A Little HELP For and From Our Friends


H.E.L.P. Impact Report 

 

These days the halls of MaineGeneral are bustling with blue-smocked, yellow-buttoned HELPers busily visiting patients on 2 West as part of our new Hospital Elder Life Program (HELP). A pilot program launched in February of this year, HELP is a cost-effective method for improving care for hospitalized older adults by identifying and preventing delirium in patients age 70 and older.

Delirium, an acute, episodic onset of confusion, often presents in older patients with extended hospital stays. Various risk factors contribute to the severity and longevity of this condition; it can be subtle and difficult to diagnose but with targeted patient assessment and active preventive measures, delirium and its complicating factors can be shortened if not altogether averted.

HELP is nationally recognized as an evidence-based way to improve patient outcomes and reduce length of stay, returning elderly patients to their home of origin more quickly. MaineGeneral is the second hospital in New England to implement this program; Maine Medical Center has been using it for over a decade and is now recognized as a “Hospital of Excellence” in elder care. With these initial steps of implementation, MaineGeneral has its eye on that same status.

Patient Experience & Impact

The experience and consequences of delirium for patients and families are very real and can be difficult to understand. If a patient experiences delirium and it goes undiagnosed, the condition can worsen and potentially be masked by medications administered to treat the ailment of origin.

In addition to a decreased length of stay, preventing delirium can reduce a patient’s level of functional decline and increase their likelihood of a quicker recovery. The primary goal of the HELP Program is that patients get back to previous levels of functioning and ultimately return home.

Dr. Nathan Harmon, a geriatrician and the program’s medical director, emphasizes knowledge as the key to positive outcomes for patients at risk for delirium. “This program helps family members put a name to uncharacteristic behaviors in their loved ones,” he said. HELP allows us to educate so they understand what delirium is, how it’s assessed and treated. This program also allows us to move those conversations up in the course of care, close to the time of admission, which can be very helpful. Knowing is really empowering.”

With Maine’s aging population programs like HELP become all the more essential.

"HELP can shorten a patient's stay and decrease the likelihood of readmission; it can make the difference between a patient returning home or going to a long-term care facility"

-Amy Perez-Blaisdell-

Amy Perez-Blaisdell, the program’s elder care specialist and volunteer coordinator, has been involved in building the program at MaineGeneral since inception.

“We do a thorough cognition assessment of patients age 70 and over to see if they meet the program criteria,” she said. “We have a dedicated nurse practitioner on our team, Nancy Rushton, and we work with nursing staff on the floor; we consult with the medical director and engage the patient and family as part of the process.”

The program is free and patients have to agree to participate.

“Relatively simple measures can prevent delirium,” Perez-Blaisdell said. “Creature comforts and company have a huge impact. The three most common things we make sure our patients have are glasses — even just the ‘cheaters’ so many of us use, dentures if needed and batteries for hearing aids. Without those common items, patients may stop reading, talking and eating, which leads to malnourishment; if they can’t hear, they can’t interact, respond to providers or understand their course of care.”

Creature comforts and company — how can such simple things change a patient’s outcomes so dramatically? The essential ingredient is the human element, which is where the most crucial member of the HELP team comes into play — the volunteer force trained and deployed each day to sit and stay a while.



A Little HELP from Our Friends

The HELP program is low-budget given its reliance on dedicated, compassionate volunteers.

“This program is the right thing to do for our patients — and it’s nice to know that the right thing is also the fiscally responsible thing,” Dr. Harmon said.

Volunteers take an eight-hour training course after which they sign up to work a four-hour shift anywhere from once a week to once a month. During each shift, they visit four to five patients for 45 minutes to an hour. Volunteers are equipped with a care plan for each patient that helps them understand the patient’s condition. They engage patients around subtle assessment points such as their level of orientation to date, time and location as well as their favorite activities; they encourage them to move as appropriate to their circumstance, taking walks or leading gentle stretches for the bed-bound.

Elaine Bridge has been volunteering with the program for just over a month.

“We come in and greet patients, review the white board in their room with all their provider and pain level information. Most importantly, you just visit — get them to talk about themselves and familiar things, their kids, their pets…relate to them. Keep familiar things top of mind.”

-Elaine Bridge-

“A lot of what HELP volunteers do is intuitive,” Dr. Harmon said. “It makes sense to engage with someone and get to know them; it makes sense to sit and have meals and talk since meals are so social. Those are the things that work — it’s less about medication and those other things,” he said.



While HELP is in its infancy at MaineGeneral, the increasing need is evident, as is the benefit. Volunteers have been able to help prevent and identify inconsistencies in patient behavior, communicate any detours to nursing and medical staff and potentially allow for important interventions. When the six-month pilot ends in August, program expansion will depend primarily on volunteer capacity.

Karen Garcia, the practice coordinator, notes that in addition to the preventive aspect of this volunteer-driven program, the peace of mind it brings patients and families can’t be undervalued.

“Families know that twice a day, their loved one is being visited and engaged on a personal level — someone is getting to know their story and that matters in many ways,” she said. “It’s a kind of treatment that complements the clinical work being done. Human presence is one of the most powerful medications on the market.”

 

 

Hospital Elder Life Program (H.E.L.P.)

Nationally each year, up to half of all hospitalized elders have a decline in both mental and physical function. H.E.L.P. offers specialized care to prevent seniors from experiencing such declines while they are in our care so they can return home and back to their fulfilling lives. You can help patients at risk for these declines by making a gift to this important program.

This program really matters. H.E.L.P. is nationally recognized as an evidence-based way to improve patient outcomes. The program uses donor dollars to purchase simple patient-engagement supplies such as:

  • Eye glasses (“readers”) = $60/box of 36
  • Pocket talkers (help patients hear) = $50 each
  • Weighted activity blanket = $100 each
  • iPads = $500 each
  • Volunteer education/appreciation
  • Other needed supplies: newspaper subscriptions, puzzles, games, hearing aid batteries, etc.

With needs as basic as these, your dollars will make a big difference!

H.E.L.P. operates on a shoestring budget and is largely volunteer-driven. This team and its work would benefit greatly from $15,000 -$20,000 in donor dollars each year. Already in FY17 we’ve seen incredible kindness making a real difference. Dr. Michael and Maggie LaCombe made a multi-year commitment to support H.E.L.P., $5,000 of which will have an impact this year on many of our aging family and friends in fragile situations. We thank them for their kindness and encourage you to join them with a gift of any size!

What is delirium?

  • Delirium is a state of mental confusion that develops quickly and usually fluctuates in intensity.

What is the incidence rate of delirium?

  • for MaineGeneral Health patients age 70+ is 20 percent.
  • For the 73 patients enrolled in the HELP program pilot since Feb. 4, two developed delirium which is an incidence rate of 2.7 percent.
  • The national average ranges from 15-40 percent and MGH’s is 13 percent.

What are the most prominent risk factors?

  • Age 70+ (national guideline)
  • Hearing/vision impairment
  • Pre-existing cognitive impairment
  • Dehydration
  • Medications
  • Specific maladies such as hip fracture and urinary tract infections which lead to dehydration

MaineGeneral Health
Office of Philanthropy

Physical location
35 Medical Center Parkway
Augusta, ME  04330-8067
Phone: (207) 626-1809
philanthropy@mainegeneral.org

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Waterville, ME  04903

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