KWQC had a recent article about the benefits of robot pets which are becoming more common in retirement homes. They’re not as much responsibility as a regular pet, and can bring a lot of joy to the residents.  Where it might have gotten lonely before, now there’s a friend. This can help residents who suffers from agitation or dementia with behavior issues.

“When a person is in a room by themselves basically, it’s nice to have something that you feel is there with you,” said Clair Odell, whose daughter is a resident. “The sounds, the purring, the mewing seems to be very soothing.”

Odell remembers the first time he met his daughter’s pet.

“When we went to see her and her new cat, the excitement and the joy that she had when she was showing it off and showing off its antics,” he said.

Officials at Ridgecrest Village say the next step is getting pets with reminders in them for residents – letting them know about appointments and when to take their medicine.

WHAS11 had an incredible story about two friends who really made a difference in the lives of nursing home residents.  Sandy Cambron and Shannon Blair provide baby dolls to nursing residents suffering from dementia.

It began as a gift to Sandy Cambron’s mother-in-law.  “We would buy her a TV, buy her stuffed animals and nothing would work and one day, we were out shopping and I told my husband, maybe we should get her a baby doll,” Sandy Cambron said.  It made all the difference.

“She loved it. She took that baby and slept with it, had meals with it. You could see the biggest difference with her. She would not leave that baby. It was always by her side. When she passed away, we buried the baby with her,” Cambron said.

Then, last year, when her friend, Shannon Blair, was going through a similar experience with her own mother, Sandy offered a baby doll.

“It was actually my mom’s roommate’s response. She immediately reached out and started crying. I went back to Sandy the next day and I said, I get it. I get why you wanted to give my mom a baby,” Blair said.

“300 babies later, we are boomin’. We are visiting as many places as we can,” Blair said. They hand out baby dolls, stuffed puppies and kittens. Each doll is color coordinated and wrapped in the softest of blankets.  They’re changing lives one baby doll at a time.

“It is just a baby doll, but whatever emotions it stirs up, it’s all happy. It takes them back to a joyful time. It’s happy and it’s sad at the same time,” Blair said.

Pearl’s Memory Babies runs purely on donations. Shannon and Sandy buy the baby dolls and shop all the bargains they can find to get the outfits, blankets, and even the diapers. If you’d like to donate or learn more, you can visit their Facebook page or website.

Texas has slowly reduced the misuse of antipsychotics in nursing homes in recent years, but experts and advocacy groups say more can and should be done. Texas legislators are considering a pair of bills that would require the written consent of a patient or a family member before an antipsychotic drug is given to a nursing-home patient.

Amanda Fredriksen, associate state director at AARP Texas, explained about 12,000 nursing home residents are being given antipsychotic drugs for no legitimate reason, perhaps other than the convenience of staff in caring for patients who otherwise might be difficult. She said these medications are intended to treat schizophrenia, bipolar disease and Tourette’s syndrome, but are dangerous for those with Alzheimer’s and dementia.

“These drugs can increase the risk of falls, increase blood glucose levels, they dramatically increase the risk of stroke – all these risks are well known,” Fredriksen said. “We outlawed physical restraints many, many years ago and now we’ve moved to chemical restraints. It’s fairly barbaric. ”

Fredriksen noted there are other alternatives to antipsychotics, including music and memory therapies and safer medications.

“There are also behavior techniques that can be used to know how to anticipate some of the reactions from residents and intervene with different kinds of behavior techniques that don’t require any drugs at all,” she said.

Tulsa World reported on a bill pending in the Oklahoma House to crack down on the administration of antipsychotic drugs to nursing home residents. Oklahoma ranks first in the nation in giving antipsychotic medication to nursing home residents, according to AARP Oklahoma, which is backing Senate Bill 142, by Sen. Stephanie Bice, R-Oklahoma City.

This legislation will provide a stop to this immoral practice of drugging our seniors,” said Sean Voskuhl, AARP Oklahoma director.  “We rank No. 1 in the country in this category with the high use of antipsychotic drugs,” Voskuhl said. “We owe it to our most frail and vulnerable citizens to provide dignity and care.”

