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Local nursing homes leading movement to reduce chemical restraints

Original source:

Ventura County Star
Tom Kisken
March 7, 2013

Ventura County long-term care watchdogs and nursing homes are helping lead a national movement to reduce the use of powerful drugs aimed at controlling the behavior of people with dementia, according to leaders of a Thursday forum.

The use of antipsychotic drugs on nursing home residents in the county fell by 20 percent from 2010 to 2012, said attorney Tony Chicotel of the California Advocates for Nursing Home Reform, citing data from the U.S. Centers for Medicare & Medicaid Services.

The use of psychotropic drugs, a broader category medicine that can control the mind, emotion and behavior, fell 12 percent over the same period.

“Ventura County is an epicenter for this movement,” Chicotel said at a symposium dedicated to alternatives to so-called chemical leashes. He cited the Medicare agency’s goal to reduce the use of antipsychotics on Alzheimer’s patients and others.

“What CMS is trying to prompt the nation to do, you’ve already done,” he said. “What’s going on here is remarkable. It’s worthy of praise. It’s worthy of continuing.”

Chicotel and others cited the education efforts of the watchdog group, Long Term Care Services of Ventura County, nursing homes that are finding ways to better understand and communicate with residents who have lost their ability to reason, and a growing awareness of studies stating antipsychotics can increase the risk of fatalities.

Deirdre Daly, administrator of an assisted living facility, Autumn Years at Ojai, cited CMS and other agencies that are trying to hold care facilities and doctors accountable. Her emphasis is on better understanding the needs and backgrounds of her clients — to the detail of knowing their tastes in music and books — and using that knowledge to meet their needs. She said the barrier for some facilities to building such relationships is simple.

“It takes time and they have to focus on the medical,” she said.

Daly is part of a team of care providers working with Long Term Care Services of Ventura County to build awareness of relationship building and similar alternatives to chemical restraints. Nursing home leaders want to do the best they can for the residents, said Brett Watson, administrator for the Camarillo Healthcare Center.

“It’s an education process,” he said.

That path involves changing the culture of a society where the benefits of pills are maximized and the risks are minimized, said Dr. Jonathan Evans of Charlottesville, Va., keynote speaker at the symposium and medical director for several nursing homes.

Evans, president-elect of the American Medical Directors Association, told a crowd of 300 people they shouldn’t look at pills as a solution for patients who fight, wander or even urinate in potted plants outside their room.

“Rather than encouraging you to run away from medication,” he said. “I want to encourage you to run toward something much better.”

If residents have dementia and believe they are living at home in the 1970s, don’t try to force reality on them, Evans said. Don’t try to change the mind of people who can no longer reason.

“Meet them where they live,” he said, discouraging people from trying to force behavior change. “... Tough love doesn’t work with dementia.”

He said often the most effective way to communicate with people who have dementia is not with medicine or words, rather nonverbal communication that shows trust and respect.

He told of a nursing home that threatened the eviction of a resident with Alzheimer’s because she kept pulling the facility’s fire alarm. He suggested the reason was obvious: the sign told people to pull in case of an emergency.

“She thought she had done her good deed of the day. It said ‘pull,’ so she pulled it,” he said, suggesting the solution was to somehow change the environment or at least adding a new sign that said “not you, Ethel.”

Long-term care administrators said they support the move away from chemical restraints.

“He’s right on,” said Ruth Grande, general manager for Aegis Living in Ventura, referring to Evans. “A lot of time behaviors are a way of communicating something’s wrong or they need help.”

The movement is a good thing, said Ann Monroe, social services worker at Valle Verde retirement community in Santa Barbara. But the powerful medication may be needed if all other options have been exhausted for a patient suffering from extreme paranoia or hallucinating to the point of fear.

“Seeing a person in distress is an awful place to be,” she said. “That’s when the antipsychotics may help.”

The symposium was organized by Long Term Care Services of Ventura County Ombudsman Program and California Advocates for Nursing Home Reform. Sylvia Taylor-Stein, executive director of the ombudsman group, characterized the efforts made in reducing the use of antipsychotics locally as a good start.

“Can we bring it down another 20 percent in the next year?” she said, referring to handful of nursing home administrators and health care professionals. “Our team was saying, ‘We think we can.’”