Janean Kinzie
Janean Kinzie

Reducing antipsychotic medication use in long-term care residents has been a focus for both nursing home operators and practitioners for nearly 10 years since the launch of the Center for Medicare & Medicaid Services’ Partnership to Improve Dementia Care in Nursing Homes. 

The initiative called for a reduction in off-label antipsychotics as well as improved training and behavioral health services in nursing homes. At American Senior Communities (ASC), collaboration with behavioral health service providers has yielded excellent results both in reduction of antipsychotic use as well as improved and diversified educational offerings for direct caregivers.

Like other providers, ASC began its initiative by focusing mainly on the antipsychotic medications themselves, requesting gradual dose reductions for residents who had been prescribed those medications for an off-label indication for use. What we saw was a “boomerang effect,” a drop in medication use followed by an increase due to “failed reductions” of the antipsychotic medications.

When we focused on just the medication, we did not see lasting results. Residents would either continue to have behaviors or have an escalation in behaviors. It was not until we shifted to a more educational focus that we began to see lasting results. 

We began by educating our interdisciplinary teams on how to assess behavioral expressions thoroughly to identify root causes and non-pharmacological interventions. From there, we began working with our direct caregivers to ensure they felt comfortable using those nonpharmacological interventions. Recently we expanded our focus to include collaboration with behavioral health partners.

Behavioral health providers are critical to delivering holistic and research-based care in nursing homes. Over the past four years, ASC has worked to ensure that a full spectrum of behavioral healthcare is provided to each community, including psychiatry, psychological and counseling services. With these services in place to offer a more holistic approach, ASC has established collaborative quarterly business reviews to align priorities between both partners.

These reviews have allowed leaders in both organizations to understand critical performance metrics such as the antipsychotic quality measures, psychiatric hospitalizations and frequency of education to direct care staff. Communities with metrics above the determined threshold are reviewed with actionable items from both ASC operators and behavioral health providers.

The results of this collaboration have yielded a company average long stay antipsychotic measure of 8.9%, compared to the national average of 14.2%.  ASC continued to decrease antipsychotic use even during the restrictions and limitations of COVID-19.

The collaboration has also helped solidify partnerships with professional services to improve both physician communication and community-specific education. Jose Pinon, M.D., senior vice president of medical affairs, participates in each review to ensure that professional services and medical directors are aligned with behavioral health service and key metrics. 

“ASC shares our specific goals with our psych service providers, and their work in response to our needs has been tremendously effective. It’s gratifying that what began as simple and direct communication has resulted in a collaboration that is benefitting our resident population so markedly. We are appreciative of the interest shown by our partners in escalating our level of care for our residents,” said Pinon.

Identifying the need for continued and community-specific education has also been an effective intervention discussed during the review. Will Sampson, Ph.D., director of clinical training for Eventus WholeHealth, has designed training modules specifically for a community serving younger and more mentally ill individuals. 

Sampson explains, “The collaboration between ASC, with its innovative rehabilitation programs and high standards for staff education, and Eventus’s multidisciplinary model, has proven to be an excellent match. An important part of that collaboration has been engaging in education of community staff about various topics in mental health. More knowledge can be empowering for staff who work with challenging residents, and ASC has leveraged Eventus’ ability to provide in-service education to improve care and facilitate our collaborative relationship.” 

This training has been used during onboarding for direct caregivers to ensure behavior management competencies for newly hired employees. This collaboration with behavioral health and professional services is impacting not only antipsychotic metrics but it is also improving the quality of care and education in each community. 

Janean Kinzie is the director of Social Wellness & Enrichment for American Senior Communities.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.