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

(Continued from page 2)

click image to enlarge

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

In a sampling of 19 nursing homes in central Maine, some have much higher rates of antipsychotic drug prescriptions than others, according to data from the Medicaid and Medicare centers. The numbers refer to the number of overall patients, not just those in dementia wards.

Five nursing homes are above the state average, including MaineGeneral Rehab and Nursing at Glenridge in Augusta, at which 32.5 percent of seniors are on antipsychotics; Sanfield Rehab & Living Center in Hartland, 30.5 percent; Woodlawn Rehab in Skowhegan, 29.9 percent; Pittsfield Rehab in Pittsfield, 26.8 percent; and Maine Veterans Home in Augusta, 25.3 percent.

On the other end of the spectrum are Orchard Park Living and Rehab in Farmington, which has the lowest rate of antipsychotic use at 2.9 percent; Lakewood, with 7.9 percent; Somerset Rehabilitation in Bingham, with 8.5 percent; Edgewood Rehab in Farmington, with 10.3 percent; and Winthrop Manor in Winthrop, with 10.6 percent.

While overmedicating seniors is a problem, sometimes a prescription is the best answer to a difficult situation.

Sometimes medication is the only way to reduce anxiety and keep both staff and patients safe, said Connie McDonald, administrative director for MaineGeneral's nursing homes.

"They might be very combative when someone is trying to keep them clean, and the medication can help them not to feel so anxious and frightened," McDonald said. "People do need to be cleaned, and staff have to have some assurance that no one will get seriously injured."

Still, McDonald said, the organization, like most in the country, is addressing the issue of overmedicating residents.

The data from the Medicaid and Medicare centers show one of MaineGeneral's nursing homes, Glenridge, topping the list at 32.5 percent, but McDonald said the percentage, which includes aggregate data for the last eight months of 2012, doesn't accurately reflect a significant trend of reduction of antipsychotics there.

At the beginning of 2012, 46.9 percent of Glenridge's 125 patients were on antipsychotics, but by the end of 2012, the number had dropped to 16 percent, where it remains today, she said.

"We really did a lot of work on that," she said.

She also said that antipsychotics might be needed more at Glenridge, where all of the patients have moderate to severe dementia, than at a nursing home with a mixed population of dementia patients and others.

Both McDonald and Dyer stressed the importance of education in reducing antipsychotic prescriptions at a time when families and health care workers have come to expect that the answers to their problems lie in medication.

Dyer said that doctors often respond to pressure from nurses and family members who are desperate to stop unwanted behavior.

All three groups can gain a better understanding of when antipsychotics are called for, she said. Lakewood achieves its success by talking candidly with families and doctors in an effort to try an environmental approach to resident care.

Staff members undergo sensitivity training, in which they wear Vaseline-smeared glasses, headphones playing both music and television programming, rubber gloves with some fingers taped together, and corn kernels in their shoes. They are then taken into a dimly lit room and told to brush their teeth, fold towels, put on a particular sweater, write a letter to the family and pour a drink of water and drink it.

They come out of the exercise with a new understanding of the people they're caring for, Dyer said.

While there are some patients who do need antipsychotics, she said, the need is tiny compared to the number who receive them. Of the hundreds of patients who have gone through Lakewood's dementia ward, she said, only a very few have needed psychoactive drugs.

Pauline, for one, has a more positive outlook on the workers who care for her at Lakewood -- and on life -- now that she's off medication.

"When you've got friends and other people that take care of you, you know it's going to be better," she said.

Matt Hongoltz-Hetling can be contacted at 861-9287 or at:

mhhetling@centralmaine.com

 

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