Question:
Discuss about the Dementia Care for Training Content and Didactic.
The requirement of addressing dementia care for patients has to be associated with flexibility of the model of care services delivery leading to the distinct variations in the outcomes for the patients, families as well as carers. The selection of research study literature as a credible source of information helps in determining a model that can help in effective realization of a healthcare service delivery system for dementia (Boersma, et al., 2015). The particular indications towards the increasing share of ageing population in major OECD countries leads to the detrimental consequences that can be identified in the long run by these countries. The recognition of dementia as a formidable aspect of social policy, healthcare settings and care for the aged individuals is essential in order to develop appropriate frameworks that can address the contemporary health trends with respect to dementia.
The following report aims to reflect critically on evidence pertaining to the model of care service and models of service delivery that can be implemented in practice (Borson, et al., 2013). The report explicitly discusses the reason for implementing the model and the potential outcomes that can be derived from the model. The application of the service delivery model in dementia care is discussed with evidence pertaining to the process available in literature as well as the change management process and quality improvement strategy that can be ascertained from the existing literature from research studies. The concluding section of the report would be supported with the use of timelines and plans that could be derived from other business cases and proposals (Brooker & Latham, 2015).
The initiatives for development of dementia care service delivery models could be associated with noticeable investments as observed in the examples of countries like America which invest approximately more than $100 billion annually. The service models are based on the implications of clinical research and evidence based practice outcomes. As per Dalkin, et al, the care model that has to be considered for implementation in context of this report includes references to a collaborative framework that would enable members to perceive the depreciation of inequalities in the care services for dementia (Dalkin, et al., 2017).
The increasing number of ageing population and the escalation in number of people suffering from dementia could also be assumed as a major substrate for development of a framework that could facilitate improvisation of dementia care on a national level. The negative social stigma associated with dementia could be identified as a profound setback for the delivery of care to patients suffering from dementia (Dalkin, et al., 2017).
Furthermore, the personal apprehensions of a person regarding the terminal nature of dementia and the fact that it cannot be cured once it is diagnosed could lead to the fear of an individual patient to avail treatment for dementia. Another noticeable pitfall that can be observed in the case of care services for patients suffering from dementia is the lack of competences among the health practitioners for implementing diagnosis for the patients. As per Elliott, et al, Health practitioners also depict the insufficiencies such as lack of training to use information and support services for addressing the health conditions of the patient after diagnosis (Elliott, et al., 2016).
The framework considered for this report would be directed towards improving the volume of information pertaining to dementia that is accessible for patient, family and the caregivers. This framework would also comprise of profound references to the inclusion of health and social support domains. As per Eggenberger, Heimerl & Bennett, accessibility of information for patients and their families as well as the health and social support groups would enable the access to productive outcomes such as wellbeing and independence in their treatment. The existing scenario suggests that people suffering from dementia are more likely to obtain diagnosis of their condition from the secondary healthcare services that is possible only in advanced stages of the illness (Eggenberger, Heimerl & Bennett, 2013).
According to Gridley, et al, the delay in diagnosis of dementia could be reflective of the inability of the patient to communicate significant aspects of their condition to the healthcare service provider. The late diagnosis could also be held as a disadvantage for the patient as well as their family since they would be subject to additional stress due to the lack of access to support and information services that could have contributed to the reduction or prevention of symptoms associated with dementia (Gridley, et al., 2016).
The lack of information and support services could be considered inept for the treatment of dementia since it the delay in diagnosis and service delivery could lead to the proliferation of opportunities wherein consequential symptoms can be observed in the patient such as psychological, depression, anxiety and behavioural patterns. The model of service care delivery is also associated with the improvement of awareness regarding dementia alongside addressing the social stigma pertaining to the affliction. The model would include a functional care plan and the appointment of an attorney that ensures the improvement of wellbeing of patients alongside ascertaining their potential needs in the future. The particular specialist services provided for diagnosis of dementia are observed in minimal quantities thereby suggesting the detrimental consequences arising from the lack of appropriate number of specialist services that can impose substantial pressure on the specialist service providers. Primary healthcare service systems would have to be improved in order to improve the care services and enhance the early diagnosis of dementia thereby assisting the families and caregivers of patients with dementia (Heinrich, et al., 2016).
