Julia Temple is a unique building

  • A non-secured sub-acute rehab neighborhood.
  • A secured sub-acute rehab neighborhood for those admitting for rehab with either Dementia, Alzheimer’s disease, or cognitive impairment with elopement risk.
  • Three secured LTC neighborhoods for residents with Alzheimer or Dementia with behavioral disturbance as primary DX.

Nursing & Therapy collaboration:
Nursing and Therapy collaborated on a dual project that would:

  • Help decrease occurrences of residents using assistive devices assigned to other residents.
  • Provide CNAs/nurses with a visual cue indication resident’s basic cognitive abilities to reference before initiating care.
  • Reduce the risk of infection from share equipment.
  • Reduce the risk for falls due to using improper equipment.

License Plate System

  • Occupational Therapy performed ACL assessments on all LTC residents.
  • PT and OT assessed all residents for appropriate equipment.
  • Equipment is labeled with a license plate contacting the resident’s name.
  • Resident’s name is color coded to match ACL reference sheet.
  • Back side of license plate lists equipment needs and ACL assessment date.

How Does it Work? An Example
Mr. Rover’s walker has a “Colorado” license plate with his name in BLUE, indicating ACL Level 5.
The back side notes that Mr. Rover was assessed ACL level 5 in April 2017 and requires gait belt with ambulation.

Involving the Staff
The DON/ADON/SDC/Restorative/Rehab Program Manager educated staff during monthly “All Staff” and “Neighborhood Watch” meetings on the new License Plate system, including the ACL reference sheets.

A reference sheet is posted at each nursing kiosk for easy reference. In addition to listing the ADL level, the laminated reference sheet lists bullet points of possible cognitive abilities, approach, and expectations for each ACL level.

  • This aides in reducing frustration for the resident because staff is not expecting them to complete tasks that are beyond cognitive abilities.
  • Staff experience less frustration as they have more realistic expectations.

Shadow Boxes
Lastly, all long term residents have “Shadow Boxes” outside of their rooms which contain a star. The star is also color coded by ACL level so staff entering the room can easily identify ACL level upon entering the room.

Shadow boxes also highlight things that have been a part of the resident’s life allowing staff to share experiences with them.

Program Goals

  • Promote ease of identifying that residents have appropriate equipment assigned
  • Decrease falls
  • Decrease infection risk
  • Nursing staff able to quickly access reference sheet for tips on approach, cues, and expectations when providing care for residents with different cognitive levels
  • Allow staff to provide appropriate cues and care based off of indiv8idual cognitive abilities (Best Practice)
  • Provide nursing staff a quick reference for understanding


View poster: License Plate ACL Program (PDF format)

By Patty Fantauzzo, COTA/L, TPM & Wendy Power, RN, DON, Julie Temple Healthcare Center