MENTAL HEALTH ON THE FRONT BURNER
All these considerations need to be addressed in a conversion of
units from assisted living to memory care. Recently, First Colonial Inn, a Kisco Senior Living community in Virginia Beach, Va., started expanding to include a memory care neighborhood. Jackson Cherry, executive director at Kisco, noted,” For us dur- ing the process, we wanted to make sure that everything we are doing in this space is intentional and doesn’t look like an after- thought.” They had to work to make sure that the unit that was converted to memory care reflected the unique aspect of this set- ting and the specific needs of memory care residents.
Worth the Investment Implementing cutting-edge programming and technology for memory care residents isn’t without a cost. But there is a real value to these efforts. Frantz said, “ROI is something everyone is looking for – the ability to attract new prospects, etc. We started an online system to track resident engagement. When we create spaces where residents are safe and enjoy life in new ways, we can grow census and hopefully enable residents to age in place longer.” It is important to be able to track outcomes related to programs
that cost money. For example, Harder noted that they use a plat- form that collects data about participation in activities. “We can
see what activities are successful and popular and what ones aren’t being used or don’t resonate with residents. We can use this data as a jumping point to increase participation and engagement,” Harder said. Other ROI is more specifically related to resident care and out-
comes. For instance, Harder said, “The more engaged someone is, the less likely they are to need pharmacologic interventions.” At the same time, she suggested that when residents are happier and more joyful, it also takes the stress down in memory care for staff; and this contributes to retention. Hether Arce, director of strategic accounts at PharMerica, noted
that polypharmacy and adverse events contribute to residents hav- ing to leave memory care for a hospital stay or to move to a nurs- ing home. Therefore, she suggested, “It is important to work with pharmacists and prescribers to help them optimize medication use, identify and address possible side effects, as well as understand the unique aspects of memory care.” She added that she is starting to see teams coming together to
focus on the patient so there aren’t disconnects. “We are scratching the surface on this, but it’s a big pain point when you have different practitioners prescribing drugs that result in different interactions,” Arce said.
INTERACT ENTERS MEMORY CARE SPACE AS ACUITY RISES
Originally, INTERACT, or Interventions to Reduce Acute Care Transfers, was designed as a quality improvement program designed to enhance the identification, evaluation, and communication of condition changes in nursing home residents. However, as the acuity of assisted living residents has increased and memory care units are seeing more people with moderate dementia, INTERACT has been adapted to these settings to help prevent hospitalizations and ER visits among their residents.
There are four basic types of tools in the program. These address quality improvement, communication, decision support, and advance care planning. “INTERACT is useful in this setting because people aren’t just coming to us with dementia but also comorbidities. It is important to teach staff to recognize subtle changes of condition so that we can address these promptly and attend to the individualized needs of each person,” said Betty Brunner, RN, an INTERACT master trainer, and senior nursing consultant with Pathway Health.
INTERACT, said Brunner, teaches staff how you look at each person on admission including their comorbidities.
It’s not just looking at clinical issues but also psychosocial ones. The goal is to truly know who each person is so the team can identify subtle changes and work to manage these without sending them out to the ER or hospital.
One advantage of tools like INTERACT is that they are evidence-based and enable communities and their teams to proactively address condition changes without reinventing the wheel.
In the training, Brunner noted, “We walk unlicensed staff through Stop and Watch, an early-warning tool that is a checklist of signs team members can watch for. They learn how to be the eyes and ears for nurses on the unit.”
Brunner suggests that INTERACT is different in memory care because it looks at information that residents won’t or can’t communicate. “It teaches aides to be proactive. We want to prevent sending people to the hospital or ER.” This is part of quality improvement efforts that enables community leaders to look at outcomes and give staff feedback on what positive changes can be made, she said.
18 SENIOR LIVING EXECUTIVE MAY/JUNE 2023
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