St. Croix Hospice started was founded in 2008 in Minnesota with a commitment to provide comfort and quality of life for patients facing a terminal diagnosis, and their loved ones. Since then, they have rapidly grown to offer their services through dedicated care teams in multiple facilities across 10 midwestern states. Expanding their service region not only meant an increasing overall patient census, but an increase in patients living with dementia.
“We have a lot of patients in our care not only with dementia as a primary diagnosis, but also as a secondary diagnosis,” says Laura Christensen, Director of Education at St. Croix Hospice. “They might be in our service for heart disease, but they also have a secondary diagnosis of dementia.”
21% of their admitted patients—almost 1 in 4—have a primary or secondary dementia diagnosis.
This growing dementia-diagnosed population led St. Croix Hospice to make the decision in 2019 to invest in training that would enable their staff to provide the absolute best possible dementia care to patients and their families. The program they chose was Dementia Capable Care from Dementia Care Specialists at Crisis Prevention Institute.
Dementia Care Training and “Light Bulb Moments”
Kiley Logan, a social worker, was among the first to be trained in Dementia Capable Care, and among the first to see staff reactions as she trained them in the new program. “That ‘light bulb moment’ would go off for different people at different times. Learning where that person living with dementia is and start with them there. We now have more than 1,800 trained staff demonstrating the skills that they've learned from dementia training.”
Light Bulb Moment: Empowered, Confident Staff
“It is a mandatory training for all full-time clinical staff,” Laura says. “Whether it's nursing or hospice aide or music therapy or massage therapy or chaplain or social worker, they're all getting this training. I think that the benefit to our staff is they feel prepared to provide the best clinical care for our patients.”
According to Bethany McKenzie, an RN educator, “we're trying to capture this training for our folks as they come on board ... really before they're going out to meet patients for the first time, working for our organization. So, coming together as a group and meeting folks from across the organization helps everyone to get to know each other and relate to each other in different areas and expertise.
“Our RN case managers lead patient care, but by training our aides, chaplains, and social workers, we have additional staff support that helps the whole team recognize declines and better care for patients. It's bringing the full picture of the patient to every staff member that we have and then allowing them to recognize when something might need to be addressed.”
Light Bulb Moment: Person-Centered Care
“Using a person-centered approach to our care just allows our staff to do better care planning and really get into what does this person need specifically on an individual basis, says Bethany. “There's no cookie-cutter way to take care of someone. So, digging down and getting at the root of what each individual needs just helps us provide the best care to our patients.
“All of us getting together in a group, even though it's a virtual training, it brings staff from all over our service area. We bring people together and we talk about the dementia training, of course. But then also I ask folks to share if they have any personal stories of a loved one or a close friend that has had experience with dementia or going into a long-term care facility. Sharing those stories really helps everyone to kind of relate to the people we’re taking care of. They have families, they have loved ones and sometimes it's very personal for, for even our coworkers.”
“It helps everyone remember that the people we’re taking care of who have dementia are still people, and that they have loved ones out there.”
— Bethany McKenzie, RN, St. Croix Hospice
Light Bulb Moment: Behavior is Communication
Laura’s experience with dementia patients made her think the training wouldn’t offer her any new insights. “I have been in healthcare for years as an aide in the field at a nursing home, then as an LPN, and then as the nursing manager of a branch when I took the training. So, in my mind, I was thinking I wasn't really going to get a whole lot out of the training because I've worked with dementia patients before. But there were definitely light bulb moments for me.
“’Behavior is communication’ was really one of the biggest. Working with our patients, we have staff come in and make assumptions on why these patients are having all these behaviors and ‘what do we do,’ and just reminding them that ‘you know, well, we need to figure out what they're trying to tell us. Reminding them that because ‘behavior is communication’ there's a whole different way to look at behaviors than what we sometimes think about. Helping them to have that knowledge base and provide that best patient care, just reminding them that you know those behaviors are not necessarily that they're reminding them not to take it personally, things like that. So that was kind of the bigger takeaways for me.”
Beth shared a patient story that illustrates this: “The specific patient I'm thinking of is in end stage dementia and having those reflexive abilities that are remaining. And oftentimes this person is opening their mouth to eat and was potentially being overfed, causing some bloating, so I worked with staff in this facility. I explained to them that this patient may not still be hungry even though they're opening their mouth. It only appears that they want to eat more. So, working through that, we were able to reduce portions for this patient and watch for other cues that this person may be full, and got this patient a little more comfortable. We just really came together with that facility to provide good patient-centered care for this person.”
Light Bulb Moment: A Business Advantage
According to Laura, Dementia Capable Care benefits St. Croix Hospice’s business growth as well as staff growth.
“The facilities we work with know we have CPI training, and that is something we can market. We have the extra training as dementia care specialists, and facilities know that expertise is beneficial to them. They know they have somewhere to call for that expertise and we can provide that extra education—not only to our own staff, but the facilities that we work with, our other partnerships, hospitals, and things like that.
“So having the extra dementia training does set us apart when we serve facilities that do not have clinically licensed or trained staff. They are always grateful to have our expertise on hand in the building. They need that extra assistance to appropriately care for these complex residents.”
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