Public Reports and Testimonies

THE NEW YORK CITY COUNCIL COMMITTEES ON AGING AND HEALTH
OVERSIGHT HEARING: ALZHEIMER’S DISEASE IN NEW YORK CITY

Good morning, my name is LaRay Brown and I am the Senior Vice President for Corporate Planning, Community Health and Intergovernmental Relations at the New York City Health and Hospitals Corporation (HHC). I am pleased to be here today with my colleagues from the Department for the Aging, Deputy Commissioner Caryn Resnick and Dr. Robin Fenley. As Deputy Commissioner Resnick mentioned, HHC enjoys a productive relationship with the Department for the Aging on behalf of our mutual consumers. I will provide testimony about HHC’s services directed to individuals with Alzheimer’s disease and their families.

As the Deputy Commissioner has noted, people with Alzheimer’s disease, which is a form of dementia, gradually lose their ability to perform many activities of daily life such as eating, walking and speaking. It can also lead to significant changes in personality and behavior. Our hospitals, long-term care facilities and outpatient clinics provide diagnosis, care and treatment of patients with Alzheimer’s disease and dementia. While there is no cure for the disease, the care our facilities provide can help to improve the lives of patients who have the disease and that of the families who are caring for them.

In Fiscal Year 2011, HHC facilities served 3,428 patients with Alzheimer’s disease. A small number of these patients were treated in our Emergency Departments. Most were provided care in an HHC hospital inpatient unit or in our nursing homes.

I want to highlight some of the geriatric programs operated by HHC facilities to give you a sense of some of the services that are offered to seniors in general and to those with Alzheimer’s in particular.

• Elmhurst Hospital Center operates a Senior Care Clinic which specializes in geriatric primary care and provides a wide range of services including health education, nutrition counseling, social work services and referrals to specialty services and diagnostic testing. All patients are screened for depression; and patients with mild to moderate depression are managed in the Clinic. Patients with Alzheimer’s disease and/or dementia are also referred for specialized community-based services.
• Lincoln Medical and Mental Health Center’s Geriatric Wellness Center provides both routine and specialty medical care, physical and occupational therapy, nutritional assessment and depression screening. The availability of this array of services at one central location, eliminates the need for visits to multiple clinics. A strong social work component provides patients and their families with assistance with referrals to home care, Adult Day services, nursing homes or assisted living facilities and other support services. I would like to thank Council Member Arroyo for her generous support to the Center.
• Woodhull Medical and Mental Health Center operates a Geriatric Wellness Center that provides comprehensive health services to patients 65 years and older. The Center is staffed by gerontologists, nurses, professional and support staff who have received specialized training in working with seniors including patients with Alzheimer’s and other forms of dementia. Woodhull provides primary and preventive care, social services evaluation and counseling, psychiatric consultations and transportation assistance for eligible patients.
• Woodhull’s Geriatric Mobile Crisis Team provides urgent mental health care and crisis management to seniors in the community. They visit seniors in their homes when they are having a mental health crisis and provide therapy to cope with challenging life situations. Referrals and linkages are also made to appropriate resources in the community.
• Woodhull also has a Geriatric Outreach Program. They work with local senior centers and senior housing developments to conduct outreach to seniors. Their services include:
  • Presentations on health promotion and disease prevention information.
  • Screening for health conditions including: high blood pressure, blood sugar, total cholesterol, hearing impairment, dental/oral health, colorectal cancer, depression, and tobacco cessation.
  • Group discussions on behavioral health issues.
  • Post-discharge home visits for seniors who have been inpatients at Woodhull Hospital, as needed. They assess patients’ overall medical and social well-being, the safety of their homes and their ability to take their medications.
• Metropolitan Hospital operates an Outpatient Center for Geriatric Care which specializes in the complex medical needs of adults who are at least 65 years old and experiencing dementia, delirium, falls, dizziness, polypharmacy, or frailty. The primary focus of Metropolitan’s Center for Geriatric Care is to help its patients remain active and healthy by providing information on disease prevention, as well as providing treatment for acute and chronic illnesses. Metropolitan’s health care team has expertise in Alzheimer’s diagnosis and care, cardiology, neurology, rehabilitative medicine and behavioral health.
• This summer, Harlem Hospital Center will open a new unit dedicated to providing holistic coordinated care to its elderly patients. This state-of the art, Acute Care for the Elderly (ACE), unit will be designed to accommodate the special needs of older patients. The ACE Unit will be fitted for patient safety, and will initially include four newly renovated two-bedded rooms, a community/day room, a satellite rehabilitation center and railed and color-signed hallways to facilitate ambulation and way-finding. Patient rooms will be designed to accommodate the special needs of elderly patients especially those with Alzheimer’s. For example,
  • Special lighting to reduce glare;
  • Beds with low-level settings to reduce fall injuries; and
  • Bed alarms that alert the nursing staff if a patient attempts to get out of bed without assistance.
• In recognition of the need to support caregivers, Harlem Hospital runs a support group for caregivers. The support group offers a welcoming and confidential environment which allows participants to express their care giving experiences, learn more about Alzheimer’s disease and find out about resources in the community.

HHC’s long-term care facilities provide specialized care for patients with Alzheimer’s. This includes skilled nursing and rehabilitation services, Adult Day Services and behavioral health services. I’d like to highlight some of the evidence-based programming that has been implemented at some of HHC’s long-term care facilities:

HHC’s largest long-term care facility, Coler-Goldwater, has an 85 bed Dementia Unit. Coler-Goldwater offers individualized care, sensitive to each person’s medical needs. They work with the client and family to develop a treatment plan that focuses on achieving maximum functioning and independence in a safe, culturally sensitive environment. Residents diagnosed with Alzheimer’s or dementia are treated in a nurturing, supportive and stimulating environment to ensure dignity and comfort. The interdisciplinary care team addresses many conditions including pain management, depression, bladder and bowel functioning, falls, pressure ulcers, and ongoing medical care to improve quality of life. Coler-Goldwater provides onsite dental care, complex wound care and physical rehabilitation.

