35318968_thmI recently learned of a wonderful program that was developed by Dr. Sharon K. Inouye and her colleagues at the Yale University School of Medicine to be used in hospitals worldwide.

The Hospital Elder Life Program (HELP) is “a program for hospitals, designed to prevent delirium by keeping hospitalized older people oriented to their surroundings, meeting their needs for nutrition, fluids and sleep and keeping them mobile within the limitations of their physical condition.”  And they are doing it with volunteers !

Delirium is a sudden disturbance in perception,  attention or cognition and can produce an altered form of semi-consciousness.  Delirium can result in increased morbidity and mortality (death and complications), prolonged hospital stays, increased hospital liability because of patient actions and complications, increased possibility of needing long term care which in turn, increases health care costs.

In my own father’s case, he developed delirium on about his 2nd day of hospitalization and was never able to return home.  He was transferred to a skilled nursing facility where he died 4 days later.  Would he have had a different outcome if the HELP program were in place at the hospital where he was admitted?  Perhaps.

The program uses volunteers with extensive training to provide personal, supportive attention to vulnerable hospitalized elders by offering daily orientation to person, place and time, early mobilization, feeding and drinking assistance, therapeutic activities, hearing and vision adaptations and a non-pharmalogical sleep protocal.

Of course, the program also includes professional personnel.  Its members include an Elder Life Nurse Specialist who is Master Prepared with experience in geriatrics, an Elder Life Specialist who has a bachelors degree in a healthcare related field, a Geriatrician ( MD) to provide clinical consultation, a Program Director (who can be either the Elder Life Nurse Specialist or the Geriatrician), and an interdisciplinary support staff ( chaplain, pharmacist, dietician, rehab therapists, discharge planner, social worker and psych liason nurse).

This might seem expensive, but the program has been proven cost-effective in multiple studies published by highly respected medical journals such as The New England Journal of Medicine.

Ellie is one of the volunteers participating in this program in a hospital in Ontario, Canada.  She told me that as part of her training to be a volunteer in the program, she attended workshops given by The Alzheimer’s Society, The Hearing Institute, the dieticians (who discussed textures of food, colors of food on plates, etc.) and The Heart and Stroke Foundations.

“We go in each day and visit the patients to assess their condition as it applys to the program.  We can talk, walk, visit, play cards, make sure call bells are within easy reach,  and make sure that glasses, hearing aids or amplifyers are being worn.  We aid in menu choices in accordance to their dietary needs, forward any social concerns , check to be sure their sleep has been comfortable and uninterrupted as (lack of) sleep is detrimental to good health and generally make sure that they do not perceive the hospital stay as the end of the road, (as this would make) them less able to cope upon release.  We chart each time we visit a patient so that the R.N. and the social worker that head up the program can then document the information.”

Unfortunately, Ellie says that often they are not well received by the nursing staff.  I must say that as a registered nurse myself, I understand this mentality and it’s something that must change.  Nurses (AND their support staff)  tend to want to control the environment and having what they perceive as a lay person performing what used to be nursing duties can muddy the waters, so to speak.  But with health care costs rising and nurse’s ability to offer nursing care being stretched to the limit, we must realize that this program  is an awesome gift to both the patient and the health care team.

I would love to see a trial of this program in every major hospital in North America.

For more extensive information on this program, please visit http://elderlife.med.yale.edu/public/public-main.php


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