Palliative Care for Elders with Dementia
Jewish Home has long recognized the benefits of palliative care for nursing home residents. Comfort First, developed at the Beatitudes Campus in Phoenix, is a program to adapt palliative care techniques for elders with dementia. Jewish Home was chosen as one of three long term care facilities in New York City to participate in this program funded by the New York City Chapter of the Alzheimer’s Association.
In The New Yorker story Tena Alonzo, Director of Education and Research at the Beatitudes Campus discusses the importance of learning how to understand elders with dementia, who may be unable to verbally express what they are feeling. Speaking of a nursing home resident who was agitated and moaning, Alonzo explained that “it can be particularly hard for people with dementia to identify the source of pain or to articulate their experience of it. But his body told the story… All behavior is communication.”
Jed Levine, Executive Vice President at the New York City Chapter of the Alzheimer’s Association says of his visit to the Beatitudes campus, “What was most impressive was not what was going on but what wasn’t going on – the absence of palpable distress.”
Overlapping with Other Innovations in Long Term Care
The New Yorker story sees Comfort First as overlapping with other innovative models for long term care, such as The Green House Project and small house models being implemented at Jewish Home. The models share a commitment to less intrusive clinical care and to creation of a
comforting, calming environment. They emphasize understanding an individual’s desires and choices and using that understanding to promote comfort and bring joy and pleasure to their lives. Ms Alonzo is quoted as saying “For people who no longer can think clearly, a life of small sensory pleasures is a considerable achievement.”
Staff Training and Participation is Key
The training provided to nursing home staff is critical to the success of Comfort First. All staff that work on a unit, Housekeepers, Certified Nursing Assistants, Social Workers, Nurses, Physicians… all are key players in understanding what residents are communicating and in finding creative ways to enhance each individual’s quality of life.
Deirdre Downes, Corporate Director of Social Work Initiatives at Jewish Home Lifecare, cites as a subtle but significant change, that Certified Nursing Assistants participating in Comfort First have, “stopped talking about residents ‘resisting care.'” Learning how to carefully observe and learn from a resident’s behavior is key to the training and even seemingly simple insights can lead to significant effects. For example, at Jewish Home, Certified Nursing Assistants observed that one resident likes to watch television while being bathed and are now careful not to block his view of the television while assisting him.
Reducing Psychotropic Medications
The Comfort First model also makes a concerted effort to replace the use of psychotropic medications. Psychotropic medications are seen as an inappropriate means to address symptoms of dementia. Such medications often mask a resident’s pain or other conditions that could be more effectively addressed by understanding and addressing an individual’s underlying needs and feelings.
Family Members Play an Important Role
Helping family members of residents to understand and accept dementia is also important to the Comfort First model. The daughter in law of a Beatitudes resident is quoted as saying of her mother in law that while she no longer recognizes her children or grandchildren, “she still makes us laugh and because of that we still feel that we have a connection with her.”
It’s About Quality of Life
When the author of The New Yorker article, Rebecca Mead, asks after a resident she had met at the Beatitudes Campus, Tena Alonzo informs her that the resident has died. Ms Alonzo goes on to say, “She was singing and dancing up until the day before she died… If you have to go, that’s a good way to go.”
As the Comfort First program continues to make a difference in residents’ lives, the lessons learned will be shared and applied more broadly when the program is rolled out across Jewish Home Lifecare campuses.