The measure defines antipsychotic drugs as a “drug, sometimes called a major tranquilizer, used to treat symptoms of severe psychiatric disorders, including but not limited to schizophrenia and bipolar disorder.”

Bice said the legislation requires written informed consent from the patient or legal representative.

If the nursing home resident is given the antipsychotic in an emergency situation, a physician would need to do a follow-up exam to ensure the proper diagnosis, according to the measure.

The medications are being prescribed for nonpsychotic reasons, Bice said.

“We want to ensure that if there is a medical diagnosis and they need it, they get it,” she said.

But if a patient doesn’t need it, caregivers must be careful about over prescribing, she said.

Some of the medications have negative side effects, such as sedation, which can increase the risk of a fall, Bice said.

There is a high occurrence of nursing homes giving antipsychotic medication when it is not necessary.

Nico Gomez is president and CEO of Care Providers Oklahoma, which represents about 200 nursing homes. Gomez said his organization is not opposed to the measure.

“It is an issue we have been working hard to improve for a number of years,” Gomez said. “We can understand that people who care for our residents like we do are getting frustrated with the lack of progress that other states have made.”

He said his organization is working to educate its members and with physicians to make sure “we are prescribing the right medications to the right person at the right time.”

Gomez said he didn’t have an answer as to why the state ranks first in the nation on administering the drugs to nursing home residents.

USA Today had the tragic and preventable story of James “Milt” Ferguson Sr., a blind World War II veteran, who died from a head injury suffered at a VA nursing home in Iowa. Ferguson was removed from one-on-one supervision, and he wandered into other residents’ rooms repeatedly, medical records show. When he rolled his wheelchair into one room unsupervised Dec. 20, 2018, his son said VA staff told him the resident of the room flipped Ferguson backwards out of his wheelchair. He landed on his head, causing a massive brain bleed.  A surveillance camera captured footage of James Ferguson Sr.’s fatal injury at a Veterans Affairs nursing home.

People are outraged that he wasn’t monitored more closely and what policies are in place to prevent a similar injury or death.  A USA TODAY investigation that chronicled Ferguson’s case and what specialists say was a concerning series of decisions by VA staff, before and after his deadly injury.

Nursing staff didn’t report the incident for 40 minutes, according to the records and surveillance video. They didn’t take him to the emergency room for more than two hours and he wasn’t transferred to a trauma hospital until five hours after the fall. He died from the injury two days later.
Ferguson was admitted to the acute psychiatry ward at the VA Medical Center in Des Moines in November after his dementia worsened. He had been in a private nursing home but became aggressive and wandered into other residents’ rooms. VA healthcare providers adjusted his medications and placed him on one-on-one observation with an aide to prevent him from straying into other rooms.

But on Dec. 11, 2018, staff removed the strict observation even though he was still determined to be a danger to himself and others, the medical records show. He was transferred to the VA nursing home on the medical center’s campus the next day. Ferguson continued to enter other residents’ rooms repeatedly, but records show staff did not reinstate strict observation.

After the head injury at 3:49 p.m. Dec. 20, Ferguson wasn’t taken to the emergency room until about 6:30 p.m., and he wasn’t transferred to a trauma hospital until 8:55 p.m.

Charlene Hunter James, President of AARP Texas, wrote the following for TribTalk, a publication of the Texas Tribune.

Imagine the horror of living in a deep fog day in and day out. Your steps, if you’re able to walk, are wobbly. Your memories are confused. Your grasp of reality is lost.

And to discover that you’ve been purposefully sedated for no legitimate reason.

Federal reports show that thousands of nursing home residents in Texas are being inappropriately prescribed antipsychotics. They’re not given the drugs because of psychiatric conditions for which they can legitimately be prescribed. Rather, they are being administered for other causes. Sometimes, it’s merely for the convenience of nursing home staff.

