Service Design Report: Comparing Dementia Care Services and Models

This report delves into the critical area of service design for dementia care, focusing on the challenges and complexities of supporting older patients experiencing behavioral and psychological symptoms of dementia (BPSD). The report begins by comparing and contrasting two distinct service models: the Dementia Centre in Australia and HopeHealth in the United States, highlighting their approaches to patient care, philosophies, and the specific services they offer. A detailed critique follows, leveraging the student's understanding of dementia's pathophysiology and the manifestations of BPSD to evaluate the strengths and weaknesses of each service. The analysis then extends to the extent to which these services meet the needs of older patients with BPSD, providing a nuanced perspective. The core of the report presents a proposed service model designed to enhance the daily lives of dementia patients, incorporating features that promote independence, safety, and therapeutic benefits. The rationale behind this service model is thoroughly justified, supported by relevant research and evidence-based practices, including considerations for fall risk, security measures, sensory interventions, and family support. The report emphasizes a holistic approach, integrating emotional, social, and cultural support alongside medical care to improve the quality of life for individuals affected by dementia.

Running head: SERVICE DESIGN
Service Design
Name of the Student:
Name of the University:
Author Note:

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Table of Contents
Introduction..........................................................................................................................3
Part A...................................................................................................................................3
Comparison of two services from two different countries..................................................3
Dementia Centre..............................................................................................................3
HopeHealth......................................................................................................................4
Critique of the services based on my knowledge of the pathophysiology of dementia and
BPSD...............................................................................................................................................4
Dementia Centre..............................................................................................................4
HopeHealth......................................................................................................................5
Reflection on the extent to which the services support meet the needs of the older patients
with BPSD.......................................................................................................................................5
Part B...................................................................................................................................6
Service Model......................................................................................................................6
Justification of the service model........................................................................................7
Support for merit of my idea...............................................................................................7
Conclusion...........................................................................................................................8
References............................................................................................................................9

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Introduction
Dementia is a medical term for the decrease in the mental ability of a person, which
gradually worsens over time. It is a term for the set of symptoms that affects the reasoning and
thinking ability of a person. Alzheimer’s disease is the root cause of dementia in many cases. It
is challenging to provide care services for people suffering from dementia as the symptoms vary
to great extent and still there is no cure available for it (Heinrich et al. 2016). This report
explains the importance of providing better service facilities to support older people suffering
from behavioural and psychological symptoms of dementia (BPSD). The report compares and
contrasts two different services from different countries and develops a better service design that
helps in providing a better life to the older people with BPSD.
Part A
Comparison of two services from two different countries
Two different services such as Dementia Centre that are available in Australia and Hope
Health that is located in the United States of America , which have been selected to compare and
contrast the services provided by them. Although, both of the services work towards the goal of
betterment of the life of older people suffering from dementia, differential approaches exist
between them.
Dementia Centre
The dementia centre had been founded by Hammond care in the year 1995, which can
provide care services for the patients those who are aged and are suffering from dementia.
Dementia care is based on the “spark of life” philosophy which is the way to lift spirit with the

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highest intent and awaken the dormant abilities. This philosophy fosters empathy, kindness,
respect and attitude of unconditional love. The vision of the organisation is to help dementia
patients to live joyous and meaningful life, with optimism to make improvement possible
(Dementia Centre 2017).
The ideology behind Dementia Centre is to provide a homely and domestic environment
that is welcoming and safe for the patients so that they do not feel secluded from the world. It
provides emotional support and comfortable life to the patients. Apart from this, there are
counselling facilities, guidance, recreation, training facilities provided to the patients. It uses
patient centered model. With this philosophy and vision of the organisation, implemented
effectively, it was found that there was significant reduction in the distress behaviour of the
patients along with the decrease in fall, increases in resident, staff and family satisfaction level
(Dementia Centre 2017).
Hope-Health
The Hope-Health was founded in 1991 basically to provide home for providing primary
healthcare and implements the person focused and family centered care to treat the whole
person. The service vision is to serve others, give hope and change life. The service values
compassion, accountability and innovation. The mission and vision is same as that of Dementia
care. The ultimate philosophy of Hope-Health services is to educate and support not only the
patient suffering from dementia but also their families who are equally affected by the condition,
where Dementia care focuses mainly on patients (Hope-Health 2017).
Hope-Health generally provides health services such as primary care, behaviour health
and psychiatry, pain therapy, massage therapy and health services for women for Dementia

