Alzheimer's and Dementia Care in NC

How Hospitals and Businesses are Improving Care

The number of people with Alzheimer’s disease and other forms of dementia is rapidly growing. This alarming trend has brought about creative solutions across North Carolina to improve care for those with dementia and enhance support for their caregivers.?

Alzheimer’s disease is a brain disorder that slowly destroys memory and thinking skills. The most common cause of dementia, it eventually impacts a person’s ability to carry out the simplest tasks. In North Carolina, 180,000 people 65 years and older are living with Alzheimer’s. That number is expected to rise to more than 210,000 by 2025.

Living with Early-Onset Alzheimer’s Disease?

Jay Reinstein lives with the disease in its early stages. The Raleigh resident has worked in city government for nearly 30 years, and he still remembers the day when he couldn’t answer a citizen’s question nor recall what departments he managed.?

“I went into my office, and I would say I had a little bit of a breakdown,” said Reinstein. “I was afraid because I thought, first of all, I’m not going to be able to do my job anymore.”?

Reinstein talked to his wife and got in touch with a neurologist at Duke. There he received the diagnosis no one wants: early-stage Alzheimer’s disease.?

“It hit me hard, probably later that evening,” said Reinstein. “I thought, ‘Oh my god.’ What really made me think is what’s going to happen in my life. What about my daughters, my grandkids, my job, financial bills? I mean, how am I going to support my family?”?

Reinstein retired in 2018, and his daughter Elizabeth has taken on a supporting role at home when his wife is at work. She joined him on trips while he was on the Alzheimer’s Association’s National Board of Directors, helping him navigate the frustrations of travel.?

“I just try to be as positive as I can,” said Elizabeth Reinstein. “I always spent a lot of time with my dad before, but now I try and spend as much time as I can with him. We’ve been going on trips. I try to take as many pictures and videos as I can just for good memories. I just try to look at the silver lining of it all.”?

Jay’s daughter and wife help him look after his medication. He prefers short articles over books and says he needs to binge-watch a series so he can remember.?

“I think the thing that worries me the most is I don’t want to be a burden,” said Reinstein. “And I know that day will come.”?

He says until then, he will continue to contribute his time to the Alzheimer’s Association and fight against the stigma, while not letting the disease become who he is.?

“I’m not going to be that guy when I’m hanging out with friends, always talking about my disease,” said Jay Reinstein. “I want to talk about the Washington Commanders, which there’s nothing good to talk about there. I want to talk about politics. I want to talk about other stuff other than Alzheimer’s.”?

Creating a Dementia-Friendly Hospital System?

It’s estimated that one in four hospital beds are occupied by a person living with dementia. The Dementia Friendly Hospital Initiative is aimed at reducing hospital stays and improving outcomes for patients with dementia. While the program is relatively new, healthcare workers tell us they are already seeing positive results.?

UNC’s Dementia Friendly Hospital Initiative is underway at five different hospitals: UNC Hospitals Hillsborough Campus, NC Memorial Hospital in Chapel Hill, Pardee UNC Health Care in Hendersonville, Wayne UNC Health Care in Goldsboro and Chatham Hospital UNC Health Care in Siler City.?

“We really didn’t have a true approach in the past,” said Jenny Parnell, Administrative Director Medical/Surgical Nursing at UNC Wayne Health. “We took care of patients. If they seemed confused, we tried to determine how safe they were. We didn’t have the knowledge or education of how to approach them.”?

This UNC pilot program trains health care workers how to approach a patient with dementia and, more importantly, to meet patients “where they’re at” through role-playing exercises.?

Anyone who comes into contact with patients—from housekeeping to security—receives the training.?

“I might approach someone who thinks we’re at their house. And I might say, ‘Well, you have a beautiful home,’” said Kim Guillemette, Clinical Educator and Supervisor at UNC Wayne Health. “It’s just important to be agreeable and accept them wherever they are.”?

For every 1,000 people in North Carolina with dementia, there are an estimated 1,600 emergency room visits. Experts say patients with dementia are admitted more often and end up in the hospital longer.?

“It’s costly for the patient’s family, for the healthcare system and for the patient themself,” said Dr. Adil Ahmed, Geriatric Medicine Specialist at UNC Wayne Health. “So we look at the reward of people who stay less in the hospital, less complications, less cost and less life lost. That’s our reward for taking the time and having enough staff to do this job.”?

The hospital also installed purple lights to signify a patient with dementia. And the hospital has created dementia “busy boxes” to help preoccupy patients as they receive care.?

The Dementia Friendly Hospital Initiative requires extra time in an already stretched hospital system, but the health care workers at UNC Wayne Heath say it’s been worth it.?

“We’re starting to hear people come forward with stories about how this is working,” said Guillemette.??

Meeting Those with Dementia “Where They’re At”?

Hospitals aren’t the only organizations working to better serve the dementia population. Orange County’s Dementia Friendly program is creating a network of businesses and organizations that understand how to best communicate with individuals who have dementia.?

One of the businesses involved is The Downsizers, a Chapel Hill–based move management company.?

Elizabeth Hirsh, owner and downsizing manager of The Downsizers, says downsizing can be especially helpful for those with dementia. She and her team have certain policies when they help move individuals with dementia. A lot of what they’ve implemented is thanks to the Dementia Friendly program.?

“It allowed us to really think about how we want to specialize in it, and that’s actually enabled us to build an entire internal training program and protocol,” said Hirsh. “If we are replicating [their new space] as much as possible, their comfort levels are higher, their stress level is way lower and they are feeling more confident in their new space.”?

The Dementia Friendly program, run by the Orange County Department on Aging, provides training to local businesses and organizations on how to best communicate and interact with people who have dementia.?

“We think it’s played a vital role with folks who have cognitive issues,” said Janice Tyler, Director of the Orange County Department on Aging. “And it just makes them feel more at ease when they go to a restaurant or they go to their bank, go to their fitness studio.”?

More than 100 Orange County businesses and organizations have received this training since the program launched in 2015.?

“Just making sure that businesses know that there are a lot of folks in this community that are working on this too,” said Marie Dagger, an Aging Transitions Occupational Therapist at the Orange County Department on Aging, “We’re trying to bring our community forward and become a little bit more dementia-capable together.”?

Meals on Wheels Orange County is another organization that’s been through the training. It’s helped their volunteers not only interact with individuals who have dementia, but also teaches them how to recognize early signs.?

“I think people volunteer because they want to help their community. They get engaged with us, they pick around and they get to know the people on their route,” said Rachel Bearman, Executive Director of Meals on Wheels Orange County. “Then they see the other issues that are affecting older adults, and they want to be able to do something to help beyond just the delivery of the meal.

#Alzheimers #Dementia #Cognition #CaregiverSupport #Hospitals

David Hurst is a producer and reporter for ncIMPACT , a multiplatform series produced by PBS North Carolina in association with the UNC School of Government .

Hosted by UNC Professor Anita Brown-Graham, season five of ncIMPACT visits communities, organizations and businesses across North Carolina that are developing creative solutions to critical issues like health care, education, employment, the economy and the environment. Watch Fridays at 7:30 on PBS NC and stream anytime with the PBS App.?

PBS North Carolina provides quality content and services to engage communities, enhance education, enrich lives and tell the stories of North Carolinians.?