Culture Change Througout Aging Services
Reducing Antipsychotic Medications in Nursing Homes - Ecumen Awakenings Initiative
(Source: Author, Eric Schubert, Minneapolis Star Tribune)
In six months, Ecumen colleagues at Sunrise nursing home, working with physicians, residents, and family members in Two Harbors, Minnesota eliminated the use of psychotropic drugs and decreased use of antidpressants by half. Eva Lanigan (above, left), an Ecumen clinical director who led this work, told the Minneapolis Star Tribune in a article yesterday:
"The chaos level is down, but the noise is up -- the noise of people laughing, talking, much more engaged with life. It's amazing."
Now based on the work of Eva and her team, Ecumen is bringing this drug-reducing strategy to Ecumen's 15 other nursing homes. Helping make the work possible is a multi-million dollar grant from the State of Minnesota. The initiative is called "Awakenings," because people are literally awakening. This is important work (see stats below) and hard work. But we know it will make lives better and provide insights for our entire profession. It is changing aging.
- In 2005, Medicaid spent $5.4 billion on atypical antipsychotic medicines, which is more than it spent on any other class of drugs, including antibiotics, AIDS drugs or medicines to treat high blood pressure.
- According to a study published in the Journal of the American Geriatrics Society, more than half are prescribed inappropriately to control dementia-related behaviors even though there is no mental illness diagnosis.
LINK TO ARTICLE
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Mary Jane Koren
Modern Healthcare’s August 16 issue features a commentary on the many ways that consistent assignment benefits nursing homes and residents, written by Mary Jane Koren, M.D., M.P.H., chair of the Advancing Excellence in America’s Nursing Homes campaign. Koren, a geriatrician and vice president at The Commonwealth Fund, explains in “Predictable Scheduling: Nursing Homes Can Boost Quality, Bottom Line with ‘Consistent Assignment’” that when a nurse aide routinely cares for a nursing home resident, it improves the quality of care and is cost-effective.
Relationship between Consistent Assignment and Quality
Consistent assignment is one of the targets identified by Advancing Excellence in America’s Nursing Homes, a national campaign to improve the quality of nursing home care. Participating nursing homes set quality targets, and the campaign provides tools to measure progress and achieve goals. The campaign data shows that nursing homes that have made inroads in improving quality outcomes are often facilities “with low staff turnover and…rely on consistent assignment,” Koren writes.
For example, she explains that when an aide develops a relationship with a resident through consistent assignment, the use of physical restraints can decrease and the development of pressure ulcers can be reduced. Ongoing relationships allow aides to observe and report potential medical problems, thus reducing costs.
Since residents rate relationships with caregivers as important, Koren says that nursing homes that employ consistent assignment have a “competitive edge in a tough market.”
“The PHI team has coached many nursing homes to implement consistent assignment,” said PHI Director of Training and Organizational Development Services Susan Misiorski. “I can’t emphasize enough how critical this practice is to ensuring high job satisfaction, high resident satisfaction, and quality care outcomes,” Misiorski said. MORE
The Leipzig Longitudinal Study of the Aged examines predictors of nursing home admissions among seniors without a dementia diagnosis. It is one of the first analyses that don't consider dementia.
1,024 elderly adults over 75 without dementia were interviewed six times on average every 1.4 years, according to the report. During the study, 7.8% of seniors without dementia were admitted to a nursing home. Factors that led to faster admission to a nursing home include living alone, functional impairment, major depression and stroke. Seniors who had home care aides, as well as seniors who did not regularly see specialist physicians were also more likely to be admitted to a nursing home sooner. MORE
The reasons for admission did not strike me as unusual but may to others. Particularly those living alone being more likely to be admitted. Often that loneliness leads to depression. And it speaks to the fact that many people discount the positive social aspects that any type of senior living arrangement offers. It also makes sense that seniors not under the care of a specialist tend to be more likely to go to a nursing home, most likely because they were not keeping up with their health issues. Those having home care aides surprised me but when I thought about it made sense. Those same care aides are probably more acutely aware of just how much care their clients need and recognize when home care is truly not enough.
Some of these non-dementia issues we can control. Certainly a functional impairment or stroke could be out of our reach to prevent but we can help our elders living alone and often depressed. That is a societal role for anyone. Do you know the seniors in your neighborhood and their circumstances? Perhaps they can use a new friend.
The study appears in BMC Health Services Research 2010.