It’s called a chemical restraint and it’s akin to the way people were handled in the Dark Ages.

This is a misuse of one of the most powerful classes of psychiatric drugs. For those with dementia, which is not uncommon among nursing home residents, receiving antipsychotics is especially dangerous, even deadly. That’s why the Food and Drug Administration gives these medicines a black-box warning: an alert of an increased risk of death among people with dementia.

No one disputes that providing daily care for nursing home residents is a patience- and stamina-testing ordeal. Attending to these moms, dads, grandparents and other loved ones is a truly honorable profession. Working with those who have Alzheimer’s and other dementia adds greatly to the frustrations.

Through music and memory programs, and other therapies, Texas and some other states have made progress over recent years in reducing inappropriate use of antipsychotics among nursing home residents. But this crisis in care has by no means been eradicated.

So, it’s exasperating that lobbyists for the nursing home and medical industries this legislative session are opposing reasonable proposals to rectify the problem.

Today, the law says that nursing home residents must give consent for antipsychotics to be administered. And yet, all too often, family members of nursing home residents still report a lack of awareness of these drugs being administered. They see sudden and solemn changes in the mental well-being of their loved ones. Later they learn — or come to suspect — a culprit: antipsychotics being administered without their knowledge.

A stronger consent law that would require written consent of a nursing home resident or a legal decision-maker. And that’s essentially what’s offered in Senate Bill 1212 by Sen. Kelly Hancock, R-North Richland Hills and House Bill 2050 by Rep. Chris Paddie, R-Marshall.

To improve nursing home safety, please ask your state representative and senator to support those bills.

Disclosure: AARP has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. 

The family of Barbara Jones-Davis is suing Wesley Enhanced Living assisted living facility because the facility’s negligence resulted in their loved one’s death. The resident, who was visually impaired and suffered from dementia, was allowed and able to leave the facility unsupervised and was killed after falling from the second floor onto a sidewalk.

The incident happened July 2018 when Jones-Davis opened an unguarded and unlocked door on the side of the facility and wandered outside alone. The door Jones-Davis used to exit allegedly had an alarm, but surveillance video shows no one from the facility responded to the alarm for 25 minutes  She was outside for 23 minutes until she walked to the edge of the property and fell almost two stories onto the sidewalk. An employee allegedly later closed the door without inspecting the property for any residents who may have left.

Jones-Davis was found alive by a passerby and was taken to the hospital where she later died.  The facility allegedly learned of the incident about an hour later when a nurse was notified.

“Wesley Enhanced Living at Stapeley and its security contractor, U.S. Security Associates, were both negligent and grossly negligent for failing to put the appropriate systems, processes, and precautions in place to prevent such an event from happening, especially where similar instances involving unsupervised residents who wandered from the facility had occurred previous to this tragedy,” alleges the suit.

Officials with the Pennsylvania Department of Health and Human Services say there have been three recent incidents where residents have left the facility unsupervised, according to the lawsuit.

Popular Science had a great article on the #1 public health crisis–the opioid epidemic sweeping the United States.  The article shows several factors caused the crisis including the greed of the pharmaceutical companies and doctors, opioid overprescription, slow government response, and the availability of street drugs like heroin.

The largest and easiest to control is overprescription of this dangerous and addictive painkillers by doctors themselves. The medical community now recognizes the dangers opioids pose and the FDA introduced a special protocol for handling them. However, a new study, published last month in JAMA, from researchers at Johns Hopkins University shows that protocol was ignored by most doctors.

The most potent class of prescription opioids is known as transmucosal immediate-release fentanyls (TIRFs). These painkillers, which are fast-acting and powerful, are intended to help breakthrough pain in cancer patients, whose normal opioid pain relievers aren’t managing all the pain. “This is not a usual drug,” says Caleb Alexander, a Johns Hopkins professor of medicine and the corresponding author of the new study. It’s a last-resort drug. For that reason, he says, in 2011, the FDA instituted a program, known as the Risk Evaluation and Mitigation Strategy for TIRFs, or TIRF REMS.

