Lockport, N.Y.-based Niagara Hospice is applying new training and new methods to its recently expanded dementia care and family support program.
Through the program, a dedicated dementia care team uses new behavioral monitoring, treatment techniques, and memory and sensory activities to improve patients’ quality of life and help them stay at home as long as possible. A nurse certified to train clinicians in dementia care leads the program.
“Too many patients who are suffering with dementia are lacking the proper care and support that they deserve to receive to maintain a good quality of life,” Frank Maietta, vice president of hospice for Niagara, told Hospice News. “The program was developed to reduce the suffering that arises from dementia symptoms, including agitation, restlessness and confusion, and it strives to reduce the stress and strain of family caregivers.”
The hospice is investing heavily in the program in terms of staff, equipment, and training, and is investigating new telemedicine systems for future implementation. In the long term, they expect returns on investment through reductions hospitalizations and emergency department visits, as well as increased patient volume as rates of dementia continue to rise.
The incidence of dementia is rising in the organization’s Niagara County service area. Niagara Hospice cared for 250 dementia patients during 2018, out of a total annual patient census of one thousand, and they expect the number to grow 5 to 10 percent each year.
“We have the capacity to treat more patients, and now we have more knowledge to provide customized care,” Maietta said.
An important aspect of the program is orienting care around patient behaviors related to the diagnosis, including nonpharmacologic interventions designed to improve quality of life, alleviate physical and psychological symptoms, as well as enhance emotional and social support. Many of the methods are based on the behavior-based ergonomics therapy (BBET) model pioneered by Govind Bharwani, M.D., of the Hospice of Dayton in Ohio.
BBET uses music therapy, video therapy, stimulation therapy, and memory prop therapy, customized to each patient’s needs, interests, and capabilities to alleviate symptoms and reduce stress.
In memory prop therapy, the patient may be exposed to a fragrance—a perfume, a food, or other favorite scent—for 30 seconds. This would be followed by music therapy or visual stimulation. When used in succession these therapies can help improve recall among dementia patients.
Patients and caregivers in the program receive increased visits from social workers, and home health aides spend 2-to-4 hours per day with the patient, compared to the typical aide time of 1 to 4 hours per week. The hospice is also in the process of training volunteers to work with dementia patients.
“In addition to helping the patient, the aides and volunteers can give caregivers the break they need, whether they go shopping, attend a support group, or otherwise tend to their own needs,” Maietta explained. “Caregivers are tremendously impacted by their loved one’s dementia.”
Through the program, Niagara Hospice is partnering with the Center of Excellence for Alzheimer’s Disease (CEAD) at the State University of New York at Buffalo to serve as a liaison and educational resource for primary care physicians in the county they serve. CEAD will educate primary care physicians and their staff on diagnostic evaluations and treatment interventions, as well as facilitate early identification of patients in need of hospice.
Also to help them reach patients sooner, the hospice is marketing the program heavily in Niagara County, emphasizing the comfort and support hospice brings to patients and their families, as well as substantial medical cost savings.
“We want residents who are affected by dementia to realize sooner that there is support available to manage the care of loved ones,” Maietta told Hospice News. “From a patient and family economic perspective, hospice care can save significant money that would be spent on their care in a nursing home or on their own.”