Understanding Nursing Home, Hospice, and Palliative Care for Individuals with Later-Stage Dementia Proceedings of a Workshop–in Brief (2020) / Chapter Skim
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Understanding Nursing Home, Hospice, and Palliative Care for Individuals with Later-Stage Dementia: Proceedings of a Workshop - in Brief
Understanding Nursing Home, Hospice, and Palliative Care for Individuals with Later-Stage Dementia: Proceedings of a Workshop - in Brief
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It increasingly focuses on midlife prevention of chronic age-related diseases, including dementia, exploring the malleability of risk and protective mechanisms and the potential to intervene to reset and improve aging trajectories before the onset of decline. BSR supports principle-based behavioral interventions and large-scale pragmatic trials embedded in health systems to optimize dementia care and care coordination.
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The panel examined this from a variety of perspectives, including the impact of policy, the role and accessibility of palliative care programs, and preparation for end-of-life decisions made by and for people living with dementia. HISTORY OF DEMENTIA CARE RESEARCH – ADVANCED DEMENTIA Dementia affects an increasing portion of the aging population, with approximately 1 million individuals currently diagnosed with advanced disease (defined as Global Deterioration Scale Stage 7)
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Gray observed that the capacity of hospice services to meet the palliative care needs of dementia patients at end-of-life is often complicated by limited caregiver support at home, lack of sufficient staff caregiving hours, limited access to hospital services, and differing ability to access care in nursing homes. However, informal family caregiving is not a viable alternative: Gray's clinical experience confirms that families caring for their loved one are often ill-equipped to achieve the goal of keeping their family member comfortable at home.
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He argued that palliative care programs require a stronger reimbursement structure and the resources to provide home health aide hours, 24/7 crisis triage, in-home primary care, caregiver counseling, and transportation for specialty services. Gray emphasized that the "dementia care field should shift from a one-size-fits-all hospice model toward graduated need-based interventions." Elaborating on this, he emphasized that to achieve this goal, Gray suggested, researchers should focus on in-home interventions for patients -- to determine the best strategies for goal-concordant palliative care -- and should investigate the comparative effectiveness of various financing methods on access, quality, and cost of care.
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Snyder explained that although this model applies broadly to aging, it is highly applicable to dementia care. Its system-level measures include tracking the number of admissions to long-term care facilities and caregiver strain as well as routine mentation screening and documentation.
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Act of 2014 mandated a new quality measure of "successful community discharge" that reflects the performance of PAC skilled nursing facility care. However, nursing home admissions of dementia patients can make the "successful community discharge" quality metric difficult to meet.
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POSSIBLE FUTURE DIRECTIONS FOR CREATING GOAL-CONCORDANT CARE In a final discussion, many workshop attendees deliberated on the merits of an interconnected, coordinated health system for treating people living with AD/ADRD. As Mor observed, even centrally governed health care systems typically divide care for dementia patients across multiple practitioners, including a primary care physician, gerontologist, neurologist, and others.
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. Understanding Nursing Home, Hospice, and Palliative Care for Individuals with Later Stage Dementia: Proceedings of a Workshop -- in Brief.Washington, DC: The National Academies Press.
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