The strategy didn’t work. Through careful analysis of the reports, which cover the years 2011 to 2017, Alexander and his colleagues found that between 34.6 and 55.4 percent of TIRF prescriptions had been given inappropriately. That’s especially troubling because TIRFs can cause a person who isn’t already “opioid tolerant”—that is, taking a specifically defined number of opioid painkillers—to overdose, because their bodies aren’t used to them.

“I think our findings raise serious concern regarding the role of manufacturers and the FDA,” Alexander says. They also suggest that far more documents currently unavailable for public and academic scrutiny might contain even more key information about the state of the opioid crisis—that’s if we can get them.

“These documents provide just a tiny peek through one window that reveals just one piece of the epidemic,” says Alexander. “There’s an enormous amount about the inner workings of the FDA and pharmaceutical manufacturers that the public hasn’t been able to see.”

The CDC estimates that 130 Americans die each day from opioid overdose, while the Substance Abuse and Mental Health Services Administration reports that millions of Americans misused prescription opioids in 2017.

In September 2018, the FDA approved a widespread REMS program covering opioid painkillers more generally, but it remains to be seen if that program will be more effective than the TIRF REMS. “The FDA’s opioid REMS activities extend far beyond the TERF products,” Alexander says, “and our findings raise questions as to the adequacy of the broader response of the FDA and manufacturers to the epidemic.”

Phyllis Ayman worked as a speech-language pathologist in more than 40 skilled nursing facilities. She has a certificate as a dementia practitioner and consults with individuals and families seeking nursing home placement for themselves or their loved ones. Her website is www.voiceforeldercare.com.  She recently had an article for McKnight’s about decreasing the use of anti-psychotics medications as a way to treat dementia. The article considers the underlying causes of the behaviors presented and alternative methods of management.

“An April 2018 article by Lois Bowers in McKnight’s Senior Living titled “Antipsychotic drug use increasing in assisted living, AARP says” cited the growing off-label use of antipsychotic medications for individuals with Alzheimer’s disease and dementia who reside in assisted living communities or in the greater community. The percentage of people aged 65 or more years who were prescribed antipsychotic drugs increased by more than 6%, from 12.6% to 13.4%, between 2012 and 2015.

This growth is in direct conflict with the National Center for Assisted Living’s goal to reduce off-label antipsychotic use by 15% between 2012 and 2013 as well as between 2015 and 2018.”

“As we know, Alzheimer’s disease is progressive and manifests itself in decline in several areas: behavior, communication and physical abilities. We may be able to view it on a kind of bell curve in which the decline in function begins with the last-learned, highest-level behaviors or abilities and regresses to those that are first learned.”

“It may help us understand the frustration an individual may be experiencing with decline or loss of communication ability in Alzheimer’s disease and dementia if we draw an analogy to any person experiencing a paucity or loss of language, whether it be developmental or the result of a disease process or sudden onset. The stroke or brain-injured resident who is at a loss for words due to aphasia, the child who has not developed sufficient language to express himself or herself or is unable to interpret his or her own behaviors sufficiently to put them into words.”

“Continuing this way of thinking, the same communication strategies we apply to those children or other populations experiencing loss of language may benefit the adult who is exhibiting behavioral or communication issues associated with Alzheimer’s disease or dementia. We should be responding to what we think is the need or emotion behind the behavior, rather than the behavior or the words that we are seeing or hearing. In doing so, we could adjust our response to meet the person at his or her level. This may include a combination of physical, gestural and verbal strategies.”

“As with any other person, child or adult, with reduced language, it may take several attempts to determine the underlying cause(s) of the behavior being exhibited.”

“Areas for consideration:

  • What are the antecedents of those behaviors?
  • What environmental or social factors are reinforcing or prompting the behavior?
  • How is the environment structured, and what role is that playing in the behavior?
  • What are the consequences to that behavior, or what effect might they have on perpetuating or continuing the behavior?”

