Thursday, May 3, 2012

Leading by Example

In series of Boston Globe articles published earlier this week, reporter Kay Lazar focuses on a hot issue in the long term and post-acute care profession: the off-label use of antipsychotic medications. Recently, leaders in the LTC industry have taken a deep look at the often troubling use of antipsychotic drugs to attempt to manage the behavioral responses of persons with dementia, a use that the FDA considers off label. As the article points out, many individuals in nursing and assisted living facilities are living with some form of dementia. For these residents behavior is often an important method of communication, which can pose particular challenges for families, staff, and care providers. Too often, medication is used to modify such behaviors. 

Recognizing the need for rapid, measurable improvement in this area, the AHCA Quality Initiative challenges the Association’s members to safely reduce the off-label use of antipsychotics by 15 percent by December 31, 2012. If AHCA achieves its goal, then 18,400 fewer individuals will receive antipsychotic medications each year. This same goal was mirrored in the recently launched CMS Initiative to Improve Behavioral Health and Reduce the Use of Antipsychotic Medications in Nursing Home Residents.

To reach these goals, the AHCA Quality Initiative emphasizes person-centered care, regardless of situation. Person-centered care, as a holistic approach to caring for our nation’s elderly, not only puts a focus on the individual, but it also encompasses many other important aspects of care, such as staff stability. As mentioned in the Boston Globe articles, there are clear links between a resident’s behavior and his/her interaction with staff. If a person knows his caregiver, and the caregiver knows the best ways to communicate with the individual, then it’s less likely that a negative behavioral response will be triggered. The more in-tune the caregiver is with the resident’s likes and dislikes, eating and bathing preferences, and what makes that person happy, the better the caregiver can adapt treatment, therapy, and daily lifestyle for the individual. AHCA has challenged its members to renew their person-centered care efforts not only through reduced use of off-label medications, but through staff stability, increasing resident satisfaction, and reducing hospital readmissions.

The creation of such distinct and measureable goals by both AHCA and CMS indicates a real effort within the long term and post-acute care community to not just meet numbers for one year, but to create sustainable programs within their facilities that will benefit staff, caregivers, and—above all—the residents that are at the heart of care.

And when the profession posed this challenge, facilities across the nation rose to the occasion.

The Boston Globe series highlights two great examples of facilities that have adapted their care models. Life Care Center of Nashoba Valley is one of several facilities that are moving toward non-pharmacological, person-centered care approaches for persons with dementia. Nashoba, located in Littleton, tailors care to each resident by focusing on the qualities and preferences of the individual. According to the article, in 2010, the facility had zero residents who received antipsychotics without illnesses that warranted the drugs. Rather than revert to the use of medications, caregivers found other items that stimulated positive responses in residents, such as serving hot chocolate before a meal to pique one resident’s appetite, or drawing the shades for another so that the sunlight did not irritate his eyes.

In another testament to the importance of person-centered care, Beatitudes Campus in Phoenix made changes to its caregiver-to-resident time ratio. At Beatitudes, caregivers spend 50 percent more time with residents than in the average facility. This allows the caregivers to see changes in behavior and to find solutions based on that individual’s preferences.

With the help of available tools and resources, AHCA hopes to see even more positive shifts in quality care occurring in nursing facilities across the nation.  

Has your facility taken the initiative to reduce off-label use of antipsychotics? What are you doing to focus on person-centered care? Lead by example: share your story today!


  1. I recently came across your blog and have been reading along. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often

    Future Leader

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