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CMS Launches Partnership to
Improve Dementia Care in Nursing Homes

Updated 5/14/2013

On March 29, 2012, CMS launched a national initiative aimed to improve behavioral health and minimize the use of medications (such as antipsychotic medications) to manage individuals with dementia. As part of the initiative, CMS is developing a national action plan that will use a multidimensional approach to improve care for individuals with dementia that includes public reporting, raising public awareness, regulatory oversight, technical assistance, provider and consumer education and research.

The Advancing Excellence in America’s Nursing Homes Campaign has offered to make available a variety of resources and clinical tools to assist nursing homes achieve the goals of this initiative. Nursing homes are encouraged to review the resources and tools and select those that will be most useful. This site will be updated regularly as new tools become available.

Resources and Tools

Background

(Press release) LeadingAge, March 2012.

Video (50 minutes) that describes the national initiative to reduce the use of antipsychotic drug usage by 15% by December 31, 2012.
Centers for Medicare and Medicaid Services

Recorded Webcast (58 minutes) describes the national initiative to reduce the use of antipsychotic drug usage, and provides in-depth discussion about the symptoms and various management/intervention strategies to help nursing homes work toward the national goal.
Dr. Cheryl Phillips and Tena Alonzo LeadingAge

A PowerPoint presentation that describes the state of research and effort to improve dementia care in the UK.
Dr. Clive Ballard | King’s College London & Director of Research, Alzheimer’s Society (UK)

A two-part PowerPoint presentation describing the background and current state of knowledge about unsafe prescribing of antipsychotics among people with dementia.
From Alliant | Georgia Medical Care Foundation

This presentation provides an overview of the magnitude of the risks and benefits of antipsychotics for individuals with dementia residing in nursing homes; information on interpreting CMS’ quality measures on antipsychotic use; and strategies to safely reduce these medications in the long term care setting.
Dr. Dave Gifford | American Health Care Association

Initiatives and Presentations

Recording of live event presented March 28, 2013. This is the first in the Mental Health and Aging Training Initiative, Series II, presented by the Geriatric Mental Health Planning Partnership, in collaboration with the VCU Department of Gerontology and the Riverside Center for Excellence in Aging and Lifelong Health

Recording of live event presented April 22, 2013. This is the second in the Mental Health and Aging Training Initiative, Series II, presented by the Geriatric Mental Health Planning Partnership, in collaboration with the VCU Department of Gerontology and the Riverside Center for Excellence in Aging and Lifelong Health

Call hosted by CMS Partnership to Improve Dementia Care in Nursing Homes

Call hosted by CMS Partnership to Improve Dementia Care in Nursing Homes

From Centers for Medicare and Medicaid Services

Continuing Care Leadership Coalition

LEADER (Louisiana Enhancing Aging with Dignity Through Empowerment and Respect)

Call hosted by CMS Partnership to Improve Dementia Care in Nursing Homes

The Hand in Hand training was created by CMS to provide nursing homes with a high-quality training program that emphasizes person-centered care in the care of persons with dementia and the prevention of abuse.

PowerPoint presentation providing background and examples for work on inappropriate use of antipsychotic medications.
Kathie J. Gately, BSW

Handouts

Steve Levenson

Brochure on antipsychotic medication and dementia developed by the Georgia Medical Care Foundation in collaboration with the Advisory Board on the Partnership to Improve Dementia Care team

First of a series of monthly tips from Primaris (Missouri QIO) on working to reduce inappropriate antipsychotics

American Geriatrics Society

American Geriatrics Society

Item #2 of this campaign form the American Board of Internal Medicine is " Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia" and includes several physician education and public education resources.

Long Term Care Community Coalition (LTCCC)

A useful resource as a reference for long-term care teams focused on antipsychotic drugs
Co-developed by the Delmarva Foundation for Medical Care (Maryland/DC QIO) and Healthcare Quality Strategies, Inc. (NJ QIO)

Centers for Medicare and Medicaid Services

Individual Tools and How-To's
Sample Nursing Home Readiness and Preparedness Assessment

A list of questions for direct caregivers and nursing home leadership to assist facilities in assessing their approach to dementia care.
Partnership to Improve Dementia Care in Nursing Homes

Suggested list of questions for provider to use to assess their approach to dementia care.
Partnership to Improve Dementia Care in Nursing Homes

A flow chart with suggested steps for implementing quality improvement efforts to reduce inappropriate use of antipsychotics.
Partnership to Improve Dementia Care in Nursing Homes

Resident Assessment Tools

Christine M. Waszynski, MSN, APRN, BC, Hartford Hospital

The Confusion Assessment Method (CAM) was intended to provide a new standardized method to enable nonpsychiatrically trained clinicians to identify delirium quickly and accurately in both clinical and research settings.

