NYU Meyers launches Aliviado, a resource for teams caring for people with dementia

Up to one-third of patients receiving home health care have dementia, and 16 percent of hospice patients have dementia as their primary diagnosis—but many clinicians working in home health and hospice have little training on how to manage the challenging symptoms of this complex set of diseases.
The Hartford Institute for Geriatric Nursing at NYU Rory Meyers College of Nursing is working to change this through a new initiative called Aliviado Health.

Aliviado—which means “relief” in Portuguese—aims to provide relief to people living with dementia and their caregivers through helping home health and hospice agencies provide high-quality, compassionate care.

Developed by Ab Brody, PhD, RN, FAAN, FPCN, and based on his research on community-based dementia care, Aliviado offers training, education, mentoring, and resources to home health and hospice teams to give them advanced expertise in the complexities of care for older adults.

“Aliviado was built around the idea that people with dementia, caregivers, and clinicians all need relief from the symptoms that occur from this set of diseases. We’re currently failing people with dementia by not providing effective care, but there is a significant body of research on how to care for someone with dementia; Aliviado is working to bring these best practices to front-line clinicians,” said Brody, associate director of the Hartford Institute for Geriatric Nursing and associate professor at NYU Meyers.

The Need for Evidence-Based Dementia Care

Patients with dementia experience challenging symptoms and high rates of healthcare utilization. Early in his career as a nurse practitioner, Brody was caring for people with dementia and observed a lack of understanding of and resources for how to support this population at home and in hospice.

For the past decade, Brody has been studying symptom assessment and management of dementia in home health and hospice settings and developed a program for training clinicians in caring for people with dementia and their caregivers, which has been shown to be effective in improving clinicians’ knowledge and confidence. It also aims to decrease hospital readmissions, healthcare utilization, and overmedication, which can lower costs for patients and the healthcare system, as well as increase referrals to home health and hospice agencies.

Aliviado translates Brody’s research into a comprehensive program for home health and hospice agencies. He is continuing to evaluate the model in a National Institutes of Heath-funded study in three home health agencies around the country.

Caregivers

More than 16 million Americans—spouses, children, friends, or neighbors—act as caregivers for people with dementia. Caregivers play a vital role in daily activities such as bathing and feeding, but are also at risk for stress and burnout.

Because front-line clinicians may only spend a few hours a week with a patient, while caregivers are often there around the clock, Brody designed Aliviado with an explicit focus on supporting caregivers via clinicians. Clinicians are given the tools to educate caregivers about symptom management and caring for their loved ones.

The Components of Aliviado

Aliviado works with agencies to support patients and caregivers through several components:

• Dementia-specific training occurs with all front-line skilled clinicians, including nurses, physical therapists, occupational therapists, social workers, chaplains, and hospice medical directors. Clinicians learn to assess and manage pain and behavioral and psychological disturbances such as depression, agitation, aggression, and psychosis.
• Aliviado provides clinicians with caregiver education training and materials. These materials help caregivers to understand important topics in dementia like agitation and hallucinations, and reinforce what the clinicians and caregivers discuss together.
• Interdisciplinary care plans and treatment algorithms help clinicians assess patients, make evidence-based decisions, and provide effective interventions.
• Mentoring for leaders of home health and hospice agencies provide agencies with both advanced skills in dementia care as well as developing or enhancing an organization’s quality assurance performance improvement (QAPI) infrastructure, a requirement of the Centers for Medicare and Medicaid Services to ensure patients receive high-quality care.

“Nationwide, there is recognition that we need better care for people with dementia. The National Plan to Address Alzheimer’s Disease calls for expanded support for people with dementia and their families, optimized care quality and efficiency, and effective treatments. Aliviado is designed to be scalable and implemented across the country, fundamentally changing how we care for people with dementia,” said Tara Cortes, PhD, RN, FAAN, executive director of the Hartford Institute for Geriatric Nursing and professor at NYU Rory Meyers.

In the future, Aliviado’s resources will be expanded to also support home health aides, as well as patients with other serious illnesses such as heart failure and cancer.