Person-Centered Dementia Caring: Crossing the Quality Chasm

1. Person-Centered Dementia Caring: Crossing the Quality Chasm Karen Love & Elia Femia, PhD Co-Founders ~ FIT Interactive

2. Patient-Centered/Person-Centered IOM Report - IOM, 2001 report - “Crossing the Quality Chasm”; Affordable Care Act Called for a redesign of the nation’s healthcare system and a shift from a clinical/disease model of care to a person-centered one.

3. Models of Care Person-centered orientation Medical-disease orientation Focus on holistic bio-psycho-social-spiritual dimensions; Based on relationships that foster self-determination, normalcy, choice, purpose, belonging, security and responsibility to optimize health and well-being. Personal “Individualized practices” “Behavioral expressions” Focus on medical and disease condition; Typically based on efficiencies of the provider of services or supports. Less personal “Non-pharmacological practices” “Behavior problems”

4. Concerns That Coalesced a National Initiative • NAPA – too narrow and silent on person-centered • Fragmented and often impersonal care • Overuse of antipsychotics • Aging demographics

5. Concerns Coalescing a National Initiative • Too narrow a focus on Alzheimer’s disease • Focus on CURE and treatment – not CARE • No one with dementia represented on Advisory Council • No mention of person-centeredness • Approach is the conventional clinician/disease ethos

6. National Dementia Initiative • Led by CCAL • Karen Love - Founder • Jackie Pinkowitz - Chair • Leadership Team • Jayne Clairmont -English Rose Suites • Angela Lunde – Mayo • Lene Levy-Storms – UCLA • Anne Montgomery – US Senate Aging Committee

7. Good Person-Centered Models for Dementia Care

8. Understanding the WHAT of person-centeredness is important; understanding the WHY is life changing.

9. The WHY of Person-Centered Dementia Caring

10. Optimizing Well-being Doing things that continue a sense of normalcy, having fun, and experiencing purpose and meaning.

12. Maintaining Personhood If you had dementia, what would be important in your daily life ?

14. There is a physiological basis for well-being… LIMBIC SYSTEM

15. The Power of the Limbic System Controls humans’ emotional feelings and memories

16. Supporting Meaningful Life and Engagement People living with dementia are not as able to initiate activities on their own such as finding interesting things to do. Imagine sitting on a plane for 3 hours WITH NOTHING TO DO OR LOOK AT.

17. Positive Approaches to Person-Centered Living Therapeutic Engagement

18. Research EvidenceWhat is done and how it’s done are key to optimizing well-being.

19. Positive Approaches:BUILD A PERSONAL RELATIONSHIP Facial and bodily expression Tone of voice – use a normal tone at normal speed Conversations – deep knowing Quality of time – not quantity of time WHY?

20. Reciprocity

21. Laughter

22. Quality not quantity

23. Positive Approaches:BUILD COMMUNITY AROUND THE PERSON Make them feel included Provide a sense of purpose Ensure that the environment reflects that purpose WHY?

24. Personal Interests and hobbies

25. Activity and exercise

26. Spirituality

27. Children

28. Positive Approaches:SUPPORT THE RHYTHMS OF DAILY LIFE What goes on in your day are the same as what goes on in their day. Ask them directly. WHY?

29. Building on visceral feelings and memories

30. Trying new things

31. Spontaneity

32. Touch

33. Pets

34. Passive engagement

35. Positive Approaches:NURTURE THE ENGAGEMENT HOW MANY PEOPLE DOES IT TAKE TO CHANGE A LIGHT BULB? WHY?

36. You never know unless you try

37. Thank you.To access a copy of this presentation, go to www.fitkits.org – then click on COMMUNITY and PRESENTATIONS