The use of the information dissemination model in context of primary healthcare settings would facilitate comprehensive cost effectiveness and flexible distribution of patient case load for specialist service providers and secondary healthcare settings. As per Knapp, Iemmi & Romeo, the consideration for this information delivery model could be associated with the profound underlying factor which is the age group of the patient. However, the concerns of dementia could be observed in case of different people such as people with alcoholism and drug addictions, younger people and patients with Down syndrome (Knapp, Iemmi & Romeo, 2013). Therefore the development of information dissemination platform in the project would have to be characterized by the exclusive involvement of the aspects of sector knowledge, training requirements and appropriate information. The model for care should also include references to the consideration for needs of ethnic minorities in the concerned jurisdiction since the evidence drawn from literature suggests the inappropriate healthcare delivery systems for ethnic communities.
The representation of minorities in the management level of healthcare with respect to this information delivery model would have to be realized in order to ensure that people with dementia in ethnic communities such as the Maoris in New Zealand and the Aboriginal and Torres Strait Islander people are able to receive early diagnosis of dementia. It is also essential to consider the cultural barriers that can be reflective of profound impacts on the delivery of information regarding dementia. As per Lorenz, et al, Cultural barriers in certain communities are observed in the form of apprehensions to diagnose dementia and its perception in the social circle of the individual as a stigma (Lorenz, et al., 2017). Therefore, ethnic communities are less likely to engage in diagnosis and treatment of dementia that escalates the risks of the problems faced by people with dementia alongside increasing the concerns of the caregivers for patients suffering from dementia. The implementation of the model could be described through a subjective interpretation of dementia care and the information delivery models that are intended for health and social support groups to deliver appropriate care opportunities to dementia patients.
The implementation of the framework considered in the above section could be reviewed from a detailed interpretation of the guiding principles and the significant elements that are required for effective dementia care. The key element considered in the awareness and risk reduction model for dementia care can be observed in the evaluation, early diagnosis, intervention and continual support (Steiner, 2016).
The other crucial elements refer to living well, addressing challenges for improving the wellbeing of an individual alongside profound references to the end of life. Addressing these individual elements in the model would have to be directed by specific guiding principles. First of all, the model would follow an approach that is person specific and is centred on the benefits for people. The health and social support services involved in dementia care should be able to facilitate opportunities for patients, their families and carers for upholding their rights and access services without any apprehension.
The families, caregivers and patients with dementia should be involved in the planning and provision of care services as partners through precise communication and training facilities which should be reflected comprehensively in all the levels of decision making. As per Surr, et al, Empowering of the individual stakeholders for involvement in the decision making process would have to be ensured in order to address their capacities for participation in the model (Surr, et al., 2016).
The framework also implies formal references to the imperative of addressing the distinct spiritual, social, economic and cultural variations observed in the background of patients with dementia. The support and care services are also include of references to the symptoms and disease progression requirements that should be facilitated despite any setbacks such as reduced capacity of the patients due to the affliction.
The next principle that must be emphasized by health and social support services refers to the early diagnosis of dementia and improving the participation within the relevant communities. This principle could be realized effectively in the case of providing appropriate support to improve the culture of engagement and partnership in the domain of dementia care. The services should be characterized by formal characteristics such as proactive nature and accessibility alongside implying the mandatory precedents of flexibility that could be productive in addressing the distinct needs of individual patients that can be observed in the variations of economic and social needs. The health and social support services should also be aligned with supportiveness for the choices that are made by the individual suffering from dementia, their family and caregivers (Testad, et al., 2016).
The proper implications for appropriate training of the staff should be adopted in this model that can enable the staff to understand the varying dimensions of dementia care according to the variations in age and culture. Furthermore, the necessity of a proactive and friendly approach should be identified in the case of physical environment of the care providers and their service provision approaches. As per Testad, et al, the guiding principle of improving the accessibility of health and social support services could be realized only if the services are integrated to accomplish service specific objectives (Testad, et al., 2016).
The service models are adapted to address the local requirements for dementia care that would be supported by the frameworks for regional and local dementia care process governance. As per Webster & DiBartolo, the integration of services would also be reflective of the outcomes such as consistency and flexibility of the care planning process across varying services in healthcare and social support which encompass the government organizations, primary and secondary healthcare apparatus, private sector organizations and non government organizations that facilitates opportunities to maintain the continuity of support and care for people with dementia. Another prominent outcome that can be derived through the implementation of service integration is identified in the evaluation of interdisciplinary dimensions in the service delivery framework alongside planning of care delivery pathways with formidable references to the social, functional and psychological goals (Webster & DiBartolo, 2014).
