This document discusses adopting a culture of comfort for palliative care of advanced dementia. It outlines the progression of dementia and problems with antipsychotic use. The speaker describes implementing a comfort model at Beatitudes Campus that individualized care, liberalized diets, and used a soft approach. Positive outcomes included no episodes of problem behaviors, less antipsychotic use, more pain medication, and cost reductions. The presentation concludes that focusing on patient comfort can positively impact those with dementia.

1. Palliative Care for
Advanced Dementia:
Adopting a Culture of
Comfort
Tena Alonzo, MA
Director of Research
Co-director Palliative Care for Advanced Dementia
Beatitudes Campus

2. Session Objectives
1. Identify and discuss why antipsychotics are not
the answer
2. Describe the progression of dementia
3. Compare and contrast models of care/service
that support people with dementia
4. Identify at least three elements of a comfort
culture
5. Define and describe at least three positive
outcomes of implementing a comfort culture

3. So what’s the problem with
antipsychotics anyway?
 Who gets these medications and why
 Why should we be worried about antipsychotic use
 Are there alternatives to medication
 What can we do about California’s overall use of
antipsychotics

4. Name brand & generic
antipsychotic Medications
 Haldol (Haloperidol)
 Seroquel (Quetiapine)
 Zyprexa (Olanzapine)
 Risperdal (Risperidone)
 Abilify (Arprazole)
 Geodon (Ziprasidone)

5. Demographics of Dementia
 5.4 million Americans have Alzheimer’s
disease. 5.2 million are age 65 and older
 It is the 6th leading cause of death for all
ages with death occurring 4-6 years after
diagnosis
 Alzheimer’s disease is the most common
form of dementia accounting for 50-75%
of all irreversible dementias
 Alzheimer’s disease costs the United
States $183 billion annually
 Alzheimer’s disease is the only top 10
illness that can’t be prevented, cured or
slowed down
Every 69 seconds
someone develops
Alzheimer’s disease…

6. Progression of Dementia
Mild Moderate or Severe or Late Terminal
I Mid-Stage Stage
N
D Impaired Confusion; Resistiveness; Bedfast;
E memory; Agitation; Incontinence; Mute;
P Personality Insomnia; Eating Intercurrent
E changes; Aphasia; difficulties; infections;
N
Spatial Apraxia Motor Dysphagia
D
E
disorientation impairment
N
C ADVANCED DEMENTIA
E
(Hurley & Volicer, 1998)
TIME

7. Recognizing Strength
 The five senses are not adversely impacted by dementia
 The five senses continue to carry information from the
world into our brain
 The information from the five senses can create positive
or negative responses with our emotions
 People with dementia know when they’re comfortable
and when they are not
 Human actions/behavior are a legitimate form of
communication that gives us insight into each person
needs

8. Medical v comfort culture model
Medical Model Comfort (Holistic) Model
Focused on the physical body and Focused on body, mind and spirit
cure
Care/service is driven by the medical Care/service is driven by the person
provider receiving care/service
Emphasis on staff for task completion Tasks are scheduled according to a
person’s needs and wants
Staff members are instructed not to Staff members are encouraged to
get close to “patients” “know the person”
May see family members as problems Understands that family members
experience problems

9. Reality check-why are
antipsychotics prescribed?
People with dementia
 resist care
 Call out
 Elope
 Do things that are challenging and sometimes
unsafe
 We don’t know what else to do

10. What if there was an alternative
to medication?
If we could eliminate episodes of
 resisting care
 calling out
 elopement
 doing things that are challenging and /or unsafe
EVERYONE WOULD BENEFIT

11. The Comfort Culture-an alternative
to using medications first
 Involves changing the way staff provide
care/service
 Involves examining and revamping
organizational systems
 Involves educating families about the
benefits of adopting a culture of comfort

12. Beatitudes Campus

13. Palliative Care for Advanced
Dementia
 Educates staff and families about
dementia
 Adopted policy and practice that comfort is
the goal for everything
 Examines and revamps the systems to be
dementia-friendly and personalized

14. Palliative Care for Advanced
Dementia
 Individualized all routines including sleep, dinning and
bathing
 Liberalized all diets consistent with the ADA 2005
position paper
 Utilized a soft approach during caregiving with those we
serve
 Aggressively identified and treated physical pain
 Observed each person’s actions for discomfort and did
something about it

15. Palliative Care for Advanced
Dementia- Individual Outcomes
 No episodes of resisting care/service
 No episodes of calling out
 No episodes of sundowning
 No discharges d/t behavior problems
 Less than 8% use of antipsychotics
 More than 95% receive pain medication

16. Palliative Care for Advanced
Dementia-What about Cost?
 No change in staffing ratios
 No turnover and minimal call offs
 Cost reduction once the program was
implemented Approximately $12,000
 Long waiting lists/stellar reputation
 No family complaints
 Five star rating

17. Final thoughts
 It is possible to impact the lives of people with dementia
in a positive way by adopting a culture of comfort
 The people we serve can help us help them achieve
comfort
 There is great opportunity for both the person with
dementia and the organization to have great benefit from
making comfort the goal of all decisions

18. Questions & Discussion

19. Thank you!
Contact Information
Tena Alonzo, MA
Director of Research
Co-director Palliative Care for Advanced
Dementia
Beatitudes Campus
talonzo@beatitudescampus.org