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(Robinson et al., 2013). Their team generally works for the prevention and detection of the
illness and tries to provide routine healthcare check-up and treatment as soon as possible. It is an
emotional challenge for the patients and its loved ones and requires a lot of patience and
understanding. Hope-Health works towards innovation and is ready to accept new discoveries in
its working practice (Hope-Health 2017). Similar to Dementia Centre, it provides an array of
facilities such as healthcare professionals, counselling, conference, and workshops. However, in
contrast with Dementia Centre, it is engaged towards research and innovation rather than design
and construction of Dementia services (Khanassov et al. 2014).
Critique of the services based on my knowledge of the pathophysiology of dementia and
BPSD
Change in the blood vessels in brain along with lewy bodies leads to many behavioural
and psychological changes in the dementia patients. Patients have navigation trouble due to
decline in the mental ability and usually seclude themselves from other people as they suffer
from social anxiety issues. With this neurodegenerative disease, there is impairment in thinking
and memory. These results in behavioural and psychological problem like paranoia, delusional
jealousy, screaming, auditory hallucination, sleep disturbances, aggressive behaviour,
depression, social isolation (Cerejeira, Lagarto & Mukaetova-Ladinska 2012).
In Dementia care, the patient centered model includes good communication with the
patients that ensures healing, patient enablement, and informed choices. With effective verbal
and non-verbal communication pattern help gain knowledge on people’s resilience. It decreases
threats to vulnerability as patients communicate their feelings. This model also includes giving
food of patient choice, includes their hobbies and favourite activities to make them control of

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themselves and increase adherence to treatment. It reflects the patient centered cognitive
behavioural therapy. The use of open room type using Design-Smart technology is helpful and
easily accessible by the patients (Lourida et al. 2017). With the help of open room type, it is able
to monitor every patient discreetly. Social isolation is harmful to the patients and in this service
model a soothing environment and social connectedness is promoted. Hence, Dementia Centre
makes patients calmer and happier, which decreases delusional jealousy and paranoia. It also
enables the patient to function while less dependent on the caregivers, which boost the
confidence and self-esteem of the patients (Gibson et al., 2015).
Hope Health supports research and innovation and incorporates it into the practices
(Hope Health 2017). Innovations and developing new techniques to treat the patients helps in
improving the conditions of the patients (Prince et al. 2013). Being person focused is necessary
to educate the people about the effects and treatment of BPSD by fostering patient engagement
in addressing the symptoms (Low et al. 2013). In order to treat memory impairment, there are
activities of listening together, use of journals, photos, and goal directed activities, giving
feedback and sharing of ideas. It also provides consultation to the families to incorporate their
needs as well. This model overcomes the aggressive and agitation behaviour by improving the
sleep pattern (Teno et al. 2013). There is less focus on disease, but the time focus care has been
found to decrease the behavioural issues in dementia patients.
Reflection on the extent to which the services support meet the needs of the older patients
with BPSD
Both Dementia Centre and Hope-Health work towards providing a better life to the
patients with BPSD. According to my view both the approaches are slightly different but the

