Confronting the challenges

It’s a force to be reckoned with. Alzheimer’s disease and related dementias (ADRD) are debilitating conditions that impair memory, interfere with thought processes, and limit day-to-day functioning. As the disease continues to surge—affecting more than five millionAmericans and as many as 16 million by 2050—the nation is seeking new ways to care for people with ADRD. One leading approach is focusing not on losses but on remaining potential.

“Fear about getting Alzheimer’s disease is pervasive,” says Kim Warchol, an occupational therapist and president and founder of Dementia Care Specialists, a nationwide dementia training and consulting company. “Why is the disease so scary? Because of the belief we continue to hold that if you’re diagnosed with dementia, you’re on your way down a long road of suffering.

“Although this perspective is gradually changing, it’s still there in part because of the way we’ve traditionally cared for people with the disease. As soon as a person experiences memory challenges, we confine them to a world of losses—what they can’t do anymore. Over time, we begin to use labels like ‘wanderer,’ ‘rummager,’ or ‘feeder.’ Suffering is born out of this negativity.”

Facing the realities

For healthcare stakeholders—providers, payors, and patients and their families—the challenges of ADRD are steep. Seniors with dementia are hospitalized three times more often than seniors without dementia and experience a greater reduction in quality of life. They may need intensive long-term services and support. Psychotropic medications are often overused to control behavior issues. Many caregivers eventually burn out and leave their profession.

ADRD is also taking a huge financial toll. At an annual cost of more than $200 billion, it is the most expensive illness in America today.

According to Warchol, the devastating effects of the disease are made even more so by mistaken perception.

Flipping the perception

The result can be such problems as depression, physical weakness, negative behavior expressions, more hospitalizations, and eventually, failure to thrive.

“Yet if we come from an empowered, person-centered point of view, focusing not exclusively on the disease, but on the person first and his or her remaining potential, we can significantly change the future for this individual and the downward spiral of events.”

Warchol notes that forward-thinking memory care providers are taking what she calls a “strength-based approach” to ADRD, training staff to highlight residents’ cognitive abilities. For example, the strength-based program was introduced two years ago to staff at Pathways Memory Care at Villa Toscana in Houston, Texas, one of seven memory care communities operated by StoneGate Senior Living. Since then, staff members have received specialized training in tailoring care to individuals and helping residents with dementia do as much as they can on their own.

Following the developmental stages

A key theory that’s helping to change the perception of ADRD is retrogenesis, meaning “back to birth.” Warchol explains this as the concept that the brain of a person with Alzheimer’s disease deteriorates in the reverse order that the brain developed from birth. “Cognitive skills acquired last are the first to go, and the ones attained first are the last to leave.

“Functional cognitive capacity defined in the stages of dementia can be equated to capacity within developmental ages. Someone at the end of life with Alzheimer’s has the same cognitive abilities and functional capabilities as an infant. Yet we need to remember that regardless of their stage of cognitive development, children live a quality life. Even an infant has quality of life, because we celebrate who they are and what they can do—and we accommodate for what they can’t do. We create many meaningful moments, not despair.

“That’s the way we need to see people with dementia. True, their brains are not fully functional, but that person is still there. If we as care partners can learn to adjust our perceptions and celebrate who that person is, those living with ADRD can have a quality life.”

Caregivers strive to deliver the highest-quality care, but they are often at risk of burnout.

The physical, emotional, and mental exhaustion caused by long-term involvement in emotionally demanding situations can wear down the effectiveness of staff in caring for their patients, their colleagues, and themselves. The U.S. Department of Health and Human Services describes burnout as an occupational hazard. It can result in safety issues for patients and the exit of talented workers from the profession of healthcare.

Attacking the problem

“Preventing burnout is essential to reducing the clinician shortage, retaining high-quality staff, and improving patient outcomes,” says Kristin Johnson, regional human resources and safety consultant at StoneGate Senior Living. A leading provider of senior living services, StoneGate employs more than 3,900 staff in its rehabilitation, skilled nursing, assisted living, respite care, and memory care facilities in Texas, Colorado, and Oklahoma. The company has been named one of the Dallas area’s Top 100 Places to Work.

