An innovative model of dementia care
June 11, 2019
Dagmarsminde Care Home in Denmark
May Bjerre Eiby is working at the forefront of dementia care in Denmark. Her care home, Dagmarsminde, which opened three and a half years ago is home for 10 residents with severe dementia. May is an RN with a Masters degree and a keen interest in the humanistic model of care. She bases her care on 18th century principles – use hands, skills, nature and the environment, rather than relying on medication. Staff ratios are 1:4 and are all RN’s or EN’s, and they do everything with residents including therapy, cooking, personal care and activities. The only other staff are cleaners who do all the facility’s cleaning.
The facility, which is in a country area, has been designed and furnished to look like a home. It has no institutional furniture. The animals which include dogs, cats, chickens and goats are looked after by the residents with the help of the RNs and ENs. The residents have their own ensuite bedrooms which are only used for sleeping at night. They spend all day in the common area, which has extra beds for afternoon naps. This gives the signal that day time is not time for a big sleep, but just a rest. During nap time the staff have their meetings, or wander around, bake bread or cakes etc so that residents are still aware of activity around them. Family and friends are welcome to visit at any time.
The same program is followed every day. Residents rise between 6am and 9am and everyone has breakfast together (including staff) at beautifully set tables, with fresh baked bread, fresh juices, with music playing. Afterwards, someone reads the newspaper out loud to keep people in contact with society and what’s going on in the world, and those who can will discuss the news together with nurses just like a normal family.
While the routine appears to convene principles of consumer directed care, it has successfully restored normal circadian rhythm for all residents, ensuring a good night’s sleep (no sleeping pills are ever administered) and completely eliminating both sun-downing and wandering during the night.
There are activities every day, some even led by residents, and everyone must go outside for at least an hour every afternoon for fresh air and to maintain good health. The residents are free to move around the home and large gardens at all times as the grounds are fenced and the security gate is coded. A staff member is present at all times.
There is an ongoing focus on learning and on restoring abilities such as walking. Through therapy, including daily sessions in the indoor therapy pool, almost all residents are able to walk without mobility aids. Staff continually comment how well the residents are able to learn and improve through the many activities, both mental and physical.
Technology use is limited in favour of more stimulating activity, and the TV is never turned on until the 7pm news, which may then be followed by a movie. Evenings are more relaxed with signals for winding down to rest such as reading books, singing and massage. Lighting is subdued to indicate time for rest.
The facility has a medication room and a small laboratory to test urine etc, which has been proven to reduce the need to go to hospital. Hospitalisation rate is 0% over the three and a half years the facility has been opened (compared to 42% p.a. in residential care).
The same GP visits all residents once per month and there is a strong focus on reducing or removing medications. The medication rate is 1.4 pills per person day, compared to 10-12 for most people in Denmark with advanced dementia. Most significantly, anti-psychotics, anti-depressants and sleeping tablets are never used.
The main medications used are antibiotics, pain medication or anti-seizure drugs. This reduction in medications has been demonstrated to reduce the risk of falls. Residents may also go off heart medications with the aim of focusing on improved quality of life rather than quantity. Ethics comes into this, including the age of the resident, and it is all discussed with residents and their families. A dentist and podiatrist visit monthly, and other allied health services and social workers are also brought in when needed.
Medications are used at the palliative care stage, generally the last three days of life or when residents can no longer swallow. During this time they are sedated and an RN is with the resident at all times (their office is moved into the room). When a resident passes away the closed coffin is taken into the common room where everyone sings hymns and says their goodbyes.
The model of care is proving effective not only for the residents. Staff turnover is minimal, limited only to when they are leaving the area to relocate. Sick leave is less than 1%, compared to an average 7%.
Another site has now been opened in Copenhagen which is not government funded. As this is in the city it operates slightly differently. It is called a ‘sanatorium’ for treating dementia, and operates as a day program with just a couple of bedrooms which are available for short respite stays.
This is such a beautiful and respectful model for caring for people with dementia.