The last few years have brought a groundbreaking trend in care for nursing home residents living with dementia. Thanks to programs like Advancing Excellence in America’s Nursing Home and the Centers for Medicare & Medicaid Services’ (CMS) National Partnership to Improve Dementia Care, nursing home staff has begun weaning residents off of antipsychotic medications and exploring more patient-centered treatment.
This was the case for Garden Terrace Alzheimer’s Center for Excellence, a Life Care Centers of America skilled nursing and rehabilitation facility in Houston, Texas. In September 2014, Garden Terrace received its quality measures report from CMS and discovered it had scored above the 90th percentile for long-stay residents receiving antipsychotics – among the poorest national scores. Because Garden Terrace is a skilled nursing facility specializing in dementia care, with 14 out of 40 patients on antipsychotics, many believed the facility would always trigger poorly on its quality measures report for this measure, since most residents have certain behaviors the staff assumed could only be contained by administering antipsychotic medications.
Nancy Flowers, director of nurses at Garden Terrace, believes the poor quality measures score was the push they needed to make a change. However, she states that leading up to the push “there was a paradigm shift in thinking about the use of antipsychotics with dementia patients among the administrative staff that drove the change. Antipsychotics with dementia patients began to be seen with the same alarm as with the use of restraints many years ago.”
The TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO) worked with Garden Terrace to provide webinars and resources educating the nursing home’s staff on quality measures, best practices and alternate solutions for administering antipsychotics.
The post-acute facility started with one resident at a time, using a variation of the Serial Trial Intervention (STI) model, an assessment given to residents with dementia who can no longer communicate pain effectively. In conjunction with this model, they also used the Abbey Pain Scale, a Life Care Centers of America corporate policy for measuring pain. After evaluating pain levels, Garden Terrace interviewed each resident’s family, asking questions encompassing their personal, familial, educational, occupational and social history.
Once the skilled nursing facility finished screening residents, the staff started focusing on offering alternate solutions such as massage, music therapy and aromatherapy, even contracting with a certified aromatherapist to provide services to residents. “We stopped calling the psychiatrist as the first action,” explains Flowers, “and instead tried non-pharmacologic approaches such as lavender oil massaged into the extremities twice a day and music provided via iPod shuffles with playlists generated from the families.”
By incorporating these methods, Garden Terrace has trained its staff to follow a more patient-centered model of care. To date, the skilled nursing facility has cut the number of residents with dementia who had received antipsychotics in half, from 14 to seven, and it continues to work to gradually wean the remaining seven residents off of antipsychotics.
Garden Terrace knows it has been making a difference since it received positive feedback from a satisfaction survey the residents’ families took after first initiating the project. And, as an added bonus, the facility no longer triggers a poor score on its quality measures report.
“Residents are getting their needs met and their eyes sparkle again… some dance now, many smile and their families are thrilled,” explains Flowers. “Next, we plan to target our short-stay residents and involve the families [in their care] before they are admitted.”
As a member of the TMF QIN-QIO Nursing Home Quality Improvement Learning and Action Network, Garden Terrace and other nursing homes like it in Texas, Oklahoma, Arkansas, Missouri and Puerto Rico benefit from access to exclusive and complimentary webinars, resources and coaching to make a difference in the lives of their residents.
For more information on Garden Terrace Alzheimer’s Center for Excellence, please contact Nancy Flowers, Nancy_Flowers@lcca.com.
For more information about the TMF QIN-QIO Nursing Home Quality Improvement Learning and Action Network, please visit tmfnetworks.org, or email nhnetwork@tmf.org.
This material was developed by TMF Health Quality Institute, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. This content does not necessarily reflect CMS policy. 11SOW-QINQIO-C2-15-145