Why People Living with Dementia Do Better With Care at Home

There really is no place like home for the more than six million Americans living with dementia. These individuals face memory loss and other cognitive barriers that are severe enough to interfere with daily life, both in familiar and unfamiliar environments. This is why a trip to the hospital can turn someone living with dementia’s world upside down, often leading to delirium, functional decline, and distress. 

With the number of people aged 65 and older diagnosed with dementia expected to increase to 12.7 million by 2050, our healthcare system faces a tremendous challenge in treating these patients. A report published in the International Journal of Geriatric Psychiatry notes that people living with dementia have a “significantly higher risk for all-cause hospitalizations and longer hospital length of stay.” The Alzheimer’s Association points out that people living with dementia have twice as many hospital stays per year as other seniors and are more likely to have chronic conditions.  

Even more alarming, a study in Cambridge University Press found that people living with dementia who are admitted to the hospital for a urinary tract infection or pneumonia – two of Contessa’s most common conditions – had a higher mortality rate during admission. 

And this is just the tip of the iceberg. What about patients living with dementia who are not acutely ill, but need rehabilitation or other ongoing long-term care? There are challenges in these environments as well. One study published in the Journal of the American Medical Association found that 71% of nursing home residents with an advanced dementia diagnosis died within 6 months of admission to the facility, concluding that most nursing home residents with advanced dementia “do not receive optimal palliative care.” All these realities were both exacerbated and unmasked by the COVID-19 pandemic in which dementia patients were shown to have even high rates of ED use, hospitalization, delirium, distress and death. 

The Value of Person-Centered Care at Home 

In 2018, the Alzheimer’s Association published Dementia Care Practice Recommendations, which focuses heavily on person-centered care. This approach builds care around an individual’s needs and is contingent upon knowing the patient’s unique individuality. While this is an easy concept to grasp, it isn’t always easy to execute.  

This is especially true in a care setting where physicians or nurses are juggling a large patient census. The difficulty is also evident when patients have complex medical needs and care is fragmented– a problem addressed by the “optimal palliative care” that the American Medical Association found lacking for many advanced dementia patients. 

But Contessa’s Comprehensive Care at Home model is purposely designed to take a person-centered approach. After all, what could be more patient-centered than building their care plan around to meet their specific treatment needs whilst in their place of most comfort and safety? 

Our home-based care teams provide the same care as traditional doctors and nurses, but on a very personal level. The relationship and meeting cadence is often more intimate, personal and regular than during a traditional hospital or skilled nursing facility stay.  

This offers the unique opportunity to learn a lot about a patient’s social determinants of health by observing their home environment and lifestyle. It also helps providers and families to earlier identify symptoms of any potential problems that could result in poor outcomes. We design a care plan that is especially suited for the patient’s day-to-day life, which is the essence of person-centered care, and is proven to deliver strong patient outcomes. 

In our Palliative Care at Home model, this is especially apparent: after all, by definition palliative care is person-centered and addresses quality of life and coordination of care in a way that allows patients with complex, serious illnesses to live longer and feel better. 

Creating an Improved Experience With Care at Home 

Comprehensive home-based care models, like Contessa’s, offer many advantages for people living with dementia. Being in a familiar environment surrounded by familiar faces is a major benefit. At home, a patient’s support system is more inherent, and they are more likely to be able to participate in their own care.  

By being treated at home, people living with dementia remain familiar with the details of their surroundings such as the floor plan, furniture and bedrooms. If they get up in the middle of the night, they are less likely to have trouble finding the bathroom or experience other obstacles that may lead to a debilitating fall or create acute panic from disorientation. Often, their loved ones are by their side, rather than having to meet and get to know unfamiliar caregivers. Further improving comfort and routine, their favorite things are also nearby (pets, books etc.) and meals are home cooked. 

It must be emphasized that despite the many comforts of home, we know family members and caregivers alone are not designed to help patients navigate demanding health conditions. In Contessa’s Comprehensive Care at Home model, our teams are in patients’ homes both physically and virtually. Each program allows for personalized, one-on-one visits by specially trained medical professionals, including registered nurses, nurse practitioners, or members of the rehabilitation treatment team.  

For patients living with dementia, our palliative care services prove to be an especially valuable tool in helping caregivers and family members create long-term care plans in the home that address both ongoing and changing needs. Rather than feeling overwhelmed with all the details involved in caring for someone living with dementia, these caregivers and families can rely on a source of advice, support, planning, and resources through Contessa’s Palliative Care at Home program.  

Hardly anyone enjoys medical care in a hospital or skilled nursing facility, even less so when you’re unclear about where you are, who you’re with or why you’re there. For people living with dementia, anticipating an extended stay in a healthcare setting can be confusing and scary. Their home, a place of comfort and familiarity, is a simple solution to a complex issue in healthcare.