It’s rare to meet a home care provider that’s dedicated to dementia care who hasn’t name-dropped Teepa Snow.
Snow — a thought leader and innovator in the dementia care space — is the founder of Positive Approach to Care, a renowned dementia care training program. Home care companies such as FirstLight Home Care, Senior Helpers and Tender Rose have all adopted Snow’s teachings and incorporated them into their care delivery.
In addition to Positive Approach to Care, Snow has served in a number of leadership and advisory positions in professional organizations, including the Alzheimer’s Association, Alzheimer’s Foundation of America, American Occupational Therapy Association and National Board for Certification in Occupational Therapy.
Home Health Care News recently caught up with Snow to learn more about how home-based care providers can improve their dementia care services, the common mistakes providers make and the role telehealth can play in care delivery.
The below is edited for length and clarity.
HHCN: For readers who aren’t familiar with Positive Approach to Care, can you give an overview?
We’re a virtual company that also does in-person training. We also offer a lot of support. We offer products, services and consults to agencies, organizations and individuals.
We’re a resource for professionals, for families and for organizations when it comes to someone in the mix showing signs of dementia or brain changes that are impacting their ability to live independently, alone and how they’ve always lived.
Over the years, we have seen a number of home care organizations become Positive Approach to Care designated organizations. For these organizations, what’s the value-add of adopting these philosophies and techniques for dementia care?
My background is as an occupational therapist (OT). OTs are well-known for activities of daily living or function.
Most home care and home health agencies are trying to help a person continue to live where they prefer to live while having support in place that makes sense for them. When somebody is starting to have some changes in their brain – which can increase risks, or cause stressors, or actually make living totally on your own not possible – having an organization that really is tuned in and tuned up for having carers and leaders who are familiar with the idea of dementia prepares them to better serve families and individuals. It allows them to serve in situations that otherwise they may be overwhelmed with.
Dementia is more than just memory problems, and it’s more than just Alzheimer’s. It’s actually a fairly complicated phenomena.
Can you talk to me about the overall demand for specialized dementia care?
With about 70% of everyone who’s receiving, or has requested in-home service, there’s significant changes in cognitive abilities.
Now, many of those individuals are not yet diagnosed as having dementia. They may have mild cognitive impairment, they may be identified as having depression, they may be identified as having anxiety issues. Maybe they’ve had just the death of a spouse and they’ve lost their support system.
But it turns out that for a vast majority of individuals being served, there’s actually some cognitive changing that’s going on, which is really important for us to notice, because even if it’s fairly early in their dementia, it can really impact how agencies are going to be able to stay involved, get involved, and actually make their carers safe and comfortable, and their clients safe and comfortable. It could be that you’re seeing them for a hip fracture, but the reason they fractured their hip is because they have cognitive impairment. Understanding all that really does make a huge difference in the care plan and then the delivery of care services.
What are some actions home care providers can take today to become better at serving dementia patients?
A big piece of it is to recognize that family members may have a different take on what the person needs than the person who [providers] are trying to serve. Therefore, we already have a conflict. The conflict is between what the person who we’re serving wants, or is comfortable with, and what the people who are funding, or want us to be involved, are comfortable with and seeking.
Very frequently, agencies will get asked to come in and do care for someone, and it turns out that individual is No. 1, not interested in having the care done. And No. 2, not even interested in having somebody come into their home. It’s sort of this really uncomfortable phenomena. It’s important to have some staff who are skillful at engaging and interacting with a person living with brain changes so that it occurs without there being conflict.
Reporter’s note: During the conversation Snow and I replayed a scenario where a senior did not want caregiver services. In this hypothetical scenario, the caregiver had been hired by the seniors’ adult children. Snow demonstrated how to resolve the conflict and ensure that the senior became accepting of these services.
This was skill on my part, as the person who’s standing there when the individual said, “Get out, leave me alone.” If we don’t have a few of those people on our team, as a home care or home health agency, what we end up doing is having a person who doesn’t want us around. It’s exhausting, or non-productive, to try and figure out how to be with someone when they don’t want you there. Building a team so that you have people who know what to do in those situations is important. I tell people it’s not rocket science, but there is an art and a science to this. Understanding brains is really important in these situations.
What are some of the common – and in your view, avoidable – mistakes that you see home care providers make?
Agreeing that you will help somebody take a shower — that is one of the biggest. Quite honestly, showers are monsters in the closet, because by the time most people are asking someone to assist someone with a shower, there’s a lot of negative history around it. There’s a lot of emotion around it. There’s a lot of blame and frustration around it. We want to help people get clean, but we’ve got to be really cautious about signing up to say “Yes, I will help your mom get a shower” without really thinking it through and finding out the history.
The other one is framing things as, “I’m going to come in to take care of you.” It is one of the biggest mistakes people can make. [Instead frame it as], “I’m here, I would love for us to get familiar with each other and see how things are going for you, what you’re doing well, and where there are places I could be helpful or maybe not.” This is going to be a developing relationship. If I walked up to somebody in the grocery store and said, “I’m going to help you get your clothes off and take a shower,” most of us would be like, “I don’t think so.” To have someone come into your home, and without thinking, put their stuff down and say, “I’ll be here for eight hours” to someone who’s having some brain changes is a no no.
The third piece is when someone is indicating that you don’t belong there, and that they don’t know who you are. They’re experiencing fairly sudden, or fairly rhythmic patterns of disorientation to place time or situation. We need a game plan much sooner than we typically develop. If there’s dementia involved, realize that afternoon to evening change in ability is real.
Recently you partnered with Sensi.AI, an in-home virtual care agent. Can you talk about the nature of the partnership and what you’re both hoping to accomplish?
We’re very excited because the Sensi is this audio sort of awareness system. It has that level of awareness — what’s happening in that environment 24/7. It’s not really recording every second, it’s just noticing things.
When it picks up on something that’s care related, or distress related or good care related, or an anomaly, then it records about 10 seconds of an interaction right around that. Then it creates a signal to the dashboard that says this has happened, and it could be an indication that something good or not good is going on here. What we love about this is it is present 24/7, so it helps us really identify where there are gaps in the person’s ability to do something, or interest in doing something, or distress about doing something.
More broadly, can telehealth or virtual care play a role in improving dementia care for home care providers?
I think it’s going to be a central part of home care because trying to help people get places for care can be a huge challenge. It already has. Certainly, we’ve seen that over the course of time.
I think it empowers home options in a way that nothing else had. I think until the pandemic, we thought, “Man that won’t work.” And you know what, it actually sort of does.
I work with PACE programs, and what we’re finding out is we could do more exercise programs, we could do a lot more than we ever thought we could with the right support in place. Doing things virtually has really freed up resources in a way we would never have thought possible before. Creative and innovative companies that are willing to put puzzles together and figure it out can do this, and can do it well.
What kind of partnerships should home care providers be going after that will help them improve dementia care?
If you are not familiar with some of the adult day health or adult senior programs in the area, if you’re not aware of the geriatricians and not aware of all the resources in the area, I think you’ve disserved yourselves, as well as the people who you are working with.
Exercise programs as well. We know that there are now some virtual programs out there that are really helpful to people living with dementia and their family members, or potentially some of our employees, so that the care provider themselves in the house doesn’t have to be the only resource.
We’re starting to look beyond the obvious. Looking at animal therapy and pet therapy, for example, those are all possibilities. Maybe not bringing them in the house, but looking at what’s out in the community that we could plug into. Support groups for people living with dementia and for family members that could make a big difference. I think partnering with a variety of service providers in the area is really essential for not only survival, but thriving in the home care industry when people are living with dementia.