Minn. nursing home program minimizes medication - San Express News

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Minn. nursing home program minimizes

medication

JOHN LUNDY, Duluth News

Tribune

Published 03:00 a.m., Saturday, April

23, 2011

DULUTH, Minn. (AP) — Superior native Stanley Keller has

lived in a Park Point nursing home for 21 of his 57 years, but

he hasn't forgotten his favorite football team.

Keller's room at Ecumen Bayshore Health Center is

decorated with every imaginable Green Bay Packers

keepsake. He wears a Packers jersey, and parks his wheelchair

under a Packers-fans-only sign in a second-floor hallway of the

nursing home.

Keller has Huntington's disease, a brain disorder with a range

of symptoms including dementia. And he's part of a pilot program

in the Ecumen system designed to give him a little less

medication and a lot more personal attention.

On a recent afternoon at Bayshore, Keller was getting face time

with Tom Cline, a "restorative aide." He grinned from

ear to ear as Cline gently massaged his hands with lotion and

then held up a hand for him to kick.

The program is Awakenings, now in use at 15 nursing homes owned

by Ecumen, a Twin Cities-based nonprofit. The idea is to wean

residents, especially those with dementia, off nonessential

drugs that might be robbing them of their personalities and

harming them physically.

Keller takes a daily dose of haldol, an antipsychotic drug.

Before Awakenings was implemented four months ago, Keller was

given additional doses "as needed" when "out-of-character"

behaviors occurred.

Now, if those episodes occur, Bayshore responds with

human help.

"It's about enhancing quality of life," said Alseth,

a registered nurse who is Awakenings project leader at Bayshore.

"When you take medications that could sedate, that could take

away your functional abilities and your ability to interact with

your environment, you're decreasing the quality of life that the

client may have otherwise."

Laurel Baxter, who directs Awakenings for the Ecumen system,

said use of psychotropic medications is similar to the abandoned

practice of using physical restraints.

"If you see a person, be it a resident or even one of your

family members, and they're agitated and they're upset, it's

easy in our society to look at giving a pill to treat

something," Baxter said.

Bayshore resident Lagine used to shuffle her

feet when she walked.

"When I'd take her out I thought she was going to trip, because

she couldn't pick her feet up," Florence Lapcinski said

of Lagine, her sister.

Lagine, who is 61 and has dementia, can walk normally again —

because she's taking less medicine.

Awakenings began on a small scale at Ecumen Scenic Shores

Care Center in Two Harbors with Eva Lanigan, then

the resident care coordinator. Lanigan said she came back from a

seminar in 2009 with a question: "How can we provide residents

with behavioral interventions and modifications instead of

medicating them?"

Officials and staff at Scenic Shores were open to a new

approach, said Lanigan, who is now director of nursing. "We

found that when we took away the medications and implemented

exercise and activities . that worked well," she said. "We saw a

large increase in their quality of life and a decrease in their

medications, and we let their personalities come out."

Scenic Shores became a noisier, livelier place, Lanigan said.

Ecumen officials took notice. So did the Minnesota

Department of Human Services, which OK'd a $3.8

million, two-year grant to expand it to Ecumen facilities that

use Medicaid funding. It doesn't apply to Ecumen Lakeshore in

Duluth, which isn't a Medicaid facility, Baxter said.

The program was given the name Awakenings because a goal is to

restore patients' personalities as they emerge from a

medicine-induced fog. The title wasn't inspired by Dr. Oliver

Sacks' book of the same name, or the movie the book inspired,

Ecumen officials say.

Doug Aretz, director at Bayshore for just under a year, said

Awakenings is a response to a greater problem.

"We are in a society where we go to the doctor (and) we want a

quick fix," Aretz said. "It's been proven that it's not the best

way. It hasn't given us the results that we need."

That doesn't mean doing away with medications altogether,

Alseth said. But someone who is mourning the death of a loved

one doesn't necessarily need an antidepressant. Relaxation

techniques at bedtime can be a better method of dealing with

insomnia than pills.

So someone has to be available to listen to the resident

who's in mourning, or to help the sleepless resident relax.

"It is more staff time," Aretz said. "We're putting face time

and human intervention back into the program, back into care."

It's the right approach, said Dr. Deborah , a

geriatric psychiatrist and assistant professor in the Department

of Psychiatry and Behavior Sciences at Northwestern

University's Feinberg School of Medicine.

"I think that's actually an excellent initiative, and I

support it wholeheartedly," said. "We always try to use

medication for behavioral disturbances in dementia as a last

resort. . Any technique that helps a patient feel contained,

calm and safe is of tremendous benefit for patients

with dementia."

But offering that kind of personal treatment requires a

bigger staff, said.

At Bayshore, which has 160 beds, it meant bringing back

Alseth from another assignment with Ecumen. It also meant

hiring four nursing assistants also known as "restorative

aides." Each nursing assistant works with 13 to 15 residents

on a shift, Alseth said.

"It's revolutionized the way I do things," said restorative

aide Cline, 29, who has been a nursing assistant for about six

years. "I can do more individual care. I can spend more time

with the residents. And I get to be extremely creative."

One recent morning, for example, Cline worked with a resident

who wanted to wash dishes and cook. He filled that need by

helping her make a sandwich.

All of the Ecumen facilities in the program had to hire a

leader and nursing assistants, Baxter said — one reason the

state grant plays a key role.

Aretz said he hopes something like Awakenings will become

standard in all nursing facilities, but to do so will require

adequate funding once the grant runs out. "We really can't go

far down that road unless we're reimbursed adequately, and

today, we're reimbursed $25 per day less than what it costs to

care for that Medicaid person," he said.

Some residents' families welcome the change; others don't.

"You have families that absolutely don't want their loved one

to receive a psychotropic medication, and others that if they

have been successful with — in their minds — with a pill, they

don't want to discontinue it," Baxter said.

Lapcinski, 71, attended meetings about Awakenings and decided

it would be a good change for her younger sister, who suffers

from the effects of fetal alcohol syndrome. "I just don't

really think that she needed all that (medication),"

Lapcinski said.

But decreasing the use of psychotropic medications goes

against the grain of current thinking, and it could encounter

well-funded opposition, Aretz said.

"It's the powerhouse of the pharmaceutical companies that are

in play here," he said. "(It goes) back to the mentality in

America, which is the quick fix. It takes longer to figure out

the root cause of a condition and what's making those

behaviors happen as opposed to a pill taking hold in

15 minutes."