According to a press release from the national
Department of Health and Human Services last March, the CMS (Centers for
Medicare and Medicaid Services) launched a new initiative aimed at improving
behavioral health and safeguarding nursing home residents from unnecessary
anti-psychotic drug use. As part of the initiative, CMS is developing a national
action plan that will use a multidimensional approach including public
reporting, raising public awareness, regulatory oversight, technical
assistance/training and research. The action plan will be targeted at enhancing
person centered care for nursing home residents, particularly those with
dementia-related behaviors. This
aggressive goal aims at reducing anti-psychotic drug use by 15% in nursing
homes by the end of the year.
Medications,
when used appropriately, help promote the resident’s highest practicable
mental, physical, and psychosocial well-being. Inappropriate use of medications
can compromise a resident’s well-being and even cause death. Initially this
goal will focus on medications that are used to control behaviors such as
anti-psychotic drugs. Working on this goal will provide the nursing home staff
with alternative non-pharmacological interventions for residents who otherwise
would be treated with anti-psychotic medications. The result will be better
health for residents.
When I was a part of the team that opened the first secured
Alzheimer’s unit in Baton Rouge in a nursing home over 20 years ago, I
personally witnessed the use of anti-psychotic drugs, the most popular being
Haldol. At the time, this medication
seemed to be the only answer and a quick fix in combating aggressive behaviors
among the residents with Alzheimer’s or dementia. Observing the medication’s use among a wide
variety of my residents was a tough pill for me to swallow, (no pun intended),
because I saw the effects of Haldol on them---the sedation made them oblivious
to their surroundings, unresponsive, and
oftentimes did more harm than good. I
remember thinking at the time, What kind of quality of life can these
residents have if this medication has such an effect on them? I detested the use of this drug (inasmuch as
I understood why it was used) just as much as I did physical restraints (which
are no longer used). Moreover, I felt,
as many do now, that the causes of elevated behaviors are mostly due to unmet
needs and environmental triggers. Once
we figure out what those are, we understand the root of the behaviors and can
deal with them accordingly, without anti-psychotic medications.
Dr. Alan Power, author of “Dementia Beyond Drugs” revealed a study in his book that of the 2.5 million Medicare
recipients who spent time in nursing homes in 2000-2001, 27.6% of those residents were prescribed
anti-psychotic drugs, while 17% exceeded recommended dosages. (Briesacher BA,
etal (2005). Further, at best, fewer
than one in five residents show improvement when prescribed these medications.
(Karlawish, J. (2006) NEJM 355 (15) 1604-1606.
The risk of anti-psychotic drugs is of concern, too. In addition to sedation, residents can
experience falls, weight gain, constipation, elevated blood sugar, and even an
increase in mortality rate.
Dr. Power promotes and encourages a culture change, with the
primary goal to create well-being among the residents. “Each person has a unique path and
individual needs,” Power proclaims. “Our goal is to grow meaningful
relationships throughout the care environment.”
Hopefully, the goals of the new CMS initiative can be met
and the use of anti-psychotic drugs in nursing homes will be curbed. It’s a small step in transforming the care
environment for nursing home residents.
It will take many larger steps to bring culture change, awareness, and
education to provide staff with alternative
non-pharmacological interventions.
I am proud that our organization will support this new CMS
initiative, and I will personally be on the lead team with LEADER (Louisiana Enhancing Aging with Dignity through Empowerment and
Respect) in meeting the goals on this most important
project.
By Dana Territo, Director of Services
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