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'Awakenings' changes the way meds are handled at nursing home

Original source:

Detroit Lakes Tribune
By Pippi Mayfield
August 26, 2011

George Jernberg suffers from Parkinson’s disease and had a brain tumor removed 20 years ago, and he now has dementia from a combination of the two.

His days were not good.

But, after four years of living in Emmanuel Nursing Home, he was asked in June to take part in a program called Awakenings for residents with dementia.

“He has totally transformed and the change has been unbelievable,” his daughter, Terri Jernberg, said. “My dad, who was very lethargic and having significant issues with memory, has turned around. It’s like he’s truly awoken from a sleep.”

One of the first things Emmanuel did with George was change his medications.

“They were able to determine that one of his sleep apnea medications had the possibility of really affecting his memory issues, so they took him off of it and have had him with different therapy for quite a while,” Jernberg said.

George has been wheelchair bound since moving into Emmanuel, and the staff is now working on strengthening his legs and arms so he can pull himself up.

Last week, Jernberg saw her father take his first steps in four years.

“It’s very emotional for me,” she said. “To me it was unbelievable, and I immediately burst into tears.”

“This is a culture change,” Cheryl Krause, director of nursing, said. “It’s been an eye opener.”

Through a Department of Human Services three-year grant, Ecumen Nursing Homes — including Emmanuel, Sunnyside, Heritage Community and Pelican Valley Health Center — are participating in the Awakenings program.

A nurse at Scenic Shores Nursing Home in Two Harbors started the program, and from her experiences, the grant was written.

“It’s a person-centered model. We’re looking at each individual,” said Executive Director Janet Green.

There are two parts to the Awakenings program. First, staff takes a look at resident medications and sees how they can be reduced, or even eliminated in some cases.

“Instead of medicating to deal with (issues)… When people are upset, everyone is upset,” Green said.

“We interact with the residents and get to know them and wean them off medications that aren’t good for them,” Krause agreed.

The second portion of the program trains staff to get to know each resident in the program — geared toward those with a form of dementia, whether it be Alzheimer’s, Parkinson’s, or something else — and help the resident get off the nursing home’s schedule and live as they choose.

That includes studying the resident and seeing what makes them happy, or which staff they respond to better and why. It also includes talking with family members because they know the resident better than anyone, and knew what made them happy before dementia set in.

Changes can be as simple as getting down to eye level and talking with the residents.

“A lot of it is little things,” Green said.

It can be things like what time do they like to get up in the morning? Do they like to have breakfast right away or sit and have coffee first?

One resident, Krause said, is now able to sit through church service after staff gathered information and learned that she liked to shower, have her hair done and put on her best clothes right before the service because that’s the way she did it when she was able to.

“We can’t bring their memories back, but we can bring back the quality of life,” Green said.

Through the grant, Emmanuel was able to add more staff to individualize care. They started the program almost a year ago, first with training staff and then getting the residents involved.

And while it’s focusing on dementia patients, it’s also being used throughout the nursing home, too.

“Medications are individualized, but we’re learning it’s for everyone,” Green said of the one-on-one learning about residents and doing what’s best for each individual.

The individualization could be encouraging the resident to paint, quilt, garden, do crossword puzzles, whatever they once enjoyed doing. Staff members are taking residents outside more and for more walks, too.

“Not that we didn’t do that before, it’s just added focus and time,” Green said. “The activities have changed.”

Krause said now when someone walks into the memory care unit, there is a noticeable difference.

“There’s a lot more activity,” she said.

“We think it’s going to change statewide and nationwide how we care for patients with Alzheimer’s and dementia,” Green said of other nursing homes following the Awakenings program.

“Because we’re seeing it working, and because it’s the right thing to do.”

Since the program began this year, those participating are on fewer drugs, some even completely off medications.

“It’s not that we don’t use medications (when needed),” Green said. It’s just a matter of changing medications for some residents. Nursing homes work with doctors and a pharmacist to study the medications residents are on and see where changes could be made.

“We’re using them (medications) more carefully, and making sure we’ve exhausted all other options,” she added.

With such success, Green said Emmanuel hopes to keep the program even after the grant runs out in a couple years.

“We see no reason not to continue it,” she said. The only question is how to fund it.

Besides making the changes to medications and being more focused on what each individual resident needs, Emmanuel has made some environmental changes as well.

More single rooms are available, which means better sleep at night without a roommate. There is a private dining room where couples can go and feel like they’re out for dinner rather than in a nursing home. There will be an exercise room soon as well.

There’s even a nursery set up for female residents needing to rock their babies.

“Some (residents) are back in that era and want their baby,” Krause said.

It’s not just the residents and their families that are pleased with the results. Green said the staff enjoys the changes as well.

“The staff really loves the residents here. They’re family,” Krause said.

Green said that the grant and the program has allowed them to hire more quality staff as well. It’s not just about experience, but about the care someone can give a resident.

“It’s very relationship based,” Green said. “They have to be flexible and honor the patient’s choices. “We’re letting go of the schedule and looking at the individuals. We’re very pleased. Our residents are changing and it’s a wonderful change that they want to stay active and be strong,” she said.

As most things are, Awakenings, and health care in general, is a learning process. Improvements are constantly being made in the way nursing homes care for their residents.

“We do the best with what we know and then learn better ways,” Green said.

For instance, she said years ago, nursing homes medicated their residents and used restraints on them.

“There’s no rocket science behind this,” Krause added. “It’s just being open to trying new things.”

“The word is out there. Interest is growing,” Green said of the new program.

Jernberg said her father is now driven to exercise, is eating healthier and is anxious to make even more improvements.

“It is absolutely amazing,” she said.

He now watches the news and wants to know what’s going on in the world, he interacts with people more, and he’s asking questions about the health of his wife, who also suffers from memory loss and lives at Emmanuel.

He even got to attend a football game Thursday and visit with various coaches.

“It truly is miraculous. We say, ‘dad’s back.’ It’s improved his quality of life tenfold,” Jernberg said. “I can’t say enough how thankful I am that they put him in this program. We were given the opportunity to make more memories with my dad.”

Jernberg said she knows her father still has dementia and will talk about things that don’t exist, but his clarity has changed.

“Having a conversation with him is exciting again,” she said. “It is truly amazing.”