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National Learning Collaborative Webinar Series on Using MDS 3.0 as an Engine for High Quality Individualized Care

Series Four: Reducing Anti-Psychotics Through Individualized Care – Medical Perspective and Case Studies

CMS announced an initiative to reduce use of anti-psychotic medications by 15% by December 31, 2012 and make further reductions in 2013. Individualizing care is the best "non-pharmacologic intervention" to prevent "environmentally-induced" agitation. In the two preceding webinars (MDS and Quality of Life: Operationalizing Customary Routines and MDS and QAPI – available as archive recordings), nursing home teams described how to operationalize quality of life, and how to use performance improvement processes to do so.

In the upcoming Series Four, physicians and nursing home teams describe how they use individualized care practices to prevent and alleviate resident distress. They understand that this distressed behavior is a communication of needs. By knowing each person through consistent assignment, and huddling to problem solve when issues come up, these nursing home teams adjust their care to the residents' rhythms, reducing the causes of distress and reducing distressing behaviors without using medications. Each webinar comes with a facilitator's guide that includes exercises and discussion points to be used for group viewings of the webinar.

 Part Nine

Individualizing Care and Environments: Non-pharmacologic Interventions Instead of Anti-Psychotic Medications
Lead Presenter: G. Allen Power, MD, Eden Mentor at St. John's Home in Rochester, NY, and Clinical Associate Professor of Medicine at the University of Rochester, and team from Windsor at Buckingham, Norwood, NJ

The evidence is conclusive that anti-psychotic medications rarely have a benefit for people with dementia. Indeed, they often cause serious harm because of their sedative affect and how they mask the needs being expressed by residents through their behavioral communication. Except when used on a short-term basis in response to an acute condition, often the dangers of medications far outweigh the benefits. Research indicates major adverse outcomes with antipsychotics over the 6-12 weeks (Schneider et al 2005, Ballard et al 2009) including gait disturbance, increased respiratory infections, oedema, accelerated cognitive decline, and higher risk for stroke and death. These risks increase over longer periods of drug use, while benefits diminish. Individualizing care and environments is often the most effective non-pharmacologic intervention to prevent and alleviate the distressed behaviors that the medications aim to quell. Dr. Power, author of Dementia Beyond Drugs, will describe key practices needed to create the safety and well-being for residents with dementia. Hear case examples from a team of nursing home staff about how they individualize each resident's care routines and living environment to reduce distress and promote well-being by learning about residents' routines, understanding what they are communicating when they express distress, and reducing their distress rather than masking it with medications.

Download Facilitator's Guide

 Part Ten

Promoting Mental Health Through Team-based Individualized Assessment and Care Planning
Susan Wehry, MD, Commissioner, Vermont Department of Disabilities, Aging and Independent Living, Agency of Human Services; Donna Howie, Sunbridge, MA with nursing home staff and residents from Lowell and Lawrence, MA, and Laurie Herndon, Massachusetts Senior Care Foundation

When we understand what residents are communicating, we can meet their needs instead of escalating their sense of crisis. Agitation means "Help Me!" while aggression means "STOP!" Geriatric psychiatrist Susan Wehry explains the meaning behind behaviors and the organizational practices, such as consistent assignment, that help staff build the relationships with residents necessary to understand and respond to this communication. Staff and residents from Sunbridge nursing homes in Massachusetts join their regional staff in describing how they use five key principles to promote well-being among their population of residents with mental illness. These principles are: (1) Person Centered: Care based on the person, their likes, dislikes, hopes and dreams; (2) Strength Based: Care based on what a person can do, not on what they can not do or what disease they have; (3) Recovery Based: Living each day to the best of their abilities; (4) Meeting Needs: All behavior is a form of communication, and (5) Group Programming: Skill based groups that give the resident the skills they may need. Laurie Herndon will share how these principles have been used successfully in homes across Massachusetts to lower medication dosages by knowing residents, understanding their needs, and reducing residents' distressed behaviors.

Webinar 10 Mental Health Facilitator's Guide (doc)
Home Worksheet (doc)
Maslow Worksheet (doc)
Sunbridge Handout (doc)
Fishbone PowerPoint (pps)
Homelessness Among the Institutionalized Elderly (pdf)