Alzheimer’s Care Research and Practice: What’s New and on the Horizon Argentum Conference Nashville, TN May 2, 2017 Sam Fazio, PhD Constituent Services
Doug Pace, NHA Constituent Services 1
Overview • Alzheimer’s Association – Overview – Facts & Figures
• Alzheimer’s Disease – – – – –
Risk Factors Early Detection and Diagnosis Biomarkers Interventions Prevention
• Person Centered Care • Policy
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The Alzheimer's Association is the leading voluntary health organization in Alzheimer's care, support and research.
We enhance care and support •The Association works on a global, national and local level to enhance care and support for all those affected by Alzheimer’s and other dementias. We are here to help.
We advance research •As the largest nonprofit funder of Alzheimer's research, the Association is committed to accelerating the global progress of new treatments, preventions and ultimately, a cure.
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Programs and Services alz.org®
Alzheimer’s Navigator Community Resource Finder ALZConnected Caregiver Center Safety Center 800.272.3900
24/7 Helpline
alz.org/findus
Support groups, education programs and more available in communities nationwide training.alz.org Free online education advocacy forum programs available at Take action against training.alz.org
Alzheimer’s.
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2017 Alzheimer’s Disease Facts and Figures Alzheimer’s Association
Alzheimer’s Disease & Related Dementia
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Cost of care In 2017, caring for people with Alzheimer’s and other dementias will cost the United States an estimated $259 billion, including $175 billion paid by Medicare and Medicaid.
Alzheimer’s is a major driver of health care costs for older Americans. Medicare payments for a senior with Alzheimer’s or other dementias are more than 3 times as great as those for a senior without these conditions. Medicaid payments are 23 times as great.
Average annual per-person payments for health care and long-term care
Why is Alzheimer’s such a cost driver? Nearly 30 percent of people with Alzheimer’s or other dementias are on both Medicare and Medicaid, compared with 11 percent of people without dementia.
Why is Alzheimer’s such a cost driver? People with Alzheimer’s are more likely than people without dementia to have other chronic conditions, and dementia complicates the management of these other conditions.
Why is Alzheimer’s such a cost driver? A senior with diabetes and Alzheimer’s costs Medicare 81 percent more than one with diabetes and no Alzheimer’s. A senior with Alzheimer’s and cancer costs Medicare 57 percent more than one with cancer but no Alzheimer’s.
And costs will continue to grow. The costs of caring for people with Alzheimer’s or other dementias are projected to increase from $259 billion in 2017 to more than $1.1 trillion in 2050.
Millions of Americans are living with Alzheimer’s. •
An estimated 5.5 million Americans are living with Alzheimer’s dementia today — 5.3 million people age 65 and older, and 200,000 under age 65 with younger-onset Alzheimer’s.
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Among those 65 and older, 1 in 10 has Alzheimer’s, and among those 85 and older,1 in 3 has Alzheimer’s.
Millions of Americans are living with Alzheimer’s. Every 66 seconds, someone develops Alzheimer’s dementia. By 2050, someone will develop Alzheimer’s every 33 seconds.
Alzheimer’s doesn’t just happen to individuals — it happens to families. More than 15 million family members and friends provided more than 18 billion hours of unpaid care to those with Alzheimer’s or other dementias in 2016.
Alzheimer’s doesn’t just happen to individuals — it happens to families. The economic value of the unpaid care provided to those with Alzheimer’s or other dementias totaled $230.1 billion in 2016.
Alzheimer’s doesn’t just happen to individuals — it happens to families. In 2016, Alzheimer’s and dementia caregivers had $10.9 billion in additional health care costs of their own due to the tremendous physical and emotional burden of caregiving.
If Alzheimer’s and dementia caregivers were the residents of a state, it would be the 5th highest populated state in the country. CALIFORNIA Population: 39,250,017
TEXAS Population: 27,862,596
FLORIDA Population: 20,612,439
NEW YORK Population: 19,745,289
ALZ/DEMENTIA CAREGIVERS Population: 15,975,000
ILLINOIS Population: 12,801,539
Alzheimer’s is more than “a little memory loss”— it kills! • Alzheimer’s is the 6th leading cause of death in the U.S. • It is the only disease in the top 10 that cannot be prevented, slowed or stopped. • An estimated 700,000 Americans will die with Alzheimer’s disease in 2017.
