Facing the Dementia Wave – Redesigning Elderly Care Pathways

Thank you very much. Very welcome, to the session, about dementia and and how to improve the elderly pathway in in the care. I've got three very great panelists, so with me Cecile, Emma and Mark who run businesses in their own, restricted in their own markets and they will introduce themselves and we then go from there.

Cecile, may I ask you to start please?

Yes, with pleasure. Cecile Lorenzo, Marketing Director at Sodexo Catering Company, at Continental Europe.

And Sodexo is dealing with many activities including seniors, nursing homes and independent living, food for them.

Do you want to just talk about these slides for a moment?

Okay. With pleasure.

So we have financed a scientific research on, called vibrant mind.

This is, the link between food and what we can do against dementia, food as medicine.

So our ambition is to go against aging and cognitive health crisis.

Two facts.

The first one is dementia is huge.

In US, it's one Americans over seven with dementia.

The rate in a nursing home in US, it's sixty eight percent of people with dementia. And in Europe, we can say that more or less it's the same rate.

Second figure is that it is proven that a big part, forty five percent on average of dementia, could be delayed or even prevented with daily life factors such as nutrition, such as social interaction and physical activity.

Two impacts of this is budget. Budget is huge on mental health and on neurodegenerative disease.

And the second impact is that there is a high turnover of the teams within Sodexo and within clients' teams because dementia is quite hard to deal with when you are not trained.

On the right, you can see a chart that I like.

It's to show that the brain is not an isolated organ and also that food and nutrition is a complex process from the mouth up to the brain through gut, through blood, and that our daily habits might, and we have to prove it, but might impact brain health up to eighty percent.

So our ambition with this scientific research and the white paper called Vibrant Mind is to present a practical and evidence based dietary guideline, which is quite easily to incorporate in our daily life, so that we take more control on our brain health.

And it's a science based, as I said, approach and global one.

We have worked with an association and with a famous doctor in US, doctor Jean Bowman with a teacher in in Harvard Medical School.

They have analyzed the six major proven diets, which have impact on one health and cognition such as DASH, Mediterranean diet, and mind.

Six of them have in common three types of nutrients, that can help on, brain health.

It's omega three fatty acids such as salmon, antioxidants such as blueberries, and the third one is, of course, vitamins such as green leafy vegetables.

But each of these six diets, have some nutritional gaps and do not take a holistic approach.

So it was the ambition of the scientific research to make the best of the six diets and to simplify it, to make it global and practical.

And you can see on the right, the very practical dietary guideline with what to take, encourage, moderate, or limit, and in what portion.

This is a US one, and we have started to work on the French and European, adaptation. And for example, we have already added water.

Water was not in the US one.

And now this will be the time of measuring it with a two years trial.

So they are looking for financing now.

Mhmm.

So that we have two groups.

And the journey starts today.

It's nearly time of lunch. And with the choice that you make and we make for every meal, it's to get healthier but also more sustainable for tomorrow.

And this is it.

Thank you very much, Cecile. Very interesting. Clearly food has a very great impact, so and that's Emma, maybe a couple of words to you.

Thanks, Ayla. Hi. I'm Emma Pearson. I'm the chief executive of Helping Hands. Helping Hands is a UK based business, delivering home care, almost exclusively private pay home care.

And, we deliver around seventy thousand hours a week, a combination of visiting care, so anything from half an hour half an hour visit through to live in care where somebody would move into your home.

I thought it'd be useful just to spend a a couple of minutes on this one slide.

And if you start at the bottom and think about what we mean by the dementia wave, which is the part of the title of this session, I let, and as Cecile said, clearly, this is something that's coming at us already now. We see prevalence increasing, and it's going to continue. Part of that is a good news story around the fact that people are living longer because other conditions are not causing them to die earlier. So this is just also about people living longer and healthier lives partly down to diet, nutrition, and and and wellness.

But in addition to that, what what we're seeing particularly in the UK, and it's probably true elsewhere as well, is that, that wave that's already happening is not being caught and dealt with sufficiently by the system which is under pressure. So just taking an example of that, the waiting lists for diagnosis of dementia in the UK are up by sixty percent post pandemic.