Aging Committee chief hears complaints about nursing homes
Sen. Herb Kohl (D-WI) took advantage of his position as chairman of the Senate Special Committee on Aging to hold a field hearing in his home state to drum up support for re-authorization of the Older Americans Act. But he might have received more than expected Tuesday, when a local agency leader used the hearing to blast nursing homes “not appropriate for people to live in.”
Criticizing what she calls outdated, poorly designed facilities with overcrowded rooms, Milwaukee County Department on Aging leader Stephanie Sue Stein said a national campaign is needed to bring buildings up to par, the Milwaukee Journal Sentinel reported. "There are facilities that are simply not appropriate for people to live in," Stein said to raucous applause at the Wilson Park Senior Center. “It is not a way any of us want to live our lives.”
Stein said an overhaul of the system would be in line with goals of the Older Americans Act. Kohl noted that 10 million Americans use services provided by the Act, many aimed at keeping seniors well fed, healthy and out of institutional care.
Also at the hearing, Assistant Secretary of the Administration on Aging Kathy Greenlee noted that 12 states will be receiving federal funding for the development of community-based respite-care programs for caregivers. The funds, which include $188,000 for Wisconsin, will be used to coordinate respite services, identify service gaps and solutions, and recruit paid and volunteer respite providers, Greenlee said. LINK
Ideas about changing the nursing care at Virginia Mennonite Retirement Community (VMRC) began when carpets were replaced in one of the memory neighborhoods. For several days residents with memory disabilities spent their waking hours visiting a more home-like assisted living area. The caregivers immediately spotted a change — people from the memory neighborhood were more engaged in the activities and more active. The visitors even asked if they could stay.
Looking Toward the Shenandoah Mountains from a Valley Farm
President/CEO Ron Yoder walked over to see for himself and was deeply moved. He began thinking more about physical environments and how they affect the lives of elderly residents at VMRC. So over a number of years the philosophy of the Harrisonburg, Virginia, continuing care retirement community nestled in a valley in the Shenandoah Mountains of Virginia, began to evolve. Eventually a plan emerged, one that imagined ten residential houses for people who require nursing care, but with the medical care functions masked and the “just like home” aspect emphasized.
VMRC connected with Eden Alternative (read the 10 principles) and the Pioneer Network, two organizations dedicated to moving long-term care away from a medical model. Both groups support the development of welcoming, community-based settings where both older adults and their caregivers make choices and enjoy independence (and use of the word “neighborhood” as opposed to word like “unit”). Choices that stress community are everywhere at VMRC, and residents — even those who need nursing care — get to make them, enjoying gardens, musical events, connections with the university next door, residential care areas with a minimum of long halls, nursing areas that do not dominate, social activities with town residents on a regular basis, and even a rehab and wellness center shared by residents and members of the Harrisonburg community. Read about VMRC resident-centered initiatives. READ MORE
(Source: Dr. El - Eleanor Feldman Barbera, PhD, , My Better Nursing Home)
Complaint #1: No One Coming When the Call Bell is Pressed
I've worked on units where the moment the call bell goes off, the charge nurse immediately and calmly asks an aide to check on the room. The bell goes off, someone arrives. Simple customer service. This leads to a unit full of residents who feel confident their needs will be addressed in a timely fashion, and are therefore far less anxious. Staff training is a good way to change the nursing home culture on this issue, but each worker can take it upon themselves to make it their own personal policy even if the nursing home as a whole isn't making it a priority. READ MORE
Following Racial Caregiving Preferences of White Resident Violates Civil Rights Act, Court Rules
An Indiana nursing facility's decision to honor the request of a white resident who refused to be treated by a black certified nursing assistant violates the Civil Rights Act of 1964, a U.S. Circuit Court recently ruled.
Plaintiff Brenda Chaney sued former employer Plainfield Healthcare Center after being discharged after three months of employment. Chaney, who is black, claimed that the facility's daily reminders on her assignment sheet created a hostile work involvement, and that her firing was racially based, the Bureau of National Affairs reported. The assignment sheet instructed her not to provide care to a resident who “Prefers No Black CNAs." Also, the constant reminders of the racial preference of the patient led to harassing comments from co-workers, she said.
Initially, a trial court had sided with Plainfield, judging that the facility had made an acceptable effort to end the harassing co-worker comments, and to recognize the patient's wishes under Indiana state law. The U.S. Court of Appeals for the Seventh Circuit on July 20 unanimously overturned that decision. MORE