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Best Practices:

Check Out The Ins And Outs Of Caring For Residents With MS

Published on Thu Jan 01, 2004

New guidelines for nursing homes offer invaluable practical care strategies.

Ever wish someone would hand you a great care plan to address the unique needs of residents with multiple sclerosis, who are often younger than the usual geriatric population in nursing facilities?
 
A group of MS and long-term care experts has done just that. The National Multiple Sclerosis Society recently published a guidebook titled, Nursing Home Care of Individuals with Multiple Sclerosis: Guidelines and Recommendations for Quality Care. The guidelines present best practices and care strategies developed by a task force that included neurologists, social workers, rehabilitation therapists, several nurses and nursing home staff who specialize in caring for MS residents, notes Dorothy Northrop, director of clinical programs at the National MS Society."Our goal was to take their knowledge and experience and find a way to get it into nursing homes that only care for a few people with MS," Northrop tells Eli. Yet the guidelines also have broader application to numerous issues encountered by all people with disabilities, including urinary and bowel incontinence, pressure ulcers, swallowing problems and spiritual distress.

Follow This Specific Advice
 
The majority of the guidelines focus on practical strategies to help nursing homes understand the unique symptoms, meds, rehab and other needs of the resident who has MS. For example, the guidance suggests facilities:
 

  •  Understand how to evaluate symptoms within the context of MS. For example, heat worsens symptoms in 80 percent of residents with MS, according to the guidelines. So don't confuse this temporary "exacerbation," which can be relieved by cooling, for disease worsening. (Air conditioning for MS patient is critical.) Symptoms of new weakness, confusion and a decline in functional abilities may signal an MS flare-up. But you also need to rule out drug side effects, urinary tract infection, pneumonia, or other acute illness.
     
    Tip: Neurofacial pain seen in MS can be mistaken for tooth pain, according to the guidelines. A lidocaine mouthwash can offer temporary relief, as can application of liodcaine patches directly to the cheek or jaw.
     
  •  Consult with rehab professionals who are experts in MS. The guidelines suggests linking up with community resources, such as Easter Seals, a local rehab hospital or the local MS center, to meet the resident's complex rehabilitation and assistive technology needs.
     
  •  Teach staff how to deal with spasticity. A number of techniques can help this involuntary condition. For example, telling the resident to relax during a spasm will likely make things worse, so stop what you are doing and wait until the spasm passes. Avoid quick sudden movements of limbs, which can trigger spasms. Instead, tell the resident what you are going to do and rest your hands firmly on the limb before moving it.

    Meet Needs of Younger Residents
     
    The guidelines also identify the difference between a geriatric population and a younger population in a nursing home, comments Marva Serotkin, CEO of the Boston Home in Massachusetts, and chair of the Nursing Home Task Force of the Long Term Care Committee for the National MS Society, which helped develop the best practice guidelines. "So while the guidelines are specific to MS, they also apply to younger people and cut across issues having to do with socialization, feeding and general preventive health," she notes.
     
    For example, providing age-appropriate ADLs and activities is very important for the younger population, the guidelines emphasize. Suggested activities include:
     
  •  continuing education,
     
  •  computer activities,
     
  •  volunteer opportunities outside the nursing homes, and
     
  •  theater trips and shopping trips outside the facility.
     
    "We advocate that nursing facilities admit more than one or two younger people," says Serotkin, "because then they will be more likely to develop the programs to meet the needs of a younger population," she says.
     
    Editor's Note: You can download a free copy of the MS guidance online at      www.nationalmssociety.org/pdf/forpros/MS_nursing_guide.pdf.

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