DIMENSIONS Winter 2000


by Julie Cleveland

When people with Alzheimer's disease reach the later stages, they may need to be placed in a long term care (LTC) facility such as an adult family home, assisted living center, or nursing home. The University of Washington Academic Medical Center (UWAMC) provides a service which can help patients and their families with this transition. The UWAMC Long Term Care Service's (LTCS) purpose is to maintain clinical care continuity for patients who have been cared for by UWAMC and require rehabilitative, end-of-life, or long term nursing home care. UWAMC-related facilities include Fred Hutchinson Cancer Research Center, Children's Hospital, Department of Veterans Affairs, Harborview, and University of Washington Medical Centers.

The Long Term Care Service team consists of medical doctors, nurses, social workers and discharge planners who fill out the appropriate paperwork and facilitate patients' moves to long term care facilities. They also visit patients at the hospital and after they move to a facility. "This helps the patients enter the facility smoothly," states Dr. Wayne McCormick, section chief of LTCS. "More importantly, they will see a familiar face when they get there. This move can be a pretty disheartening experience for patients, so if we can provide a way for them to see somebody from the academic medical centers when they get there, we're hoping that helps at least a little."

Many different groups of people use the LTCS program, including persons undergoing medical rehabilitation and those who have a chronic illness such as AIDS, cancer, or dementia. Approximately half of the LTCS patients are in for rehabilitation, and about one-third are in for end-of-life care. Although the average person using the LTCS is younger than 60 years old, approximately one-third of patients have some sort of dementia.

One important issue in long term care has to do with meeting the unique needs of residents who come from different cultural and religious backgrounds. There are LTC facilities that focus on ethnic groups such as Asian-American, Jewish, or Scandinavian. However, it is important to note that although a nursing home may have a particular cultural focus, by law they cannot refuse admission to anyone based on race, creed, color, sex, or sexual orientation.

Two ways that LTC facilities serve the unique needs of diverse individuals are by accommodating language preferences and by creating culturally relevant environments in the home. If the staff speak the same language as the patient, the patient can better make his or her needs known. The patient can converse and socialize with other residents, which is very important to making that person feel comfortable at the facility. A cultural atmosphere or general ambiance is achieved with the use of specialized architecture, interior decoration or art, and food. If the atmosphere is congruent with the patients' cultures, it will seem more familiar to them, thus helping them feel more at home. Often the patient prefers the food and other elements of their own culture, such as unique seasonal celebrations and daily routines or rituals. They may also have special end-of-life preferences that include decisions about cardiac resuscitation or feeding tubes to prolong life, and the acceptability of autopsies, as well as various funeral and burial practices.

When caregivers are choosing a facility for long term care, McCormick strongly suggests that they "shop around." He states: "We ask them to physically go the facility and get a tour; to stay for a while and see what the care is like." Although this understandably may be difficult under the circumstances, it is the only way to find out if the facility will be a good fit or not. It is also helpful to talk to family and friends to see if they know of any good LTC facilities. In addition, McCormick suggests using social workers and state agencies such as the Department of Social and Health Services (DSHS) to learn more about the type and quality of care available in the facility. Finally, McCormick stresses that when a loved one enters a LTC facility, it is important for families to continue their relationships with the patient's primary care provider and organizations such as the Alzheimer's Association. LTCS works with the patient's family to encourage the continuance of these relationships, as well as the quality of care the patients receive.

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