By Thomas Goldsmith
In a Goldsboro hospital hallway, purple lights shine from about half the doorways to patients’ rooms. Each unusual glow informs staff and visitors that the person inside has dementia and will benefit from something other than the standard bedside manner.
The lights are part of a health-care movement that focuses on the outlook of a person with memory problems, recognizing that some useful methods for patient communication can be counterproductive or even frightening for those with impaired cognition. When patients are going through shifts in reality and perception, the old medical approach of serving up firm direction and orientation must give way.
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Sometimes, the choice to use dementia-friendly practices means that providers must work counter to their instincts and previous training, health educators told hospital staff during training last month at Wayne UNC Health Care.
“Do not confront or correct; that’s the hardest part,” health educator Karen Yarbrough said to a room full of Wayne UNC Health medical professionals ranging from physician assistants to transport staff. “You’re going to have to just go with what they’re saying. Arguing is the worst thing you can do.“
The designated lighting and other physical and practice adaptations are all part of the new approach, tailored for people with dementia and being taught to thousands of employees at five UNC hospitals. A $720,000 grant from the Duke Endowment pays for the training here and at other participants in the Dementia Friendly Hospitals Initiative.
Partners include the North Carolina legislature, UNC Hospitals, the NC Institute of Medicine, the state Division of Aging and Adult Services, and other public, private and nonprofit players. The effort shows recognition that people with neurocognitive diseases such as Alzheimer’s tend to stay hospitalized longer, experience less positive results from treatment, and incur higher costs and more readmissions than other patients.
‘Step back and wait’
During sessions at Wayne, Yarbrough joins licensed practical nurse Yolande Kelley and recreational therapist Deanna Raineri to place staff in the middle of role-play situations that could be uncomfortable or difficult in a patient’s room. Remember, they remind them, contradicting doesn’t work, even if a symptom may not be real.
“My foot hurts! Why can’t you do something about my foot hurting?“ certified nurse aide Pearlie Ammons, portraying a patient with dementia, says heatedly to Kelley, portraying herself.
“You’re right, I should!“ Kelley responds. “I will do something!“
With a typical patient, the professional might bustle into the room, asking cheerfully how it’s going, making sure the person is oriented as to place, time and identity. Under dementia-friendly guidelines, the provider knocks then enters the room in a non-threatening posture, with no hand extended for a shake.
“You’re going to have to step back and wait — 35 seconds, 45 seconds, it may take longer than that,“ Yarbrough said. “If you say, ‘Hey, how are you?’ they may just lay in the bed or sit in the chair and look like they are not hearing you, but really it may be just taking a little longer to connect.“
A repeated bit of advice is key to the training: Slow down. A more relaxed pace allows the hospital staffer to build an informed connection with a patient that can make things go easier for both.
“The more you know about them, the better it’s going to go,“ Yarbrough said. “If I know that my patient loves flowers, gardening, that’s a great way to connect with her. We have to learn about our patients. We’re going to have to do it through word of mouth and asking questions.“
Sometimes knowing the patient’s beliefs can be especially valuable when the thoughts are negative or even lacking a basis in fact.
“I went into one patient’s room and she was telling me she had two big worms on the floor of her room,“ Kelley said. “She said, ’Can you get them?’ So I said yes and I stamped on the floor a couple of times. She said, ‘Did you get them?’ And I said, ’Yes, ma’am, I did.’“
It’s permissible to tell white lies or otherwise divert a patient, as in the dispatching of the imaginary worms. But health workers should draw the line at a significant untruth such as telling someone her departed husband is still alive, the educators said.
Jenny Parnell, administrative director for medical/surgical nursing and clinical educator at Wayne, had recent personal experience that showed her how a person with dementia can encounter difficulties at the hospital. Her father, Ben, 75, came into Wayne with chest pain but had the symptoms diminish while he was in the emergency department.
“He couldn’t remember where he was and why he was there,“ Parnell said. “He had to say, ’You know I have a touch of dementia.’ He knows he can’t remember.
“That was the eye-opener to me to say, we have more work to do.“
A growing movement
Almost 4,000 employees are in the process of being trained in creating dementia-friendly facilities in hospitals that are part of the UNC system: Wayne, UNC Health’s Hillsborough Campus, the N.C. Memorial Hospital in Chapel Hill; Pardee Hospital in Hendersonville, and Chatham Hospital in Siler City.
Parnell sees many ways in which the principles of this effort can be extended. That could take place within the system to cover functions such as EMT services and the emergency department. It can also be extended into community locales such as restaurants, where being dementia-friendly could simply mean putting customers first, just as they are.
That’s the pioneering approach to customer care taken by the Outer Banks Hospital, a facility that initially drew the attention of UNC’s Ellen Schneider, who became co-project director for the Dementia Friendly Hospitals Initiative.
“Outer Banks is training their businesses and so we went to visit with them, going to banks and restaurants there,“ Parnell said. “And they can actually declare a place a dementia-friendly business. That’s our hope, eventually to get to that.“
Disclosure: The Duke Endowment supports NC Health News’ coverage of children’s health. Funders have no input into editorial choices or coverage.
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