Listening to several presentations on long-term care facilities for dementia and Alzheimer’s patients at the recent AAIC Conference in Copenhagen I was surprised by the limited amount of time devoted to a patient-centered approach to care versus the multitude of institutional/staff/medical/economic problems that these organizations face operationally. One statistic from a study of 140 facilities still sticks in my mind. What’s the average amount of time staff spend communicating directly with patients each day? It’s a pretty scary number. Two minutes! Obviously it’s difficult to be very person-centered when time for listening and communicating is so brief. The other message here is that even in private facilities with a higher staff to patient ratio this is still a pretty small number.
Two things really stand out to me. First, in this context, every moment of communication, entertainment, joy, laughter or anything else that connects is precious. As I described in “The Long Moment,” for a person with Alzheimer’s or dementia, when the time dimension has collapsed from normal clock time to hours or minutes, long moments are all that is left. As a caregiver, it is easy to get caught up in the helplessness that you may feel when you observe these short term cycles of behavior occur over and over; but, the truth is that interrupting any one of them with some form of focused interaction may be the best you can do. And, there is no doubt that laughter or good feelings or an awareness that provokes a memory or sense of competence lingers across many of these cycles like the emotions that linger after hearing a favorite song or the warmth on your skin after a day at the beach.
The other thing which is obvious is that without the support of family or friend caregivers the professionals who are part of the team at any long-term care institution are simply too busy to provide all of the nurturing needed for residents in the memory-care division. I’ll have more about tackling the practical side of this in a later post. My Aunt, with Alzheimer’s, who died recently, was fortunate to have a daughter living nearby who could visit almost every day; but, that is often not typical. More visits from the primary caregiver, already stretched by emotional, financial and practical challenges that these diseases present is definitely NOT the answer but, there is some help coming here. Stay tuned.
If you would like to learn more about person-centered care approaches to dementia I recommend the articles by Tom Kitwood or the excellent book by Dawn Brooker on this subject.