There are 47 million people worldwide diagnosed with dementia and 9.9 million new cases each year (World Health Organization Media Center, 2017). It is well known that residents living with dementia have complex care needs that should be taken into account by providers involved with their care. Recognizing these challenges, person-centered care has become a key focus in the delivery of healthcare for those living with dementia. A 2018 article in The Gerontologist® describes person-centered care as a philosophy of care built around the needs of the individual and contingent upon knowing the person through an interpersonal relationship. This primary approach to healthcare emphasizes partnerships between residents and healthcare providers by acknowledging the resident’s preferences and values and seeks to move beyond the traditional approach to healthcare.
The Alzheimer’s Association has been a leader in outlining principles and practices of quality care for individuals living with dementia. In 2018 they developed Dementia Care Practice Recommendations to better define quality care across the care continuum and throughout the disease process.
1. Know the resident living with dementia
Gathering information from a spouse, significant other, family, friends, and the resident is important in getting to know the resident. Understanding both their past and present life and recognizing who they were prior to their dementia diagnosis will assist caregivers in getting to know the resident as a unique and complete person.
2. Recognize and accept the person’s reality
It is important to see the world from the perspective of the resident living with dementia. Understanding what their reality may look like is an important care consideration.
3. Identify and support ongoing opportunities for meaningful engagement
Engagement with the resident living with dementia should be geared towards their interests and likes. Consider hobbies or other forms of pastimes that they took comfort in earlier in life.
4. Build and nurture authentic, caring relationships
Resident’s with dementia would benefit from having constant caregivers that they may grow to recognize. Completing tasks with the resident and not for the resident can be part of a supportive, nurturing relationship.
5. Create and maintain a supportive community for individuals, families, and staff
Encouraging frequent visitations ad opportunities for reminiscing with family and friends allows for the resident with dementia to share experiences and maintain a sense of autonomy.
6. Evaluate care practices regularly and make appropriate changes
It is important to regularly evaluate practices and models, share findings, and make changes to interactions, programs, and practices as needed.
So how do providers support person-centered care in the skilled nursing facility? The Alzheimer’s Association Principles For Advocacy To Assure Quality Dementia Care Across Settings provides a framework to examine interventions to support the dementia care workforce in long-term care settings. It includes:
1. Provide a thorough orientation and training program for new staff, as well as ongoing training
A comprehensive orientation is essential for new staff and should be included in ongoing education for all staff members. Having a team leader assist in the process can help develop staff members and prepare them for the care needed for the dementia resident.
2. Develop systems for collecting and disseminating person-centered information
All staff must know the person living with dementia as an individual. Establish procedures for collecting person-centered information that includes choices, preferences, and life history such as through the baseline careplan. Section F interviews can assist the staff in getting to know the resident.
3. Encourage communication, teamwork, and interdepartmental/interdisciplinary collaboration
The facility can use in-services and team huddles to collaborate and execute the delivery of care.
4. Establish an involved, caring, and supportive leadership team
Creating a person-centered “community” is not possible without service-oriented leaders, managers, and supervisors. Creating this community is a central part of person-centered care.
5. Promote and encourage resident, staff, and family relationships
Encouraging relationships among residents living with dementia, staff, and families is vital to person-centered care and is fostered in part by implementing consistent staff assignment.
6. Evaluate systems and progress routinely for continuous improvement
It is important that the facility routinely evaluates their systems and analyze their progress. For example, QAPI, or other monthly meetings could be a time to measure effectiveness of all systems and identify areas for improvement.
The quality of dementia care given to residents and families is contingent upon the quality of assessment and care planning, and the degree to which those processes are person-centered. Taking the steps listed above and continuing each of these processes will assist the SNF in successful, competent nursing care for all residents, and especially those who need additional support throughout the challenging and progressive stages of dementia.
References
- World Health Organization (2021). Dementia. https://www.who.int/en/news-room/fact-sheets/detail/dementia
- Fazio, S., Pace, D., Flinner, J., & Kallmyer, B. (2018). The fundamentals of person-centered care for individuals with dementia. The Gerontologist, 58, S10–S19. doi:10.1093/geront/gnx122.
- Gilster, S., Boltz, M., & Dalessandro, J. (2018). Long-term care workforce issues: Practice principles for quality dementia care. The Gerontologist, 58, S103–S113. doi:10.1093/geront/gnx174.
- Alzheimer’s Association. (2017b). Long-term care workforce issues: Principles for advocacy to assure quality dementia care across settings. Retrieved from: https://alz.org/national/documents/LTCworkforceissues.pdf
Blog by Jessica Cairns, RN, RAC-CT, CMAC, Proactive Medical Review
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