The BBET program was initially developed to address two strategic imperatives: 1) to reduce the falls in the 18-bed Alzheimer’s unit, and 2) to design an Alzheimer’s care strategy that would be piloted in the unit and eventually reproduced in the new memory care facility on the St. Leonard campus.

The resulting program was a revolutionary approach that has benefited the staff, residents and families in many ways.

The Project’s Principals

The project’s advisory board spanned the industry, including representatives from St. Leonard, Wright State University, Nursing Institute of West Central Ohio, and the Alzheimer’s Association (Miami Valley Chapter), as well as family members and physicians.

A separate cross-functional project team of St. Leonard staff and management met weekly for several months to develop and implement the program. This team had a combined total of 90 years of hands-on Alzheimer care experience and was led by Dr. Govind Bharwani (Director of Nursing Ergonomics and Alzheimer Care at Nursing Institute, Wright State University, Dayton, Ohio) and his daughter Meena Bharwani (an independent consultant and a graduate of MIT and Cornell).

Focus on Fall Reduction

For the first objective, the project team drew the following conclusions based on research and observation:

• There was a higher occurrence of falls in the Alzheimer’s unit, not only because these residents are ambulatory, but also because their fall triggers were driven more by behavioral issues.
• Residents with Alzheimer’s or dementia experience challenging behaviors when their cognitive stress level increases.
• Cognitive stress may have a clinical cause (infection, hunger, pain, etc.), or a nonclinical cause (boredom, disengagement, or dissatisfaction with the environment).
• Behaviors may be aggressive and outward in nature, such as agitation, or may instead be more subtle and quiet, such as rummaging, wandering, shadowing or being passive/withdrawn.
• Each resident manifests stress differently, but each resident also has their own language to communicate how they are feeling, so the relationship with the caregiver is critical to understanding when a behavior is escalating into a fall risk or safety concern.
• The caregivers work hard and love their residents. However, their responsibilities are centered around managing crises on the unit and completing clinical tasks, and there is little of their workday remaining for quality time.

For the second objective, the team decided to focus on customized resident engagement, and they had the following goals for the new program:

• Caregivers should be able to take action right away when they see a resident becoming bored, rather than waiting for a scheduled activity.
• There should be tools available to help residents that become disengaged during a group activity.
• The interventions should be easy to initiate, and they should engage a resident without extended one-on-one assistance from the unit staff.
• The program should be accessible to families during visits.
• The tools should address the needs of both high-functioning and low-functioning residents.