The Massachusetts Health & Hospital Association (MHA) Alzheimer’s and Related Dementias Workgroup has issued a new guidance document to assist hospitals with implementing care and management practices for patients with Alzheimer’s and related dementias. Every acute care hospital licensed by the state Department of Public Health is required to implement such plans by October 1, 2021.

The 25-page document – Guidance for Developing an Operational Plan to Address Diagnosis and Care for Patients with Alzheimer’s Disease and Related Dementias in Hospital Settings – is based on recommendations issued in June of 2017 by the state’s Alzheimer’s and Related Dementias Acute Care Advisory Committee. The advisory committee was coordinated jointly by the state Department of Public Health and the Executive Office of Elder Affairs.

MHA also received input on the guidance document from state regulators to ensure that the recommendations align with mandates contained in Chapter 220 of the Acts of 2018, which among other things created new caregiver training and care planning requirements and a statewide advisory council to coordinate the development of Alzheimer’s and other related dementias services.  

Clinicians from 11 Massachusetts hospital and health systems, along with patient advisors and members of the Alzheimer’s Association – MA/NH Chapter, served on the MHA workgroup, which met from December 2017 through the summer of 2018. The workgroup developed the following six broad recommendations:

1. The need to provide culturally sensitive training on dementia and/or delirium to a broad range of caregivers;
2. The importance of providing the optimal environment for patients, which may include sound reduction measures and special lighting;
3. The necessity of learning the patient’s prior history by working with the patient, family, caregivers, EMS personnel, among others;
4. Management of treatment once the patient is in the care of providers in the hospital;
5. Improving communication in care transfers and in discharges; and
6. Incorporating advanced care planning into the general information provided to a patient and caregivers to ensure that patients with Alzheimer’s and related dementias have the full resources available to them.

Each broad guideline is accompanied by a list of the care team members who would be involved in carrying out a given component of the guidance, as well as suggested action steps and additional resources to assist hospitals in adopting or revising their clinical and operational dementia care practices.

There are several forms of dementia, the most common of which is Alzheimer’s disease. However, hospitals also treat patients who suffer from delirium, which is separate and distinct from dementia. Unlike dementia, delirium – a condition that is common in hospitalized patients with dementia – is a temporary condition and may be preventable. The MHA guidance addresses both dementia and delirium in patients in hospital emergency departments and inpatient units.

The report finds that, as is true for all aspects of care across the continuum but especially so for those living with Alzheimer's and related dementias, the handoffs from one care setting to another are extraordinarily important. Perhaps the most important recommendation repeated throughout the guidance document is the necessity of screening appropriate patients promptly and thoroughly to determine treatment protocols and appropriate interventions.

“MHA would like to thank the outstanding clinical experts and patient advisors from our member hospitals who served on the Alzheimer’s and Related Dementias Workgroup for all of their important contributions,” said Steve Walsh, President & CEO of MHA. “We hope this report – which is also posted on MHA’s PatientCareLink quality and patient safety website – assists hospital caregivers in their ongoing efforts to enhance treatments and supports for Alzheimer’s and other dementias successfully meet the unique needs of this vulnerable patient population.”

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