1. Susan Gilster PhD The Physician and Pharmacist as Teachers in a Specialized Alzheimer’s Facility: 25 Years of Experience Susan Gilster PhD Susang@hcmg.com susang@careleadership.com www.alois.com www.careleadership.com 513-673-1239

2. Susan Gilster PhD

3. Alois Alzheimer Center May 1987, first AD facility in the US May 1987, first AD facility in the US Continuum of care (Assisted-Nursing) Continuum of care (Assisted-Nursing) Day and respite-to support care in home Day and respite-to support care in home 5 self contained households/units 5 self contained households/units Gardens-designed for stage of disease Gardens-designed for stage of disease Redefined success-they would not get better and go home Redefined success-they would not get better and go home Importance of belonging and fun Importance of belonging and fun

4. Susan Gilster PhD

8. Educational Mission 1986-HCP lacked knowledge of dementia 1986-HCP lacked knowledge of dementia Impact of AD found in the “experience” Impact of AD found in the “experience” Established Alois educational mission Established Alois educational mission Content of Affiliation Agreement Content of Affiliation Agreement Defining roles and responsibilities Defining roles and responsibilities Creating environment for success Creating environment for success Benefits-residents, families, staff, students Benefits-residents, families, staff, students Promoting positive student experience Promoting positive student experience Facilitating mutually beneficial research Facilitating mutually beneficial research

9. Susan Gilster PhD Alois Alzheimer Center 25 years later-affiliated with several universities in the region-University of Cincinnati 25 years later-affiliated with several universities in the region-University of Cincinnati Educational setting for students Educational setting for students 150-200 students year-national and international 150-200 students year-national and international Physicians, pharmacists, nurses, architectural students, allied health Physicians, pharmacists, nurses, architectural students, allied health Research Research Clinical-what can we do to improve care Clinical-what can we do to improve care Drug research-experimental and symptom Drug research-experimental and symptom

10. Susan Gilster PhD Alois-Non Traditional LTC Founders not LTC Founders not LTC Established Center under a service model Established Center under a service model Service oriented-resident, family, staff, students, community Service oriented-resident, family, staff, students, community Individualized care Individualized care Students experience service, importance of respect, team work, families and fun Students experience service, importance of respect, team work, families and fun

11. Susan Gilster PhD S.E.R.V.I.C.E Model S=Service-Serving others-why we exist-to serve S=Service-Serving others-why we exist-to serve E=Orientation, job preparation, ongoing education, expectations for performance E=Orientation, job preparation, ongoing education, expectations for performance R=Respect as a foundation for all R=Respect as a foundation for all V=Vision-shared, a destination, direction V=Vision-shared, a destination, direction I=Inclusion-all have a voice in the organization I=Inclusion-all have a voice in the organization C=Communication, routine, open, ongoing C=Communication, routine, open, ongoing E=Enrichment-self awareness, growing, learning, caring and nurturing of all E=Enrichment-self awareness, growing, learning, caring and nurturing of all

12. Susan Gilster PhD

13. Student Experience: Residential normal living environments

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18. Students experience: Therapeutic nature of outdoor gardens – designed for specific population

19. Susan Gilster PhD

22. Students experience: The importance of activities, events, outtings and the inclusion of families on quality of life

23. Susan Gilster PhD

27. Students experience: Students experience: Welcoming environment-all have preceptor Normal living environments 5 households differ Individualized - ”person- centered” Outdoor environments differ Impact of atmosphere and stimulation on behavior Normal, fun activities 185 trips out each year Integration of families Impact of consistent staffing Importance of training and support

28. Susan Gilster PhD Student evaluations Physicians: Physicians: Exposure to real life experience of patients with different types of dementia Exposure to real life experience of patients with different types of dementia Interdisciplinary approach to care-best care Interdisciplinary approach to care-best care Face to face interactions with the residents and staff Face to face interactions with the residents and staff Discussions with families-more insight Discussions with families-more insight Impact of educated and supported staff in all departments Impact of educated and supported staff in all departments So much you could do So much you could do

29. Susan Gilster PhD

30. Student evaluations Pharmacists, nurses and others: Pharmacists, nurses and others: Interdisciplinary interactions centered on improving the life for the patient Interdisciplinary interactions centered on improving the life for the patient First hand experience, face to face w patients First hand experience, face to face w patients Team approach best interest of the patient Team approach best interest of the patient Helped me learn more about AD and needs Helped me learn more about AD and needs Staff explained everything-individual patient needs, disease process and family needs Staff explained everything-individual patient needs, disease process and family needs Patients were delightful and made me want to extend my work in this field Patients were delightful and made me want to extend my work in this field

31. Susan Gilster PhD Students experience: Effectiveness of multidisciplinary approach Effectiveness of multidisciplinary approach How to minimize hospitalization: How to minimize hospitalization: Alois rate 3 years <1-5% Alois rate 3 years <1-5% Medication is not the only answer: ‘ Medication is not the only answer: ‘ Alois per resident half of national average Alois per resident half of national average Impact of consistent, nurtured staff: Impact of consistent, nurtured staff: Alois high staff retention – 90% Alois high staff retention – 90% How to impact family satisfaction: How to impact family satisfaction: Alois satisfaction 3.94 out of perfect 4.0 Alois satisfaction 3.94 out of perfect 4.0

32. Susan Gilster PhD Conclusion Evaluations reinforce that physicians, nurses, pharmacists, even those with extensive training are not fully in touch with the impact of AD until they actually experience it Evaluations reinforce that physicians, nurses, pharmacists, even those with extensive training are not fully in touch with the impact of AD until they actually experience it Offers greater sensitivity and ability to work effectively with persons with AD and families - their own practice Offers greater sensitivity and ability to work effectively with persons with AD and families - their own practice Understand much can be done to improve the daily life of residents and manage challenges Understand much can be done to improve the daily life of residents and manage challenges Experience the impact of a vision and service oriented experienced, trained and consistent staff Experience the impact of a vision and service oriented experienced, trained and consistent staff