Core principles of a dementia friendly hospital
At its core, a dementia friendly hospital is founded on the principle of seeing the person first, not just the diagnosis. The busy, unfamiliar, and noisy atmosphere of a typical hospital can be overwhelming and frightening for a person with dementia, leading to increased confusion and agitation. By contrast, a dementia friendly hospital implements specific changes to mitigate these challenges, focusing on five key attributes:
- Staff knowledge and education: All hospital employees, from physicians and nurses to food service and housekeeping staff, receive specialized training on dementia. This education focuses on effective communication, recognizing dementia symptoms, and understanding person-centered care. Staff learn to approach patients with empathy, patience, and clear, simple language.
- Environmental modification: The physical environment is adapted to be less disorienting and more comforting. This includes using contrasting colors for doorways and grab rails, installing non-slip and glare-free flooring, and using clear, simple signage with words and images. Memory boxes outside patient rooms or familiar items brought from home can help with orientation. Quiet rooms or communal spaces can also provide a sense of calm and reduce sensory overload.
- Person-centered care: Care is tailored to the individual patient's needs, preferences, and life history. Gathering personal information from the family, such as routines, likes, and dislikes, helps staff provide care in a way that aligns with the patient's identity. Non-pharmacological interventions, such as music or pet therapy, are used to manage behavioral symptoms.
- Nursing care delivery: Clinical staff are empowered and have the flexibility to adjust care practices based on the patient's individual needs. This can include altering routines, providing more time for tasks, and interpreting behaviors as expressions of unmet needs rather than simple confusion. Regular, consistent staffing assignments for patients with dementia help build trust and rapport.
- Inclusion of family caregivers: Families are recognized as crucial partners in care and are actively included in decision-making and discharge planning. Hospitals offer resources and support to caregivers and may allow for flexible visiting hours or rooming-in. Their insights into the patient's baseline functioning are invaluable for creating a personalized care plan.
Creating a supportive environment
Implementing changes to create a supportive environment for people with dementia involves focusing on key design elements that reduce stress and improve safety. By creating a less institutional and more familiar atmosphere, hospitals can significantly ease patient anxiety and confusion.
Environmental design considerations
- Clear wayfinding: Large, simple signs with contrasting colors and images help patients navigate the hospital. Color-coded systems, like coloring doors to patient bays, can also serve as a visual cue.
- Lighting and flooring: Glare from shiny floors can be frightening to those with dementia, who may misinterpret it as a wet surface or a hole. Matt, non-slip flooring and adequate, even lighting are crucial for patient safety. Dynamic LED lighting can be adjusted to mimic natural light cycles, promoting a healthier sleep-wake rhythm.
- Sensory balance: Unnecessary noise from alarms, intercoms, and equipment should be minimized to avoid overstimulation. Quiet rooms, music therapy, and access to natural outdoor spaces can provide calming sensory input.
- Personalization: Encouraging family to bring in familiar items like photos, blankets, or music players can make the hospital room feel more personal and less intimidating.
Comparison of hospital care models
| Feature | Traditional Hospital Care | Dementia Friendly Hospital Care |
|---|---|---|
| Staffing | General training; may not have specialized dementia knowledge. | All staff receive comprehensive, dementia-specific training. |
| Communication | Often fast-paced, complex medical language. | Uses simple, clear language; focuses on empathetic, person-centered interaction. |
| Environment | Overstimulating, noisy, and unfamiliar with complex signage and shiny floors. | Calming, familiar, with clear wayfinding, reduced clutter, and specific lighting/flooring. |
| Care Planning | Standardized, task-oriented care plans. | Individualized, person-centered care plans based on patient history and needs. |
| Patient Involvement | May struggle to understand patient's perspective or verbal cues. | Proactively gathers information from family to empower and include patients as partners in care. |
| Family Inclusion | Standardized visitation hours; families may feel excluded. | Encourages family involvement, offers flexible visiting, and provides support for caregivers. |
| Behavior Management | Often relies on medication to manage agitation. | Prioritizes non-pharmacological interventions; understands behavior as communication of unmet need. |
| Outcomes | Higher risk of delirium, falls, and extended hospital stays. | Improved patient safety, reduced agitation, shorter lengths of stay, and fewer readmissions. |
Training and communication for compassionate care
Effective communication is one of the most critical aspects of dementia friendly care. Staff training programs, such as the CARES® Dementia-Friendly Hospitals curriculum, provide specific, evidence-based tools. These programs help staff recognize and respond to patient needs, reduce adverse events like falls and readmissions, and improve overall patient outcomes. Training extends to all hospital personnel, ensuring that every interaction a patient has is handled with empathy and understanding. The CARES® approach emphasizes approaching care with patience, understanding, and person-centered strategies, including using simple and clear language, maintaining eye contact, and listening for unmet needs.
For family caregivers, communication resources like the 'About Me' booklet provide valuable information about a patient's preferences and routines to hospital staff, fostering a shared understanding of the patient's needs. In addition, many dementia friendly hospitals implement a 'family ambassador' program, where a team member acts as a dedicated guide for the family during transitions of care.
Benefits for patients, staff, and caregivers
The positive impacts of dementia friendly initiatives extend to everyone involved in a patient's hospital stay. For patients, the familiar, calming environment reduces stress, confusion, and the risk of complications like delirium. This, in turn, can lead to shorter hospital stays and better functional abilities upon discharge. For staff, the specialized training and supportive environment lead to improved morale, job satisfaction, and a higher sense of confidence in their skills. For families and caregivers, the inclusion and support provided by the hospital alleviate stress and anxiety, empowering them to participate more effectively in their loved one's care.
Conclusion
A dementia friendly hospital represents a profound shift in healthcare, moving beyond a purely medical model to embrace a holistic, person-centered approach. By integrating specialized staff training, supportive environmental modifications, and dedicated caregiver inclusion, these hospitals provide a safer and more compassionate experience for people with dementia. As the population ages, the demand for this specialized care will continue to grow, making dementia friendly principles not just a best practice, but an essential standard for quality healthcare. Research shows that simple, cost-effective environmental changes and staff training yield positive outcomes, demonstrating that prioritizing the needs of people with dementia benefits the entire hospital system and community. For more information on supporting a person with dementia during a hospital stay, resources from the Alzheimer's Association can be helpful.
Best Practices in action
Practical steps like using colored crockery for better visibility, replacing large, impersonal nurses' stations with smaller, welcoming reception desks, and ensuring easy access to outdoor spaces illustrate how hospitals can create a more supportive atmosphere. Some hospitals also utilize volunteers trained in dementia care to provide companionship and meaningful activity to patients when family members are unavailable. The systematic identification of patients with dementia upon admission, using tools like a purple magnet on the door, ensures that all staff are aware of a patient's needs. These proactive measures are critical in addressing the unique vulnerabilities of people with dementia in an acute care setting.
