Jayne Clairmont, owner and operator of English Rose Suites near Minneapolis, has worked with residents who have memory loss for decades and has developed her own ideas of what quality care for this population requires. “It’s been many years of making tons of mistakes over your career path to figure out how to do excellent dementia care,” she says.

 

Her views today coincide remarkably well with those espoused by G. Allen Power, MD, author of “Dementia Beyond Drugs,” and Jonathan Evans, MD, president-elect of the American Medical Directors Association (see main story).

 

Over the years, she has consistently scaled down the size of the residences to facilitate creating a real homelike environment. Today, she operates five “facilities” that are actually ordinary residential family homes in upscale neighborhoods around Minneapolis, each home to six people with dementia or other memory problems.

 

During the day, two staff members at each home provide assistance, perform caregiving activities, and keep residents active and safe. At night, one staff member is in the home in case a resident has a need.

To help create long-lasting relationships between residents and staff—relationships that the residents can count on—Clairmont provides the tools and training that staff need to excel and find satisfaction in the work they do and provides good pay and benefits so that economically these are jobs that staff want to keep.

 

As a result, “residents can have the same relationships for a long time. That creates comfort and joy for the resident,” she says.

 

But the most basic key to excellent dementia care, she says, is having leadership that “gets it.”

“One element that’s absolutely critical for great care to happen is great leadership,” says Clairmont. “If your leadership wanes, your care wanes. If your leadership is committed to a learning environment and is supportive of employees, shows them respect, and honors them,” the quality of care goes way up, she says.

If a member of the direct care staff falls short, that can likely be corrected with more training. But if leadership isn’t making the mark—and Clairmont can tell just by a glance at the medication administration record whether that’s happening, if psychotropic usage is high—the only sure remedy is to replace that person, she says. They either buy into the philosophy of care or they don’t, and the residents shouldn’t suffer while an owner works to alter a leader’s mindset, she says.

An interesting side note is that Clairmont is so focused on supporting her staff and centering their focus on caring for and pleasing residents rather than pleasing her, that she has inverted the traditional organizational chart to place herself at the very bottom and the residents at the top. That’s a perfect snapshot of her philosophy of how to provide excellent care.

The “learning environment” that she mentions is also critical and goes beyond the traditional initial staff training and occasional in-houses.

Clairmont believes quality care hinges on having staff that are well-trained; empathetic; empowered; supported with necessary skills and tools, clear expectations, and positive reinforcement; and held accountable for their decisions.

Before Clairmont even hires a new staff member, she starts teaching the individual.

During interviews, she tells candidates in great detail everything their jobs require. Those who are still interested and appear to have the necessary personality traits shadow a staff member, still without being hired, to see with their own eyes what the work entails, so Clairmont can see how quickly they can learn the job.

Once hired, new staff are given a very detailed job description that’s several pages long, and their evaluations are tied to how well they adhere to it.

“The state of Minnesota told us it was the best job description they’d seen in the entire state,” Clairmont says proudly.

Clairmont urges providers to give dementia caregivers plenty of training. “Our training program for each staff member before they even touch a resident is 56 hours of classroom teaching,” she says.

After the 56 hours of classroom learning, each new staff member works with a mentor on the floor, who pays close attention to what kinds of questions the new hire asks to identify whether further training in certain areas is needed.

“We pay very close attention to a new employee for the first 90 days,” says Clairmont, “and then we do a re-tooling, bringing them back into the classroom and going back over every concept to make sure everyone’s thoroughly understanding. We do a gap analysis to find out what we can improve on in our training. Then we do monthly training throughout the year. Then we have competency training, which is a certain number of hours spent learning further skills. Because we’re a small organization—we have less than 16 employees—we can keep very close tabs on staff.”

If a nurse or Clairmont notices that a direct caregiver seems a little unsure in certain situations, Clairmont will bring the worker in for one-on-one training to resolve the issue.

Clairmont holds a month-long “summit” every year in which all staff are involved and encouraged to prepare for it by coming up with ideas that will make life happier and more meaningful for the residents they’ve come to know so well. Learning doesn’t only happen in classrooms; some of the best learning takes place between peers.

And Clairmont practices what she preaches. Along with keeping up with current literature, she tours facilities wherever she goes, looking for things the facility does or doesn’t do that she can learn from. She networks with the most brilliant minds in dementia care and has made friends of many of them. She speaks on the topic of her passion whenever she gets the chance, meeting more people, learning more.

“You never stop,” she says. “You’re always working to learn how to improve, how to create excellence. I’ve been working with doctors at the Mayo Clinic in Rochester, Minn., on research projects for many years.”

That continual learning mindset applies to the residents, too.

Clairmont agrees with Power and Evans that an in-depth understanding of each resident is the best way to both manage and prevent residents’ distress, which may otherwise be expressed in ways that are disruptive or disturbing to other people.

“It starts with understanding, truly knowing, who the resident was and still is,” she says, adding that English Rose Suites staff members develop a lengthy life story for each individual upon

admission.

“We go through a huge amount of vetting of that information from families as part of our assessment,” Clairmont says. They place that so early in the process because “we use that every day in our approach to [each resident’s] care,” she says.

Just as she strives to never stop learning, Clairmont never seems to stop teaching. As part of her effort to make families feel welcome and at ease—along with little touches like bringing them a glass of iced tea and some cookies for their visit—she offers to teach them in private how they can continue to connect well with their loved one with dementia, even as the disease progresses.

Something else that Clairmont does that she thinks makes a big difference is she gives her staff permission to love the residents. “They have a fear factor. The state says you cannot touch them in an inappropriate way, and you get it through your nurse’s training where you have to create a space between you and your patients,” she says.

“When you give staff permission to love, you give them permission to hug a resident, to kiss them on the hand or cheek—those kinds of demonstrative pieces that families of course want you to do.”

And that, of course, is what happens when a person is living in their own home with their own family. A family member who’s down or who’s had a success gets hugged; you might hold hands with your grandmother on a walk. Many studies have shown that caring physical touch is extremely important to humans’ well-being. “It’s taking a very simple thing and bringing it right into your philosophy of care,” says Clairmont.