Karen Gayman
Senior Director,
Senior’s Health
Primary and Community Care
Background
 In 2002 AHW, in collaboration with stakeholder from the
Regional Health Authorities, developed a paper entitled,
ALZHEIMER DISEASE & OTHER DEMENTIAS: Strategic
Directions in Healthy Aging and Continuing Care in Alberta.
 Health Authorities were charged with developing regional
implementation plans to address the strategic direction outlined
in this document.
 Regions had varying capacity to accomplish the work. In April of
2009, the former health regions joined to become the provincial
operating unit of Alberta Health Services (AHS).
 The Seniors Health Provincial team was created in this
reorganization.
Cognitive Impairment Team
Deliverables:
 Develop and implement a provincial dementia/delirium
strategy across Alberta to improve the quality of care and
enhance the provision of services provided to Alberta’s
continuing care clients assessed and diagnosed with
dementia or delirium.
 The strategy will help to promote a shift in the approaches
utilized by AHS to support the unique needs of cognitively
impaired continuing care clients from a chronic disease
perspective, and will also help to support and standardize
programs that provide opportunities for socialization,
engagement in meaningful activities, and exercise.
Our vision: Persons with
Dementia and their
Carers are supported
throughout their journey
Health Service
Planning
Policy and practice
Service Framework
Workforce: Staff
competence
Education
AHS - Seniors Health 2012 Cognitive Impairment Strategy
Prevention &
Wellness
Early
Recognition
Living With
End of Life
Congregate
SupportiveLiving
Care,
Symptom
management,
Bereavement
Support
Create and Implement Dementia Sensitive Policy and Services Guidelines
Across the continuum
Public health
Public
Awareness &
prevention
Home
Primary Care
Acute Care
living
Diagnosis,
Community services,
education, System
Crisis response,
navigation, Advance
Delirium Protocols
care planning
Implement best practice guidelines for Dementia care and
Delirium prevention/management
Ensure Healthcare staff have the knowledge and skills to provide quality dementia
care in settings where this competence is supported and valued
Family caregiver
support: respite,
Offer appropriate support and education to Carers at each stage,
provide quality respite services
education
Community
Partner with community services to enhance quality of life for those with dementia
partners
Research and
Support Cognitive impairment research agenda: partner with academic institutions
Innovation
Information
Plan, Provide and monitor care based on valid outcome indicators (KPIs)
management
Our mission is to provide person centered care that is accessible and sustainable for all
Albertans
Strategy Pillars
Health Service planning for those with Cognitive
Impairments (Dementia) is grouped into four phases
of the disease journey:




