind enough to provide the following description of the vital role therapy can play in managing the care of dementia clients at the same time addressing the potential of increased revenue through therapy.  Following are her thoughts....
How many times has it been heard: “John is being treated...but he has dementia.”?  What is being said when this statement is made?  When a statement is made is there limitations made in client care and the revenue that can be generated as well?  As the awareness of dementia grows, so does the cost in caring for clients with dementias, but are we leaving health care dollars on the table?

The Risk Factors involved with dementia care are falls, skin integrity, dehydration/malnutrition and decreased socialization/interaction with others just to mention a few.  These risk factors can all add up to added health care costs for all involved whether in nursing facilities, assisted living environment, or in a client’s home.

The costs related to care for the client with dementia can become a burden for all involved, causing us to work “harder instead of smarter”.  With increased risk factors, the cost of care for dementia clients also increases.  For example, risk factors lead to increased risk documentation (incident reports), increased need for safety equipment, increased use of medications (as warranted through documentation), and can ultimately increase the need for more staff to monitor the dementia clients safety, producing a feeling at times of “chasing the tail”.  Not only do cost accelerate, but slowly the approach of staff/care givers become reactionary instead of proactive.  This can lead to loss of staff retention due to “burn out”, and costs associated with proper replacement of staff.

So the question remains, what can be done?  It begins with accurate assessment of the individual with dementia.  Therapy can be utilized to assist in decreasing associated risk factors, such as falls; thereby strengthening the components associated with therapeutic interventions with set protocols, and staff/family education. Decreasing risk factors has the potential, then, to decrease healthcare costs.

What is the result of Instituting Dementia Interventions?  Through consistent dementia assessment and programming, there can be a decrease in cost factors, a staff focused on being proactive, increased client/family satisfaction which will lead to increased in overall reputation and as an end result enhances census development.  Finally, a facility’s financial performance is enhanced by revenues obtained by therapy. 

So are we leaving those health care dollars on the table?  We are when we do not meet the needs of the dementia client.  However, when therapeutic interventions address risk factors as well as when specialized dementia programming is implemented, a facility’s revenues can be enhanced and in turn operational costs reduced.


  1. Have you seen a dementia assessment tool that can be used to help determine interventions for the residents? Our OT and PT says nothing really can be done and they are afraid fraud and overuse of Medicare Part B services.

    1. Thanks for your question. There are two cognitive assessments I am familiar with. Both have been researched and validated. The first is the ALLEN COGNITIVE LEVEL assessment which has been a part of the occupational therapy curriculum for over 25 years.
      The second is the REALITY COMPREHENSION CLOCK TEST which has been utilized for over 15 years.

      Both assessments can determine the person's remaining cognitive processing ability. Armed with that data, the level of interventions that can be successfully utilized can be selected. Both tools contain the interventions as the second step of the process.

      Please feel free to contact me if you have additional questions. I can put you in touch with Lynn Dennie who can provide your therapists with more in-depth billing information.

  2. We try to be proactive but what do you do with a resident that is still ambulatory, almost blind, and walks right into a w/c, door, etc. causing her to fall.

    1. You are spot on when you say "proactive." All behavior is motivated. The challenge is to determine what is her motivation for walking and assist her to accomplish her goal. Learning her as a social being is the basis of your interventions. Managing, NOT controlling, her behavior is the key. Knowing her cognitive functional age coupled with knowing her social interests will enable you to select tasks that capture her attention. Engaging her in those activities has the potential to reduce her actions that lead to the falls. An example would be to "need" her to help you with a task she can accomplish with her remaining cognitive abilities. Consider utilizing tasks that she likes to hear, smell, taste and touch. Depending on her visual ability you could also utilize things she likes to see. Knowing her favorite stories...ones that make her happy, provides the staff with conversation material, again with the focus of redirecting her actions.

      Perhaps you might find some additional helpful information in my several of my other blogs. Check out the one entitled FALL IN NURSING HOME RESIDENTS (8/10) and HEY HELP ME HERE! (10/10) and VISITS WITH VALUE (10/10).

      Success to you...keep me posted.


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