A Unique Tribute by Family Affected by Alzheimer’s Disease

Prior to establishing The Gilster Group, Susan Gilster was a founder and Executive Director of the Alois Alzheimer Center, the first facility for people with Alzheimer’s disease in the United States. Recently, the family of a former resident made a unique donation to honor Susan Gilster and the staff of the Alois Alzheimer Center.

Referring to Susan Gilster, the daughter stated, “I have deep gratitude to her and staff that allowed her (mom) to live out her final days in a very peaceful way.”  The article, “Mosaic a tribute to center’s staff,” appeared in the Cincinnati Enquirer in early January, 2013.

Dr. Susan Gilster Authors Monthly Column for Gannett Newspapers

Following her popular article in The Cincinnati Enquirer, “Taking action while younger may stave off Alzheimer’s, dementia,” Susan Gilster, PhD, has been asked to author a monthly column on healthy living and aging.

As a regular contributor, Dr. Gilster’s monthly columns will be syndicated and published in other Gannett publications as well.

If you don’t receive a Gannett publication, check The Gilster Group’s blog for regular updates.  We’ll be sure to post each article published.

The Holiday Season…not always merry and bright

Those of us who work in healthcare dedicate ourselves to serving others – patients, colleagues, staff, and families. For years we have observed – and experienced – the stress that December and the holidays bring to those with whom we work. Outside of work, there is often so much to do, and so little time.

In a 2010 column by Susan Gilster and Jennifer Dalessandro in Long-Term Living Magazine called, “Ask the Staffing Experts,” we addressed the need to acknowledge that the holidays aren’t always merry and bright. We also offered suggestions to help you and your colleagues embrace the true meaning of this time of year by concentrating on your blessings and sharing the holiday spirit with others.

The column is entitled, “Brightening this holiday season for your staff.” But the subtitle is actually more appropriate – “Don’t let the holidays drag anyone down.”

The holiday season may be a time of stress and worry, but it should also be a time of appreciation, joy, and fun. And you can help to make it that way—at least at work!

Reasons to Address Dementia when Exploring Readmission Penalties

Found an interesting article by Kevin Shrake entitled, “Hospital CFOs contemplate ‘play or pay’ with readmission rates.” CMS hospital readmission penalties are currently 1%, and will increase to 3% over the next two years. Much debate exists as to whether the penalties are small enough that hospitals will not be overly concerned with losing a “relatively minor” amount of reimbursement funding.

Given that our focus is on individuals with dementia and memory loss, we consider what this means for those with Alzheimer’s disease, dementia, cognitive impairment and/or memory loss. Providing quality care, and avoiding readmissions for those patients with dementia, is possible.
As Kevin explains, the focus of healthcare is – or should be – to provide quality care to those we serve. He provides a reminder of readmission management “Best Practice” checklist, which includes 2 important points when dealing with individuals with Alzheimer’s or dementia.

• Provision of critical information to patient care coordinators: basic information and demographics of a patient is not sufficient if that patient has any memory impairment at all. More important is to include information on degree of impairment, ability to understand and follow directions, etc.
• Identification of at risk population and enrollment into a specific plan of intervention: people with dementia are certainly at risk – and will require a specific plan of intervention. Conventional provision of care, and transitional care planning as it currently stands, alone will not suffice for this population.

Caring for a hospitalized individual with dementia – regardless of admitting diagnosis – requires a unique approach, and can seem complex. However, when a thoughtful, educated and deliberate process is used, quality of care will improve, and readmissions will be avoided.

Though hospitals may consider readmission penalties a low priority in the big picture, they will not be able to do so for long. As the baby boomer population increases, so too will those over 65 diagnosed with dementia. Folks with dementia suffer more adverse effects, falls, etc., while hospitalized and are more likely to be readmitted. If not an area of concern, penalties for readmissions will continue to grow and thus become a concern to hospitals.

Readmissions and Dementia – Why Wait?

One sure think about healthcare – it is sure to change. While CMS is currently focusing on hospital readmission penalties for 3 diagnoses, we know additional diagnoses will be identified in the future. And while we know the penalties will increase gradually to 3% over the next two years, these rates may increase as well.

The purpose of this effort is to improve the quality of healthcare provided in our country. And while a great number of our population suffer from cardiac issues and diabetes, the number of people diagnosed with memory loss, cognitive impairment, dementia and Alzheimer’s disease is increasing at an alarming rate.

This increase in dementia should be of great concern to those stakeholders in healthcare, including hospitals and physicians, as well as managed care, insurance, and accountable care organizations. Many individuals with dementia and Alzheimer’s disease will suffer from the 3 diagnostic areas of focus and will be hospitalized. Those with dementia are at greater risk for readmission.

Yes, healthcare providers are focusing on the identified diagnoses. But how many acknowledge the role that cognitive impairment will play in success of this new quality initiative? Much can be done to improve the quality care this special population will require – but it requires a distinct, specific program for individualized care provided by educated and specially-trained staff members.

Tips for Hospitalization for People with Alzheimer’s, Dementia, Memory Loss

A visit to the emergency room or an extended hospital stay for an individual with Alzheimer’s disease, dementia or early memory loss will result in confusion, fear, fatigue and possibly agitation, aggression, or delusions – or all of the above!