And from a Helping Hands perspective, that then takes us up into the top part of the slide, and where we can impact. So I won't talk too much about that pathway, but really just to point out that on the, that point one, that early education piece, is particularly critical in in our view. So how early can you have the conversation with the person who's receiving the care, our customer?

How early can you have the conversation with the customer in a world where diagnosis is not happening swiftly enough?

So lots of opportunity, I think, to to do more and better there.

Our services would take a customer through from from that early education picking up the phone often in a moment of crisis actually when the family realizes that support is needed, right through to potentially end of life and even complex dementia care.

So that's the Helping Hands pathway. We're in a world where demand is just going to get more and more, and, the the middle piece, final piece on this slide, is that we can't do any of this as well as we need to do it without that circle of support. So family members, GPs, local services, community, and and friendship groups, and, and I'm sure we'll touch on that later on as well, that just the importance of community and society around. Because at the end of the day, so putting people well at home, helping them to live in the communities and homes that they love is what is going to be needed with the huge kind of change in society that we're seeing and the demographic change just by nature of the aging of the population.

Thank you very much, Emma. That's clearly a very, very important part of the future to look after the elderly.

Marc, your business.

Yes. Hi, Marc.

I'm with Hermans. Hermans has been around for forty years now. The company was founded by a psychiatrist and a neuropsychologist.

And really back in the eighties, the the the founder of Almag was called in the what the nursing homes were back then, asking him to help them with difficult patients, I. E. People with, you know, behavior problems.

And he came to two conclusions. One, that drugs were not the answer, and two, that the environment very often were actually the cause of the behavior problems.

And because, he was of the school of thought of cognitive behavioral therapies, he thought there was a good opportunity to apply the CBT techniques to dementia care. He looked around, couldn't find anything, and he designed his own homes, bearing in mind that environment has an impact on the way people behave.

And during that time, we also came to the conclusion that behavior problems are actually not a fatality.

You can prevent them. You can solve them.

And you can also provide good quality of life for dementia patients.

So that was how we all started and how we developed our own method of care to deal with dementia and ideally prevent it, or slow it down at least. And, we have two lines of business. We run our own, nursing homes dedicated to dementia care, one hundred percent. We've been doing that for forty years.

And more recently, we've been advising and sharing our know how with other care home operators, but also home care operators because, as the previous panel was saying, people move into nursing homes with higher and higher levels of dependency, meaning they're staying at home for longer with higher levels of dependency as well. And although care homes are not that prepared for the dementia wave, you know, home care services are even less. And yet, pretty much every policymaker in Europe has decided that home care is the answer to everything, which is great because that's what people want. But

what kind of home care and what kind of home care services do you provide?

And what we what we teach or what we share with our clients is the fact that to have a good dementia related service, you don't need more resources. You don't need more time. You just need more skills. You need a strategy. You need a coherent approach to to this.

And the slide you're seeing here is really the essence of everything that we do, and that is both applicable at home and in nursing homes.

And I'm not going to go through all of them because it's going to be a bit long, but one of the key ones is pleasure above all. As I said earlier, the, the Almas method is a non drug based approach, and we use pleasure as a natural antidepressant.

So much so that, you know, after three months, after moving in into our homes, we reduce the number of molecules people take by half.

And pleasure I mean, people will say, oh, we always provide pleasure to to our residents or our clients, but it's great. But what we do is that we work on self esteem because very often with dementia and certainly with Alzheimer's comes depression and if you fight depression by, you know, providing building back up the self esteem of the people, then you can do without the drugs.

And that's just one example. There are millions of them, but, another one very important to us is families are essential because, as you know, dementia impacts not just the person, but the whole, you know, family and relatives and and people that are close to that person. So if you don't deal with their suffering, with their difficulties, then you're only answering half of the problem or part of the problem.

So that's something we do. And at home, it's also very essential, obviously, to include the relatives because they hold some of the answers that you need to solve the the the case when you're facing a behavior problem.

And to us, a problem a behavior problem is actually not a problem. It's, an information that the the person is giving you. It's that person telling you, I need something. I need to escape something, but I don't know how to say it with words, so I will say it with my behavior. And people with dementia will, work on an emotional level very much. So you have to reach to that level. And we say we have to decode the new language that people are developing when they have dementia.