Coler-Goldwater provides formalized restorative nursing programs such as range of motion programs, strength and endurance programs, toileting schedule programs, and unit ambulation programs geared toward residents with Alzheimer's and dementia. These programs promote the resident’s ability to adapt and adjust to living as independently and safely as possible. This concept actively focuses on achieving and maintaining optimal physical, mental, and psychosocial functioning. Nursing Assistants and Aides who are trained and deemed competent in these techniques provide the activity at least 6 days a week. The restorative nursing programs are planned, monitored, evaluated and coordinated by a Registered Nurse.

In addition to their medical and rehabilitation services, Coler-Goldwater offers recreational activities, spiritual care services and other amenities for seniors and persons with Alzheimer’s or dementia. Activity Therapists provide structured morning, afternoon and evening recreational programming according to the individual abilities of each resident. Programs include art, music, dance therapy, sensory, movement and relaxation, yoga and meditation, choral group, drama, photography, pet therapy and gardening in their greenhouse and in open areas. The Chaplaincy and Spiritual Care Services are available to meet the needs of a diverse resident population and their families. The Resident Library offers large print books and books on tape and there is computer availability with devices to assist physically impaired residents. Licensed hair dressers and manicurists are available onsite. The facility also offers a sports gym with assistive devices for strength training and maintenance.

The Therapeutic Recreation staff at Coler Goldwater employ Dementia Practice Guidelines on the Dementia Units. The guidelines were implemented after a 3-year study that was grant funded by the New York State Department of Health. The program’s outcomes include a higher staff skill set in working with residents with Alzheimer’s disease, an environment sensitive to their needs, individualized care and interventions to help reduce or eliminate inappropriate behaviors and a reduction or elimination of pharmaceutical interventions for some residents.

An iPod Music Memory Program is offered to residents with Alzheimer’s disease and dementia. Music, both current and that which is familiar to a resident, is downloaded to an iPod for the resident. Outcomes have included: increased engagement, attention and cooperation; reduced wandering and the associated risks to health and safety; a reduction in pharmaceutical interventions for inappropriate behaviors; minimized agitation and improved sleep and restfulness. All of these leading to improved quality of life for participants and staff.

The Nursing staff who work on the Dementia Units employ principles and techniques that are part of a Bathing without a Battle Program. The program provides the staff with the tools and skills for improved communication and interaction with cognitively impaired residents as they perform alternative methods of bathing. Outcomes include a reduction in the prevalence of residents’ verbal and physical aggression, a reduction in the use of psychotropic medications, increase in overall staff job satisfaction, increase in staff’s awareness regarding residents’ preferred method of bathing and enhanced staff-resident interaction resulting in a pleasant bathing experience.

At Sea View Hospital Rehabilitation Center and Home on Staten Island, they operate three units dedicated to the care and treatment of patients with primary diagnoses of Alzheimer’s or dementia. Sea View operates a medical model Adult Day Health Program serving 64 patients. Clinicians monitor the total health of an individual and the program’s services include physical and nursing rehabilitation, sensory stimulation activities, medication monitoring, provision of meals, day trips and special events. Transportation to and from the program is provided as well.

In Central Brooklyn, the Dr. Susan Smith McKinney Nursing and Rehabilitation Center (DSSM) has two 40-bed Dementia Units on a designated floor. DSSM operates a unique program known as the P.A.C.S. program for the residents in these units. P.A.C.S. stands for Purposeful Activity, Consistency and Structure. P.A.C.S. is comprised of three primary elements that enhance cognitive functioning, reduce untoward behaviors, and improves the resident’s quality of life.

• Purposeful Activities are those at which a mentally impaired resident can be successful and which they enjoy. These include touch therapy, sensory stimulation, exercise, music, art, reminiscence and socialization. All activities have been designed to be performed successfully depending on the residents’ functional level.
• Consistency relates to doing the same basic activities in the same order each day which gives residents with limited learning capacity the ability to know, at some level, what to expect from their days. This provides a sense of security for mentally impaired residents. Similarly, all staff respond in the same consistent manner to untoward behaviors with planned behavioral interventions. This, again, helps impaired residents to know what is expected of them.
• Structure relates to providing enough of the other two elements throughout the day and throughout the week to have a lasting impact on the resident’s overall behavior.

DSSM also operates Adult Day Health Care programs in Brooklyn and Queens with a capacity to serve 40 residents from Brooklyn and 50 residents from Queens. These programs are medical model Adult Day Services programs, similar to the program operated by Sea View.

Before I conclude, I want to also mention HHC’s Palliative Care Programs. Palliative Care is the medical specialty focused on relief of the pain and other symptoms of serious and chronic illnesses. The goal is to prevent and ease suffering and also to offer patients and their families the best possible quality of life. It is provided simultaneously with appropriate medical treatments. As part of the Administration and Council’s Age Friendly NYC Initiative, HHC expanded palliative care programs to all of our acute care hospitals in order to make this service available to more New Yorkers. Our palliative care teams consist of physicians with various specialties such as geriatrics, neurology, psychiatry, as well as nurses, psychologists, social workers and chaplains. The program serves end of life patients as well as individuals suffering from chronic pain and stress of a serious illness, including cancer, sickle cell anemia, multiple sclerosis, AIDS, congestive heart failure and advanced dementia.

Thank you for your focus on this important topic and the opportunity to provide information about HHC’s services for individuals with Alzheimer’s and their families.