Case Studies

Improving Emergency Services for People Affected by Dementia

Challenge
When people affected by dementia are admitted to a hospital, the outcomes are often less than optimal, frequently resulting in additional debilitation such as weight loss, development of pressure ulcers, use of excessive medication, and increased confusion. These conditions can cause longer hospital stays and repeated readmissions, increasing costs to the hospital and stress to the person affected by dementia. When a major California hospital in South Orange County, recognized that their emergency room staff was unprepared to provide adequate triage and care for patients with dementia who came through their doors, Anne developed a plan to strengthen the ER team’s skills in order to improve care to their dementia patients.

Solution
Anne observed that while the ER staff necessarily focused on the crises that brought patients to the hospital such as injury from falls, pneumonia or other infections, the underlying dementia that may have caused or contributed to the crisis in the first place was unrecognized. Working with the team, Anne realized they were not adequately trained on how to recognize and care for people living with dementia. Consequently, she set up a series of customized presentations for the ER staff, which included both physicians and nurses.

These interactive educational programs required that the staff participate in virtual dementia experiences to learn how a person with dementia might perceive the actions of the ER staff. The team also received training on how to screen for dementia so this important condition could be recognized and supportive discharge plans put in place from the beginning of the patient’s hospital stay. Anne also trained the staff in communication techniques so they could improve connections with dementia patients.

Outcome
Staff members who completed Anne’s workshops on dementia care expressed greater confidence in dealing with dementia patients. The following year, the ER measured improved outcomes for this important patient group.


Upgrading Memory Care in Assisted Living

Challenge

A large assisted living provider of dementia care realized that they needed to implement unique staffing models and improved training standards to bring their dementia care up to the level of excellence they desired to establish for their entire company. They designated a group of seven of their dementia care residences as a laboratory to initiate and trial the needed changes.

Solution
They contracted Anne, who completed site visits to all the dementia care residences and reviewed protocols, training requirements, staffing models and the physical environments.

Anne and the team observed that the dementia care units had not received the upgrades and remodels that had improved conditions in the general assisted living facilities. She suggested that they review and recommend specific dementia-friendly environmental changes that would enhance quality of care for those residents. She also recommended additional training on dementia-appropriate engagement programs for the activity staff and care staff.

Outcome
Weekly conference calls with leadership to discuss changes and review new training modules were scheduled. Pets were introduced to be part of a more home-like environment and residents began to initiate care and walking of their dogs. All engagements were reviewed to improve person-centered activities. Training with staff about resident rights and dignity was implemented and the leadership team was empowered to “think outside the box” to develop stimulating activities and also to reward their staff for delivering improved care. With renewed focus on the standards of care, the team was able to offer care that maximized independence and dignity for their residents affected by dementia.


Consulting on At-Home Dementia Care for Private Families

Challenge
A family with several adult siblings hired Anne to consult on care for their elderly mother who was living with moderate dementia. The siblings, who were spread across several states, disagreed on the type of care that was best for their mother. One daughter lived nearby and provided most of the in-home care, supplemented with hourly caregivers. With all of the children willing to contribute to the budget to care for their mother, there were many options to explore but no ground-rules or direction for this exploration.

Solution
Anne scheduled a series of conference calls and discussed with the siblings how to interact respectfully and establish appropriate boundaries with one another. Once they were able to communicate collaboratively, the local daughter was able to share how burdened she had felt by shouldering the majority of her mother's care. With her siblings practicing newfound active listening skills, she finally felt heard by the other family members.

Anne taught the family about person-centered care and, collectively, they brainstormed what that would look like for their mother. The siblings determined what would be most meaningful for their mom and created an initial plan. They decided to hire in-home caregivers who were better trained in dementia care than the present hourly workers and also sought caregivers who would be more consistent companions than the revolving group they'd had in the past. The siblings and caregivers planned outings that would be meaningful to the mother and also introduced an older dog as a giver and receiver of affection into the household.

Outcome
For the first time in many months, the mother expressed interest in social events. She was responsive and engaged more frequently with her children and caregivers. As she progressed more deeply into living with dementia, the care plan was revised. For the last 14 months of her life, she lived in a dementia-specific residence that offered dignified care as well as much-needed socialization. After three months of hospice services, she passed away peacefully with her family by her bedside.