We face a problem of epidemic proportions.
So much information about the growing prevalence of Alzheimer’s and related dementias has been in the news. The reports have had a sense of urgency that we find solutions to this growing issue. Solutions exist in the form of nonpharmacologic interventions that have been shown to minimize dementia-related problems. However, solutions cannot be implemented without proper training.
Statistics
According to the Alzheimer’s Association, there are approximately 5.4 million Americans living with Alzheimer’s disease (AD). As the baby boomer generation ages, the number of people age 85 and older anticipated to have AD by the year 2050 is 7 million (Alzheimer’s Association, 2016). Evidence indicates that 68% of nursing home residents are impacted by dementia, with as much as 41% functioning at the moderate to severe level of impairment (Joint Commission, 2014).
Background
The use of antipsychotic medications to manage the behaviors associated with Alzheimer’s/dementia is typically ineffective and may have poor outcomes. Best practices in dementia care indicate that alternative approaches to medication can be effective in preventing and managing the behaviors associated with AD (Kales, Gitlin, & Lyketsos, 2014).
National and state initiatives
Several national initiatives are underway to address healthcare service delivery for those impacted by dementia. The National Alzheimer’s Project Act (NAPA) was enacted in 2011 (Alzheimer’s Association, n.d.). From this act, the National Plan to Address Alzheimer’s Disease (National Plan) was developed in 2012 (National Plan, 2016). This strategic plan identifies core initiatives to address specific areas within our society that are affected by Alzheimer’s disease.
Many states have written plans in response to the National Plan [PDF]. Education is a core component of this initiative. Pre-service and in-service education is being evaluated to determine where improvements in education can be made. There is also a movement to educate family members—the informal, unpaid caregivers.
Photo: baranozdemir / iStock
The National Partnership to Improve Dementia Care in Nursing Homes originated in 2012. This initiative focuses on the reduction of anti-psychotic medication use in nursing home residents living with dementia, as well as on promoting person-centered care for those individuals living with Alzheimer’s disease and related dementias (ADRD) (CMS, 2016). It was through the National Partnership to Improve Dementia Care in Nursing Homes initiative that the
Focused Dementia Survey was piloted in 2014 and 2015 (CMS, 2016). Areas of focus within this targeted survey include:
- Person-centered schedules for daily routines.
- Activities that promote physical and emotional well-being.
- Comprehensive and standardized assessments that generate comprehensive care plans.
- Demonstration that non-pharmacological interventions were used prior to the inclusion of medication to manage behaviors associated with dementia.
Why is training so urgently needed?
Education is necessary to ensure that all who provide direct care are equipped with the tools they need to successfully support and engage a person living with ADRD at every stage of the disease.
It is not enough to remove anti-psychotic medications from a person’s plan of care. If health care professionals serving those with ADRD do not have proper skills to evaluate, treat, and train others, people with ADRD and their caregivers will suffer immensely. For care partners to be successful, they need to know how to engage the resident living with dementia (you can read more about the need for this kind of staff training
here). This requires specialized care approaches that incorporate knowledge of stage-specific abilities and person-centered approaches that are customized from the individual’s
life story.
Education is necessary to help our care partners assimilate a new perspective in best practice in dementia care.
When the going gets tough, the tough MUST get going.
We must all dig deep inside to find the strength to advocate for quality of life for those with ADRD. We must make our case for all therapy staff and other professionals to receive the dementia training they need to be able to assess and treat those with mild to severe dementia.
We must use the training we have to make real changes to the quality of life, functional performance, safety, and health of those we serve. When we facilitate successes, we must share the results with others through informal conversations, care plan meetings, published articles, and research.
We must take every opportunity we have to educate families and direct caregivers. This can be through skilled service as a part of the maintenance program training. It can be a part of staff in-services and family speaking engagements.
We must encourage leadership to understand the many benefits of sending their staff through dementia training that is abilities-focused and has a congruent frame of reference between all disciplines. Training benefits can include better QI results (e.g., less weight loss, fewer falls, and less depression); better resident, staff, family, and surveyor satisfaction; and increases in revenue through therapy use and census.
Dementia education must not take a back seat during difficult economic times or any other time. The number of people living with ADRD in the settings in which we work is staggering. The impact their dementia has on their health status, safety, and the therapy, nursing, and activity plans is overwhelming. We cannot ignore these individuals or pass them up during screenings or other patient identification activities. We cannot let our fellow humans exist in a world of loneliness and helplessness.
We are at a crossroad. Which path will you take?
As the incidence of dementia rises, the number of people with ADRD that nurses, therapists, and other professionals come into contact with every day is growing. How will we address this challenge?
We believe that while the fight to find a cure for Alzheimer’s continues to wage, the best hope for people with ADRD now is the specially trained therapist, nurse, CNA, activity professional, and social worker.
Through the best-abilities care approach delivered by competent and loving professionals, we may be able to slow the progression of the disease, ease the burden on caregivers, reduce dementia-related behaviors and the overuse of psychotropic meds, and increase overall health and well-being.
Without a proactive, best-abilities approach delivered by competent professionals, the huge number of people with ADRD will simply
exist with many disabling co-morbid conditions such as activity dependence, mood and behavior issues, poor nutrition, weakness and falls, and depression.
To fix this, we must get out of our “same-old, same-old” mentality. The population in our nursing homes, assisted living facilities, and home care is different than it used to be. The dementia prevalence is much higher, and we must respond accordingly with staff dementia training and specialized programs—so that our elders and loved ones don’t merely exist. So they don’t merely survive. Because with our skilled and caring approach, they can in fact
thrive.
The choice is yours. Will you do everything in your power to provide and advocate for people with dementia and their families, and for your skills as a professional—or will you take a path of least resistance?
If you are reading this, you are a leader.
You are an advocate. We implore you to fight for the right to quality of life for all those with ADRD. Leading a quality life in spite of having ADRD can only happen for our loved ones if caring professionals are empowered with knowledge.
More information on how you can learn and implement best practices in dementia care:
References