“Our commitment to supporting the health and wellness of each person who enters one of our facilities extends not only to our patients but to our care providers,” Johnson notes. StoneGate has launched several initiatives to help its staff stay mentally and physically healthy. For example, the company offers a Wellness Program across all its locations. Initiatives include discounted memberships to local gyms, periodic health fairs at each facility where all employees can have a free health screening, a 24/7 life assistance program line to call for help with life challenges and life/work balance issues, and access to the in-facility wellness and rehab departments for general health and wellness questions. “Providing these kinds of resources for our staff gives them peace of mind and outlets for monitoring, treating, and most importantly, preventing burnout.”

Addressing compassion fatigue

“Many don’t realize the kind of fortitude healthcare workers need to provide consistent, compassionate care,” says Shawn Ruff, who is also a regional human resources and safety consultant at StoneGate.

StoneGate trains employees in the hazards of “compassion fatigue,” encouraging them to eat well, sleep well, find time to decompress—and most of all talk about their feelings. “It takes not only skill and endurance but heart. Often, those most likely to burn out are those most dedicated to their roles. They’re on their feet all day. The patients and residents they care for may be severely ill or disabled and require continuous vigilance,” says Ruff.

Aligning the team

StoneGate’s teamwork approach is a prime antidote to burnout, Johnson explains. “Each day, as our front-line workers check in on patients and residents, they report back to the care team to discuss observations and issues.” This open forum helps teams tackle difficult situations together and gain insights into shared concerns. The company also uses employee surveys to solicit feedback on the work environment and address any problems.

StoneGate staff communities celebrate successes, look for opportunities to have fun together, and take extra steps to foster a feeling of family. Special employee events, from cookouts to potlucks, help deepen staff bonds.

Adopting stress-reducing technologies and ergonomic designs

“We’re always thinking about the future and how we can make life better for our employees,” Ruff says. The company has invested heavily in health information technology at its facilities, with time-saving systems that help ease staff stress. Innovations range from patient scheduling software to electronic charting, which computerizes nursing documentation systems. “Whoever’s providing care can log in real time, enter information, and be assured that patient updates can be accessed by all who need them.” The system improves clinician workflow and gives nurses more time to devote to patient-centered care.

StoneGate has also invested in facility upgrades and new buildings in several of its locations, most recently opening new facilities in downtown Dallas, Oklahoma City, and Golden, Colorado. “How communities are constructed can affect staff members’ outlooks—and help reverse burnout,” Ruff points out. “Building design and décor can play an important part in helping staff members and residents feel at home. Common spaces and resident living areas now include more personal touches in the décor, staff work spaces are arranged more efficiently and are ergonomically appropriate, and many of the previously industrial-looking aspects of our buildings have been transformed to look more like a residential home.”

Asking for help

According to Johnson, healthcare professionals often encounter people who need help but don’t know how to ask for it. “When someone finds it hard to reach out for help—perhaps because they don’t want to be seen as dependent or as a burden on others—health needs can go unmet and the patient may eventually require even more care.”

The same is true for professionals who are struggling but don’t know how to ask for help, she explains. “We educate our supervisors on how to watch for employees who show signs of being ‘off,’ to ask if they’re OK, and to see what we can do to assist when something’s amiss. We’re reminded of how important it is to know how to ask for help when we need it—and how to offer help to others, even when they may not know they need it.”

Aiding family caregivers

StoneGate’s front-line workers are trained not only in how to recognize burnout in themselves and each other but also in how to spot it in family caregivers. “Our staff members interact often with patient and resident loved ones and offer guidance—making sure family caregivers don’t forget to take care of themselves,” Johnson says. “It’s an honor to serve their needs.”

Contact Us to learn how to identify caregiver burnout, and still deliver the highest-quality care to support patient health and wellness initiatives.

