I recently detailed, in a Huffington Post blog post, the amazing disconnect among physicians caring for my mom during her last hospitalization prior to her passing on June 2. In a nutshell: A hospital that lives and breathes the patient experience, even with all of its EMR sophistication and patient experience processes, still treated mom in isolated silos.
Luckily, my mom had no cognitive impairment whatsoever and I was advocating on her behalf. But what if that is not the case?
Philadelphia Inquirer reporter Stacy Burling wrote an article on just that implication. In a nine-year period in Pennsylvania, 3,710 safety events occurred involving people with dementia or unrecognized dementia. There were five causes:
- Failure to recognize the patient had dementia
- Failure to assess their decision-making ability
- Failure to identify someone who could give reliable history or make decisions
- Failure to contact a surrogate
- Failure to tell all team members about the patient’s cognitive impairment
It’s not surprising to find that a Tufts Medical Center study showed that 1 in 7 Alzheimer’s hospitalizations are avoidable, as reported by Medscape.
Few physicians seek family caregiver input, and seldom do they ask caregivers about their own health. Yet systemic in the issues above are caregiver identification and support. Caregiver input impacts safety and quality. So providers need to document the caregiver in the record; establish patient advisory councils with family caregivers; promote portal engagement and EMR tools to communicate with caregivers; and gauge the health of family caregivers.
Keep in mind that 6 out of 10 caregivers are employed, according to the AARP, which also notes that 25 percent are millennials. Look around your workforce. Taking care of the family caregivers on staff will go a long way to improve employee experience, which in turn will improve patient experience. Retaining good workers, not stigmatizing them (it happens a lot) means better morale, less turnover, better retention, more productivity and huge savings in recruitment.
Get better at admissions
There are a number of tools that can help providers better know the patient. The Alzheimer’s Society in the United Kingdom has a tool called “This is Me” that is used to tell staff about their needs, preferences, likes, dislikes and interests. Ellen Belk has the “Get to Know Me” tool. And Sheila Brune’s Living History Program can capture a person’s story.
A bit more controversial, perhaps, is Gary LeBlanc’s Hospital Wristband Program. It is controversial because it suggests that a dementia screening be added to the admission process. While not a diagnostic tool, patients identified as at risk, plus patients with a prior dementia diagnosis, have a Purple Angel affixed to their standard issue hospital wristband for identification purposes. A Purple Angel is placed on their door so that anyone entering knows they should approach with the patient’s special needs in mind. Hospital staff, volunteers and first responders receive training developed by LeBlanc.
This only scratches the surface of how providers can become better when caring for elders. And it does not even scratch the surface when it comes to partnering with others in the community to look at dementia not as a medical diagnosis but as a societal issue.
Anthony Cirillo is president of The Aging Experience. He helps organizations craft experiences and seize opportunities in the mature marketplace, and helps family caregivers thrive and individuals make educated aging decisions. A consultant and professional speaker, Anthony also is an executive board member of the Dementia Action Alliance.