Emily Zuehlke, Marketing and Planning Leadership Council
As penalties for readmissions and unnecessary care episodes continue to climb, provider organizations need to give special consideration to an often-overlooked group: dementia patients.
This population is at heightened risk of falls, fractures, escape, dehydration, and anxiety in hospital settings, and, given that a recent World Alzheimer’s Report and Neurology study expect the number of cases of dementia to triple by 2050, these dementia-related incidents are likely to increase.
Use our Chronic Condition Inpatient Estimator to gauge the volume of dementia patients in your service area and consider these five steps that you can take to minimize the risk of complications during and after a dementia patient's hospital stay.
1. Strengthen staff skills
Encourage staff to exceed state requirements for dementia training by becoming a Certified Dementia Practitioner or taking other Alzheimer and dementia trainings offered through the National Council of Certified Dementia Practitioners.
Organizations can encourage staff to earn this credential, the highest standard in dementia education, to provide a higher level of care to dementia patients.
2. Collaborate on care
Create cross-service line dementia care teams. For example, at New York-Presbyterian Hospital, dementia patients receive care from a multidisciplinary team of healthcare professionals including neurologists, neuropsychologists, social workers, nurse practitioners, and rehabilitation specialists.
In addition to screening and treatment services, this team provides neuropsychological assessments, patient and caregiver education, and assistance in managing patient care. By providing a cross-service line team to these patients, New York-Presbyterian Hospital has committed to improving care coordination and making the hospital a less overwhelming, frightening, and stressful place for easily-confused dementia patients.
3. Promote outpatient settings
Work with physicians and marketers to encourage dementia patients to seek care at outpatient centers when possible. Although patients can still feel disoriented and confused in outpatient clinics, these sites of care tend to be less overwhelming and upsetting to dementia patients than inpatient settings.
When possible, structure consultations or tests to be conducted in outpatient facilities before inpatient admission. The Marketing and Planning Leadership Council has resources on outpatient geriatric assessment centers and geriatric emergency departments if you are interested in alternative options for better accommodating dementia patients.
4. Provide privacy
Make private or semi-private rooms available to dementia patients. The Alzheimer’s Association recommends assigning dementia patients to private rooms to minimize delirium and to more easily accommodate patients’ routine caregivers, while Medscape suggests semi-private rooms for low-key social stimulation.
As explained in a Daily Briefing article earlier this year, dedicated dementia units in the nursing home context produce mixed results, but assigning dementia patients to private rooms requires minimal investment for hospitals and can greatly improve dementia patients’ experience.
5. Demystify discharge
Create easily-understandable, printed discharge materials about planning for future care for dementia patients and their caregivers. A recent JAMA study found that even elderly patients without dementia struggle to understand discharge directions.
Materials written at an accessible reading level and accompanied by pictures help patients and their caregivers understand post-treatment procedures and how to prevent complications.
More from the Marketing and Planning Leadership Council
For more information about how the aging population will affect hospitals and how hospital planners can improve geriatric services, check out some of our other research.
By 2030, one in five Americans will be 65 years of age or older, representing a dramatic shift of patient mix toward high acuity, multi-morbid Medicare patients. To improve care and finances for treating this burgeoning population, hospitals may develop geriatric-specific programs. This webconference outlines key considerations for developing services specific to this growing and complex population.
Prompted by the aging Baby Boomers, providers have begun to reconsider how they provide emergency care to seniors. This report surveys the efforts of four hospitals and health systems to meet this challenge by setting up specialized geriatric emergency departments (EDs).
Every day, 11,000 seniors become eligible for Medicare. How can health systems prepare to support this growing population’s future needs? To help seniors manage functional decline and proactively plan for future care, some organizations have implemented outpatient geriatric assessment centers, which offer comprehensive, multidisciplinary evaluations and treatment plans for complex, elderly patients.
Administrators of geriatric care coordination and discharge planning programs report that constant and complete communication among providers is crucial to the success of their departments. Medication reconciliation presents significant challenges at some institutions, while others have adopted pathways and technology to facilitate the transmission of information across care locations.
Furthermore, program managers note the importance of communication within the hospital to ensure that geriatrics services receive the support of top-level administrators at the institution.
As health care providers respond to federal incentives to develop care continuum models, no care alignment strategy between hospitals and post-acute care providers is complete without considering the dementia patient population.
Dementia patients pose significant challenges for providers—from treatment refusal to physically threatening behavior— and these challenges contribute to the higher admission rates and longer lengths of stay.