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Top 10 clinical innovations in LTC

September 14, 2011
by Tobi Schwartz-Cassell
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Person-centeredness is in command

Clinical innovations in long-term care might bring to mind invasive procedures and/or pharmaceutical interventions. At least that's how it used to be. According to the experts, innovations in the now second decade of the 2000s, by and large, lean more toward non-invasive means and a “person-centered” model.

The term person-centered is tossed about quite a bit, but a closer look reveals that the phrase has emergent significance. “An overarching philosophy of person-centered care has been around for a while, but is now being implemented in more creative ways,” says Elizabeth Gould, MSW, project director at the Alzheimer's Association. “There is a mind shift from managing the behavior to understanding the behavior.”

As you'll see, person-centered care is involved in just about every entry on this list. And most-though certainly not all-are fairly low-tech, leading one to believe that in some cases, “the more things change, the more they stay the same.”


ALZHEIMER'S/DEMENTIA CARE

“Developments in dementia care are driven by increasing public awareness of the enormous increase in the numbers of persons with dementia in the coming years,” says Susan D. Gilster, PhD, Fellow, and co-developer of the Alois Alzheimer Center, the nation's first freestanding dementia care facility located in Cincinnati. “However, in relationship to the daily care of individuals with dementia in long-term and acute care, we have not made near enough progress. Despite research in the early 1990s regarding the clinical care and enriching environments for enhancing dementia care in all settings, many have not yet embraced that knowledge.”

Segregating individuals with dementia from the rest of the population, Gilster says, is just not enough. “Resident choice, living a ‘normal’ life in the confines of a residential environment, reduces issues. Decisions should be driven by ‘person before task,’ and ‘person before convenience,’ recognizing and appreciating that this [the long-term care facility] is their home.”

A patient interacts with the paro robot
Photo courtesy of Passages Hospice
A patient interacts with the PARO robot


Here are a couple examples of innovations being integrated into contemporary dementia care settings:

TimeSlips. “Forget memory. Try imagination.” So says the t-shirt that represents TimeSlips, a storytelling program developed by the Center on Age & Community of the University of Wisconsin-Milwaukee. First implemented in 1998, it is finally hitting its stride. TimeSlips moves away from the emphasis on memory and factual reminiscence and steers residents toward creative expression via storytelling. And when the pressure's off, the fun begins.

PARO Therapeutic Robots. Dovetailing the high and low-tech worlds is Illinois-based Passages Hospice, which is using PARO therapeutic robots for patient memory disorders. “We started with one and it worked so well we just received our fourth,” says Kaitlyn Henderson, media and communications manager of Passages Hospice, the only hospice in the country to use PARO. At first glance, PARO looks like a stuffed animal from the toy store. But it's actually a soft, sweet-faced plush baby seal wrapped around intricate mechanics that simulate the sounds and movements of a companion animal. It even coos and purrs when a patient pets it and has been shown to help stem depression and enhance communication. Since Passages introduced PARO to its patients in August 2010, the robot is being successfully used in skilled nursing facilities throughout Illinois and Michigan. You may have even seen it featured in the Idea House at LeadingAge's annual conference.


TELEMEDICINE

Telemedicine reduces travel costs related to transporting residents to and from medical appointments, but more importantly, it increases resident access to doctors and specialists. A particularly innovative example of telemedicine comes from the University of Iowa Hospitals & Clinics' Department of Family Medicine, which embarked on a research project using a rollabout system that is outfitted with an electronic stethoscope, otoscope, dermascope, dental scope and EKG machine. Although no longer in use at the university, it is being used at a number of skilled nursing facilities in Spain where the rollabouts move from bedside to bedside allowing residents access to medical assessment easily and more comfortably. A computer is housed in the system, as is a videoconferencing unit and a monitor on a moveable arm so doctors, nurses and family can be part of the virtual examination.


RESTRAINT-FREE SYSTEMS

Although the use of restraints in long-term care has been reduced considerably over the years, Beryl Goldman, director for Kendal Outreach, notes that there's a long way to go when it comes to advancements. Kendal Outreach is a nonprofit organization offering creative solutions in healthcare. It is a subsidiary of The Kendal Corporation, which operates older adult communities in the Quaker tradition in eight states, clustered mostly in the eastern United States.

Goldman co-wrote a chapter of the book “Rights, Risks and Restraint-Free Care of Older People,” published in 2009 in both London and Philadelphia by Jessica Kingsley Publishers. The book details how to provide safer long-term care by putting older people at the center of decision making about their own well-being.

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