Successfully decreasing antipsychotics use

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Elizabeth Newman
Elizabeth Newman

If you're wondering if anyone outside the profession is paying attention to the antipsychotics-use debate in long-term care, allow me to direct your attention to Boston.

In a two-part series last weekend in the Boston Globe, health reporters Kay Lazar and Matt Carroll put together a package that looked at data on more than 15,600 nursing homes nationwide, the result of a Freedom of Information Act request sent to the Centers for Medicare & Medicaid. They were looking at the percentage of long-term residents without a diagnosed psychotic illness who received antipsychotics (which is contrary to federal recommendations), and the profile of the nursing home, such as staffing level, percentage of Medicaid beneficiaries and numbers of residents who had behavioral problems.

They found that in 21% of nursing homes in 2010, at least one-quarter of the residents without illnesses recommended for antipsychotic use received the medications anyway. They also found a significant correlation between staffing levels and the percentage of residents on antipsychotics.

While there's a natural inclination to bristle at media tackling a thorny issue — what do they know about your lives, anyway? — there's no denying that Lazar and Carroll did their homework. But what makes the series notable is that the Globe reporters didn't just wring their hands and say, “Oh, what a terrible problem” or present a scathing indictment of the industry. There's acknowledgement that nursing homes sometimes use antipsychotics with the best intentions, namely to keep residents with dementia from hurting themselves or others, or because the resident's family members get pushy about it.

And the newspaper spent time highlighting how some nursing homes have successfully managed to decrease their antipsychotic use. Take, for example, Life Care Center in Nashoba, MA, which had a director of nursing who made it a priority. According to the Globe, Nancy LaRock began “weaning residents off the medications and training staff about alternative strategies.” In six years, the center went from having a quarter of residents without illnesses warranting antipsychotic use and receiving them anyway, to zero residents in that situation in 2010.

One way it did it was by promoting animal interaction, from the executive director's golden retrievers greeting visitors, to a caretaker taking a llama through the halls.

While I'm pro-furry friends (look for the McKnight's Long-Term Care News Llama at upcoming conventions), I understand that is not everybody's cup of tea. But another nursing home highlighted in the Globe, Beatitudes Campus in Phoenix, reduced its antipsychotic use by including chocolate before some residents' meals, which resulted in those with dementia being more likely to eat, and being less aggressive. It also cut down on the money spent on dietary supplements.

There's little argument that decreasing antipsychotics has become a major priority of long-term care groups and lawmakers. Now is the time to turn to those nursing homes that have found success and ask them to share their stories. Here's hoping all local newspapers will find examples like those of Life Care Center of Nashoba and Beatitudes Campus.


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.