From 2000–2014, Alzheimer’s disease deaths increased 89% while … Deaths from: HIV Declined 54% Stroke Declined 21% Heart disease Declined 14%
Prostate cancer Declined 9%
Breast cancer Declined 1%
Nursing Home Admission By Age 80
Risk Factors
Alzheimer’s – Plaques & Tangles tangles
plaques
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Risk Related to Cognitive Decline & Alzheimer’s • Age: The greatest known risk factor • Heart-head connection • Increased risk suspected if high blood pressure, heart disease, stroke, diabetes and high cholesterol
• Head injury • Family History • Risk and deterministic genes 26
African-Americans are about twice as likely as whites to have Alzheimer’s or another dementia, and Hispanics are one and a half times as likely.
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Statement of Evidence: Modifiable Risk Factors for Cognitive Decline & Dementia (1) Regular physical activity and management of cardiovascular risk factors (diabetes, obesity, smoking, & hypertension) have been shown to reduce risk of cognitive decline and may reduce risk of dementia; (2) Lifelong learning/ cognitive training and a healthy diet may reduce the risk of cognitive decline. (3) There are many unanswered questions and significant uncertainty with respect to relationship between individual factors and dementia.
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Early Detection, Diagnosis and Biomarkers
Continuum of Alzheimer’s Disease Normal
Alzheimer’s disease
Adapted from Sperling et al. 2011 34
Early Diagnosis is Important • • • • •
A better chance of benefiting from treatment More time to plan for future Lessened anxieties about unknown problems Increased chances of participating in clinical trials An opportunity to participate in decisions about care, transportation, living options, legal and financial matters • Time to develop a relationship with doctors and care partners • Benefit from care and support services
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What is a Biomarker? • Biological marker to measure change • Reliable predictor and indicator of disease and disease progression • Example – Glucose for Diabetes – Cholesterol for Heart disease
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Amyloid PET Imaging
RED = maximum uptake
VIOLET = minimum uptake
Clark et al. (2011) JAMA 305(1). 37
Interventions Pharmacological Non-Pharmacological
Pathway to Develop Interventions
PhRMA 2012 Annual Report 39
Current Alzheimer’s Therapies: Symptomatic Cholinesterase Inhibitors Tacrine (Cognex) Donepezil (Aricept) Rivastigmine (Exelon) Galantamine (Razadyne)
Glutamate Moderators Memantine (Namenda)
Combination Therapies Donepezil & memantine (Namzaric) 40
Interventional Agents in Phase II Clinical Trials in Alzheimer’s Disease AADvac1 Adenosine triphosphate ANAVEX2-73 Atomoxetine AZD0530 BAN2401 Bexarotene BI 409306 BI 425809 Bryostatin 1 Candesartan Cilostazol CPC-201 Crenezumab DAOIB Davunetide Doxycycline E2609 Exendin-4
Fesoterodine Formoterol Gantenerumab Immune globulin Insulin Interpiridine/ RVT-101 JNJ-54861911 Ladostigil hemitartrate Levetiracetam Liraglutide LY3202626 Mesenchymal stem cells Metformin Methylene Blue Naproxen ORM-12741 Oxybutynin Perindopril Piromelatine
PQ912 Rasagiline Riluzole S47445 Sargramostim Simvastatin Simvastatin + L-Arginine + Tetrahydrobiopterin SUVN-502 T-817MA T3D-959 Telmisartan Thalidomide TRx0237 UB-311 VX-745 Xanamem
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Interventional Agents in Phase III Clinical Trials for Alzheimer’s Disease Aducanumab Biogen Antibody to protofibrillar beta-amyloid ALZT-OP1 AZTherapies, Inc. Inhibits beta-amyloid polymerization and inflammation Azeliragon vTv Therapeutics Inhibits receptor for advanced glycation endproducts CAD106 Novartis Pharmaceuticals Vaccine against beta-amyloid Candesartan Emory University Angiotensin receptor blocker CNP520 Novartis Pharmaceuticals BACE inhibitor Crenezumab Hoffmann-La Roche Antibody to beta-amyloid
