Step 5: Goals and Objectives
The goal of the health promotion plan is to garner sufficient community support to successfully implement the EA model in a local nursing home, thereby increasing the quality of dementia care for patients with end-stage disease. The objectives are the following:
1. Identify all stakeholders and convince them of the need to improve the quality of care for end-stage dementia patients
2. Obtain the necessary funding from the local, state, and federal governments to implement the EA model
3. Shift the focus away from organizational needs to patient-centered care, including advanced care planning for life-sustaining care decisions
4. Engage patients and family members in the decision-making process
5. Implement dementia-specific care strategies with the assistance of dementia experts
6. Combat the three plagues of nursing home residents: loneliness, helplessness, and boredom (Monkhouse, 2003)
Step 6: Messages
Many of the local stakeholders may not realize the current state of dementia care; therefore, the main message will be that loved ones with end-stage dementia have traditionally suffered needlessly due to suboptimal care and neglect. Fortunately, interventions exist which can remedy this situation, but public support for implementation is needed. The main media outlets chosen to transmit this message are flyers handed out to patients and their families and advertisements in newspapers and on radio and television stations.
Step 7: Timeline and Budget
The timeline that Monkhouse (2003) used when implementing the EA model was three years before evaluating success. The Swiss nursing homes asked for and received a 30% increase in funding levels to support the transformation from the local government. A similar strategy will be implemented for this health promotion plan.
Step 8: Evaluation
The evaluation will be both qualitative and quantitative, since the quality of care depends to a significant extent on the experiences of patients and their loved ones. Questionnaires and validated instruments will be used to assess whether the experiences of residents and their family members have changed. Clinicians will also be asked to record the frequency of signs and symptoms associated with quality of care, including the prevalence of shortness of breath, constipation, fever, eating difficulties, falls, chemical restraint use, and life-sustaining interventions (Parsons, Hughes, Passmore, & Lapane, 2010). Additional measures will include the prevalence of advanced care plans, medication expenditures, sleeping pill use, staff turnover, staff sick days, bed occupancy, effective pain management, and time spent in hospice care
The TQM and EA care models offer the promise of dying with dignity for dementia patients, who have been called by some the 'disadvantaged dying.' This often neglected and marginalized patient group deserves high quality care and to be free of the three plagues of traditional nursing home care: loneliness, helplessness, and boredom. This health promotion plan is designed to address the current shortcomings in dementia care through implementation of the TQM and EA models.
Brownie, S. & Nancarrow, S. (2013). Effects of person-centered care on residents and staff in aged-care facilities: A systematic review. Clinical Interventions in Aging, 8, 1-10.
Barbosa, A., Sousa, L., Nolan, M., & Figueiredo, D. (2014). Effects of person-centered care approaches to dementia care on staff: A systematic review. American Journal of Alzheimer's Disease & Other Dementias, published online ahead of print 20 Jan. 2014, doi: 10.1177/1533317513520213.
Department of Health, Australian Government. (n.d.). About the Community Health Action Pack. Retrieved 13 Feb. 2014 from http://livelonger.health.gov.au/about-the-community-health-action-pack/.
Goodman, C., Evans, C., Wilcock, J., Froggatt, K., Drennan, V., Sampson, E., Blanchard, M., Bissett, M., & Iliffe, S. (2010). End of life care for the community dwelling older people with dementia: An integrated review. International Journal of Geriatric Psychiatry, 25, 329-37.
Monkhouse, C. (2003). Beyond the medical model -- the Eden Alternative in practice: A Swiss experience. Journal of Social Work in Long-Term Care, 2(3-4), 339-53.
Parsons, C., Hughes, C.M., Passmore, A.P., & Lapane, K.L. (2010). Withholding, discontinuing and withdrawing medications in dementia patients at the end of life: A neglected problem in the disadvantaged dying? Aging Drugs, 27(6), 435-49.
Puurveen, G. (n.d.). Caring for Persons with Dementia at the End of Life: A…