The focus of the services on person involved in the care delivery framework would have to be complemented with the aspects of early intervention, escalating the levels of maintenance, independence and health improvement, obtaining the consent of the people and their families and support. The appointment of welfare guardian, personal order guardian and the enduring power of attorney can serve as apt facilities for people with dementia that cannot provide consent or are legally classified as incapacitated. The improvisation of the potential standard of care for people with dementia should also be emphasized in the case of the development of a model for disseminating information and creating awareness for dementia. The development of services would be aligned with the mandatory implications of providing the appropriate services in the context of appropriate location and time (Lorenz, et al., 2017). The standard of excellence perceived in dementia care should be reflective of prominent references to the international standards and trends alongside the use of evidence based practice models.
The standard of services acquired from the implementation of the model could also be validated through the comprehensive training and education processes implemented to develop a skilled workforce. The implications of cost effectiveness and safety could also be considered as major highlights in the implementation plan derived from guiding principles that help in upholding the continuity of services facilitated in dementia care. The standardization of dementia care with respect to national and regional perspectives could also be a productive measure in the implementation plan that validates the credibility of the care service delivery model.
The implementation plan should also emphasize on certain aspects pertaining to the effectiveness of the distinct areas and stages of dementia care. The factors should be assumed as priorities in order to address compliance with the guiding principles for the model. The first factor refers to the education and training for people with dementia (Dalkin, et al., 2017). The educational opportunities and facilities for training of the patients and their families could be addressed through development principles established for development of health education resources alongside emphasising on the positive aspects of a lifestyle with dementia and the value of physical activity.
The education and training should be reflective of measures to address the distinct learning styles and competences of the patients, their families and carers with profound emphasis on resolving communication issues. The training and awareness of the workforce is also an imperative concern in the implementation plan as it would ensure that there is not lack of professional support to patients with dementia and their family (Brooker & Latham, 2015). The workforce training is vested in the focus on people and delivery of care approaches that imply access of inputs from the involved people. The opportunities for the workforce in dementia care to acquire substantial support in the form of references to the distinct learning styles and abilities as well as the references to the responsiveness of the workforce to people with other underlying conditions such as Down syndrome and other incapacities. Other factors that should be considered essential in this case refer to the governance, family support, culturally appropriate services, advocacy, monitoring and evaluation and sources of funding streams (Borson, et al., 2013).
The implications associated with the delivery of a dementia care service model could be apprehended with prominent references to the scope of change management. Change management is required primarily for addressing the human stakeholder concerns such as training and support for patients, their families and the caregivers associated with them as well as the new workforce that would be included from the primary healthcare sector. The change management process in context of the model for dementia care proposed in this report has to be explicitly associated with the key factors in the model and references to the best practices that can be implemented in context of each element (Elliott, et al., 2016).
The foremost dimension of awareness and risk reduction could be associated with primary objective of leveraging on the national and regional efforts for increasing the awareness of people regarding a healthy and active lifestyle for people that are perceived to be suffering from or depicting chances of developing dementia. The improvement of awareness could be assumed as crucial factor to be addressed by the change management process since it is considered significant for resolution of the issue of social stigma associated with dementia (Knapp, Iemmi & Romeo, 2013). The change management process implies references to the best practices in order to improve awareness regarding dementia and can be observed in the form of the following measures.
The first step is to improve the awareness of public regarding the issue thereby implying formidable references to self-identification and associated strategies could be informed through the use of national websites and awareness programmes and participation in community training sessions. The local change management best practices could be identified distinctly in the provision of training to the primary healthcare service apparatus thereby contributing to the proficiency of healthcare personnel in the reduction of risks (Lorenz, et al., 2017).
The implementation of a model for acquiring and providing information regarding dementia care through evidence based practice and research should be aligned with the mandatory facets of improving interdisciplinary training and increasing co-operation between the agencies for healthcare and social support services. Another prominent aspect that could be observed in context of addressing the concerns of awareness and risk reduction with respect to dementia care can be observed in improvement of media opportunities that can enable the social acceptance of the training provided to the public and other involved stakeholders in the realization of the plan. The second crucial element that should be addressed in the change management process is vested in the empowerment of people to improve their cognitive assessment capabilities.
The necessity of evaluation on time could be considered as a significant factor that is responsible for profound change management application (Surr, et al., 2016). It is also necessary for the implementation of programs that would inform the healthcare teams, support staff and health practitioners regarding the significance of early diagnosis and obtain opportunities. The particular aspects that should be included in the change management process refers to the inclusion of comprehensive dimensions such as cultural barriers, limited access to medication, missed appointments and other underlying conditions that could complicate the issue.
The change management process is primarily inclined towards preparing the framework to be responsive to the emerging trends in dementia healthcare. The implications for health practitioners in this case would also involve profound references to the acquisition of information and competences that assist in cognitive assessment and information regarding dementia (Eggenberger, Heimerl & Bennett, 2013).
