Rebecca Mead’s New Yorker feature The Sense of an Ending describes some really dramatic (and successful) reframes in care for dementia patients. There’s a number of profound shifts in how the caregivers describe their role and in the kind of experience they seek to deliver for the patient (and their family). The whole article (linked above, but subscribers only) describes those shifts and the cultural and organizational efforts to get there. I’ve included just a portion here
One of the first things Alonzo did, in 1998, was to ask an aide who was born in Vietnam to talk to staff members in her native tongue. “It was the only language I could find that nobody else could speak,” Alonzo recalled. “So we had her tell us very sweetly, in Vietnamese, what she wanted us to do, and we couldn’t understand her.” The staff had to become attuned to the woman’s nonverbal cues.
On another occasion, Alzono underwent a public bed bath, in front of the entire staff, of twenty-seven. She didn’t allow herself to move her limbs, and behaved as if confused. Afterward, she was able to describe the nature of her discomfort, and staff members analyzed their own activity in light of it. “Let me tell you, it sucked – it was incredibly uncomfortable,” she told me. Staff members then spooned food into one another’s mouths and brushed one another’s teeth, in order to be on the receiving end of activities that they performed for their charges every day. “You can find how threatening it is to have something touch your mouth when you have not brought it to your own lips,” she said.
In the most radical experiment, the staff wore adult diapers. “That was kind of life-changing for everybody involved,” Alonzo told me. “We all recognized just how uncomfortable it was to sit in a wet brief. Some of our front-line staff, who really wanted to know how bad that felt, did not change them for a couple of hours.” Previous may residents had been dressed in diapers, as they tend to be in a majority of nursing homes. Not long afterward, aides decided to stop the practice with most residents, instead taking them to the bathroom fifteen or twenty minutes after mealtimes. This made residents happier while making the staff’s jobs easier, because they no longer had to change people who were agitated.
There’s a rich tradition of participating in the experience our customers are having (see this great war story about an adventure in an “old age simulation suit”) and what feels like an increasing mention of empathy. I really like how this story highlights not so much the ergonomic or functional task aspects that are revealed but how this drives to revisiting the fundamental ideas of how the institution conceives of the patient experience it provides. I also like the full-on simplicity of the approach, the people who do this stuff to others now try it themselves and talk about it.
See also Richard Anderson’s blog post from this week about reframes in general and in healthcare specifically.