Partnership to Improve Dementia Care in Nursing Homes

Dr. Karyn Leible

American Geriatrics Association (AGS)

Sample Medication Policy
Shared Decision Making

Substance Abuse and Mental Health Services Administration (SAMHSA)

Practice Guidelines
Comprehensive Tool Kits

Kathy Gately, BSW, designed this Home Thermostat (HT) to assist nursing homes, resi­dential care and assisted living facilities with a tangible tool to evalu­ate and discover behavioral “hot spots” throughout their perspective homes. This tool will guide you to objectively listen, look and discuss what root causes within the facility may be promoting behaviors, and what alternatives and rearrangements you may utilize to decrease behaviors and differentiate between abnormal and normal behavior.

American Health Care Association (AHCA) /National Center for Assisted Living (NCAL)

California Advocates for Nursing Home Reform (CANHR)

Iowa Geriatric Education Center

The Pioneer Network’s comprehensive list of tools to assist nursing homes in various aspects of staffing, culture change, and quality improvement activities that are important to improving care for residents with dementia.

Developed by Planetree in partnership with Picker Institute, the Long-Term Care Improvement Guide was created in 2010 to propel long-term care communities in their improvement efforts.

Consumer Information

Brochure on antipsychotic medication and dementia developed by the Georgia Medical Care Foundation in collaboration with the Advisory Board on the Partnership to Improve Dementia Care team

HealthinAging.org

Arthur D. Hayward, M.D. writing for HealthinAging.org

National Consumer Voice for Quality Long-Term Care

The National Consumer Voice for Quality Long-Term Care

The National Consumer Voice for Quality Long-Term Care

Alzheimer’s Association

Substance Abuse and Mental Health Services Administration (SAMHSA)

Evidence-Based Research

Agency for Healthcare Research and Quality

Preface, Chapter 1: Diagnosis & Chapter 2: History Taking and the Medical Record from: LeBlond, RF; DeGowin, RL; Brown, DD. DeGowin’s Diagnostic Examination 9th Edition. McGraw Medical; 2009.

From the American Psychological Association, a comprehensive list of articles and other resources for non-pharmacologic approaches to dementia care.

(Book) Department of Veterans Affairs. Washington, D.C.; 2011.

Free article available through the Journal of the American Medical Association which includes information on characterizing common behavioral symptoms and a method for selecting evidence-based nonpharmacologic dementia treatments. Nonpharmacologic management of behavioral symptoms in dementia can significantly improve quality of life and patient-caregiver satisfaction.

Innovations

National Public Radio story on the use of music with nursing home residents with dementia. Click here for YouTube clip of documentary.

Developed by psychologist Kelly O’Shea Carney, PhD, CMC, the Eldercare Method is a systematic process of behavioral health consultation designed for use within long term care settings. It is based upon a clinical model of geriatric behavioral health care.

A nursing home in California has built a fully-accessible community garden for residents to grow and harvest their own produce and donate it to citizens in need. This shift in culture has allowed residents to find new purpose and engage in daily activities, and has helped improve the care and quality of life among residents with dementia. Click here for a short YouTube documentary of this amazing program.

Mission View Health Center’s most recent community project is making “Helping Hands Hand Soap,” a glycerin-based soap in a variety of shapes, colors and scents. By allowing residents to become “givers” instead of just “care receivers”, Mission View has reintroduced meaning and a feeling of purpose to residents who showed significant signs of depression and withdrawal. Residents fully run this non-profit business, which sells the soaps and then donates the proceeds to various causes, including buying food which the residents prepare and serve to people at a local homeless shelter. All proceeds go to local charities which are be chosen by our residents. Click here and here for a two-part YouTube presentation of this great program.