So the reason why I'm saying all this is that, dealing with dementia does not require more needs, more stuff. It needs more skills, and it needed strategy and it needed a structured approach to dealing with them with the aim of providing quality of life because you can have quality of life even though you have dementia.

Thank you very much. All three, so probably picking up on the point, Mark. You're just thought about what you're already doing in your home and the strategy. Emma, so you as we pointed it, it's sort of home care quite important. What is Helping Hands doing today already in order to improve quality of care and dealing with dementia?

Okay. So I'll take that from two angles, one from the customer angle and one from the carer angle, because as Marcus referenced, the the the carer and the stress on the carer when supporting somebody with dementia can be, can can be quite severe, and particularly in an environment if there isn't sufficient training and support. So I'll I'll take those two two points separately.

From the customer perspective, so we think about the person who's receiving care as our our customer, but actually the circle of support around is also essential as well. So a lot of our conversations would be with family members. And what we try and do is make sure that there can be a structured conversation as early as possible when we're going to be supporting a new customer, which helps to educate the family on what they might expect now, but what they might expect in the future as well if there are, if there's either a diagnosis of dementia or if what we're seeing in presentation when we're doing the care needs assessment is indicating that that might be the case. So a structured conversation, access to resources, and then a tailored care plan as you would expect any care organization to have for for that customer.

But what we sort of take it to to the next step in terms of, ensuring that it's interesting your use of the word pleasure. We wouldn't use the same terminology, but but the access to community and what brings joy in living, etcetera, becomes an essential part of the care plan. It is not just about enduring medication and cleanliness and and, the basic functions of of life.

And an example would be, in some of our branches, we have a hundred and fifty branches across, England and Wales.

Some of our branches run a chatty cafe, and the chatty cafe is specific for people who have dementia, and it's an opportunity to get out in the community in a safe way with a carer in a supported environment and to meet other people. And we had a lovely example last year where, a a new customer came along to the Chatty Cafe and met somebody that they'd been at school with and great friends with through their their their youth and and had completely lost touch. And actually, the impact on those two people's lives was really material. How you measure it, I don't know.

I'd love the answer to that, but but but but but really material to to kind of build those community connections. So that's just a little example on on the customer side. On the carer side, two things. One is, really great training and consistent training.

So, from the day that a carer would start with Helping Hands and, our belief is that they all need to be directly employed by us, so we don't use agency and this enables the training to be consistent.

Dementia awareness needs to be part of the early education of a carer.

As they progress through their employment and gain more skills, then there's an advanced level of dementia training as well. And we work with the Alzheimer's Society to make sure that we've got the, you know, good access to the latest education and that we can then train our more senior people to do train the trainer and therefore the skills are already embedded throughout the business.

But the additional part for me on the carer side, training is is fine. You would expect that to be in place and to be to be really good, but it's in the moment of crisis when the carer has had a really difficult interaction, remembering that home care, you may well be the only person that the customer has seen that day. You may have a really challenging interaction. They may not want to let you into the house.

When you get into the house, you may have a very difficult experience. And so our job here really is to support the carer to understand how to handle that challenging situation and to support them to be as resilient as they can be, and and to give them the backup that they need, because it is a really it's a really tough job, and particularly when you've seen somebody move through the stages of dementia and the person that you knew is not the person that you see in front of you today. So, yeah, there's two things from the carer perspective, one around training and one really about support and resilience.

And that's where the branch network, I think, works quite well.

Very good. Well, thank you very much for both of you. Just probably to make it very relevant also for the audience.

Maybe, Mark, I'll just start with with you sort of where do home care operators start? When when they want to improve, they realize we're not doing enough, realizing actually our services are there, but but they're not quite actually holistically enough. Where do they start? How how do how should a co operate? What can they do tomorrow, next week, when they come home, and look at the operation? Where should they start? What can they do?

There's a very sort of thing various things they can do, but one of them is very often what you find in nursing homes is that some of the staff are trained on dementia, and some of the staff are involved in dementia care. The way we look at it is that everybody should be part of the, of the solution, and that's actually our our point number eight. All staff members are part of it, but that includes the cleaning people, the handyman, the home director, pretty much everybody, even the receptionist.