Gantenerumab Hoffmann-La Roche Antibody to beta-amyloid Idalopirdine / Lu AE58054 H. Lundbeck A/S 5HT6 receptor antagonist Immune globulin Instituto Grifols, S.A. Antibody to beta-amyloid Insulin University of Southern California Hormone that controls blood sugar Interpiridine/ RVT-101 Axovant Sciences Ltd. Antagonist of serotonin receptor 6 JNJ-54861911 Janssen Research & Development BACE inhibitor Lisinopril Emory University ACE inhibitor LY3314814 / AZD3293 Eli Lilly and Company / AstraZeneca BACE inhibitor
Masitinib AB Science Inhibitor of c-KIT Nilvadipine University of Dublin, Trinity College Calcium channel blocker Pioglitazone Takeda PPAR-gamma activator Sodium oligo-mannurarate
Shanghai Greenvalley Pharmaceutical Co Inhibits beta-amyloid aggregation Solanezumab Eli Lilly and Company Antibody to beta-amyloid TRx0237 TauRx Therapeutics Ltd Inhibits aggregation of Tau Verubecestat Merck Sharp & Dohme Corp BACE inhibitor
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Non-Pharmacological Interventions • Over 200 RCTs testing knowledge, skills and supportive strategies for family caregivers with small to moderate effect sizes (Gitlin & Hodgson, 2015) • 60 home-based RCTs (Phase II and Phase III) testing strategies to improve quality of life of people with dementia (Gitlin, Hodgson, Marx, Choi, in press) • We have good to strong evidence showing we can: – Reduce caregiver distress – Provide support, knowledge and skills – Prolong nursing home placement – Improve quality of life and engagement in meaningful activities for persons with dementia – Address unmet needs across disease continuum – Provide care coordination in person/by telephone 43
National Partnership to Improve Dementia Care Quarterly Prevalence of Antipsychotic Use for Long-Stay Nursing Home Residents, National 2011 Quarter 2 to 2015 Quarter 3
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Prevention
Possible Prevention of Alzheimer’s?
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FINGER Study: Receipe of Lifestyle Interventions for Cognition • Gold standard of testing any type of therapy or intervention – Randomized Control Trial (RCT) • Large, rigorous study • First solid evidence that recipe of lifestyle interventions reduces cognitive decline • Needs to be replicated in more diverse populations 6
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Person Centered Care Where we’ve been and where we’re heading
Person Centered Care for Individuals with Dementia • Humanistic and holistic • Not single intervention, guiding principles • Key components (Brooker, 2004) – Valuing people with dementia and those who care for them – Treating people as individuals – Looking at the world from the perspective of person with dementia – Providing a positive social environment ot achieve well being 49
History • Guidelines for Dignity – Family Guide
• Key Elements Of Dementia Care – Family Guide – Training programs – National conference
• Partnerships
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Dementia Care Practice Recommendations • • •
Person-centered Latest evidence Consensus built
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2005-2009
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Phase One: Assisted Living and Nursing Homes 1. Food and fluid consumption 2. Pain management 3. Social engagement and involvement in meaningful activities
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Phase Two: Assisted Living and Nursing Homes 1. Resident wandering 2. Resident Falls 3. Physical restraint-free care
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Phase Three: Assisted Living and Nursing Homes End-of-Life Care 1.Communication with residents and family 2.Decision making 3.Care provision, coordination and communication when residents choose hospice services 4.Assessment and care for physical symptoms, including pain 5.Assessment and care for behavioral symptoms 6.Psychosocial and spiritual support of residents 7.Family participation in resident’s end-of-life care 8.Staff training 9.Acknowledgement of death and bereavement services
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Phase Four: Professionals In A Home Setting 1. 2. 3. 4. 5. 6.