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methods and practices adopted by both the services are fulfilling and help in improving the
quality of life of the patients. These two services are done for meeting the needs of the residential
care, medical management, and provide education and increased awareness through counselling,
workshops, training, and conferences. These organisations provide the services which help to
improve the quality of life of people. Apart from that, the services also provide emotional
support to the patient and their loved ones. There is a slight difference between the person
centered and patient centered care. In the former, the heath and social services and the patient are
equal partner in monitoring and developing the care. It treats the whole person. In the later, the
care is responsive to the patient, respecting their needs, values and preferences, which guide the
clinical decision (De Vries 2013). The person focused and family centered care of Hope Health
meets to the greater extent the needs of dementia patents with BPSD when compared to the
patient centered care.
Part B
Service Model
The service model that I have designed has features that will support the daily function of
the patients such that they are able to work independently and freely. The design has therapeutic
impacts on the patients (Marquardt, Bueter & Motzek 2014). The main problem faced with
patients suffering from dementia or BPSD is a failure to accept and recognize places and things
around them (Cerejeira, Lagarto & Mukaetova-Ladinska 2012). The signs and symbols used in
the care place are simple and easy to comprehend. Locating the room and things is easier with
the use of bright and contrasting colours. Some rooms such as bathroom and bedroom are easily
accessible and visible to the patients.

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As it is difficult to monitor the movements of every patient, the security feature is
installed in my service design. There will be the presence of sensor in the security system that
will prevent the patient from entering into risk or unauthorized areas. Open space with the
minimum obstacle is incorporated in the design so that patients can move freely (Vernooij-
Dassen and Moniz-Cook, 2014). A calm and serene atmosphere is maintained as too much noise
and the crowd make the patient agitated, anxious and stressed (Marquardt, Bueter & Motzek
2014). Keeping in mind the behavioural changes of the patient, the service design is prepared to
ensure the well-being of the patients. Older patients with fall risk are recognised by yellow
socks. The service model also considers the family needs when caring for patients (Sellevold et
al. 2013).
Around the clock, support is provided to the patients with the help of caregivers and
medical professionals. Apart from taking care of the health and medications of the patients, the
service design will also provide emotional, social, and cultural support to the patient. In this
design the nurses will focus on therapeutic touch as sensory intervention to reduce the aggressive
behaviour and agitation. Further, the carers will provide music as sensory intervention to address
the behavioural symptoms such as agitated behaviour. A live music intervention can decrease
depression and anxiety. Group discussions are used to eliminate feeling of isolation, boredom
and loneliness (Cabrera et al. 2015). A 24-hour support and helpline number are available so
that the patient’s families and loved ones are well informed about the patient health and
condition. This model helps the patient to set small goals such as outdoor and physical activity
which when accomplished enhances the positive self-image. It may include gardening or sharing
of personal feelings to promote cognitive function. This reflects the emotion oriented care
approach. The carers in this service design will channelize the energy of the dementia patients to

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specific supervised activity to prevent them from wandering aimlessly and decrease the sun
downing behaviour (Testad et al. 2014). Further, the use reflective journal helps in preserving
the patient’s memory.
Justification of the service model
Providing care for the older patient suffering from dementia is an emotionally, mentally
and physically challenging process. The service design that I have developed takes into
consideration all these three factors.
Fall risk increases with the progression of this neurodegenerative disorder due to gait
changes, poor balance, visual-spatial problem and memory impairment. This evidence supports
the concept of relation between physical impairment and onset of dementia. Dementia patients
hurt themselves as a consequence of disorientation, difficulty in abstract thinking, and memory
impairment. (Testad et al. 2014). The presence of sensor, and use yellow socks will reduce the
risk and harm to the patients as a health safety measure (Marquardt, Bueter & Motzek 2014).
According to Testad et al. (2014), damage to the hippocampus region due to hypercortisolemia
for prolonged period was found to be linked to depression in dementia patients. Research shows
that some of the reasons for the onset of depression and anxiety issues in the patient are due to
the increased dependencies on other people for their day-to-day work. The presence of user-
friendly room design and construction as environmental intervention will allow the patients to
act independently and reduce disorientation. Care is taken to minute details such as the colours
and the lights used in the rooms, the hallways are maintained dry and obstacle free, so that
patients find it easier to live and manage their daily work without any disturbances. Use of
arrows and directions on wall will prevent patients from wandering and facilities like walker will

