By Annette M. Boyle
WILKES-BARRE, PA — For staff and residents, life in a dementia-care unit often becomes a dance of frustration. The constant struggle to interpret the world around them upsets patients; the inability to keep residents from “acting out” exhausts staff members.
Amie Dorney, certified therapeutic recreation specialist at the Wilkes-Barre VA Medical Center, has developed special intervention rooms to help patients with Alzheimer’s disease.
Amie Dorney, certified therapeutic-recreation specialist at the Wilkes-Barre VA Medical Center, has found a way to break the cycle. Thanks to a grant from the VA Employee Innovation Initiative, she’s developed a pilot program that combines intensive, ongoing staff training and special intervention rooms in an effort to replace staff anxiety with confidence and patient frustration with calm.
“For a modest amount of money — $150,000 — we have been able to pilot this promising program,” said Michael Cortright, VA innovations portfolio manager. “We need to be effective stewards of taxpayer funds, and this is an initiative we believe will offer significant benefits to many veterans.”
“It’s already difficult to place patients with dementia — and demand is growing,” noted Cortright. “Many medical centers do not have wards suitable for these patients. If this innovation program can reduce turnover by showing staff they can make a difference, it could stimulate many other medical centers to create dementia units.”
Increasing capacity for cognitively impaired veterans is important, because Wilkes-Barre is one of few specialty dementia units in the VA system, according to Cortright, noting that the state where he is located, South Carolina, has none. Even where dementia units do exist, space can be very limited. The dementia unit at Wilkes-Barre, for example, has only 22 of the105 beds at the Community Living Center (CLC).
With the aging of the baby-boomer population, the number of veterans needing long-term care in dementia units is expected to rise sharply. The Alzheimer’s Association says that a new case of Alzheimer’s disease and related disorders (ADRD) is diagnosed every 69 seconds in the United States. Even as the number of patients with dementia has risen, understanding of the disease and the needs of those who have it has struggled to keep up.
Over the four years Dorney has worked at Wilkes-Barre, she said she has noticed that patients in the dementia unit exhibit certain patterns. “Some might categorize wandering, aggression, agitation and hoarding as negative behaviors, but they are normal for those with dementia. They aren’t acting out; it’s part of the disease progression,” she said. “Staff need to understand what dementia is and how to deal with patients who have it, so that we can give our veterans the best care possible for the time they are living with us.”Innovative VA Program Provides Calm and Supportive Environment for Alzheimer’s Patients and Caregivers Cont.
While an intellectual understanding of ADRD is a necessary foundation to providing quality care for this population, Dorney wanted to go further and to enable staff to experience what dementia feels like.
Two programs filled the gaps. First, the Crisis Prevention Institute/Dementia Care specialists of Milwaukee, WI, provided an on-site, three-day “train the trainer” course to establish a common base of disease awareness and therapeutic structure for therapists, nurses and other staff members to use.
The program shifts the frame of reference from the patient’s deficits to “what is the best ability for them to function” at each stage of the Allen Cognitive Model, according to Dorney.
Staffers then learned how to build on that base to enhance communication, minimize negative behavior and support patients’ families. The program will be offered bimonthly until all personnel in the hospital have been trained. Dorney said she hopes that discussion about the program will create interest beyond the hospital, ultimately drawing in social workers, therapists and providers of in-home care to veterans and others in the community.
For the next step in training, staff took the “Virtual Dementia Tour” created by Atlanta-based Second Wind Dreams. The “tour” simulates dementia and the physical challenges many older adults face. Participants wear special goggles that replicate macular degeneration, have their fingers taped together to mimic the rigidity of arthritis, wear headphones that transmit the confusing bits of speech and background noise that plague many people with ADRD and have inserts in their shoes that create an unsteady gait. They are then asked to perform a few simple tasks such as “find the white sweater on the bed” or “set the table for four” in a limited amount of time. All staff members of the Wilkes-Barre CLC will ultimately go through the simulation.
“At the end of this sensitivity training, staff have a better understanding of our patients with dementia. They remember how they felt during the simulation. Still, we know that at the end of the 10 minutes, we can take off the goggles and untape our hands. Imagine feeling that way for the rest of your life,” Dorney noted.
As part of the pilot program, the Wilkes-Barre CLC also purchased two multi-sensory environment rooms from FlagHouse of Hasbrouck Heights, NJ. The rooms include bubble tubes, sound- and touch-activated interactive wall panels, projection screens with a variety of peaceful scenes, and music residents can activate with almost any kind of motion. A variety of seating options features rockers as well as vibro-acoustic chairs that hook into a stereo digitally engineered for a lot of bass, creating a massage with the music itself. Patients can interact with the various sensory elements as they wish, giving them a sense of control as well as pleasure and a calming environment.
“The goal is for every patient to have a plan created by a therapist so that nursing staff can know what the patient likes and dislikes and can use the room as an intervention to soothe patients,” said Dorney. When fully utilized, the rooms “are not just diversional or calming, they can also be used for therapy.”
The more therapy provided, the fewer falls and the less residents need surgery, rehabilitation and pain medications, noted Dorney. Similarly, with reduced agitation, patients need less psychotropic medication. Program metrics will track the amount of therapy patients receive, changes in the number of falls and amount of medication and overall quality of life for residents.
While the ultimate goal is to provide the best possible care for veterans with dementia, the pilot also will measure attitudinal changes in staff morale, interdisciplinary and inter-shift communication, and how patient-centered the environment is. Dorney said she expects the program to help staff “feel more confident and engaged. Nurses and nursing assistants have very tough jobs. If they can have a more positive experience, we’ll have fewer call outs and less staff turnover.”
“We’re really pleased at the progress already made in this initiative,” added Cortright, noting that the dementia-unit pilot reflects the overall goals and values of the innovation program.
“The innovation program empowers employees to make a difference beyond just the day-to-day by actually playing a role in eliminating problems and improving long-run results for the VA and the veterans,” added Jonah Czerwinski, director of the VA Innovations Initiative and senior adviser to the Secretary of Veterans Affairs. “Employees view it as a way they can contribute to the mission and help us do even better at serving the millions of veterans who rely on us.”
As a bonus, Wilkes-Barre has not needed to spend all of the grant money, noted Dorney. “Some companies have given us discounts. They understand what a huge difference this will make in the lives of our veterans.”
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