By Deputy Fire Chief Chuck Butler
If you or someone you know cares for a friend or a family member who has dementia, it is likely that you are aware of the challenges facing every individual involved in that care. At times, persons with dementia can, at no fault of their own, become aggressive or become very difficult, if not impossible, to reason with or manage. These situations can occur at home, but they can also occur in facilities that care for residents with dementia. In these circumstances, it often becomes necessary for caregivers to reach out for assistance for this crisis behavior.
Currently, calls for help are usually being directed to the Sheboygan County Communications Center by dialing 911, and historically have generated a law enforcement response to try to manage the aggressive or otherwise difficult behaviors. This approach is not really the best and can actually increase the agitation or trauma for the person with dementia. Likewise, except for specific medical circumstances, it is not always best or even necessary to transport a person experiencing crisis to the hospital emergency department. This removal from their familiar environment can increase personal trauma and also add additional costs to the patients and unnecessary burden to emergency departments. The best case scenario for managing these crisis situations is to either prevent them through better approaches and awareness of triggers or to better apply de-escalation approaches at the time of the crisis in an attempt to return the situation to baseline. This would result in being able to keep the person in their familiar home environment.
Early in 2018, a grassroots initiative of local professionals convened to examine the state of dementia crisis response in Sheboygan County. That group soon realized that to truly address the issues and to effect county wide improvements, they would need to build a large scale multidisciplinary collaboration. The Dementia Crisis Task Force of Sheboygan County was formed. The task force is a public/private partnership that is currently made up of representatives from the Sheboygan Fire Department, the Sheboygan Police Department, the Sheboygan County Sheriff’s Department, Orange Cross Ambulance, Aurora Sheboygan Memorial Medical Center, Saint Nicholas Hospital, the Alzheimer’s Association, Embrace Care Management, Pine Haven Christian Communities, and Sunny Ridge Rehabilitation Center. The task force works jointly with other related agencies and organizations to achieve its goals. This collaborative problem solving approach has proven to be very effective.
Dementia Task Force Community Conversation on September 12, 2018 at UW-Sheboygan
Over the past 8 months the task force has worked to evaluate, discuss, and work collaboratively to improve Sheboygan County’s response to dementia patients who are experiencing crisis. One major paradigm shift in the area of crisis response is to classify and approach these issues as medical issues rather than law enforcement issues. Changes to the process of calling for assistance will help dispatchers get the proper resources sent to assist the caller. Training regarding the specifics of these changes was created and will be presented to all Sheboygan County EMS agencies, all Law Enforcement Agencies, all Communication Center personnel and every care facility in Sheboygan County. The hope also is to eventually pass very specific and helpful information through home agencies and caregivers to families who may be dealing with crisis behavior in the home. Another tool for improvement is multidisciplinary education in crisis de-escalation approaches as well as education related to the county plan from the perspective of each of the agencies in the chain of care for these persons with dementia. This better understanding of roles and responsibilities related to caring for dementia patients in crisis will improve decision making with quicker and improved access to proper resources for help.
With the projections indicating that the number of people with dementia will increase significantly on a national, state and local level in the coming years, Sheboygan County needs to be prepared to manage that increase and the likelihood of a potential increase in related crisis situations. The Dementia Crisis Task Force of Sheboygan County is working hard to position Sheboygan County to be better prepared to meet those needs. For more information about the Task Force or the work it is performing, contact Mary Pitsch at embrace_maryp@att.net.