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Continuous Quality Improvement

Abe’s Garden Memory Support, with the help of Vanderbilt Center for Quality Aging (VCQA), continually assesses the effectiveness of programming, resident well-being, staffing, care, and environment. Systems are continuously identified, assessed, improved as needed, and shared as part of our mission to establish best practices and elevate the quality of dementia care on our campus and throughout the nation. Outcome data is available to researchers and other providers of residential and day programs to foster elevated dementia care.

The quality improvement team conducts direct observations of staff/resident interactions during activities of daily living (ADL), meals, and invitations to engagement opportunities. The team observes and evaluates every care partner during morning or evening ADL’s on the following 14 areas of care:

  1. Gathering needed supplies for ADL
  2. Knocking on the resident’s door
  3. Washing or sanitizing hands before and after care
  4. Putting on gloves before care is provided
  5. Providing introductions
  6. Appropriately placing dirty linens and trash
  7. Providing residents with appropriate assistive devices (hearing aid, glasses, dentures)
  8. Leaving room in acceptable condition
  9. Completing all necessary ADL’s (dental, dressing, makeup removal, etc.)
  10. Providing meaningful discussion
  11. Making sure resident does as much self-care as possible
  12. Orienting resident to care that is about to be provided
  13. Respecting resident’s dignity and privacy by keeping them covered as much as possible during relevant ADL’s
  14. Giving resident choice throughout ADL care

During weekly huddles, the quality improvement team works with the clinical team to identify items not consistently performed or occurring to the desired standard (i.e. person-centered care, engagement, meal assistance, and proper transferring). They then train direct care staff on the preferred approach and collects relevant data on improvements. Examples include encouraging residents to brush their own teeth, or using a towel to respect the dignity of the resident and keep them warm during ADL’s.

Periodically, the quality improvement team quantifies the following data:

  • Number of residents who are invited and attend two or more activities a day
  • Number of residents out of their suite during high engagement time periods
  • Number of falls
  • How frequently (percentage) hourly nighttime checks occur
  • Number of residents with significant weight loss
  • Percentage of residents who receive more than five minutes of meal assistance, eat more than 50% of their meal, and/or are offered an alternative if they do not eat 50% of their meal
  • Percentage of residents offered snacks
  • ADL quality and time required to perform person centered care with and without a shower/bath
  • ADL documentation compliance
  • Observation data that correlates high and low levels of engagement during group activities and the following variables:
    • Type of activity
    • Size of group
    • Location of group
    • Cognitive function levels of participants

Levels of engagement and affect (looking for extremes in both positive and negative affect) during activities are used as a program evaluation. Levels of engagement are evaluated employing Hearthstone Institute developed measurement techniques, with results used to improve engagement programming.  Engagement therapists systematically record assessments of resident participation during engagement groups.

Outcomes measured based on Hearthstone Institute training include:

  • Resident engagement and resident affect during activities (observational data including enjoyment and stress)
  • Staff/resident interactions during ADL care (observational data)
  • Empathic staff behaviors while interacting with residents (observational data)

A recent study conducted by Abe’s Garden Memory Support in partnership with Hearthstone Institute researchers identified the most successful “invitations” staff made to residents, success being greater resident involvement in activities.

Additionally, in an effort to share findings and elevate dementia care, Chris Coelho, Andrew Sandler, PhD, and VCQA’s John Schnelle, PhD, and Sandra Simmons, PhD, co-authored two published research papers:


Helen Crow, Oklahoma chapter, Alzheimer’s Association
“I'm so impressed to see all of the things you are doing at Abe's Garden®. Every little detail is intentional, always keeping the residents and the disease in mind.”
Donna Finto-Burks, Abe’s Garden Senior Director of Clinical Care
“Team members, residents, and families collaborate regarding the constantly evolving Abe’s Garden® model. This coincides with a dedication to providing all residents engagement opportunities that align with their likes and needs, which is also
Kenna Niles, an AGCG participant’s wife
“As [my husband] has transitioned through the different stages of his disease, the [Abe’s Garden®] Community Group has made the single biggest impact. It has helped him to see that he can still contribute, make friends and enjoy himself.”