The reason being that every interaction that we have during the day with a resident is an opportunity to, one, have an impact, two, collect information that will then be used in case studies when we're facing a problem and we need to think about strategies.

And we have tools for dealing with behavioral problems, sort of, you know, managerial tools. But if you don't have the information, then it's more difficult to use. So one of the answers is really involve everyone. It's everybody's responsibility within your home to be dealing with dementia, not just the nurses or just the, you know, designated caregivers.

Everybody should be involved because every every moment that you have, is an opportunity to do stimulation, ongoing stimulation on the resident. Everything should be stimulation. It can be fun, but the era of, oh, we have nice activities, nice entertainment in our home, to me, is over.

And the panel is called, you know, the dementia wave. I call it the dementia tsunami.

And if you're not prepared for that and you start, you know, you don't you don't start doing things purposely, like have a strategy. Why do we do things? How do we do things? How do we have a greater impact in everything that we do every minute of the day?

That is why I was saying earlier, you don't need more resources to deal with dementia. You do need more skills. Absolutely. But you also need a different mindset that everything that I do has an impact on the resident.

Let's make sure it's a positive one.

And the good news is that we have dementia focused facilities, and we apply the freedom of movement, you know, principle where people are allowed to move freely. This has, you know, physical benefits. It has benefits on your brain, on your body. It helps, you know, fighting falls potentially, but it's also an opportunity to meet other people, be stimulated. It reduces anxiety and stress.

And really, what people should start thinking about when dealing with dementia is how much freedom do I give my resident? How much risk am I taking to take? Yeah.

Am I ready to take to allow them that freedom with the benefits that come with it? And very often, when people visit our homes and see that we allow our residents to use the staircases, they say, oh my god. You're crazy.

But, you know, ninety percent of the faults happen in the room anyway.

So why deprive them of that freedom and all the benefits that come with it? So, really, people who are running nursing homes should think in that way, what benefits can I bring within the the previous panel was on, you know, real estate mostly?

There's a lot you can do with existing real estate. It's really a matter of skills and mindset.

Just one sentence also.

Do I need to go all the way immediately or can I do baby steps? Because that's sort of what I'm hearing very often say, I just can't get to the end stage, and it's just too daunting and there were no no starts. Can they what what would your advice be? Do do I need to go all all the way immediately?

Yeah. It's true that we've been doing that for forty years, so we're kind of, you know, at the at the top end of the scale. And when we were discussing our our method with other people, they were saying, oh, it's just too ambitious. We'll never make it.

But you're absolutely right, Eilat. There's so much you can do, take baby steps. And any step that you take has an impact, has a benefit, and then you will build on that. And very often, what you see in nursing homes is that you have a variety of professionals that have been trained here and there, and, they do their best, and they try and apply, you know, industry best practices, which is great.

But do you make it consistent? Do you make it group wide? Do you make it the whole, you know, home wide?

So anything you can implement will be beneficial, but it has to has a purpose. You have to have a strategy.

It's not just, oh, let's try this and and I don't really know why, but I know you worked somewhere else.

So start little, but know why you're doing it. And then witness the benefits. And it witness the benefits on your staff as well. I mean, staff retention is definitely a key issue for all of us in the industry. And by providing your staff with new skill sets, protecting them from the difficulty of dealing with dementia, because it is a tough job. If you go out there, you know, on the battlefield without an armor, then you're much more exposed.

And if you know what the disease fundamentals are, what is a behavior situation, and how to deal with it, then as an individual, you suffer a lot less and the probability that you will remain in your in your job is much greater.

Emma, from a home care operator, what should they do? Where should they start?

I'll come back to training because it impacts retention, it impacts customer experience, it impacts outcomes.

That that that's the baseline. And I think probably challenging yourself to review that training, because science is evolving, understanding of cognition is evolving.

And the next step then is how you think about that training and support for your carers to go not just across the people who have the diagnosis of dementia, but actually, for us, our you know, it's primarily elderly people that we support across the whole population because, actually, some of the issues will be the same around potential for loneliness, impact on mood just from, you know, being at home and not being out in the community. So whether you're you have dementia or you don't have dementia, trying to get the consistency that that you described, Mark, I think, is is really the baseline to start from.

