The Star Tribune reported that the Ecumen nursing care organization has been trying an experiment called the Awakenings Initiative since 2009. The program is designed to reduce use of anti-psychotic medications for patients who exhibit behavioral problems but aren’t diagnosed with psychosis. Many nursing homes and elderly care facilities use anti-psychotics to control patients’ behavior. Where memory loss makes patients confused and agitated, aggressive behavior can pose problems for caregivers. To help mitigate how aggressive a patient is behaving, drugs can be used to calm the patient down or sedate them. This practice, while common, carries with it many risks for the patient and their loved ones. The use of anti-psychotics on elderly patients results in an increase in risk of death for those patients. The sedation from those drugs can result in added confusion and memory loss, contributing to the cycle of dementia.

The Awakenings Initiative uses a behavior and environment centric approach to combat aggressive behavior from their patients. They’ve experienced remarkable success with the program, and are continuing to implement it even though the initial funding for the program has run out. They were able to reduce the use of anti-psychotics for patients not diagnosed with psychosis by 97% across the 15 nursing homes they operate. This results in a savings of $200,000-$400,000 a month for Medicare and Medicaid. The before and after use of anti-psychotics among patients who don’t need them is staggering, but the crazy part is that the Awakenings Initiative is not a radically different course of treatment. It simply revolves around patient care. Take this story, for example, which illustrates the Initiative’s approach:

“Barbara Melby chose the memory care unit Ecumen Parmly LifePointes in Chisago City for her husband, Harlan, last year because it aims to avoid stupefying medications to control his unruly behavior. Harlan, 74, has suffered from Parkinson’s disease for more than a decade and developed advanced dementia in the last two years. He had been taking trazodone and Xanax for severe anxiety, but they provided little relief; he wandered away more often and became more aggressive as he lost his ability to recognize her. After he moved into the nursing home 14 months ago, the staff noticed that loud noises and busy activities made him fearful, so they provided a quieter place for him at the edge of activities and gradually reduced his meds. Melby said he now recognizes her at times.”

Or this one:

“She gave an example of one of her former patients, a woman in her 80s with severe dementia who tore at her hair and repeatedly banged her head, complaining of hearing dead babies in the room. A staff member eventually figured out that she was delusional and misinterpreted the squeaky wheels of a medicine cart as wailing babies. “The answer for her wasn’t medication. It was WD-40 on the wheels of the medicine cart,” Phillips said.”

Or this one:

“Maria Reyes, who oversees training and management of the Awakenings programs, cited a similar case. She recalled a male patient who had a habit of urinating indiscriminately around the facility where he lived. The staff eventually learned that he’d lived on a farm and used an outhouse his whole life; he wasn’t sure where to go at the nursing home. So they decorated the bathroom door to resemble an outhouse, and that solved the problem, Reyes said.”

These ideas aren’t crazy. They don’t require expensive equipment or prodigies to diagnose and treat patients. They simply require listening to the patient and understanding that the patient’s environment is important. Instead of shoving anti-psychotic medications down a non-psychotic patient’s throat, which can have a whole host of negative side effects including increased risk of death, the caregivers could simply try to understand the patient and listen to what they’re saying. This kind of idea, while not radical in the course of treatment, is a radical cultural shift for caregivers in long term care. While it may be easier to simply prescribe a patient a medication which will keep them so sedated they can’t do anything, much less pose a behavioral problem, more nursing homes could take the approach that Ecumen has found to be so successful – actually caring about the patient and thus, caring for them.


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