Perceptions of Care Quality during an Acute Hospital Stay for Persons with Dementia and Family/Carers

Abstract

Objectives: to report on acute hospital care experiences for persons with dementia and family/carers in a pilot study (PiP) of person-centred care compared with usual care. Methods: participants were recruited from one acute aged care ward and one mixed medical/surgical ward. One-on-one interviews occurred soon after discharge using a semi-structured interview guide framed by person-centred principles whereby the person is: V—valued; I—treated as an individual; P—perceived as having a unique identity; and S—supported socially and psychologically. Data were analysed deductively with reference to these a priori principles. Results: 11 consented persons with dementia and 36 family/carers participated. A total of eight core VIPS concepts were derived from the data. While many occasions of person-centred care occurred, there was variability in staff expertise, interest and aptitude for dementia care work. Neglect of person-centred principles more frequently occurred for the usual care group, where staff failed to place the person and their family/carer at the centre of service. Conclusions: person-centred services for persons with dementia requires that hospital executive equip staff with the relevant knowledge, skills and support to adhere to person-centred care guidelines. Hospitals must address workplace cultures and procedures that favour organisational systems over person-centred services.

Views of people living with dementia and their families/care partners: helpful and unhelpful responses to behavioral changes

“…Progressing awareness and understanding of the study themes Support is growing for a new paradigm for understanding behavioral changes that people living with dementia experience (Burley et al, 2021;Górska et al, 2018;Hammar et al, 2021;James et al, 2022). Momentum is increasing for a focus on improving how others treat people living with dementia, for using person-centered approaches in care and support, and for reducing stigma and discrimination (Chenoweth et al, 2021a;2021b;Bacsu et al, 2022;Hung et al, 2021). The sections below refer to how themes identified here relate to previous reports.…”

“…Research evidence (Ballard et al, 2017;Brodaty et al, 2018), clinical guidelines (Laver et al, 2016;NHMRC Guideline Adaptation Committee, 2016), and the recent Australian Royal Commission into Aged Care Quality and Safety (Commonwealth of Australia, 2021) support the use of thorough clinical assessment and psychosocial interventions including personcentred care for people living with dementia. Although there is considerable evidence for the use of nonpharmacological approaches in residential, hospital, and community settings for people living with dementia (2021b; Ballard et al, 2017, Burns et al, 2012Chenoweth et al, 2014;Livingston et al, 2017;Burley et al, 2020;Dyer et al, 2018), acceptance and implementation of these approaches and changing practice is more challenging (Chenoweth et al, 2021a;Livingston et al, 2014). Despite their detrimental impact, psychotropic medicines, e.g.…”

New horizons for caring for people with dementia in hospital: the DEMENTIA CARE pointers for service change

“…Challenges in communication can impact effective pain medication, hydration, nutrition and all aspects of physical and emotional care. Whilst these challenges have long been recognised [ 9–11 ], it remains an ongoing issue [ 12 , 13 ], and has been further impacted by the COVID-19 pandemic [ 14 , 15 ]. It is well established that a person-centred care approach helps alleviate some of the unfamiliar stress from being in the acute care environment [ 13 , 16–18 ].…”

“…Whilst these challenges have long been recognised [ 9–11 ], it remains an ongoing issue [ 12 , 13 ], and has been further impacted by the COVID-19 pandemic [ 14 , 15 ]. It is well established that a person-centred care approach helps alleviate some of the unfamiliar stress from being in the acute care environment [ 13 , 16–18 ]. To embed person-centred care across the hospital environment, the evidence suggests cultural changes are needed at organisational and ward levels [ 19 , 20 ].…”

“…These points have been echoed by Chenoweth et al. [ 13 ] who concluded that person centeredness of hospital care for persons with dementia depends very much on staff knowledge, skill and aptitude for dementia care work, on the hospital systems and work cultures, which shape staff’s approach to this work, and staff’s acknowledgement of the centrality of the person and their family/carer in healthcare decisions. Sanatinia et al.…”