Hospices nationwide are exploring training programs using simulations of dementia systems; Raleigh, N.C.-based hospice provider Transitions LifeCare is taking their program to the next level to simulate the multiple co-morbidities that their patients often experience. 

Dementia simulators often involve goggles that demonstrate the effects of cataracts and macular degeneration, headsets buzzing with background noise and gloves to simulate peripheral neuropathy. Transitions incorporates other symptoms that their patients often experience such as placing IV bags around the participant’s abdomen to simulate the edema often associated with renal or liver failure, arm and leg weights on one side to simulate mobility impairments often experienced by stroke patients. Facilitators ask participants to breathe through a cocktail straw for one minute to simulate chronic obstructive pulmonary disease.

“We put our heads together and asked how we could simulate a lot of the symptoms and impairments that we see in our patients that go well beyond just memory loss and distraction; we are building upon the concept of virtual dementia to add multiple layers of complexity to give the participants a sense of how symptom burden can be accumulated,” said Mark Philbrook, director of education and volunteer services for Transitions LifeCare. “So often we forget what it’s like to be on the other side of the bed. The goal is for people to have a sense of what it’s like to be receiving care with this impairments and to build greater empathy and understanding.”

After the trainee dons the equipment they are asked to perform five basic tasks from daily life, such as setting a table or folding clothes. Trainees have one minute to perform each task, stationed at tables in a dimly lit room. As they undergo the tasks, staff buzz around them, talking about their weekends, making comments about the patient and to the patient, sometimes encouraging them to do the tasks more quickly. Towards the end of the simulation the “patient” is asked to sign a consent form for a surgery that the facilitators barely explain, convinced that the individual would not understand or remember the discussion.

The training program initially focused on clinical staff, but Transitions expanded the training to include all staff, from physicians and nurses to finance and administrative employees. The organization’s board has also participated. All new hires undergo the simulation.

“Virtually everybody is going to go through this at some point personally, either through their own experience as they approach end of life, or through dealing with family members or friends who are experiencing these conditions,” Philbrick told Hospice News. “It helps people connect with others in their family and their community, to better understand what folks with these conditions experience, and almost universally the things we are hearing from participants are they feel like they need to slow down their interactions with these patients and have to be more methodical in how they communicate with and support them.”

The program is gradually moving beyond the Transitions’ walls. The hospice has begun offering the training to their partners in the community including skilled nursing and assisted living facilities, as well as primary care practices. In some nursing homes, Transitions has opened the training to patients’ families and loved ones.

Recently, Transitions has received requests from medical and nursing schools to help train their students using the simulator, prompting the hospice to develop an expanded facilitator training program.

“We are hoping that through this experience the staff and families they will be more patient and empathetic with patients,” Philbrick said. “Feedback has been universally positive in the sense that almost every participant said that they finally understood what their patients or loved ones were going through, and what it’s like to be on the other side of the bed.”