After listening to President Obama talk about the National Alzheimer’s Project Act (NAPA), I share this response. It is time for all of us who share the mission to enable those living with Alzheimer’s disease to thrive to make our voices known. I believe we have something special to contribute to this discussion.
The message I sent to President Obama and all involved with NAPA is below.
Dear President Obama,
Since 2001, Medicare has provided occupational therapy, speech therapy, and physical therapy with the right to evaluate persons with dementia in order to identify their stage, remaining abilities, and risks, to establish maintenance programs to maximize function and to minimize or prevent decline.
Unfortunately, care is often reactive, and therapists are not utilized often enough to provide this service. Therefore, each and every Medicare beneficiary does not get the service he deserves. However, this proactive approach to maintain health, function, and well-being is essential, as those with Alzheimer's and related dementias (ADRD) are hospitalized three times as often as those in their age group without ADRD.
When we think of other diseases or conditions, like some forms of cancer or chronic obstructive pulmonary disease, we have a team to help the individual coexist with the condition while maintaining maximum health and well-being. However, with ADRD we most frequently see diagnostic centers and then simply a suggestion to find a local Alzheimer's Association for support for the years ahead.
The key is to develop an interdisciplinary dementia management approach in which, when ADRD is first identified, a therapist is immediately referred in order to complete a functional cognitive assessment and to develop a life maintenance program to maintain health and function as best as possible. If this person is at a more advanced stage, some of the intervention would include educating care partners such as family or paid care staff at home, or in a long-term care environment. This is relatively short-term therapy, but it can make a huge difference in preventing functional and health declines. Dementia is a root cause of so many poor health and quality of life outcomes and hospitalizations.
In addition, all of those caring for individuals with ADRD must have the basic education to know how to (a) change their approach to ensure the person with ADRD understands their message and feels safe in their care, (b) change the environment to be a support and not a hindrance, and (c) adapt the activity to the just-right challenge level for optimum success and participation. This type of care, delivered by the entire team, is the key to facilitating maximum function, health, safety, and emotional well-being at every dementia stage. In addition, this approach helps to reduce negative behaviors by understanding that most behaviors expressed by a person with dementia are a form of communication. When we understand the communication and address the "issue," we don't have to use psychotropic drugs as frequently.
Our team has implemented these approaches and trained thousands on these assessment and care techniques. They definitely work, and we need to help others understand that there is a better way to manage this disease, and that those with ADRD don't have to suffer. How can I help?
Kim Warchol, OTR/L, DCCT
President, Dementia Care Specialists