Experts say full staff engagement, training crucial to improving dementia care

Dementia-related behavioral disturbances are one of the top five reasons nursing home residents are readmitted to hospitals, according to experts affiliated with the Centers for Medicare & Medicaid Services.

Specialized training could help staff better handle disturbances, and decrease the need for antipsychotics, according to those speaking on an MLN Connects conference call regarding the National Partnership to Improve Dementia Care and Quality Assurance & Performance Improvement. Researchers Dr. Monica Tegeler and Dr. Kathleen Unroe of Indiana University included results of a study on the effect of training on staff comfort in dealing with dementia-related behavioral disturbances.

“Optimizing Patient Transfers, Impacting Medical quality and Improving Symptoms: Transforming Institutional Care,” or OPTIMISTIC, provided six weeks of dementia training to RNs, NPs, clergy, social workers and activity directors at participating facilities. The training was broken down to focus on four behavior categories: physically aggressive (kicking, hitting), physically non-aggressive (wandering), verbally aggressive (cursing, threats) and verbally non-aggressive. Trainees were also taught strategies to teach what they learned to other nursing staff in their facilities.

After completing the OPTIMISTIC training, nearly all participants surveyed said they felt comfortable managing physically non-aggressive, verbally aggressive, and verbally non-aggressive behaviors. A few trainees remained uncomfortable managing physically aggressive behaviors.

Staff from The Cedars, a skilled nursing facility in Portland, Maine, also discussed their tips on behavioral management during the call. Currently 5% of residents of The Cedars receive antipsychotic medications, down from 20% in 2012. All residents who currently receive antipsychotics are on the lowest dose.

Success in antipsychotic decrease at The Cedars involved facility-wide culture change, adopting a person-centered care model, every staff member being involved, and an emphasis on resident choice, said Chief Operating Officer Angela Hunt.

“There's no magic bullet, no one program that will act alone in the reduction of antipsychotic medication use,” Hunt said. “Do not assume your nursing department will do it all, it truly requires all hands on deck.”