New Program Revitalizes End-of-Life Care for Alzheimer's Patients

Yoga practitioners are probably familiar with the phrase Namaste, which is used to greet fellow practitioners at the end of every yoga session. When the phrase is accompanied with hands pressed together, prayer-like, and a small bow, it is an Indian equivalent of a Western handshake, but it is also more than that. It signifies a humble acknowledgement of and reverence for the spirit or spark of divinity in a fellow human being. The Namaste program, a new program for patients with End Stage Alzheimer's Disease, strives to respect the inner spirit of dementia patients facing the end of their life by utilizing the resources of family and staff within nursing homes in an innovative way. It does not call for more people or money. Instead, it requires specialized training, caring and creative staff, and a willingness to implement simple activities into dementia patients' final days that will honor their life and their death.

In a case study that the Namaste program's creator provided for an article in the January/March 2005 issue of Alzheimer's Care Quarterly, a special room in the Vermont Veterans Home in Bennington, Vermont was set aside for day programming for patients with End Stage Alzheimer's Disease. Special attention was paid to their comfort, and staff focused on clothing, grooming and hygiene, nutrition, exercise, soft music and comfortable beds and chairs. Patients' humanity was emphasized with activities that they would personally enjoy. For example, gazing out a window and listening to a tape of birds chirping was planned for a man who was an outdoors enthusiast. Staff consistently communicated with the patients with praise, conversation, and physical contact, such as hugs and massages, which did not allow isolation to occur. Finally, staff supported family members emotionally and welcomed them to share in both their loved one's life and death. Finally, when death was imminent, patients were moved into a private room, given pain medication, and surrounded by their loved ones who were fed, accommodated, and supported by staff. When death occurred, the patient was honored with mementos of their life, such as pictures and a plant. Family members and staff accompanied the patient as far as the hearse. No part of the journey was left unappreciated or unrecognized.

Programs like Namaste are important for patients with End Stage Alzheimer's Disease. While nursing homes often have special sections of their facility devoted to Alzheimer's patients and special activities planned for them, options for programming diminish as dementia increases and patients reach the end of the lives. Facilities are often too understaffed to provide the kind of personal attention that caregivers desire for their loved ones. Some experts believe that placement in a traditional nursing home may actually speed death in many patients. Alzheimer's disease is, ultimately, a fatal condition, and patients and their families have as much right to the highest quality of end-of-life care as other terminal patients. Without programs like Namaste, which focus on the whole being-mental, physical, and spiritual-nursing homes may deprive patients and their families of the support and respect they deserve.

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