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increase self dependence. According to () BPSD in dementia patients there is a decreased
orientation to time and place. Use of warning signs, calendars and clocks increases alertness of
the patients.
A calm and quiet environment improves sleep pattern and reduce restlessness and fatigue
(De Vries 2013). Light colours in rooms will provide a friendly, warm, and pleasant feeling to
the patient. A light music is the best way to initiate a calm and soothing environment. It will help
reduce the anxiety and aggression, as it will help maintain calm and peaceful environment.
Therapeutic touch is the effective method in generate responsive behaviour in patients
(Kumarappah and Senderovich 2016). The emotion-centered care will increase the emotional
balance and adaptation to the living environment of the patients. Cognitive decline results in
decrease in word recall, language abilities, attention and calculations and visuopatial skills.
Engaging the patient in the specific goal directed activity will prevent unnecessary loss of
energy, provided the activity is one that the patient enjoys most. Group discussions will improve
word recall and involving in small tasks such as budget planning increases executive skills
(Eggenberger et al. 2013). As the patient finds it difficult to express their emotions freely, face
problems in understanding and comprehending, and have difficulty in reading and writing, the
service design ensures the care providers use appropriate gestures and nonverbal skills
(Myagedcare 2017).
Support for merit of my idea
The main merit of my service design is the ability of the patients to live freely and have
control on their choices. My design involves family that enables the patients to feel comfortably
and secured. Use of yellow socks help prevent fall in at risk patients. Another merit of my

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service design is that it considers and solves the communication problem faced by the patients.
There is regular health check-up done to ensure that the communication issue is not due to
impaired hearing and visibility. Evidence shows that increase in social communication in the
patient helps in delaying the onset of the progression of dementia and BPSD (Eggenberger,
Heimerl & Bennett 2013). Thus, the intervention of helping the patient to share their personal
feelings is effective way to increase the social interaction. There is a merit in increasing the
patient engagement in specific activity. In dementia patients, I feel it will help in decreasing the
depression. Nurses for my uncle, who was also a dementia patient, used this method. It was
effective in channelizing their energy in positive manner.
Conclusion
Dementia is usually associated with the ageing process and often neglected. The report
explains the importance of the need to provide special care treatment and facilities for the old-
aged people suffering from dementia. A lot of patience and willpower is required for the process
as there is no available cure for the problem and the patients can live a better life only through
effective care. The service design should be such that it should provide a comfortable and safe
life to the patient. It should help in improving the quality of life and well-being of the patient.

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References
Cabrera, E., Sutcliffe, C., Verbeek, H., Saks, K., Soto-Martin, M., Meyer, G., Leino-Kilpi, H.,
Karlsson, S., Zabalegui, A. and RightTimePlaceCare Consortium, 2015. Non-pharmacological
interventions as a best practice strategy in people with dementia living in nursing homes. A
systematic review. European Geriatric Medicine, 6(2), pp.134-150.
Cerejeira, J., Lagarto, L. & Mukaetova-Ladinska, E.B 2012, ‘Behavioral and psychological
symptoms of dementia’, Frontiers in Neurology, vol. 3.
De Vries, K 2013, ‘Communicating with older people with dementia’, Nursing Older
People, vol. 25, no. 4, pp. 30-37.
Dementia Centre 2017, DC Homepage | Dementia Centre. [online], viewed 20 September 2017,
<http://www.dementiacentre.com.au/>
Eggenberger, E., Heimerl, K. and Bennett, M.I., 2013. Communication skills training in
dementia care: a systematic review of effectiveness, training content and didactic methods in
different care settings. International Psychogeriatrics, 25(3), pp.345-358.