Ecumen “Awakenings”: Reducing Antipsychotic Drug Use In Alzheimer's Care

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Ecumen “Awakenings”: Reducing Antipsychotic Drug Use In

Alzheimer's Care

Last Updated

February 28th, 2011

Ecumen is working to change the culture of care in Alzheimer's

through its Awakenings Initiative.  Awakenings has been introduced

in 15 nursing homes in Minnesota and is working to reduce, where

appropriate, the use of antipsychotic drugs.

We at Ecumen take the “innovate” in our tagline very seriously.

We’re constantly looking for better ways to empower and honor our

customers, whether they live in their own homes, in our senior

housing communities or our nursing homes.

A few years ago, when our staff members became concerned about the

number of people with Alzheimer’s and other dementia-related

diseases being admitted who were on antipsychotic drugs, we

started exploring alternative treatments that could provide them a

better quality of life. These treatments emphasize human

relationships and non-pharmaceutical remedies. In 2009, we piloted

these alternative treatments in one of our nursing homes in Two

Harbors, Minnesota.

We call this initiative Awakenings, (Frequently

Asked Questions here) 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.

The results of this trial were so remarkable we decided to expand

Awakenings to 14 other Ecumen nursing homes across the state.

Thanks to a $3.8 million grant from the State of Minnesota’s

Department of Human Services, we’re in the process of doing that

right now.

America's Culture of Alzheimer's and Memory Care

To help residents with Alzheimer’s lead fuller lives, Ecumen is

spurring a major shift in the way antipsychotic drugs are used in

nursing homes.

To understand how Awakenings works, you first have to understand

the culture of Alzheimer’s care in this country. In many nursing

homes, antipsychotic drugs are commonly used to stop problem

behaviors that can accompany Alzheimer’s and dementia. For some

people, antipsychotic drugs can play an appropriate role. But for

many others, they can effectively end life for the still-living.

Long-term use often results in a “zombie” effect, not calming

residents but instead stealing their personalities and energy.

Antipsychotics have been found to actually worsen cognitive

functioning among elderly people with dementia, and speed their

decline. In addition, these drugs make elders more likely to

suffer a stroke, develop pneumonia, or experience a serious

adverse drug effect that leads to hospitalization or even death.

These drugs carry a Food and Drug Administration black box warning

that elderly people who use them have an increased risk of death.

Yet, more than 20% of American nursing home residents with

Alzheimer’s-related illnesses are on such medications. The use of

these drugs has skyrocketed in recent years. Medicaid spends more

on this class of drugs than any other—including antibiotics, AIDS

drugs, or medicines to treat high blood pressure.

Ecumen Introduces A Better Way

When we piloted Awakenings, the entire culture of the Two Harbors

facility changed. Instead of the fragmentation found in much of

American healthcare, Awakenings took a more holistic approach.

Trusted, collaborative teams—“circles of care”—were built around

each resident, involving family, professional staff, and the right

doctors and nurses who created individually tailored alternative

care plans. The focus became human relationships rather than

drugs. The team’s goal was to exhaust all other resources before

turning to pharmaceutical care.

As residents in the Two Harbors home were weaned off

antipsychotics, staff members engaged more with residents, taking

them on walks, playing games, and exercising. Certified Nursing

Assistants assumed a more important role. Therapies using

validation, reminiscence, music, aroma, and pets were employed to

improve residents’ physical and cognitive functions.

Within six months, the nursing home had eliminated the use of

antipsychotics among all residents, and the use of antidepressants

decreased by 30-50%. Before the pilot project, the home was quiet;

several residents preferred to stay in bed all day and others

sometimes held a far-off, vacant look. Today, it’s not uncommon to

walk into the home and see a large group of residents playing a

rousing game of balloon volleyball.

Expanding Awakenings To Other Nursing Homes

Based on our success in Two Harbors, and with the help of a $3.8

million state grant, we have formalized and expanded Awakenings to

14 other Ecumen nursing homes across the state, including:

andria, Bethany Home Austin, St. Mark’s Lutheran Home

Balaton, Colonial Manor Chisago City, Margaret S. Parmly Residence

field, field Care Center Detroit Lakes, Emmanuel Nursing

Home

Duluth, Bayshore Health Center Grand Rapids, Grand Village Nursing

Home

Lake Park, Sunnyside Care Center Litchfield, Emmanuel Home

Mankato, Pathstone Living North Branch, Villages of North Branch

Park Rapids, Heritage Living Center Pelican Rapids, Pelican Valley

Health Center

This is a major, three-year undertaking that involves: 1)

recruiting and educating local doctors, 2)

hiring project leads and other staff ready and willing to care for

residents in new ways, 3) informing and fully

engaging families, 4) retraining management

staff, and 5) developing systems and procedures

to make sure that new methods of care are used instead of or in

addition to appropriate prescribed medicines.

At the end of this period, we’ll report our findings to the

Minnesota Department of Human Services, as well as the larger

medical community. We’re hopeful that Awakenings represents a new

Alzheimer’s care “best practice” that can ultimately bring many of

the estimated 27,000 Minnesota nursing home residents on

antipsychotic drugs new vitality, joy, and dignity. It is

innovation, empowerment and honor.

Media Coverage On Ecumen's Awakenings Initiative

New

York Times

Minneapolis

Star Tribune

Minnesota

Public Radio

The

Picker Report, Dr. Bill

KBJR-TV,

Duluth, MN

Duluth

News Tribune

Minnesota

Health Care News