The collective system fails us, not the individual clinician

Ab Brody
August 12, 2018

In my last post, I discussed how a single nurse could not identify delirium and took it for a terminal decline in a person with dementia. One could easily jump to the conclusion that the nurse was at fault in this situation, but this would be making the wrong conclusion. Our healthcare system is unbelievably complex, but it unfortunately does not value care for persons with dementia. Despite the multiple calls from the Institute of Medicine to better prepare the healthcare workforce for our aging population, including persons with dementia, and a National Alzheimer's Plan developed specifically for this reason, we are not much further in developing a dementia friendly system than we were 30 years ago.

Our system is currently geared towards high technology, and easy fixes that paper over problems. This is decidedly not applicable to persons with dementia, where it is important to understand who someone is as a person, why they are behaving in a given way, and implementing effective evidence based, and often non-pharmacologic, interventions to address the behavioral issues at hand. This is why so many persons with dementia receive antipsychotics despite having a black box warning for increased risk of heart attacks and strokes. It is also why we spend so little time on creating effective systems to care for this patient population. We should be providing effective training and resources to clinicians, and ensuring they implement these learnings. Most clinicians are never taught how to effectively assess and manage persons with dementia in school, and so when they join the workforce, it is incumbent upon their care delivery organization to train them. Unfortunately, dementia care is often left out despite the fact that up to 1/3 of home health patients are estimated to have dementia, and over 16% of hospice patients have dementia as their primary diagnosis. The little secret though, is that providing better care to this population does have business as well as quality implications, and with value based purchasing becoming a bigger and bigger part of the healthcare pie, ignoring a core group of patients will not continue to fly and cost care delivery organizations significant amounts of money.

So what's the answer? Focusing on your own organization, and ensuring that it is ready to care for this growing and high need population. Its the organization, not the individual that needs to lead this charge and ensure that persons with dementia receive high quality, effective, and efficient care, and we'd be happy to help in this organization development process, towards achieving Aliviado's vision that all persons with dementia and their caregivers will receive high-quality, evidence-based care the relieves the symptoms of dementia.