By Amelia Schafer, Vice President of Programs, Alzheimer’s Association of Colorado
News reports documenting the eviction of some challenging residents from nursing homes point up an issue that has been vexing health care professionals, residents and families for some time: how to adapt health care practices to an aging society that is showing an increasing incidence of Alzheimer’s disease and other dementias.
Nursing home staff are facing the same challenge that we are seeing with the police, first responders, ambulance crews and emergency room personnel. The traditional training given to these healthcare professionals, like that given to first or emergency responders, is not one-size-fits-all. Persons with Alzheimer’s and other dementias may not respond to these situations in the way one expects, which can lead to conflicts and, unfortunately, residents in need being removed from nursing homes.
Recent press reports have outlined how thinly staffed nursing homes have, on occasion, involuntarily discharged or evicted individuals who are seen as labor-intensive or whose dementia has led to behavior considered a risk to others.
The Alzheimer’s Association has funded research on these “behavioral and psychotic symptoms of dementia” or BPSD, and found that more than 90 percent of people with dementia develop at least one BPSD, which may include depression, hallucinations, delusions, aggression, agitation and wandering.
Since more than five million Americans are living with Alzheimer’s – a number expected to top 16 million by 2050 – cases of BPSD will increase correspondingly. Thus, by 2050 the number of Americans exhibiting BPSD could near 14.4 million, straining the nursing home industry with both sheer numbers and an exploding incidence of dementia-related behaviors.
The Alzheimer’s Association of Colorado (AAC) has been focused on this issue, providing specialized training to adult day care centers, nursing homes, assisted living facilities, in-home care businesses and hospices. The Leaders in Dementia Care curriculum helps professional staff better understand Alzheimer’s disease and other dementias, learn communications techniques and approaches to interaction, and help develop non-pharmaceutical interventions to reduce agitation among persons receiving care.
More than 80 care communities around the state have chosen to go above and beyond – both in staff training as well as client care – by participating in Leaders in Dementia Care, but that’s just a fraction of the senior care organizations in the state. There is still a substantial void to be filled.
The AAC is hoping to increase the progress against this challenge through a grant to develop “Person-Centered Dementia Care: Reducing Anxiety and Agitation to Improve Well-Being.” If approved, the grant would enable AAC to provide at no cost customized training and consultation to staff as well as families of clients at six skilled care communities in the Denver area on a trial basis.
By promoting the utilization of a consistent, non-pharmacological process to address behaviors such as agitation and anxiety associated with Alzheimer’s and other dementias, it is expected that the program will further improve the well-being of residents as well as care community staff.
Like the Leaders in Dementia Care program, the goal here is to help nursing home staff recognize common triggers for behaviors associated with dementia. If we can eliminate the triggers, in many cases we can reduce or eliminate the behaviors. By doing that, we could help these individuals with dementia stay in their nursing homes and, hopefully, reduce the use of antipsychotic medications that are used to manage the “difficult” patients.
A Center for Medicare & Medicaid Services (CMS) report found that almost 40 percent of nursing home patients with signs of dementia were receiving antipsychotic drugs at some point in 2010, even though there was no diagnosis of psychosis.
And the Food and Drug Administration (FDA) has found that treatment of behavioral disorders in elderly persons with dementia by antipsychotic medications was associated with increased mortality.
“Managing dementia without relying on medication can help improve the quality of life for these residents,” said Dr. Patrick Conway, CMS chief medical officer and director of clinical standards and quality.
We frequently hear from nursing home staff that they are frustrated by the inability to change residents’ behaviors at their care communities. By helping nursing home personnel recognize these behavioral triggers, we believe it will give staff better skills and techniques to prevent or manage the behaviors. It can lead to modifications in routines, practices and sometimes even the environments in which care is provided. Ultimately, it can enhance the relationships between staff and residents and improve the satisfaction of both parties.