Christina Stergiou-Dayment
Chief of Programs & Clinical Operations, Alzheimer Society of Ontario
Janine Reimer
Manager of Clinical Programs & Services, Alzheimer Society of Brant, Haldimand Norfolk, Hamilton Halton
The success of the DREAM program in diverting undiagnosed or non-acute dementia patients from hospital admission underscores the need for its expansion.
The number of Canadians living with dementia is growing and will continue to do so. “In Ontario alone, over 300,000 people are currently living with some form of dementia and this number is expected to reach 2.9 million by 2050,” says Christina Stergiou-Dayment, Chief of Programs and Clinical Operations at the Alzheimer Society of Ontario.
Early detection allows for advanced care planning, which is the gateway to better outcomes and cost-effective management within the health care system. “We know that people living with dementia can be well-managed at home with appropriate community supports and that the majority of them prefer to stay there for as long as possible, where they can be surrounded by their families and preserve their quality of life,” says Stergiou-Dayment. However, doing that successfully requires robust primary care infrastructure and services that can link patients to timely diagnosis and community supports.
Better supporting dementia patients
Current gaps in primary care and people’s understanding of dementia are preventing many people living with dementia from receiving that critical early diagnosis and the supports to live well at home. They or their family members may not recognize their symptoms and those who do may not understand how to navigate the health care system to obtain a cognitive assessment, diagnosis, and home care support. Additionally, primary care providers may have limited knowledge of the community support infrastructure and limited time to conduct full investigations leading to diagnosis. “Add to that the fact that wait times to see a dementia specialist can range from one year to 18 months,” says Stergiou-Dayment.
As a result, dementia patients frequently end up in hospital emergency departments (EDs) when a crisis occurs or their care partner feels overwhelmed. From there, they may be admitted and occupy a hospital bed without needing acute care until community supports or a long-term bed are available. “These patients account for half of the alternative level of care days in Ontario with over 3,000 hospital beds being used unnecessarily on any given day,” says Stergiou-Dayment.
Introducing the new DREAM program
This is the gap that the DREAM (Dementia, Resource, Education, Advocacy, and Mentorship) program aims to fill. “The DREAM program began in 2021 at Brantford General Hospital after ED staff noticed a significant increase in the number of people with dementia coming in without a diagnosis or medical reason, other than the care partner being overwhelmed and unable to access the resources they had prior to COVID, like the adult day program,” says Janine Reimer, a registered nurse and Manager of Clinical Programs and Services at the Alzheimer Society of Brant, Haldimand Norfolk, Hamilton Halton.
Through DREAM, a staff member from the Alzheimer Society with dementia training and knowledge of community resources is embedded in the hospital ED and tasked with diverting non-acute patients living with dementia away from hospital admission. This individual finds out where patients are in their care journey and what they need, and then connects them to resources available through the local Alzheimer Society, such as care navigation, respite services, behaviour support, and social programming. Diverted patients are then able to go home with the supports they need, thereby greatly reducing the risk of repeat ED visits and admissions, improving patient outcomes, and saving health care dollars and resources.
The DREAM program also provides emergency staff with strategies and tools to help manage some of the patients’ behavioural challenges, such as music players, iPads, and various activities. “This helps keep the patients calm and reduces the need for staff to have to use sedation, medication, or restraints to manage them,” says Reimer. And it appears to be working. “At Brantford Hospital, the percentage of admission rates for someone with dementia in 2019 was 58 per cent. So far in 2024, it’s 26.7 per cent, so that’s a significant drop,” she says.
DREAM needed across Ontario
Since its inception, the DREAM program has expanded to 15 hospitals across Southwest Ontario. Given its initial success, advocates hope to see it expanded across the province. “It’s a simple solution that’s cost-effective, plus you’re ensuring the safety of individuals,” says Reimer. “With the number of Canadians with dementia who live in their own home expected to increase from 55 per cent today to 62 per cent by 2038, we need to have adequate home care and community supports available across the province,” adds Stergiou-Dayment.
People who have benefitted from the DREAM program or feel they would benefit are encouraged to engage with key decision-makers and advocate for its expansion.
To learn more about becoming a dementia advocate, visit alzheimer.ca/on/en.
This article was made possible by the support of Eisai Canada.