The health practitioners in the sector of dementia care should also be provided with consistent support from specialists in the field thereby contributing to their responsiveness to change. The frequent monitoring and evaluation of the condition of patients suffering from dementia could also be a major issue for change management process in this context. It can also be apprehended that the change management process should also be reviewed from the perspectives of positive and negative impacts.
The implementation of organizational level change was not addressed in the report which was characterized by explicit references to the impairment of conventional service delivery structure. Initially, the secondary healthcare organizations and private organizations were associated with prolific references to the minimal or specialized organizational apparatus intended for addressing the concerns of dementia care. The expansion of the workforce would lead to the inclusion of a multidisciplinary approach to healthcare and social support mechanisms in dementia care (Lorenz, et al., 2017). Therefore, change management on the organizational level or work unit level could be addressed through prominent references to the implementation of prolific recruitment and selection approaches that can facilitate the selection of competent leaders and managers.
The competency of leaders has been attributed as a major attribute for ensuring the effectiveness of change management. Therefore the involvement of effective leaders in allocation of tasks and responsibilities for different stakeholders within an organization could be helpful for the workforce of the organizations to acquire substantial information regarding patients and the required approaches for addressing the care and social support for them. The change management could also be improvised through emphasizing on the attributes of communication and establishing objectives that could be accounted as positive factors for the aspects of dementia care for patients and provision of relevant support to the families and carers (Surr, et al., 2016).
The model should be communicated effectively to the different involved stakeholders through training and holistic learning approaches. Experiential learning would account for prolific outcomes in context of improving the readiness of workforce, patients, their families and associated authorities to adapt to reforms in service delivery apparatus and accessibility of information frameworks.
The aspects of quality improvement should also be considered as notable concerns for the effectiveness of a model intended to deliver care and social support for patients with dementia. The model considered in the case of this report is inclined towards the objectives of addressing the competences of patients, families, carers, primary and secondary healthcare settings, nongovernmental and governmental authorities to improve awareness regarding dementia care (Brooker & Latham, 2015).
The implementation of the model would be accompanied with a drastic change management process that should be analyzed comprehensively in order to obtain an impression of the potential gaps in the model. The pitfalls identified from monitoring of the change management process and its outcome along the course of implementation phase could be used as inputs for the quality improvement strategy for the model proposed in this report. The comprehensive evaluation of the areas characterized by insufficiencies in quality could be addressed through references to the creation of a mandatory program for enrolment of patients and caregivers characterized by the provision of opportunities for self management and support. This measure would address the quality gaps observed in the outcomes of the model’s implementation in the form of limited involvement of civil participants i.e. patients in training.
While the workforce could depict a participative approach due to their professional obligations, the objective of the model could be realized only through the awareness of patients, their families and caregivers. This insufficiency in quality can be addressed through specific measures such as support group participation, self management counselling sessions, informal communication through telephonic channels and speciality referrals (Gridley, et al., 2016). Another quality improvement strategy that can be implemented in context of the model to be implemented is the implementation of active case finding and evidence based research to identify the distinct patterns in the case studies.
The identification of insights from counselling sessions between healthcare and social support providers and the patients as well as their families would enable the proliferation of valid opportunities to implement person specific care as outlined in the guiding principle for the model’s implementation. Management of physical activity and its monitoring was also identified as a crucial pitfall in realizing the effectiveness of the model to facilitate information regarding self management of dementia and improve the competences of primary healthcare apparatus to address the same.
The model should also include notable mentions of the frequency of underlying conditions and their impact on the progressiveness of dementia in case of the patient. The inclusion of comprehensive information regarding the importance of physical activity and the impact of underlying conditions such as anxiety and depression on the health of patient with dementia would facilitate quality improvement (Surr, et al., 2016).
It is also imperative for the quality management strategy to consider the significance of the mental and physical health of the caregiver that should be complemented with the proactive monitoring. The surveillance of caregiver’s emotional and physical health has to be included in the distinct stages of the model’s lifecycle such as implementation and change management. The variations in cognitive, behavioural, psychological and functional conditions pertaining to different work settings could provide viable insights into the factors hindering professional development of workforce to cater the requirements of dementia care.
The communication with primary care physician assigned to each caregiver can be supported with patient management protocols that would enable the caregivers to follow a streamlined approach to the non pharmacological treatment of patients. It is necessary to consider the pitfalls in quality of the implementation of the model in the communication aspect which serves as a functional attribute in the change management process (Knapp, Iemmi & Romeo, 2013). However, the precedents established for communication in the implementation phase could not be translated effectively in the change management process thereby leading to a quality gap in the model.
