Horizon House has long been known for the excellent and compassionate care we deliver to our residents. This past year we have been fine-tuning that care, especially as it relates to those frailest residents who are experiencing the decline of dementia.
In January of 2015, Horizon House made the decision to partner with The Beatitudes, another UCC-sponsored Continuing Care Retirement Community from Phoenix, AZ, which, over the past 17 years, has become a leader in the delivery of compassionate, evidence-based care for those coping with mid- to late-stage dementia called “Comfort Matters.” A group from Horizon House visited their facility last fall and found that their care delivery is very similar to our own. The Beatitudes’ full time research/education specialist, Tena Alonzo, has been a leader in defining best practices in care of people with late-stage dementia and she, along with their Director of Nursing, Karen Mitchell, have been mentoring and educating staff in other facilities throughout the United States, Horizon House among them.
Comfort Matters is, simply put, a focused approach to late-stage dementia care that focuses on aggressive palliative measures to meet the physical, social, spiritual, and emotional needs of those residents. It is an intentional, person-centered approach that emphasizes knowing the whole person well, their background, past and present routines, what makes them smile, what brings them comfort, what foods they enjoy, and what causes them discomfort. This approach challenges us to honor, involve, and empower the staff closest to residents when making decisions regarding their care, something that resonates with Horizon House’s philosophy.
Our interdisciplinary staff, from diet aids to housekeepers, nurses and nursing assistants, activity leaders and managers, were trained by Comfort Matters leaders in January to employ those strategies that provide comfort above all else. We intensified our efforts to feed people before they are hungry, regardless of time of day. We offer to provide fluids before they are thirsty, let people sleep when they show signs of fatigue, eat later if they wish, and watch closely for signs that a person may be in pain. People in late dementia can rarely express verbally when they are uncomfortable, but they can tell us by their irritability, their worried expressions, their fidgeting, or calling out. All staff is trained to observe and report such signs to our nurses. Our staff is continuing to learn how to create moments of joy and make meaningful connections through individualized activity approaches. We have combined the philosophies of Comfort Matters with previously established Namaste Care and Music and Memory to use quiet soothing environments, massage and aromatherapy, and personalized music delivered by iPod headsets to create a sense of well-being and comfort.
In May, we received additional training from Marybeth Gallegher, DNP, and Director of the Dementia Care program for Hospice of the Valley in Phoenix, and invited our partners from Providence Hospice of Seattle and Group Health Hospice, along with our own Claire Raskind, ARNP, and Tammira Price, MD, our Medical Director. Together with our clinical staff, we learned how to fine-tune our approach to aggressive palliative care in late-stage dementia, which involves evaluating the medications we deliver through the lens of improving comfort rather than prolonging life. The training encouraged us to work with families and primary care providers to clarify goals of care and, where possible and indicated, to simplify the medical approach, with the goal of comfort at the center.
What are the results of Comfort Matters? The smell of hot fresh waffles can be noticed at 11pm or 2am when residents may be up and wandering and possibly hungry. Morning time is quieter and calmer, as residents are getting up when they are showing an interest in starting their day, rather than responding to our 8am schedule of meal delivery. Bathing routines are altered to promote maximum comfort and calm. Unnecessary medications have been discontinued. Staff is more relaxed and focused on what makes residents smile and feel comfortable. Music is heard at all hours. Staff members now joke that you have to be able to sing to work in Memory Support! And residents are showing less signs of distress or discomfort. Our use of psychotropic drugs has dropped dramatically.
Staff, under the leadership of Julie Jorgensen, Director of Nursing Services, and Senan Baini, Neighborhood Manager, continues to meet weekly to review, resident by resident, how we can “make their day,” how our environment supports or distracts from our Comfort Matters goals. Our programming is continuing to transform from large-group activities to smaller groups or one-on-one connections rich with meaning for each resident.
Staff is energized, empowered, and continuing to learn how to support our residents and their families throughout their earthly journey and gently hold their hands and their hearts as they leave this world. Our lives are richer because we have touched those we serve in deeper, more thoughtful ways. At the end it really is true, that Comfort Matters at Horizon House.