Kim Warchol's picture Kim Warchol

Kim Warchol has been an Occupational Therapist specializing in dementia for more than 24 years. One minute of listening to her talk about her field and you can hear the years of experience and passion in every word. But she readily admits that she wasn’t prepared to deal with cognitive impairment when she first started practicing.

Her “aha!” moment came through the work of Claudia Kay Allen, MA, OTR/L, FAOTA, which completely changed her perspective from focusing on the limitations of patients with cognitive impairment to focusing on uncovering what they could do. She hasn’t looked back since and, she says, she is no longer “leaving these vulnerable individuals to fend for themselves.”

In every part of her presentation at Kindred’s Clinical Impact Symposium, Warchol emphasized the need for assessing and understanding the patient’s cognitive abilities to develop the right approaches for caring for that patient. Without knowing the patient’s ability to process information, it’s hard to know if he or she will understand how to use nebulizers, walkers or other equipment, or if what you are asking is possible and safe for the patient.

Warchol emphasizes the importance of prioritizing understanding cognition as a team, including physical therapists, occupational therapists, speech language pathologists and neuropsychologists.

This includes:

  • formalized cognitive tests
  • general observations
  • listening to the input of the family

She notes that it’s important to use universal language to communicate cognitive assessment results to other team members and that there should be a clear path for communicating the results so they don’t end up buried (and unread) in the medical record.

To most effectively work with patients, Warchol notes that it is critical to “Learn your person and their goals.” One way is through using “Can Do, Will Do, and May Do.”

“Can do” describes what is possible and realistic for the client including:

  • cognitive status
  • physical status
  • sensory status
  • mood and behavior status

“Will do” is what the person wants to do and finds relevant. It is related to:

  • personal preferences
  • interests
  • values
  • culture

The “will do” is the person-centered aspect of the Allen Cognitive Model.

“May do” is external to the patient. It is what he or she can be expected to do with the right support.

By using activities that fall into the “will do” category, there is a greater chance of success in helping patients who are in the lower levels of cognition.

If there is one thing attendees should also remember, it is Warchol’s message to, “Adapt, adapt, adapt to where that person is at the moment.” Although the ultimate goal is to achieve a person’s Best Ability to Function, there are different paths for a chronic and progressive diagnosis versus a diagnosis with complete or partial recovery. And patients will be at different levels at different times in their stay or recovery, so it’s important to reassess and adapt the plan as needed.

By Kindred Healthcare