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Dementia care in nursing homes
Nursing home visitors may see it as soon as they walk in the front door. Residents sit listlessly in wheelchairs or doze off in front of TVs, unable to communicate with others or show much interest in anything around them. They’re in their own worlds.
This disengagement too often stems partially from the misuse of antipsychotic drugs to address the troublesome behavior that sometimes comes with dementia -- the aggressiveness toward others, the resistance to care, the wandering at night.
A recent Medicare study found that 40 percent of nursing home residents with dementia were receiving antipsychotic drugs despite the fact that they hadn’t been diagnosed with psychosis. Seventeen percent were given daily doses that exceeded recommended levels.
Especially in nursing homes where the staff may feel overworked, giving powerful sedatives to unruly residents becomes an easy alternative to more time-consuming responses, like personally calming dementia patients and turning their attention elsewhere.
Not only are the antipsychotics needlessly drugging some nursing home residents, they also can have serious, even life-threatening side effects. The Food and Drug Administration warns that the medications can increase the risk of death for elderly patients with dementia.
Calling the problem a significant challenge, government regulators and industry officials are banding together to curb the inappropriate use of chemical restraints in nursing homes, just as they successfully joined years ago to curb the overuse of physical restraints.
The Centers for Medicare & Medicaid Services has launched the Partnership to Improve Dementia Care, a coalition of regulators, nursing homes, advocacy groups, and caregivers that will safeguard nursing home residents from unwarranted antipsychotic drugs.
The partnership represents an unprecedented marshaling of public and private resources toward this issue. Its aim is to reduce the use of antipsychotics by 15 percent by year’s end and by larger percentages in future years until it eliminates the problem.
Antipsychotic drugs may be deemed appropriate in some circumstances, based on clinical assessments. But they shouldn’t always be the first option for nursing home staff trying to calm residents. Nor should their use last any longer than medically necessary.
The new national initiative will raise public awareness of antipsychotics’ misuse, improve regulatory oversight, and, most important of all, train nursing home workers how to care for aggressive or agitated patients without resorting to drugs.
CMS will post data on each nursing home’s use of antipsychotic drugs starting in July on its Nursing Home Compare website -- medicare.gov/nhcompare -- and will regularly update the information.
Nursing Home Compare is a useful tool for families researching long-term care options. The new statistics on antipsychotics’ use are likely to prompt families to ask about medication practices as they visit nursing homes they are considering for parents or other relatives.
Medicare also is improving the training of nursing home inspectors so they can better identify inappropriate medication use. As a long-standing condition of receiving Medicare payments, nursing homes must comply with federal rules against unnecessary drug use.
Most significantly, CMS is working with associations of nursing homes, physicians, nurses, pharmacists, and others to make them more aware of non-drug alternatives. As just one example, “Hand in Hand,” a DVD to help train nursing assistants, will be distributed this summer.
Some nursing homes are already teaching their caregivers a more hands-on approach to reassuring dementia patients -- one that includes individualized activities, like exercises or walks outdoor. The coalition’s goal is to spread that message throughout the industry.
One in eight older Americans suffers from dementia. As the new public-private partnership understands, finding better ways to care for them without relying on antipsychotic drugs will improve the quality of life for hundreds of thousands of nursing home residents.
Bob Moos is the public affairs specialist with the Centers for Medicare and Medicaid Services, Region 6.
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