A surge in memory care construction has pushed many senior housing operators to innovate their care techniques as a way to remain competitive in the growing marketplace.
Some are looking at innovative community designs that make it easier for residents to navigate the facility, or computer-based tech programs that are used as a memory care intervention technique. Still, others are using residents’ life stories to provide better care.
But few providers have programs focused specifically on dementia medications —or the lack thereof.
Weaning Residents Off Medications
Ecumen, which operates more than 20 senior living communities, most of which are in Minnesota, has developed a dementia care program that weans its nursing home residents off antipsychotic medications — often used to treat behavioral and psychological symptoms in dementia. The goal is to reduce dependency on and usage of these medications and, in some cases, residents are weaned off of the drugs completely.
The program, called Awakenings, started as a pilot in 2009, but soon after rolled out into all 15 of Ecumen’s nursing homes in 2010 and is now in the early stages of expanding into assisted living sites and home care. And it’s saving more than $2.4 million a year in drug costs.
Awakenings is part of a larger nationwide trend pushing the reduction of unnecessary antipsychotic medication use. In 2012, the Centers for Medicare & Medicaid Services (CMS), in partnership with other agencies and organizations, launched a federal initiative aimed at reducing the use of these meds in nursing homes.
The initiative called for a 15% reduction in the use of antipsychotics by nursing home patients by the end of 2012. Nationally, there has been a 17.1% reduction since 2011, when nearly 24% of nursing home residents were receiving antipsychotic meds.
And the numbers are even higher for dementia care patients — nearly 40% of nursing home residents with signs of dementia were receiving antipsychotic drugs at some point in 2010, even though there was no diagnosis of psychosis, according to CMS.
But through Awakenings, Ecumen seeks to improve quality of life for residents, reduce the use of unnecessary medications and facilitate a culture change in dementia care, program directors say.
“This is a different way of providing care for our elders that restores their dignity and offers them a way to express themselves as they age,” says Janelle Meyers, Ecumen programming director.
Saving Up To $4.6 Million Per Year
Between June 30, 2011 to June 30, 2012, Ecumen staff reported 800 medication decreases or discontinuations, organization data shows. Atypical antipsychotics, which have mood stabilizing properties, have an average monthly prescription cost of $250 to $475 per month, but with 800 reductions in these meds, Ecumen is saving between $200,000 and $380,000 a month for the residents and Medicaid/Medicare. This translates to between $2.4 million and $4.6 million per year.
“The most common adverse effect of the medications is death,” says Maria Reyes, a registered nurse and the Awakenings project director. “[Residents] aren’t able to engage with their environment because they’re lethargic. They aren’t walking or talking as much. It really does affect the whole client’s ability to interact with their environment.
“We saw that by taking them off these medications they just became more alive,” she says.
Antipsychotic medications are used as a short-term treatment to control psychotic symptoms, such as hallucinations, delusions or aggression. They are commonly used to treat people with Alzheimer’s disease and vascular or mixed dementia.
Instead of doling out medications, though, Ecumen emphasizes relationship-centered care and behavioral interventions as ways to treat its memory care residents.
Providing a Different Type of Treatment
The provider works with families, doctors and care staff to replace traditional drug therapies with individualized techniques that reduce anxiety and difficult behaviors while improving quality of life, the organization says.
Ecumen uses techniques such as pet therapy, aromatherapy, massage activities and music sessions to help redirect and prevent unwanted behavior in residents.
“When we know our clients we can intervene and/or prevent out of character behaviors effectively,” Reyes says. “The best diversion for an undesired behavior is what the client finds of interest.”
Reyes provided an example of exactly how this works. She says she worked with a resident some time ago who would yell and cry out a lot. The community’s staff didn’t have the ability to gather information about the resident or her hobbies and interests because she was no longer able to tell them and her family was not involved.
Caregivers tried to identify the source of her behavior, and had other interventions in place, such as reminiscing and hand massaging, but nothing worked — until the community had an Elvis impersonator visit to do a music show.
When the resident heard the music, Reyes says her yelling and crying out quieted, and she smiled. The staff quickly realized this was the intervention they needed to help calm her when she vocalized her distress.
“We provided this client with headsets and Elvis music and from that day on, when she began to vocalize distress, and we had eliminated other possible factors, that Elvis music always did the trick,” Reyes says. “Had we known she loved Elvis from the start, we would have been able to intervene with something we knew would bring her joy. This is the power of knowing our clients.”
Along with this focus on relationship-driven care, Ecumen also helps residents become more physically engaged through its restorative program. For example, a volleyball balloon toss helps patients with dementia exercise their arms and establish more upper body strength.
“We are seeing people wake up from their drug-induced state,” Reyes says. “We’re making our restorative process fun for them; we call it an activity but it’s also therapeutic.”
Facilitating a Culture Change in Long-Term Care
A culture change, the directors say, comes from an emphasis not on pharmaceutical treatments, but on how staff can foster better relationships with residents through the community’s individualized techniques and restorative program.
“The culture shift really comes about from not utilizing medication first as an intervention, but rather trying other approaches first such as relationship-based, individual likes, dislikes,” Reyes says. “The key word here is first. We may have to use medications, but we want to see if alternatives work before we do so.”
Training staff to use relationship-centered care helps them recognize what may cause a resident distress, and then they can divert that attention to something else more positive, Meyers says.
“Knowing the details of a person’s life really helps to reduce the unwanted behaviors in a person with dementia, which then, in turn, makes it less necessary to use the medications to control that,” she says.
Ecumen recently received a $265,000 grant from the Minnesota Department of Human Services to fund a one-year pilot program that will help expand Awakenings into 14 of the provider’s 33 assisted living sites.
To push the program into home care, Ecumen will focus on educating families, in-home caregivers and the community on the risks and benefits of medication use and exploring alternative ways to manage and prevent behaviors related to dementia.
“I think it’s about doing the right thing,” Meyers says. “Culture change and any change is difficult, but it doesn’t mean it’s bad. People need to learn to do things in a new way and that’s our challenge, not just at Ecumen, but as a culture of long-term care — that we’re looking at ways to do things better to serve our clients.”
Written by Emily Study