It’s a brave new world in healthcare – rife with promise but also replete with demands. Through such initiatives as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the federal government continues to signal its future direction with the industry: paying for value, not volume, of care. Increasingly, providers will be asked to navigate exacting incentive programs that tie payments directly to quality.

The rapid move toward a highly integrated, value-focused delivery system requires hospitals to collaborate seamlessly with post-acute care (PAC) partners in providing well-coordinated care. With ongoing pressure to deliver better clinical outcomes at lower costs, acute care providers will need to select their post-acute partners carefully and build them continuously into their overall care strategy.

“Collaborating closely with PAC partners helps get patients into the right setting after their hospital stay and raises the likelihood of their swift recovery,” says Henry Allen, MD, a Dallas-based internal medicine specialist named one of the “top docs” of the Dallas-Fort Worth area. “Working together, acute and post-acute providers can achieve an appropriate length of stay for each patient, reduce hospital readmissions, and improve care efficiencies.”

Delivering accountable care

According to Dr. Allen, today’s overarching imperative for healthcare providers is delivering accountable care. The two pillars of accountable care, he explains, are fiscal responsibility and quantitative quality.

“When I started practicing medicine in the early ‘90s, the healthcare community was not subject to metrics the way it is now. Although quality has always been an important goal for any individual or institutional provider, we didn’t until recently have an objective methodology for measuring and pursuing it. Today, we have metrics that can help us gauge quality, find variations in practice, and continuously improve our processes.”

The ultimate aim, he points out, is the best possible clinical outcome at the most affordable cost for every patient – while avoiding episodic care and moving toward disease prevention and health maintenance overall.

Determining the role of post-acute partners

“The patient’s care experience doesn’t end when he or she is discharged from the hospital,” Dr. Allen says. “It continues as the patient transitions to the next care setting. Continuity is key to effective care because physicians see patients in the hospital and in the PAC setting. We need to know exactly what’s going on with each patient at every point in the care continuum.”

Throughout the patient care journey, hospitals need to collaborate with PAC providers to standardize processes so that patients are not subject to haphazard care and random results, he explains. “Delivering consistently good outcomes requires providers to have greater oversight in the post-acute ‘voyage to value,’ where much of the variability in care can emerge.”

Developing a PAC network

The most important criterion in selecting the right PAC partner is its track record in quality, Dr. Allen says. The Improving Medicare Post-Acute Care Transformation Act of 2014, known as the IMPACT Act, requires PAC providers to submit standardized data on quality measures to help facilitate coordinated care and better outcomes. Reports on these measures will be shared publicly across settings.

“It’s vital to look for partners who are proactive, not reactive, in implementing care metrics and using consistent standards for specific disease management.” One of the most common metrics for evaluating PAC providers is readmission rate, he explains – how many patients under their care end up back in the hospital. Other key measures are wide ranging, from incidence of major falls to medication reconciliation.

According to Dr. Allen, post-acute care facilities vary greatly in their ability to provide and gauge quality. He offers an example from his market of a PAC provider uniformly proactive in delivering and measuring accountable care: StoneGate Senior Living, with facilities in Texas, Colorado, and Oklahoma. StoneGate’s “secret sauce” for success? “They have in place the right mission, the right vision, and the right values. This foundation empowers the care team to practice evidence-based medicine, leading to optimum patient outcomes and return to function.”

Defining the future of care

Today’s trajectory toward value-based care is only the beginning of what the future holds for the healthcare industry, Dr. Allen predicts. In the years ahead, care will be more transparent, standardized, and accountable. Expectations will accelerate for seamless care delivery in every setting. Outcomes will be easier to measure than they are today. Payment for care will be vigorously responsible and vigilantly tied to quality. Together, acute care and PAC providers will maintain a laser focus on understanding, improving, and measuring the patient experience.

“The picture of tomorrow is one of profound transformation, taking providers to an even deeper dimension in fulfilling their missions. Ultimately, we are remodeling a “sick care” system into one that delivers true healthcare – highly collaborative, exceptionally efficient, and relentlessly patient-centered.”

Join us to discuss the future of accountable care processes, value-based delivery systems, and their impact on managing patient populations.