May 25, 2013

Maine nursing home's drug-free dementia treatment a model

An Alzheimer’s patient in a Waterville nursing home improves markedly without prescribed medication.

By Matt Hongoltz-Hetling mhhetling@centralmaine.com
Staff Writer

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Gerald "Jake" Ellis, 79, reaches for the hand of his wife, Pauline Ellis, 79, in the chapel at Lakewood Nursing Home in Waterville Wednesday. A resident of the home's dementia ward, Pauline Ellis has enjoyed improved quality of life after being taken off antipsychotic drugs.

Michael G. Seamans / Morning Sentinel

Dyer was familiar with Seroquel.

"There are more adverse side effects from those medications than there are benefits," Dyer said. "Seroquel has a tendency to make the elderly combative."

During her years of experience as a licensed practical nurse, Dyer said, she realized that her patients acted up because of what was going on around them rather than because of an inner compulsion.

More than 90 percent of the time, dementia patients respond positively to changes in their surroundings, she said.

"It's just a need that they have that's not being met," she said. "Rather than give them the pill, we have to figure out what the need was and eliminate the need for the pill."

At Lakewood, the emphasis is on a soothing environment. Staff members are chosen for their calm demeanor and passion. Three chickens are in residence in a coop in the courtyard, part of the therapy program. The common rooms hold comfortable furniture, cats and entertainment options. Residents can get out of bed on their own schedule rather than being hurried through a regimented daily routine.

"If we want to have food, we have food," Dyer said. "If we want to have a party, we have a party."

When Pauline first came to Lakewood, she was frequently agitated. She could rarely sit down and be at peace and instead often took things off of shelves or put everything in sight onto her bed. Her wandering continued. One day, she found an unlocked window and tried to escape through it.

"I can't remember why I did it," she said. She does remember how she felt, though. "Aggravated."

Jake, who faithfully made daily visits, said there was a moment in the beginning of each day when he lost hope for the hours ahead.

"I could walk in and just look at her and say, 'It's going to be a bad day for me today,"' he said.

After a couple of months at Lakewood, Dyer started reducing Pauline's Seroquel dosages. Over a period of weeks, it was eliminated.

Today, Pauline sits easily and chats with the people around her. Some memories are lost to her, but many remain. She goes for rides in the community with Jake. She enjoys singing and dancing and other organized activities. She shops in Lakewood's gift store and looks forward to occasional group trips to the coast.

Jake said he feels like his wife's true personality, which he described as "jolly and fun-loving," has returned.

These days he enters her room with an air of pleasant expectation.

"Now, when I come in, she's smiling, waiting for me," he said.

RATES IN CENTRAL MAINE

In 2011, the federal Office of the Inspector General for the Department of Health and Human Services published a report that found 22 percent of antipsychotic prescriptions to seniors were in violation of federal standards on nursing home drug prescriptions.

Last year, the Centers for Medicare and Medicaid Services, which oversees those federal medical programs, responded by asking nursing home prescribers to reduce prescription rates by 15 percent.

"The nation is catching up with us," said Cathy McKay, Lakewood's director of nursing.

Nationwide, almost 23 percent of long-term nursing home residents were on at least one antipsychotic medication in 2012, according to the Medicaid and Medicare centers. Maine's statewide rate is close to that at almost 25 percent.

The Medicaid and Medicare centers recommend consumers ask nursing homes about how they manage the behavior of residents.

"Interventions that do not require medications, such as higher staffing ratios, many and varied activities, and consistent assignment, have been shown to be successful in many cases," according to the Medicaid and Medicare centers.

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