Program Proves Individualized Care Can Replace Antipsychotics For Treating Dementia

by, Kavan Peterson, Editor, ChangingAging.org

As federal regulators begin efforts to halt unnecessary use of antipsychotic drugs in nursing homes, a member of The Eden Alternative in New Jersey has completed a cutting edge program that successfully weaned residents with dementia off these medications.

Working closely with the residents’ physicians,  Buckingham at Norwood Care & Rehabilitation Center directors of nursing Rosanna Luna, RN, and Rowena Sebastian, RN, pioneered a program to find  instances where antipsychotic drugs were not deemed medically necessary and to replace them with alternative therapies.

For example, one of the first residents in the trial group was a former judge who had been wandering at night and combative with staff when redirected back to bed. After caregivers discussed his former routine with family members, it was understood that he had a habit of staying up late to review law cases and did a lot of reading at night. The night staff began reading newspaper articles to him about recent court cases, which prompted him to recall cases he had worked on. He was also able to partake in the midnight snack program, which had been especially created for the project.

The personalization of his care had a calming effect that enriched his life and negated the need for antipsychotic drugs, said Buckingham Administrator Helaine Ledany.

“We’ve been very successful in reducing antipsychotic medication use,’’ Ledany said. “Our interdisciplinary teams have created better, individualized care plans and interventions to anticipate residents’ needs instead of relying on drugs to address challenging or difficult behaviors.’’

I the first year of the program, Buckingham was able to reduce the number of residents on antipyschotics from 13 percent to 5 percent. According to officials of the U.S. Centers for Medicare & Medicaid Services, 40 percent of nursing home residents with dementia nationwide have been receiving antipsychotic sedatives, though they didn’t have conditions that should require use of the drugs. The Center announced that by the end of this year, it hopes to decrease nursing home reliance on the drugs by training staff to employ different methods of responding to dementia residents.

“Medications can be used to calm down elders with cognitive impairment, which may contradict efforts to enhance their quality of life,” said Emi Kiyota, an internationally-recognized environmental gerontologist, who works as a consultant for Windsor Healthcare, a family-owned company with nine New Jersey nursing homes including Buckingham. “Medication can be helpful for elders; however, it should not be used for staff convenience.”

Buckingham has adopted a different approach which is part of its culture change efforts to deinstitutionalize elder care, focusing on each resident’s unique temperament and personal history rather than adopting a one-size-fits all approach. The approach was based on the framework laid out by  Allen Power, M.D., in his groundbreaking seminar and book “Dementia Beyond Drugs: Changing the Culture of Care.”

Their effort began after Luna and Sebastian attended a culture change conference in 2009. They first sought the “buy-in” from staff who would be on the front line working with the residents and then began extensive education to identify, assess and manage residents whose antipsychotic medications could be reduced and ultimately eliminated.

“All departments worked with the residents’ physicians and each other to help the residents live to their fullest potential without antipsychotic medications,” said Batsheva Katz, vice president for quality initiatives at Windsor Healthcare.

The project has proved so successful that Buckingham was chosen by Power to be included in his webinars on how to train caregivers throughout the U.S. to eliminate unnecessary use of antipsychotic drugs. The Pioneer Network, which advocates moving away from institutional provider-driven models to more humane consumer-driven models that embrace flexibility and self-determination, frequently cites Buckingham as a model of care.

Buckingham, which was selected by U.S. News and World Report as one of the best nursing homes in the nation, is a registered facility under The Eden Alternative, a pioneering movement in “person-centered eldercare.’’ A global nonprofit, The Eden Alternative is dedicated to creating environments that alleviate the loneliness, boredom and helplessness that can be so pervasive in some nursing homes.