Hospital Care for People with Dementia

Going to the hospital is often a traumatic experience especially for people with dementia and their caregivers. Using this three-step process will improve the stay for everyone: the person with dementia, family and loved ones and hospital staff.

Step One

Plan ahead. Start with these questions — should we even go to the hospital; under what circumstances would going to hospital be the right choice; when would it not be the right choice.

Prepare advanced directives ahead of time to avoid having to make spur of the moment decisions. For example, decide on the health care power of attorney, complete a living will (including what types of technology to use and not to use, under what circumstances and for how long) and discuss "code" status (use of CPR) while the person is still able to express opinions and wishes. Have copies of legal documents and medical forms completed and convenient.

Divide the potential workload. Decide who will be the family spokesperson, who will stay at the hospital when and how to fill in the blanks. Expect people with dementia to need someone with them 24/7. If family can't do this, develop a back up plan of paid agency or other caregivers. Interview and establish a relationship with these people ahead of time.

Prepare an emergency bag, similar to a maternity bag. Include comfort items such as clothing, pillows, snacks, and toiletries for the person with dementia and the attending caregiver.

Develop a Personal Information Sheet and medication log. Include health information, helping strategies and routines. Examples of these are available through the Alzheimers North Carolina, Inc. office.

Finally, consider registering the person with Safe Return. The bracelet can serve to identify the person as someone who has special needs.

Step Two

Implement your plan. Present your prepared documents as you walk in the door but keep a back up copy. Highlight the most important aspects of care with each staff person, especially how to deal with behaviors. Expect to repeat yourself often and clearly. Implementing the positive physical approach, streaming interactions through one spokesperson, using good manners — Is this a good time for me to ask some questions? and saying "Thank you," will improve care and outcomes.

Offer to help with procedures, exams and personal care if you think this will help the person with dementia and if you feel comfortable with this role. But, keep focused on your job, advocating for the person with dementia. You can do this by staying true to previously made decisions, asking questions and for clarification of answers and making informed decisions. Choose your three priority issues and let go of minor concerns. One important advocacy is monitoring the person closely for changes in thinking, abilities or behaviors that occur suddenly and notifying hospital staff immediately of any changes. Be prepared to explain specifically how this change is different for this person.

Try to keep your self calm and centered — other people will take their cues from you. Be polite and patient, at least in public. Then find a way to let off steam: ventilate to a friend, take a walk, write in a journal. Make sure you take breaks and get away.

Step Three

Evaluate the process. What things are going well and what needs to change? What is the next step: home, hospice, short term or long term placement? Work with the discharge planning team to identify any resources that may be available on discharge, such as home health, equipment, etc.

Finally, remember &mdas;l this too shall end. By using these strategies, you can influence the care of the person with dementia and reduce the trauma for everyone involved.

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