The appointment of a dementia care coordinator could serve as a centralized source for improving communication quality involving the patient and caregiver. The role of a facilitator for communication would also contribute to the improvements in multidisciplinary teamwork approaches in dementia care that would address the excess disability or incapacitation occurring due to co morbid medical conditions (Gridley, et al., 2016).
Conclusion:
The model for improving the awareness of patients, family, caregivers, non-governmental organizations and primary healthcare settings regarding dementia was illustrated in this report with explicit references to the processes of implementation, change management and quality improvement. The timeline for planning, development, application, review and improvement of the model could be presented as follows in the form a Gantt chart.
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Activity |
Month 1 |
Month 2 |
Month 3 |
Month 4 |
Month 5 |
Month 6 |
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Evaluation of the current scenario and health trends |
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Selection of target groups |
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Planning and evaluation of target group needs |
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Formulation of initiatives to address the issue |
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Review of the formulated plan by higher authorities |
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Implementation |
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Analysis of pilot test outcomes |
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Review of change management precedents |
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Quality checking and improvement |
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Feedback and Evaluation |
References
Boersma, P., van Weert, J. C., Lakerveld, J., & Dröes, R. M. (2015). The art of successful implementation of psychosocial interventions in residential dementia care: a systematic review of the literature based on the RE-AIM framework. International psychogeriatrics, 27(1), 19-35.
Borson, S., Frank, L., Bayley, P. J., Boustani, M., Dean, M., Lin, P. J., … & Stefanacci, R. G. (2013). Improving dementia care: the role of screening and detection of cognitive impairment. Alzheimer’s & Dementia, 9(2), 151-159.
Brooker, D., & Latham, I. (2015). Person-centred dementia care: Making services better with the VIPS framework. Jessica Kingsley Publishers.
Dalkin, S. M., Lhussier, M., Atkinson, J., Kendall, N., & Tolman, S. (2017). 13 What works, for whom and in which circumstances when implementing the namaste advanced dementia care programme in the home setting?.
Eggenberger, E., Heimerl, K., & Bennett, M. I. (2013). Communication skills training in dementia care: a systematic review of effectiveness, training content, and didactic methods in different care settings. International Psychogeriatrics, 25(3), 345-358.
Elliott, K. E., Sanderson, K., Martin, A., Robinson, A. L., & Scott, J. L. (2016). Stress and coping of Australian community-based aged and dementia care employees. In 4th International Wellbeing at Work Conference.
Gridley, K., Baxter, K., Brooks, J., Birks, Y. F., Cusworth, L. S., Allgar, V. L., & Parker, G. M. (2016). Life story work in dementia care.
Heinrich, S., Uribe, F. L., Wübbeler, M., Hoffmann, W., & Roes, M. (2016). Knowledge evaluation in dementia care networks: a mixed-methods analysis of knowledge evaluation strategies and the success of informing family caregivers about dementia support services. International journal of mental health systems, 10(1), 69.
Knapp, M., Iemmi, V., & Romeo, R. (2013). Dementia care costs and outcomes: a systematic review. International journal of geriatric psychiatry, 28(6), 551-561.
Lorenz, K., Freddolino, P. P., Comas-Herrera, A., Knapp, M., & Damant, J. (2017). Technology-based tools and services for people with dementia and carers: Mapping technology onto the dementia care pathway. Dementia, 1471301217691617.
Steiner, P. (2016). IAM-CARE: A Newly Developed Innovative Solution in the Field of All-encompassing Dementia Care: Medienarbeit (Doctoral dissertation).
Surr, C. A., Smith, S. J., Crossland, J., & Robins, J. (2016). Impact of a person-centred dementia care training programme on hospital staff attitudes, role efficacy and perceptions of caring for people with dementia: A repeated measures study. International journal of nursing studies, 53, 144-151.
Testad, I., Mekki, T. E., Førland, O., Øye, C., Tveit, E. M., Jacobsen, F., & Kirkevold, Ø. (2016). Modeling and evaluating evidence?based continuing education program in nursing home dementia care (MEDCED)—training of care home staff to reduce use of restraint in care home residents with dementia. A cluster randomized controlled trial. International journal of geriatric psychiatry, 31(1), 24-32.
Vernooij-Dassen, M., & Moniz-Cook, E. (2014). Raising the standard of applied dementia care research: addressing the implementation error.
Webster, D., & DiBartolo, M. C. (2014). Using a standardized patient learning activity to teach baccalaureate nursing students about dementia care. Nurse educator, 39(3), 103-104
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