Prevention and Wellness;
Early signs, obtaining a diagnosis and making
plans for the future;
Living well with Dementia; and
Support at End of Life.
Strategy Pillar 1
Prevention and Wellness.
 Public information is needed to educate about
dementia and healthy living strategies such as exercise
and maintain social supports. Working with
community partners such as the Alzheimer Society is a
key strategy in meeting this goal.
 Key public message: “stay active and healthy; stay
socially connected”
Strategy Pillar 2
 Early Signs, Obtaining A Diagnosis And Making Plans For
The Future.
 Core health services include: obtaining a cognitive assessment
and a medical diagnosis of the underlying cause of a cognitive
impairment within a timely manner from the beginning signs of
cognitive decline.
 Supporting the person with cognitive impairments, and their
family caregivers, to participate in planning for their future, early
in the journey is important and occurs over time.
 Partnerships with the Alzheimer’s Society “First Link” program
are key strategies to addressing these support needs. Key public
message: “significant memory loss is not normal aging; take steps
to plan ahead”
Strategy Pillar 3
Living Well With Dementia.
 Services in the community such as Dementia specific
Adult Day Support Programs are key to “living well.”
 Support programs for those adjusting to the diagnosis
and for those providing the majority of the care at
home are also key services.
 Dementia specific respite services, provided by staff
(HCAs) who are knowledgeable and skilled at Personcentered Dementia care are fundamental services
required to support family caregivers
Strategy Pillar 3 con`t
 As needs increase, Supportive Living and Long Term Care
services may be required.
 Staff who have the education and organizational support to
provide evidence based dementia care in settings that are
designed for this population are key.
 The goal is to provide Care that aims to prevent responsive
behaviours, such as frustration that may result in ‘aggression’
and promote quality of living “in the moment”. Individualized
care planning is necessary to address Behavioural and
Psychological Symptoms of Dementia (BPSD).
 Minimizing the need for restraints (physical, environmental and
with chemicals restraints such as anti-psychotic medications) is
the goal of supporting the person to live well with the dementia
in a congregate living environment.
Strategy Pillar 4
Support at End of Life.
 Care at the end of life is supportive and avoids invasive
quality.
 Family caregivers are supported throughout the
journey to appreciate the debilitating progression of
the disease that results in death.
Our vision: Persons with
Dementia and their
Carers are supported
throughout their journey
Health Service
Planning
Policy and practice
Service Framework
Workforce: Staff
competence
Education
AHS - Seniors Health 2012 Cognitive Impairment Strategy
Prevention &
Wellness
Early
Recognition
Living With
End of Life
Congregate
SupportiveLiving
Care,
Symptom
management,
Bereavement
Support
Create and Implement Dementia Sensitive Policy and Services Guidelines
Across the continuum
Public health
Public
Awareness &
prevention
Home
Primary Care
Acute Care
living
Diagnosis,
Community services,
education, System
Crisis response,
navigation, Advance
Delirium Protocols
care planning
Implement best practice guidelines for Dementia care and
Delirium prevention/management
Ensure Healthcare staff have the knowledge and skills to provide quality dementia
care in settings where this competence is supported and valued
Family caregiver
support: respite,
Offer appropriate support and education to Carers at each stage,
provide quality respite services
education
Community
Partner with community services to enhance quality of life for those with dementia
partners
Research and
Support Cognitive impairment research agenda: partner with academic institutions
Innovation
Information
Plan, Provide and monitor care based on valid outcome indicators (KPIs)
management
Our mission is to provide person centered care that is accessible and sustainable for all
Albertans
Strategy “Swim lanes” , the Service
Framework

Health Service Delivery: define the overall service goal(s); determine the services required to meet this goal and the
care guidelines to be implemented in the provision of this care. Set the standards to be met in the care delivery.
Describe the components of the best physical environment for the services to be offered.

The Workforce: detail the workforce (type and numbers) required to provide the health services described above.
Describe the required competence for these groups of staff, including recommendations about educational programs
and innovative Knowledge Management approaches (e.g. establishment of communities of practice and introduction
of zone based Dementia Knowledge Brokers). Performance Appraisal tools to support workforce development toward
meeting the expected competence will be recommended.

Family caregivers: The service needs of the family caregivers will be addressed for each phase of the disease:
considering knowledge (education), support and respite needs. As well, each group will consider the service needs of
recognized sub-groups within the dementia population: younger adults who develop dementia; individuals and their
family caregivers who do not communicate in English, those with an aboriginal heritage, individuals who live alone.

Partners: The strategy will be enhanced by working with community partners such as the Alzheimer’s Society.
Engaging municipalities in related issues such as modifying recreation programs to meet the needs of those with early
stage dementia will help create the community response needed to help people live well in the community.

Research and Innovation: Partnering with academic institutions and being an active participants in setting research
agendas to address the “unknowns” in the strategy is a key step in building an evidence based system of health care
related to dementia.

Information Management: Determine the system level key performance indicators (KPI) that will demonstrate
the success in meeting the expectations described.
Strategy Implementation focus:
AH grant funding for implementation of CI strategy was
primarily focused on the “Living with Dementia”
components of the CI strategy
 Building Workforce Capacity through staff competency




