One of the most negative impacts of the COVID-19 pandemic has been social isolation for older adult residents living in long-term care communities, especially those receiving memory care.
An Altarum study from July to August 2020 of 365 nursing home residents in 36 states found that they felt both lonely and isolated. Seventy-six percent felt lonelier, and 64% reported no longer leaving their rooms to socialize with other residents.
It turns out, based on a recent study, that during that acute phase of the pandemic, many residents living with dementia were also being over-prescribed unnecessary antipsychotic drugs, and those prescriptions have not returned to pre-pandemic levels.
The most troubling aspect of this is that long-term care providers have always had the opportunity to prescribe meaning rather than medicine for residents, pandemic or not. And yet, most residents still do not experience meaningful engagement each day in senior living communities.
So, what is getting in the way here, and how can we finally move beyond this reliance on unnecessary medications, especially for those residents living with Alzheimer’s disease and related dementias? The key to implementing a social prescription model is to address these barriers:
- The Issue: According to a 2016 Centers for Disease Control and Prevention report, long-term care residents are typically receiving only 11 minutes of engagement per day outside of assistance with activities of daily living, and assisted living residents are only receiving 20 minutes of engagement each day.
The Social Rx Fix: Prioritize resident engagement! The providers we work with know the importance of investing in staff and tools that support resident engagement. They were able to elevate their average minutes of engagement per resident per day to 26 in 2022.
- The Issue: Activity and life enrichment departments in long-term care communities receive pitiful budget allowances that seriously impede their ability to offer meaningful resident engagement opportunities every day. Furthermore, our survey data from 161 activities professionals in December 2022 found that 35% are using only paper to track attendance, and an alarming 20% are not tracking at all.
The Social Rx Fix: Prioritize investment in technology that supports activity and life enrichment professionals by digitizing resident preference and engagement data! We have found that by doing this, activity professionals are twice as likely to be able to create individualized plans for each resident, 133% more likely to build community and groups, 162% more likely to know if residents are engaged in programs in real-time and 183% more likely to know if programs match their residents’ preferences.
- The Issue: Too often, meaningful resident engagement is considered the job of only activity and life enrichment professionals. How is this possible when there is typically one engagement staff person available for every 60 residents in the community? Our survey data from 142 activities professionals in November 2022 found that 55% reported they are not consistently getting help from other departments.
The Social Rx Fix: Embrace an interdisciplinary care model and then commit to the 35/85 rule! Providers should prescribe at least 35 minutes of meaningful engagement per resident per day, and at least 85% of all residents should be engaged meaningfully each month. To achieve this, research recommends that communities have at least one engagement person for every 27 residents in assisted living, every 23 residents in skilled nursing and every 13 residents in memory care communities.
- The Issue: Behavioral and psychological symptoms (BPSD) of dementia are still being addressed using harmful antipsychotic medications rather than making the non-drug solutions the first course of action, based on a resident’s life history, individual preferences and current abilities.
The Social Rx Fix: Educate yourself and your team on evidence-based therapeutic interventions! To name a few organizations that we support through our Resident Engagement Institute: Best Friends Approach, the Center for Applied Research in Dementia, and the Validation Training Institute (VTI). Learn more about VTI by watching the session recordings from our World Congress, which took place on Tuesday, February 21st.
Antipsychotic stewardship programs are growing in popularity; and more communities are employing formal strategies, processes, policies and procedures to prevent the inappropriate use of these medications. One key to this is consistent, ongoing training and education for staff, including those such as housekeeping, dining and maintenance, who aren’t part of the clinical team but who may have insights into residents’ behaviors, pet peeves, favorite things, etc. Their thoughts and observations, as well as those of family members, can be an enlightening part of care planning and can help identify non-pharmacologic interventions to address behavioral expressions.
If you need further encouragement to get started on implementing the social prescription model, there are already so many promising examples in our field. For instance, during the middle of the pandemic and worst staffing crisis the industry has ever reported, Janean Kinzie, director of social wellness and enrichment at American Senior Communities, led the CARE Companions programs that dramatically reduced the use of antipsychotics by more than 2% for their 59 skilled nursing and memory care communities. At the end of 2021, their average long-stay antipsychotic rate is now at 8.9%, compared to the national average of 14.2% reported by CMS.
Resident engagement has been viewed as “nice to have,” “fun,” and a regulatory requirement but not an important part of a resident’s overall wellbeing. However, if residents are engaged in a meaningful and personal way, it will decrease their loneliness, keep them independent longer, and improve their wellbeing. This, in turn, offers providers the opportunity to experience improved clinical and financial outcomes.
Charles de Vilmorin is the CEO and co-founder of Linked Senior.
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.