Personal care Safety and personal autonomy Home safety End-of-life care Home care provider training Special topics
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Revision: What We Heard • Lengthy • Excessive bullets—not clear what’s most important--diluted • Duplicative • Organized differently for different phases • Developed on both topics and environments • Not always clear actions or resources—how to apply • Not cited
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Revision: What We’ve Done • • • •
Reviewed feedback on DCPR format and structure Drafted model for revision Conducted focus group with care experts Conducted thematic analysis of existing dementia care guidelines • Revised format/model • Shared revised model with organization • Shared model with care experts for review and feedback
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Overall Plan for Revision • • • • • •
Translational Clear and specific Applicable to various settings Address disease progression Based on current evidence Citable, publishable in a peer-reviewed academic journal supplement
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February 2018 Supplement
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Editors Sam Fazio and Doug Pace, Issue Editors Alzheimer’s Association Katie Maslow, Decision Editor Gerontological Society of America Beth Kallmyer, Decision Editor Alzheimer’s Association Sheryl Zimmerman, Decision Editor UNC
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Lead Researchers/Authors Person Centered Care Focus Sam Fazio, Doug Pace and Beth Kallmyer Detection and Diagnosis Katie Maslow and Rick Fortinsky Assessment and Care Planning Sheila Moloney
Medical Management Mary Austrom and PCP
Information, Education & Support Carol Whitlach Staffing Susan Glister
Ongoing Care Sheryl Zimmerman Therapeutic Environment and Safety Maggie Calkins Transitions/Coordination of Services Karen Hirschman
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Supplement Format • Overall practice recommendations—rolled up from each article • 9 topic area articles – Literature review – Best practices – Incorporate existing DCPRs – 5-7 high level recommendations
• From practice to policy
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Policy
National Alzheimer’s Project Act • Signed into law in 2011 • Advisory Council on Alzheimer’s Research, Care and Services • National Alzheimer’s Plan – annually updated • Five goals are the foundation of the plan: – Prevent and Effectively Treat Alzheimer’s Disease by 2025 – Enhance Care Quality and Efficiency – Expand Pubic Supports for People Living with the Disease and their families – Enhance Public Awareness and Engagement – Track Progress and Drive Improvement 66
National Alzheimer’s Plan Research on Care and Services Goal 2 -“Enhance care quality and efficiency” “All persons living with Alzheimer’s disease and related dementias, regardless of location, race, ethnicity, sexual orientation or socioeconomic class, should receive high quality person/family-centered by well-trained practitioners and workers from detection and diagnosis through end-of-life, across all health care and long-term services and supports.” 2025 Endpoint Alz. Association National Plan Care and Support Milestone Workgroup
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Strategies for Goal #2 • Build a workforce with skills to provide high quality care • Ensure timely and accurate diagnosis • Educate and support people with ADRD and their families upon diagnosis • Identify high quality dementia care guidelines and measures across care settings • Explore the effectiveness of new models of care for people with ADRD • Ensure that people with ADRD experience safe and effective transitions between care settings and systems • Advance coordinated and integrated health and long-term services and supports • Improve care for populations disproportionately affective Alz. Association National Plan Care and Support Milestone Workgroup
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National Alzheimer’s Plan Research on Care and Services Goal 3 -“Expand supports for people living with Alzheimer’s disease and their families” “People with Alzheimer’s disease and related dementias, their families and their caregivers should have access to effective interventions and supports that expand their caregiving skillsets, enhance the meaningfulness and quality of their lives, and reduce the burden of Alzheimer’s disease and related dementias.” 2025 Endpoint Alz. Association National Plan Care and Support Milestone Workgroup, 2016 Alzheimer’s & Dementia
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Strategies for Goal #3 • Ensure receipt of culturally sensitive education, training, support materials • Enable family caregivers to continue to provide care while maintaining their own health and wellbeing • Assist families in planning for future care needs • Maintain dignity and rights of people with ADRD • Assess and address housing needs • Support communities that are inclusive and safe Alz. Association National Plan Care and Support Milestone Workgroup, 2016 Alzheimer’s & Dementia 70
National Research Summit on Care, Services and Supports for Persons with Dementia and Their Caregivers NIH Campus, Natcher Building #45 | 45 Center Drive | Bethesda, Maryland October 16-17, 2017
Registration opening soon https://aspe.hhs.gov/national-research-summit-care-services-andsupports-persons-dementia-and-their-caregivers
Convened by the National Institute on Aging at the NIH with support from the Foundation for the National Institutes of Health.
Potential Outcomes of Summit • Identification of low hanging fruit – Evidence-based programs, strategies, approaches that can be used now to improve care and services – Identification of strategies for disseminating evidence based programs • Recommendations of research priorities to inform Federal agencies to reach care and service milestones for 2025 • Refinement of milestones to track and guide acceleration of development and advancement of evidence-informed care and services • Identification of methodologies, measures, designs to close research-practice gap and time to implementation 72
Board Member Organizations
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Assisted Living • • • • • • •
713,00 residents nationwide 22,200 communities/ 408,000 employees State regulated – state regulations vary 70% women/30% men 53% 85+ 83% 75+ 40% have Alzheimer’s or related dementias 81% private pay (personal finances/LTC insurance) 19% Medicaid • Memory Care Units fasting growing segment
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• Medicaid Program; HCBS Final Rule – The final Home and Community-Based Services regulations set forth new requirements for several Medicaid authorities under which states may provide home and community-based long-term services and supports. The regulations enhance the quality of HCBS and provide additional protections to individuals that receive services under these Medicaid authorities. • Published in the Federal Register on January 16, 2014 • Over 2000 comments received during comment period – “In this final rule, CMS is moving away from defining home and communitybased settings by ‘what they are not,’ and toward defining them by the nature and quality of individuals’ experiences. The home and community-based setting provisions in this final rule establish a more outcome-oriented definition of home and community-based settings, rather than one based solely on a setting’s location, geography, or physical characteristics.”