Strategies that may be needed to address behaviors, depending on the behavior and the person’s cognitive level of functioning:

Communication: This may include adjusting the tone of voice, volume or intensity of voice. In addition, explanations or questions are best understood if they are short and simple. This actually serves a twofold purpose. Firstly, too much information and long sentences can be overwhelming and add to the person’s sense of confusion and frustration.  Secondly, in the event the information has to be repeated, it can save the caregiver time and energy. Repeating the same information over and over can be exhausting. Save yourself, and the listener. Redirecting attention to another activity or idea can also be helpful. The use of music can be a great tool for the individual to facilitate communication, engage with the environment and calm behaviors. Consider contacting musicandmemory.org which is a non-profit organization that provides training for using the Music and Memory program.

Physical: Physical comfort, a tender touch of the hand or hug, a gentle smile or kiss, looking a person in the eye and reassuring them you love or care about them can go a long way in helping an individual feel more calm or relaxed. Sometimes something as basic as providing something to eat or drink goes a long way in quieting or soothing behaviors. Note that as the disease process progresses, in many cases there is a preference for sweeter food items. Behaviors may also be a signal that a person is cold or hot; consider offering a sweater or blanket or removing particular articles of clothing.

Environmental: Changing the individual’s immediate surrounding. For example, going for a walk down a corridor, looking at the trees, birds or the weather outside may have a calming effect. It is also important to observe the environment for sudden changes: disruptive or intrusive behaviors from others, a sudden loud noise, etc. A feeling of boredom can be addressed by engaging the person in a familiar every day chore or activity that they used to do to give them a sense of purpose or usefulness. Music also plays a large role here. Too much, too loud, or music not suited to an individual’s interest or cognitive level can be jarring.

Setting expectations

What is the standard of behavior that we are expecting? If we continue to provide the same environments for individuals with Alzheimer’s disease or dementia, then why would we expect to get a different result?

Consider the example of many workplace environments that are designed to maximize the desired level of productivity or behavior while creating a happy and satisfied workforce. Thus, the physical environment is an essential ingredient to attempting to determine the underlying causes of particular behaviors.

Memory books

Memory books can serve an important purpose. Spending time with the person’s family and friends, as well as the individual, in finding out what is relevant to the person, and then spending time creating it, can be a valuable tool for the individual to reminisce and find comfort in familiar at those times when the person feels uneasy or confused in the surroundings. It helps him or her connect with the friends, family members, activities, places, accomplishments, he or she used to enjoy.

Memory books can be created by speech-language pathologists or recreation specialists or in consult with family members. Doing so can be especially valuable to those who no longer are in the comfortable surroundings of their own home environment.

Finally, the need to understand the causes that trigger behaviors and to provide the appropriate environment and training, including empathy and communication strategies, should be considered essential as we continue to care for individuals with Alzheimer’s disease or dementia in any setting. These could be enormously helpful in reducing the use of antipsychotic drugs whether in assisted living communities or skilled nursing facilities or the greater community.

Halcyon Hospice and Oakview Park Assisted Living have organized a baby doll drive for Baby Doll Therapy.  The simple premise is to introduce a realistic baby doll to a person with memory loss and see how that person reacts. Caregivers say it’s an inexpensive, drug-free treatment with no side-effects that can help seniors with Alzheimer’s and dementia. They hope to bring joy to assisted living residents and new success stories.

Many residents use baby dolls for stress relief and comfort. In many cases, the seniors feel needed, capable and useful again.

Tracy Pollard, Executive Director of Oakview Park hopes the baby dolls will fill a need for seniors who remember their lives as loving caretakers. She says, “They look for someone or something to take care of and I think with these baby dolls it helps them a lot to make themselves feel useful and feel like they’re doing something for someone they haven’t done in a long time.”The dolls will be taken out of their boxes and wrapped in blankets so it feels like a real nursery experience.  Organizers would also appreciate crocheted or knitted blankets for the dolls.