Debbie Hommel's A.D. Tips
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by Debbie Hommel, BA, ACC, CTRS, Executive Director of DH Special Services
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Executive Director
DH Special Services
About Debbie

Debbie Hommel, BA, ACC,
CTRS, is the Executive
Director of DH Special
Services. She is a Certified
Activity Consultant on State
and National level, with over
twenty-seven years of
experience in providing direct
care and consultation to long
term care, medical day care,
assisted living, and ICF/MR
facilities throughout New
Jersey, New York, Maryland,
and Pennsylvania. She is an
experienced trainer and
workshop presenter,
conducting a variety of
seminars throughout the
Tri-State area for the Activity
Professional, Administrator,
and allied healthcare
professional. Debbie Hommel
is an active member of Activity
Professional Associations on
State and National levels. She
is ACC certified through the
NCCAP. She is a founding
member of the New Jersey
Activity Professionals'
Association, serving terms as
Vice President and President.
She received the Weidner
Lifetime Achievement Award
in 1994 and the Monmouth &
Ocean County Activity
Professionals Life
Achievement Award in 1999.
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for Activity Professionals
in Long Term Care Settings

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Five Things Everyone Needs to Know when
Working on a Special Care Unit
Presented by Debbie Hommel, ACC/MC/EDU, CTRS

The age group over the age of 85 is the fastest growing age group in our country.  With
this increase, the number of individuals with some sort of dementing illness increases
as well.   In order to meet the needs of elders with memory loss, many facilities have
created special care units.  Memory support units are the fastest growing segment in
long term care, with 60% of facilities now having special care units catering to the
needs of these residents.
   In a previous ADO article, “What’s so Special about Special Care?” I wrote about the
special features of a SCU.  http://theactivitydirectorsoffice.
com/DebbiesADTips_archive200906.html  This month’s article focuses on what the
staff need to know when working on such a unit.  Any staff who agrees to work on the
unit should have not only empathy for the population but also knowledge regarding
dementia and professional helping skills.   

1.        What is dementia?
This may seem rather redundant to mention but there is so much to learn about
Alzheimer’s disease and all the other neurological conditions which affect cognitive
functioning.  The resident doesn’t just experience memory loss but impairments in
reasoning, judgment, abstract thinking, attention span and perception.  Any staff who
works on the unit should have extensive training on understanding Alzheimer’s disease
and how it affects the brain.  Having an understanding that the resident is at the mercy
of the damage that is occurring in the brain may contribute to staff being more patient
and understanding of the many challenges when working with elders with dementia.  
There are several great resources available for training staff, which include:
   The ADEAR Center which is the National Institute of Aging’s Alzheimer’s information
site.  They have printable handouts, booklets, images which could be used in in-
services and videos which you can download.
   Alzheimer’s Outreach is an informative and humanistic site.  Lots of great information
and wonderful poems about individuals with memory loss.
   My site also has a link page for Dementia where I have listed all my favorite sites on
the subject.

2.        What is dementia capable staff?
The Alzheimer’s Association coined the phrase “dementia capable staff” in their “Key
Elements of Dementia Care” program. (  Being
“dementia capable” means being skilled and knowledgeable in working with people
with dementia and knowledgeable about the kinds of services and techniques that are
helpful to the resident and the family.  Prior to working on the unit, the staff should
receive training in understanding the disease, communication techniques,
understanding behavior and means to keep the elder engaged in life through activities
and other quality of life interactions.  More importantly, the staff member needs to be
able to listen with their heart and be willing to develop trust relationships with the
3.        Alzheimer’s disease affects the communication centers of the brain.
We learn rather early in our work with individuals with dementia, that each person is
unique.   Knowing that, we learn there are many variations to the communication losses
they experience.  To more effectively communicate with these residents, the staff needs
to have a good understanding of the various communication strategies to assist elders
with dementia.  Accepting the resident in their reality, “joining their journey” and
validating them where ever they may be are some examples of interaction skills and

4.        The behavior is always right.
All behavior is motivated by some sort of internal or external stimuli.  As unreasonable
or “inappropriate” as some of the behaviors demonstrated by residents with dementia
may be, to that individual – the behavior is the right thing to do at the time.  Our
challenge is understanding what is provoking the behavior.   Meeting the needs or
minimizing the stresses and external cues which stimulate negative behaviors is a key
approach in resolving behavioral symptoms.  There are three articles in the ADO
archives on understanding behavior.
There is also a 3.5 hour NCCAP pre-approved independent study training program
entitled “Understanding Behavioral Symptoms, Whose Problem is it?” available on my

5.        Everything can be an activity.
On a memory support unit, the concept of “everything can be an activity” is crucial.  Many
elders with dementia do not function well within structured groups therefore; alternate
opportunities need to be available.  The memory support unit should re-create life
experiences and daily living tasks as part of the “activity program”.  Activities on the unit
can include the organized, planned and structured programs introduced by the activity
or TR department.  But, it can also include active involvement in daily care routines
(getting dressed, eating, household tasks in their room and throughout the unit).  Many
elders with dementia find greater satisfaction participating in these tasks than in
recreation programs.  All staff and family who enter the unit need to know that every
encounter is an opportunity for quality of life exchanges.  Anyone and everyone can
involve the resident in tasks or diversions throughout their day.

Special Care Units may become the norm in the future where all residents will receive
the individualized services they deserve.  Until that time, the activity professional can
assume a leadership role in guiding our facilities in creating special care units which
truly meet the needs of these residents.  

Understanding Individualized Dementia Care – New Independent Study Program