A few years ago, staff members at Ecumen in Minnosota became concerned about the number of people with Alzheimer’s and other dementia-related diseases being admitted who were on antipsychotic drugs. They started exploring alternative treatments that could provide these residents with a better quality of life. These treatments emphasize human relationships and non-pharmaceutical remedies. In 2009, Ecumen piloted these alternative treatments in one of their nursing homes in Two Harbors, Minnesota. This initiative is called Awakenings because it re-awakens residents to physical and cognitive vitality that’s often been severely diminished by an inappropriate use of antipsychotic drugs. We can’t cure Alzheimer’s, but we have learned much more about how to control the aggressive and sometimes violent behaviors that accompany it without using drugs that rob residents of their personalities and energy.

Books, Articles, and DVDs

Preface, Chapter 1: Diagnosis & Chapter 2: History Taking and the Medical Record from: LeBlond, RF; DeGowin, RL; Brown, DD. DeGowin’s Diagnostic Examination 9th Edition. McGraw Medical; 2009.

The Medical Letter: On Drugs and Therapeutics. Volume 50 Issue 1301/1302. December 2008.

Caring For the Ages editorial by Jeffrey Nichols, MD

(Article) Raia, P. Massachusetts Alzheimer’s Association Chapter Newsletter; Spring 2005.

(Book chapter) Raia, P. In: Volicer L, Bloom-Charette L, editors. Enhancing the Quality of Life in Advanced Dementia. Philadelphia: Taylor & Francis; 1999. pp. 21–37.

(Book) Power, G. A. Health Professions Press; 2010.

(Article) American Geriatrics Society. JAGS; 2012.

Independent Drug Information Service (IDIS)

(Article) Maher, A. et al: JAMA, Vol. 306, No. 12, September 28, 2011.

(Book) Scogin, F. & Shah, A., editors. American Psychological Association; 2012.

CD ROM/DVD for purchase from Pioneer Network

(Book) Brackey, J. Purdue University Press; 2008

Feil, N. & de Klerk-Rubin, V. Health Professionals Press; 2012.

Useful Websites

Psychologists In Long Term Care, Inc. (PLTC) is a network of psychologists and other professionals dedicated to providing high quality mental health services in long-term care settings, including skilled nursing homes, rehabilitation centers, assisted living facilities, and congregate housing.

The Office on Aging is a coordination point for APA activities pertaining to aging and geropsychology (the field within psychology devoted to older adult issues). The Office on Aging also supports the work of the APA Committee on Aging.

This website is a collaborative effort between the American Psychological Association’s (APA) Divisions of Society of Clinical Geropsychology and Adult Development & Aging, along with the Council of Professional Geropsychology Training Programs (CoPGTP), Psychologists in Long Term Care (PLTC), and the APA Committee ON Aging (CONA) to bring together available resources for geropsychology training, service provision, policy, and research, including online assessment of geropsychology competencies, in a central internet location.

Connecting to Combat Alzheimer’s brings together National Institutes of Health (NIH)-funded Alzheimer’s Disease Centers (ADCs) that conduct research with the Administration for Community Living’s (ACL) aging services agencies, which annually reach over 10 million older people and family caregivers.

Information about the Certified Dementia Practitioner credentialing through NCCDP

Scroll halfway down the page to “Item 2: Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia”. A variety of professional education and public information resources available.

The APA Office of Aging provides links to articles and postings on issues of aging and geropsychology, including links to dementia care guidelines, Alzheimer’s, and psychological care of older people.

This site provides information on the vital role consultant pharmacists play in improving dementia care for residents of nursing homes.

This website provides a free public repository of a growing collection of geriatric educational materials. Visitors to the site can search for key words such as “antipsychotics” to get a variety of links to podcasts, presentations, peer reviewed articles, and more.

The Eden Alternative is a small not-for-profit organization based on the core belief that aging should be a continued stage of development and growth, rather than a period of decline. This website includes a list of trainings on Reducing the Use of Antipsychotic Medications for People Living in Long Term Care Settings.

Pines of Sarasota is a nursing facility in Florida that has developed excellent resources, trainings, and presentations about compassionate and effective person-centered care of persons with Alzheimer’s and dementia. The Pines Education Institute was established as a regional training center for medical professionals, paraprofessionals and at home caregivers in order to provide cutting edge education and training for a broad range of medical interests, which will improve the quality of care for seniors in residential and home based settings. Additionally, there is a freely accessible Pines of Sarasota YouTube Channel that has many English and Spanish videos about person-centered care.