Agrace HospiceCare has opened a dedicated dementia unit within its Fitchburn, Wis., inpatient facility for patients who are no longer able to receive care in their homes.
A rising number of dementia patients are choosing to elect hospice. In 2017, 15.6% of hospice patients had dementia as their principal diagnosis, according to the National Hospice & Palliative Care Organization (NHPCO).
At Agrace Hospice, dementia patients represent 22% of their 4,300 annual patient census, up from 10% in 2010. The establishment of the new dementia unit was largely driven by this growing demand and the complex needs of those patients.
“It is very difficult for dementia patients to be relocated, so we do look closely at that. But when a patient becomes agitated or needs to wander and cannot remain at home safely, we can bring them into our secure unit,” Sue Husom, director of the Agrace Inpatient Unit and Hospice Memory Care Suites, told Hospice News. “Previously, those are the patients that we would have to turn away because we didn’t have a locked facility. Now we’re able to care for our dementia patients at any stage of their illness.”
The memory care suites are contained within a secure unit with 12 beds, each with a private bathroom. Mirrors in the bathrooms are covered because dementia patients sometimes do not recognize their own reflections or believe themselves to be younger than they are and can become frightened, according to Husom.
The unit contains a walking path and an outdoor courtyard, giving wandering patients an opportunity for exercise in a safe environment. Artwork in the facility depicts natural settings that are unlikely to alarm dementia patients who may become disturbed by certain images.
Agrace providers different levels of care in the memory care suites, including general inpatient care as well as residential care for eligible patients, for which Medicare reimburses at the routine home care rate. Residential patients and families pay privately for room and board costs.
The U.S. Centers for Medicare & Medicaid Services rebased payment rates for hospice providers for fiscal year 2020, which began in October 2019, cutting the routine home care rate by 2.7%, with a corresponding increase to the general inpatient care, continuous home care and inpatient respite care rates.
Patients with dementia tend to have relatively longer lengths of stay in hospice compared to those with other diagnoses. The average length of stay for dementia patients was 110 days in 2017. Stroke patients had the second highest average lengths of stay at 82.4 percent. Chronic kidney disease patients had the shortest average stay at 38.2 days.
Transitions from home to inpatient care can be difficult for dementia patients, who often benefit from maintaining familiar surroundings. At Agrace, a nurse and a nurse care manager visit the patient and family in the home for a pre-transition assessment. If the patient has already been receiving home-based care, the same nurse who has been caring for the patient will conduct this visit.
“They will go out and do a complete visit, including medication reconciliation, and speak with our nursing staff and social workers to help make that transition as seamless as possible,” Husom told Hospice News. “We do our best to bring that patient in usually late mornings, which is the key time for a dementia patient. We also have a nurse practitioner onsite in the morning that can help put in orders and make it more of a seamless transition.”
Staff on the unit, including the hospice’s medical staff, have received specialized training in the care of patients who suffer from dementia. Every staff member working in the memory care suites has undergone specialized memory care training in addition to two eight-hour training sessions prior to the unit’s opening. Staff also receive continuing education throughout the year, Husom said.
“We’ve also received some generous gifts from our community members to buy items for the memory care suites, including items used as non-pharmacological interventions for patients that have proven to be very successful for patients who become agitated,” Husom told Hospice News.