training programs
Best Practice Development in Delirium Management
Research and Innovation
Community Partnerships
Service Delivery model development Supportive Livingdementia (SL4-D)
Focus of Strategy Work 11/12
Building Work Force Competency through training
programs:
 Nursing Improving the Care of Health System Elderly
(NICHE) project
 Evergreening Supportive Pathways project
 PIECES review
 Decision Making Capacity project
NICHE
 2 day curriculum designed for Nurses (RN/LPN), Allied
Health professionals, developed by nurse scholars at NYU
 Curriculum has an acute care focus on delirium prevention,
however, continuing care staff reviews suggest applicable in
community practice
 Content focused on optimizing geriatric care: sleep and
rest, elimination, hydration and nutrition, independence
and mobility, orientation(dementia, delirium, depression
assessments), pain, sensory changes, communication,
atypical presentation, medication management, and
environment.
NICHE project
 NICHE education focused on delirium prevention
strategies: over 2300 staff attended NICHE education.
 NICHE Zone leads were established to provide
workshops in each zone
 In addition to the full NICHE course, 4 shorter in
services to staff on the Delirium protocol were offered
by Zone NICHE educators at MHRH and RDRH
between January and March 2012.
 Evaluation: positive results
Supportive Pathways
 A 2 day team based (RN, LPN, HCA, Allied Health and
leaders) continuous learning program designed to create a
philosophy and approach to person centred care for those
with dementia living in a continuing care stream ( SL, LTC)
 Program content covers: values and beliefs (staff, clients,
family theory, organizational), normal aging changes, types
of dementia, disease progression and impact on a person’s
abilities, effective communication strategies in caring for a
dementia client, meaningful activities for normalized
living, environmental modifications to support abilities,,
reduce challenging behaviour responses, inviting family
care activities, avoiding need for restraints and caring for
those who have tendency towards responsive behaviours
(agression)
Evergreening Supportive Pathway
project
 Clinical experts and educators developed working




group to review program of education
Revisions and updates to content completed
Supportive Pathways educators provided with updates
and changes to Supportive Pathway curriculum
Supportive Pathways was previously recognized as the
dementia training program in the AHW 2005 HCA
curriculum.
HCA curriculum was revised and supportive pathway
education was replaced with new modules for the
HCA dementia education
P.I.E.C.E.S
 Physical, intellectual, emotional, capabilities, environment and




social
P.I.E.C.E.S is a 2 day educational program for professional staff
withon one day follow up session 6-8 weeks post first session
Is a best practice learning and development initiative that
provides an approach to understanding and enhancing care for
individuals with complex physical and cognitive/mental health
needs and behavioural changes
Provides a systematic approach to common issues, diagnosis and
challenges of older persons at risk including those with
aggressive behaviour
Promotes team dialogue and shared problem solving techniques
P.I.E.C.E.S
 Copywrite to offer the program to Alberta Community
Care settings is held by Bethany Rosehaven in
Camrose.
 Staff attrition at Rosehaven has impacted the
organization’s ability to offer courses
 A comparative review of PIECES education relative to
NICHE and Supportive Pathway to be conducted
 Based on review and consultation with stakeholders
recommendations and a way forward plan to be
developed
Decision Making Capacity Project
 In 2009, a working group of the CI Advisory committee began
working on a provincial process to determine when and how
assessments of Decision Making Capacity should be completed.
 This work built on processes that had been established in
Edmonton at Covenant Health under the leadership of Dr.
Jasneet Parmar.
 The major benefit of the framework is helping clinical teams
resolve issues of DMC in the least intrusive process possible by
bringing clarity of roles and mentoring support to the clinical
teams.
Delirium Best Practice Project
 Delirium was a focus of the activities undertaken
because it is an acute, somewhat time-limited,
cognitive impairment.
 In some cases delirium can be prevented with targeted
interventions and individuals with delirium may
return to baseline cognition, or at least show
improvement once the source of the delirium has been
treated.
 Delirium is evident in some 22% of acute care
admissions over the age of 50 (Hogan, D., et al 2009).
Delirium Best Practice Project
 Staff in acute care received extensive education about
delirium as this is the location where the majority of
delirium cases develop and/or are treated.
 Efforts to move acute care units to become more elder
friendly were encouraged. Examples of changes in
practice based on this initiative include: introduction
of q2 hour comfort rounds for older patients, walking
programs to maintain strength, pain assessment
protocols for older adults.
Research and Innovation
partnerships in best practice
 CAUTI project: Dr. Andrea Forbes
 Elder Friendly Hospital initiative: Dr. Belinda Parks
 Changes and Transitions initiative: Dr. Wendy
Dugglby
 TREC (translating research into elder care) Dr. Carole
Estabrooks
Design Elements Supportive Living
Dementia Unit
 Physical design that groups smaller number of
residents (12-15 recommended) to live together in
cottage-like spaces with kitchen, gathering area and
private bedrooms.
 Cottages may be configured to open onto each other
to allow staff coverage between two spaces: A social
Milieu that provides the right amount and type of
stimulation to provide an ‘enjoyable now’ while
minimizing stress and a Service Model that ensures
that staff have the competence to provide dementiaspecific care.
Questions
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Living Well With Dementia