A recent post on DementiaToday’s website (www.dementiatoday.com) shared a nice brochure entitled, “Hospitalization Happens: A Guide to Hospital Visits for Individuals with Memory Loss,” from the National Institute on Aging.

Given my recent experience, as detailed in my blog post of 12/3/12, this brochure shares many good ideas for caregivers and families, including how to be prepared in advance of hospitalization.

These tips are just as beneficial to professional healthcare providers in the hospital setting, as well. The brochure is a reminder that we must remember that each “patient” with memory loss is, first and foremost, a person. No two people with dementia are alike, and each deserves to be cared for in an individualized manner.

Again – as healthcare providers – we must think about the impact of this difficult situation for individuals with dementia and their families. Hospitalization is likely will be catastrophic and costly. We can do better, if only we took the time to try.

Hospital Experiences for People with Dementia: We Can Do Better

I recently spent a few days in the hospital caring for a relative who had surgery. I could not help but reflect on the impact that the impersonal, noisy, hectic environment would have on an older person with dementia. Just a few of our experiences:
• A lot of “hurry and wait” episodes before and after surgery
• Repetitive questions from many staff members even I could not identify
• Hospital employees discussing expectations for what was to come regarding pain, therapy, tubes, medications, diet and preparation for transfer to home, all in one sentence
• Repeated requests for assistance left unanswered for long periods of time
• Promises of meetings at specific times with therapists, doctors, nurses, discharge personnel – all of which never seemed to happen as scheduled.

Despite weeks of planning before the surgery, discharge arrangements fell apart an hour before discharge. Suddenly, the therapy company was not approved, the pharmacy did not have the medication in stock and the “patient” was left to fend for herself.

It took both of us – younger, cognitively intact, and both experienced health care executives – to execute this discharge, and still we found a need to rely on my relative’s friends and colleagues to assist us.

So, what happens to people with dementia who go through this?

Folks with dementia, sick and hospitalized, don’t understand what is being said, can’t answer questions, and will not be able to describe their level of pain on a scale of “1-10.” Those with cognitive impairment cannot follow directions, arrange for discharge, or follow up with all that is necessary after surgery. Even if they have a caregiver, the task of making the many additional arrangements for a successful transition out of the hospital environment is overwhelming and exhausting.

Patients with dementia or Alzheimer’s disease will probably be in a great deal of pain and hence act out, which is time consuming and complicates the care provided by the medical professionals. This patient will likely be discharged quickly and leave having lost weight, on more medications, in need of therapy…and unfortunately, odds are they will end up in an Emergency Room.

A few times I took the initiative to ask hospital personnel, “What would you do if this person had dementia?” The response in all cases was, “I don’t know, get them a sitter at the hospital and hope for the best.”

We must think about the impact of this difficult situation for individuals with dementia and their families. Hospitalization is difficult enough when you have no voice; it can be catastrophic and costly. We can do better, if only we took the time to try.

Taking Action to Prevent Alzheimer’s Disease, Dementia

Susan Gilster, PhD, authored, “Taking action while younger may stave off Alzheimer’s, dementia,” for the Cincinnati Enquirer. The article, recognizing November as Alzheimer’s Disease Awareness Month, explains that while Alzheimer’s disease and dementia were once thought to be simply diseases of the very old, evidence now suggests the dementia-disease process begins much earlier than symptoms appear or a diagnosis is made – in fact, research indicates it begins years or perhaps decades earlier.
During the past 15 years researchers have found many links between Alzheimer’s disease/dementia and such common diseases as diabetes, obesity, hypertension and vascular diseases. Experts also believe medical management of those general diseases very well may decrease the incidence of Alzheimer’s disease and dementia. How do younger and older people alike prevent these diseases and possibly decrease Alzheimer’s disease and dementia? The answer is fairly simple. Control or manage your lifestyle as you would to prevent cardiovascular issues, diabetes and obesity.

Hospitalization Expensive and Likely to Result in Readmission for Those with Alzheimer’s and Dementia

A recent Annals of Internal Medicine study indicated that hospitalization for those with Alzheimer’s disease greatly increases their risk of adverse outcomes. This certainly validates our experience over the past 25 years.

Hospitals, insurers and physicians should consider that those age 65 and older with dementia are hospitalized three times more than their peers – and 25% will be readmitted within 30 days. In addition, the average length of stay is longer, and the inpatient cost is twice as much for this population. Longer lengths of stay and increased costs for individuals with dementia are often the result of a greater number of adverse events while hospitalized. During their acute care stay, many patients with dementia suffer weight loss, infections, pressure ulcers, falls, untreated pain, agitation, physical restraint – all of which are increasingly frustrating for hospital personnel. The article “Hospitalization increases chances of poor outcomes in Alzheimer’s patients,” shares some advice – but much more can be done. Let us show you how to cost-effectively improve care, outcomes, and patient, family and staff satisfaction. www.dementiaexperts.com


Susan Gilster in the News…

Susan Gilster was recently featured in an article in the Cincinnati Business Courier as she announced the formation of The Gilster Group.

The Gilster Group is comprised of a multidisciplinary team of dementia experts – physicians, pharmacists, nursing and others – to consult and guide health care leaders and professionals to improve the care and outcomes for individuals with cognitive loss in all health care settings.  Focusing on hospitals, accountable care organizations, managed care, insurance companies and physician practices, we strive to provide dementia expertise and successful care strategies to enhance care and promote significant cost savings.