Reassessments, respect spark antipsychotic-reduction success, providers told

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Reducing the number of residents with dementia who are on antipsychotics starts with reassessment, experts advised at this week's American College of Health Care Administrators convocation In Orlando. The key is a multi-step process providers can follow.

“Step one is identify the residents with dementia who have antipsychotic medication for behavioral disturbances, but no psychiatric diagnoses,” explained Helaine B. Ledany, administrator at Buckingham at Norwood Care & Rehabilitation Center.

For example, in 2008, Buckingham had a 26% rate of residents on antipsychotics in their 180-bed long-term care unit. They had reduced that to 2% by the end of 2012. That's the kind of progress being pushed by the Centers for Medicare & Medicaid Services, which has urged facilities to reduce dementia residents on Seroquel, Risperdal and Zyprexa to treat behavioral problems.

“It's a process and has taken a number of years,” Ledany said. “It takes restorative nursing; it takes respect for the individual.”

Another change was revising how residents could wander. In one case, a resident who had been diagnosed with Alzheimer's disease was admitted on Risperdal and Seroquel. Instead of restricting him to his unit, staff on other floors were told to call his caregivers when they saw him, but to allow him to walk.

“He was allowed to walk more and more, and we decreased his meds,” said Batsheva Katz, vice president of quality initiatives at Windsor Health Communities, the parent company of Buckingham. “He became much, much calmer and was able to participate in life.”

Another success has been working with Dan Cohen on the Music & Memory project, Katz says.

“All I can say is, ‘Wow,'” she said. Some residents have achieved more progress in a short time with Music & Memory than in the 20 years previously, she noted.

The success was also a result of staff education and a change in attitude. Those who weren't willing to pursue non-medication options for behavior problems have since left, Katz and Ledany noted.

“Staff had to relearn and ask, ‘What am I going to do to meet residents' needs?'” Katz said. “There has been a huge paradigm shift. It took ‘an entire village' to make this happen.”

Click on the above video to see a McKnight's interview with Katz. ACHCA continues its annual convocation, being held at the Omni Orlando Resort at Champions' Gate, on Tuesday.