The next level up then is how can you, for in our in our case, use scale to, improve things even further. So the opportunity to take the information that we have, let's say, at a branch level, unless we do this already, take the take the information that you have at a branch level to understand where the problems potentially are emerging that may not be spotted by an individual carer.

So the fact that maybe a visit is constantly running over, so it should be an hour. It's taking an hour and ten, and that's been happening for a couple of weeks. What's going on that's shifted from from a to b, looking at the fact that, a customer may not have been drinking as much as they usually do or eating as well as before, and particularly in that world where we've got the, you know, sixty percent increase in in, you know, lack of diagnosis, we know that probably around sixty percent of our customers have dementia whether diagnosed or not. So as home care operators, I think it's really our job to try and use the data that we have over and above the training that we've given the carers, use the data to try and ensure that the customer is getting the best care in the moment and that that changes over time.

Okay.

So, Cecilia, from a Sodexo perspective, anything from your experience, what can people do? Probably maybe also think about nutrition sort of is what how how should people think about that?

A very simple and basic thing is first to to have a very clear menu.

When you when you have a daily menu, the first thing and the Sodexo menu is always very tiny.

And people with dementia, seniors, aging people, but on top with dementia, have a lot of difficulties in knowing what they are going to eat.

Mhmm.

And it starts by very basic things like that.

And I have seen a very good example in Belgium with a big menu developed for four dementia with photos of the carrot, of the meat, and of the dessert, and having some activities before the the lunch so so that they they could know exactly what they could they they they were going to to eat.

So an activity around this menu, it's a very basic and concrete example. Yeah. But it starts by this, I think.

I think that. And I think, Mark, you you also mentioned me sort of in a in a previous discussion also when you're serving food actually saying this is tomato or this is a carrot or also actually sort of make sure people actually be be part of part of the plan and and and just little things can can help a lot.

Yeah. That's that's a very good example of what I was saying earlier that every second of the day is an opportunity to stimulate. Yeah. Okay. If a caregiver brings a plate to someone instead of saying enjoy your meal, if they say, oh, this is, you know, beef with carrots, then it doesn't take much longer, but you increase your chance that that person will eat. Because very often, when people refuse to eat is that they don't recognize what they're eating. You know, with the disease, they they some of them can lose the ability to understand what they see or reconnect.

So, yeah, that's a very good example, islets.

It's it doesn't take any more time.

But just to know that by saying that, you are stimulating something and you're helping that person reconnect with potentially their appetite because as we know, you know Yeah. Eating habits are are damaged with the disease.

It's very efficient.

How much And for the for the caregivers, it's great to think, I'm not just bringing a plate on the table.

Well, and and getting involved in in the preparation of the meal as well, of course, is is a great opportunity.

If you if you can do that, then it's even better. Yeah.

Just to clarify the context of of time, technology. I mean, we can't have a discussion today world without talking about technology.

So how important is technology in in in this journey to make care more dementia friendly? So, Emma, what what where where suppose you're thinking on that?

Well, I think, you know, the the age of the wearable is here, isn't it? I should think there's probably not one person in the room that doesn't have some some form of wearable device. So exactly. So so so that's kind of ancient history in terms of, of the availability of those devices, and what we see is, families in particular making good use of that. So when you can't be close to your loved one, you you can stay in touch whether it's, you know, chatting online or FaceTime and or whether it's actually monitoring what's going on physiologically.

So so that that's here. I think more interesting for us organizationally at the moment is back to that point on how do we understand our data and what does it tell us at the macro level so that we can start to do a bit more predicting to support our carers so that they know what they might be walking into and what to be looking out for.

And we're also using it I went to an earlier session on on AI, and, you know, there's there's the the customer facing, but there's also the efficiency angle. So I think for all businesses, all service businesses, we should be thinking about how we use technology to enhance the customer experience, the consumer experience at the front end, and we're doing exactly that with the eighty thousand calls a year that we get, and as I said before, often from people who are in quite a distressed and worried state. So supporting our, call operators to be able to give really expert advice and opinion at that first point of contact, which then decreases anxiety, provides solution, and hopefully starts the journey as early as possible and as well as possible because that's the thing that will make the difference in outcomes.