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HCBS Final Rule CMS presumes some settings may be ineligible
• Conditions under which residential settings are presumed to have “qualities of a institutional setting” by virtue of their location• “Any setting that is located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment, or in a building on the grounds of, or immediately adjacent to, a public institution, or any other setting that has the effect of isolating individuals receiving Medicaid HCBS from the broader community of individuals not receiving Medicaid HCBS…” 76
CEAL recommendations to CMS on guidance for implementing the HCBS Final Rule CEAL Comments to CMS 2-26-16 CEAL’s History with HCBS Attributes & Person-Centered Care – Person-Centered Care in Assisted Living: An Informational Guide – Person-Centered Care Domains of Practice: General Home and Community-Based Services Attributes and Assisted Living Indicators – Toolkit for Person-Centeredness in Assisted Living – An Informational Guide and Questionnaires of Person-Centered Practices in Assisted Living (PC-PAL)
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CEAL recommendations to CMS on guidance for implementing the HCBS Final Rule – Heightened Scrutiny Process
• Community Engagement/Isolation – Community engagement differs not among different types of people but also over time as they experience life-changing events – A move to AL may increase “community engagement”
• Setting characteristics considered to be institutional – Secured dementia units/neighborhoods within a larger AL community or as a free standing community; – Continuing Care Retirement Community (CCRC) type arrangements where AL is located on the same campus as independent living and a nursing home (NH); – AL that was built as a separate section of a NH or is a converted section of a NH; – AL that is on the campus of or adjacent to a hospital or other healthcare provider; – AL communities located at the edge of town or in a rural area that could be considered isolated.
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CEAL recommendations to CMS on guidance for implementing the HCBS Final Rule – Heightened Scrutiny Process EVIDENCE DEMONSTRATING THAT IS SETTING IS MEETING THE REQUIREMENTS OF COMMUNITY ENGAGEMENT THROUGH PERSON-CENTERED CARE PLANNING• Document
resident’s preferences ; • Provide or arrange for transportation; • Documenting evidence to enable community engagement ; • Settings bring opportunities for community engagement on site; and •Settings coordinate on site activities based on individual interests.
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CEAL recommendations to CMS on guidance for implementing the HCBS Final Rule: person-centered dementia care in assisted living WHY DO PEOPLE EXIT SEEK? Go for a pleasant walk, to get outside and get a bit of exercise. May have difficulty communicating a need, such as the need for human interaction or hunger or thirst. May be related to patterns of daily routines before they moved to assisted living. An attempt to express distress regarding aspects of the residential environment, such as noise, other residents, and restrictions on access to exterior spaces or unpleasant interactions with staff members.
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CEAL recommendations to CMS on guidance for implementing the HCBS Final Rule
• Why Do People Seek Out Secured Assisted Living Communities Designed to Serve People with Dementia? – The family cannot meet the needs of the person affected by the disease and when they are no longer safe in their own homes because they are at heightened risk of unsafe exit seeking. – 40% of residents in residential care communities have a diagnosis of Alzheimer’s disease of other dementias – 6 in 10 people with Alzheimer’s disease will engage in “wandering” behavior at some point over the course of the disease. – Balancing safety and autonomy
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CEAL recommendations to CMS on guidance for implementing the HCBS Final Rule: person-centered dementia care in assisted living
CEAL comments to CMS 6-29-16 •Theme #1: If individual PCC planning is important to every person, it is doubly important for those people living with dementia. – “No one size fits all” approach will never be successful – “The nature and quality of individuals and experiences” is critical when it comes to PCC planning and delivery. • They change over time as people – Age – Lose a spouse – Distance of children – Changes in their community surroundings – Changes in their underlying health conditions and disability status
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CEAL recommendations to CMS on guidance for implementing the HCBS Final Rule: person-centered dementia care in assisted living • Practices that providers should adopt to demonstrate acceptable person-centered dementia services planning include: – Tailored to the needs and preferences of each individual resident; – Show evidence of meaningful involvement of the resident; – Show evidence that residents were offered alternative service approaches ; – Defer to decisions made by the resident or their designated representative. – Plans discuss individual preference for community integration within and outside the residential setting and how the provider will assist in that integration. 83
CEAL recommendations to CMS on guidance for implementing the HCBS Final Rule: person-centered dementia care in assisted living
• Theme #2: A corollary to the first theme is that effective PCC delivery must rest on effective communications with residents living with dementia that is grounded in building relationships, not just providing needed services. – – – – –
Listening Observing Learning about each individual’s life story Interpreting what is seen and heard Relating to each person as an individual
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CEAL recommendations to CMS on guidance for implementing the HCBS Final Rule: person-centered dementia care in assisted living
Training programs should include important information on issues such as: Types of dementia, their causes and how they affect the individual’s ability to function; Stages of dementia and what to expect over time; Principles of person-centered care planning and service delivery; Strategies for handling behavioral expressions of need or distress.
