A few years ago, St. Leonard Franciscan Living Community, a continuing care retirement community in Centerville, Ohio, faced the same challenges that other long-term care communities face when it comes to caring for the growing ranks of LTC residents with issues relating to Alzheimer’s disease: easily agitated residents due to the disease’s unpredictable patterns and mentally and physically exhausted caregivers.
Resident engagement centered around group activities and yet residents often became disengaged or bored, resulting in undesirable behaviors such as roaming, rummaging, anger outbursts and increased falls.
It was the falls issue among the general St. Leonard population that initially led Executive Director Tim Dressman to approach an ergonomics expert, Govind Bharwani, PhD, director of nursing ergonomics and Alzheimer’s care at the Nursing Institute of West Central Ohio at Wright State University. Dressman was looking for help to reduce resident falls and staff injuries in lifting and caring for residents.
|Dr. Bharwani meets with a resident at St. Leonard. Photo courtesy of St. Leonard.|
Ergonomics is the science of tailoring the environment to reduce stress on the individual. It is often applied in the context of physical stress on muscles and joints, but ergonomic solutions can also be developed to mitigate the effects of mental stress.
During his research at St. Leonard, Bharwani, together with his daughter, Meena, who works in healthcare technical consulting and process improvement, determined that residents with dementia required a specialized program separate from other residents. After lengthy observation they discovered that falls and other negative behaviors could be reduced through customized activities.
“A lot of people say it’s good to have eyes outside your industry looking in to have the most insight and that’s exactly what we did,” says Dressman. “Here we had a college engineering professor, who never spent a day in long-term care [find a solution]. He fell in love with [long-term care] and the families and residents in turn love him.”
The Bharwanis’ innovative approach to engaging residents with Alzheimer’s/dementia—Behavior-Based Ergonomics Therapy (BBET)—was pioneered in February 2010 in St. Leonard’s 18-bed Alzheimer’s unit. The BBET program addressed two strategic imperatives: to reduce falls in the unit and to design an Alzheimer’s care strategy that would be piloted in the unit and eventually reproduced across the continuum of care and in the expansion of memory care on the campus.
|Meena Bharwani and Dr. Bharwani in the resource center. Photo courtesy of St. Leonard.|
Prior to the program’s implementation, an advisory board met monthly and included representatives from the community, faculty from Wright State University (an interdisciplinary team with members from the fields of nursing, gerontology and engineering), the Alzheimer’s Association, and family members and physicians. A separate cross-functional project team of facility staff and management met weekly to develop and implement the program. The team had a combined 90 years of hands-on Alzheimer’s care experience.
For the first objective, the project team drew the following conclusions based on research and observation: