May 10, 2012

Nursing Homes and Antipsychotic Drugs: Ten Questions a Caregiver Needs to Ask

A recent, two-part series by Boston Globe correspondent Kay Lazar about the use of antipsychotic drugs in nursing homes has Bostonians buzzing. The article examines the use of these powerful medications in residents that do not have a diagnosis of psychosis and how that relates to staff levels, number of residents on Medicaid and how many of those residents have behavioral issues. I applaud Ms. Lazar’s in-depth look at this important issue and wholeheartedly agree antipsychotic drugs are not necessarily the best solution for addressing behavior problems exhibited by nursing home patients with dementia.
Just last month I gave a presentation to the board of directors at Aviv Centers for Living. Although use of antipsychotic medications at our skilled nursing facility is already low, our history, philosophy and plans to provide cutting edge dementia care require us to further reduce the use of antipsychotic drugs. Our goal is to resort to medications only when all other non-pharmacologic options have been exhausted.
If a loved one in my family needed to go to a nursing home, I would want to know questions to ask to understand its philosophy and practices about administering antipsychotic drugs to residents. Here are the top ten areas I would address:
Meet with the Director of Nursing to gain an understanding about the facility’s philosophy about the use of antipsychotics drugs for behavior management. Come prepared with a list of general questions as well as specific concerns.
Check on the availability of mental health specialists.
Understand how staff is trained to manage dementia-related behaviors.
Ask about protocols for the management of dementia residents with behavioral issues.
Develop an understanding about the non-pharmaceutical approaches to meet individual needs of each resident.
Ask for a tour of the facility. Take note of the design of the floors and how staff interacts with residents. Look for signs that the facility fosters a patient-centric environment, one where the individual needs of the resident are being met.
Note whether the facility has secure outdoor areas where residents can enjoy the holistic benefits of fresh air and nature.
Ask to talk to the Director of Activities about daily activities as well as enhanced programming tailored to individual needs.
Inquire about how the facility records each resident’s personal history. Although elders with dementia have memory loss, they usually retain long-term memories.
Inquire about the members of the multidisciplinary team that will care for your loved one and determine his or her individual roles.
Although Aviv Centers for Living’s policy is to be extremely selective in administering antipsychotic drugs to residents with dementia, our belief is we must be vigilant in exploring new and creative ways to change the culture and further reduce the chemical treatment of behaviors. In fact, our new building includes a skilled nursing facility featuring intimate, non-institutional households; family type dining rooms and a preponderance of private rooms with personal showers. The design decisions were made with the best interests of our residents in mind. . We also have set up a Dementia Task Force and hope to be trendsetters in our practices. In my next blog, I will outline strategies we are currently employing to insure our residents live with a sense of dignity, meaning, purpose and delight.