Mark from a care home operator? Yes.

The way we're looking at technology is really when coming to the conclusion that the resources to deal with dementia are very scarce and expensive.

We have on staff neuropsychologists in our home, but not everybody does, especially not, you know, the home care operators that we're working with. So So the question we asked ourselves was, how can we help these people with our neuropsychologist skills without them having one? So we've managed to put a neuropsychologist in a box, that we're testing right now that allows people, especially, home care operators, to do neuropsychological tests at home. Mhmm.

And then the results of these tests are then plugged into a software. The software analysis analyzes the results and then generates a PDF file with all the requirements and pieces of advice to better care for that person based on their cognitive level, both in terms of continuous stimulation, targeted stimulation, activities, things that would work for them that would help them with the kind of dementia that they have and the level of dementia that they have. So effectively, it would be as if we would be sitting with that person, advising them on what to do and how to improve the quality of care that they provide, whether it's at home or in nursing home as well, or that in a device automated.

So that's what we're working on.

Does robotics sort of I'm sorry?

Robots, sort of in Japan, I know they are testing. We see sort of little sort of robots running around in camps.

Is that something where you're thinking of? Is that something that you're experimenting?

We're not big fans of robots. You're not? Okay.

No. Because as I said, people with dementia interact on an emotional level. Yeah.

And then I challenge you to have an emotion with a robot, a real one, I mean, a real shared emotion.

Yes. Okay. Cecile, any thoughts from a technology perspective from Sodexo's perspective?

Another very simple example, beyond the menu, we have worked on giving the opportunity to the most fragile people, disabled, and seniors with dementia, to to to give their satisfaction on the menu, after eating, even when they are not able to speak, to so whatever is your capacity of expression give you satisfaction rates and why is it good, why is it not good and to improve it afterwards. So we have been working on technology, very concrete technology, for example, on the menu and on the satisfaction of this menu so far.

Very good. Just a reason of one or two sentence from each of you very quickly.

How important is it some of them are how important is it for my home care providers to really deal with dementia in a more effective way to be successful in the future?

Critical.

Fine. So critical.

So therefore Just because that's the market isn't it?

That's the market. It's the need.

The only sort of additional point I'd probably make is that there's a macro need for all developed economies to be thinking about how we support people to stay in their own home for longer. So this isn't just about what the provider can do. It's also what's the system doing around that to make sure that homes are fit for purpose for the future because there's not enough land. There's not enough, building infrastructure to deal with the aging population.

Mark, in in ten years' time, will there be care homes which not deal with dementia?

Yeah. Well, I'll be a bit provocative here, but I think the residential model is dead.

And if you're pursuing it, then you're not ready for the next wave that's coming.

So prepare yourself, have a strategy, change the mindset, provide the services that people will need.

When it comes to home care, I think there's a huge opportunity for home care operators to work on prevention.

You know, not just provide a service, but really provide prevention.

And it's the same for home care sorry, care home operators. They can also work on prevention to try and slow down the evolution of the disease.

But forget forget that people will ever come to nursing homes in the future because they are just looking for friends.

Unfortunately, I think you need to repurpose the homes as dementia homes.

Thank you very much. So, maybe before we close, sort of a couple of key takeaways, I think, that I basically wrote down sort of from this. It's a very great discussion.

So, firstly sort of in actually in order to make care more dementia friendly, it doesn't need more staff. It doesn't need necessarily more cost. It needs a different skill set, a different mindset. And we can start with that mindset tomorrow and think about what actually we can do in order to improve that. I took away from you, Emma, training but also Mark says training to staff is absolutely critical again because the staff is really dealing with those really issues and the situations on a daily, on an hourly basis and therefore to reduce, churn but also improve satisfaction again critical and something that I think we can all start next week in order to prepare staff more what they're dealing with.

Second one, sort of the third one is everyone is part of the solution.

Therefore, it's not just the carer, it's everyone is really should be integrated in it.

And as a provider you don't need to go from zero to hero in one step. You can do it sort of step by step as fast as you can, but everything helps.

So thank you very much, for the contribution and please a round of applause for the panelists.