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CEAL recommendations to CMS on guidance for implementing the HCBS Final Rule: person-centered dementia care in assisted living • Theme #3: Good communications and PCC planning and service delivery can mitigate behavioral expressions of need or distress that are often misunderstood and labeled as abnormal or anti-social, including unsafe exit seeking, but safety concerns may require some form of secured egress from buildings. • Even very effective and dedicated programs for providing PCC for people living with dementia noted that they employ ways to secure egress from the building to address safety concerns, but they stressed that secured egress alone is not an adequate response to exit seeking behaviors.
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CEAL recommendations to CMS on guidance for implementing the HCBS Final Rule: person-centered dementia care in assisted living • Conclusion – Providing person-centered services to people living with dementia presents some of the most challenging issues in promoting the objectives of honoring individual preferences and enabling community engagement as required by the final HCBS rule. – Some features of residential life, such as controlled egress, may place some limitations on personal freedom. – However, denying Medicaid HCBS funding on this basis would only mean that residents are forced into more restrictive institutional settings that generally do not have the same PCC requirements or orientation. – CMS must make some balanced judgments in this area regarding the trade-offs between personal choice and safety. 87
CMS FAQs 12-15-16 • Joint project of CMS and ACL (Administration for Community Living) • These are promising practices and not regulatory guidance • They are achievable practices • The key is person-centered care planning • If you have further questions contact – – Melissa Harris Senior Policy Advisor Disabled and Elderly Health Programs Group Center for Medicaid and CHIP Services Centers for Medicare and Medicaid Services melissa.harris@cms.hhs.gov – melissa.harris@cms.hhs.gov
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Q1. How can residential and adult day settings comply with the HCBS settings requirement while serving Medicaid beneficiaries who may wander or exit-seek safely? • Exit seeking behaviors are not necessarily constant or permanent • Wandering may appear aimless but often has purpose • Person-centered planning, staff training are core components
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Q1. How can residential and adult day settings comply with the HCBS settings requirement while serving Medicaid beneficiaries who may wander or exit-seek safely? • Person-centered service plan should be developed with the individual and their representatives as appropriate – The “KNOWING”
– Assess for patterns, frequency or triggers for unsafe wandering – Use this baseline information to develop the person-centered care plan – Use periodic assessments and adjust as necessary • Staff should receive training about how to communicate with individuals who may exit seek
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Q2: Can provider-controlled setting with Memory Care Units comply with the new Medicaid HCBS settings rule? • YES, • But…. – Assess – Document • Follow the person-centered care plan • All less restrictive interventions have been exhausted • Restriction is reassessed over time
– Spouses or partners who reside in the setting but are not a risk for exit-seeking must have the code to exit
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Q3: What are some of the promising practices that HCBS settings can use to serve people who are at risk of unsafe wandering or exitseeking? • Person-Centered Care Planning is the core • Staffing – Adequate training in person-centered care & exit seeking
• Activities – In-house and External
• Environmental Design – Lockable doors on rooms unless person-centered care plan documents arrangement is unsafe 92
Q4: How can residential and adult day settings promote community integration for people who are at risk for wandering or exit-seeking? • Through individualized person-centered care planning – Maximize opportunities for engagement with the broader (outside) community – Recording individual preferences for community integration and how the setting will support those preferences
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Questions? Alzheimer’s Association We’re here. All day, every day.
24/7 Helpline: 800.272.3900 alz.org
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Thank You! Sam Fazio sfazio@alz.org Doug Pace dpace@alz.org