Abstract
The Houston Alliance to Address Dementia (HAAD), funded by a three-year grant from the Administration for Community Living, has been created to construct a dementia capable system of home and community based services and supports in Houston/Harris County, Texas. Prior to HAAD, few formal linkages existed between Harris County health and human service organizations and dementia-capable resources. HAAD has filled that gap by creating a systematic approach to identifying individuals with or at risk of dementia and their care partners and appropriately connecting them to various resources that can promote their safe and independent living in the community. This poster will describe and evaluate the partnership between HAAD and the Houston Methodist Hospital System, an eight-hospital system serving greater Houston, which serves as a good case study for this systems change. Five hospitals participated in the HAAD systems change protocols. Representatives from the social services teams participated in baseline assessments and focus groups on their hospital's dementia capability. This data informed education programs designed to address knowledge gaps within the hospitals. 16 professional trainings including 1 webinar were delivered, reaching 357 providers in the Methodist system. The Methodist team working with the HAAD project devised an easy referral process for busy healthcare providers. Knowing that elders underutilize community resources, providers struggle to stay abreast of available community resources, and patients may be ill-equipped to initiate contact with community resources, secure email referrals were put in place for Methodist providers to connect to community resources and establish a warm handoff of information. Based on location and need level, clients with cognitive impairment and/or their caregivers are triaged to either the care consultant at the Alzheimer's Association or the HAAD dementia specific case manager or caregiver support specialist. 228 PWD and caregivers have been referred and received assistance through this project over the course of twelve months. Key lessons learned: all steps must be in the natural workflow for referrals to occur. Introductory meetings helped to increase referrals and communication. Availability of resources must be advertised repeatedly. Flexibility in programs to meet needs of the hospital community were critical in success.
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