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Managing Dementia and Psychiatric Disease Through Therapy

November 19, 2018

Managing psychiatric and disease-related behavioral issues in the elderly has always been challenging in the skilled nursing facility. The increased awareness of the adverse consequences of these medications along with the requirement to attempt a Gradual Dose Reduction (GDR) has made this process more challenging.

CMS has very specific and detailed guidelines related to how facilities are to address the use of psychoactive medications. While all medications are required to be monitored closely, psychoactive medications, specifically antipsychotics, require even more diligent monitoring for the facility to avoid adverse consequences of use and potential compliance issues.

Recently, CMS announced a new national goal, involving a 15 percent reduction of antipsychotic medication use by the end of 2019 for long-stay residents in those homes with currently limited reduction rates.

Also, the use of antipsychotics is a major part of the Long Stay Quality Measure which goes into determining skilled nursing facilities star ratings:

  • The Long Stay Quality Measure: Residents Who Received an Antipsychotic Medication measure reflects the percentage of long-stay residents who are receiving antipsychotic medication during a 7-day look-back period.
  • This Long Stay Quality Measure is calculated and used both in the Five Star reporting system and is publicly reports on the Nursing Home Compare website.

So what does this mean for therapy provided in Skilled Nursing Facilities?

While the initial focus was on reducing the use of antipsychotic medications, the larger mission of CMS is to enhance the use of nonpharmacologic approaches and person-centered dementia care practices.

How Therapy Can Help Reduce Antipsychotic Usage and Enhance the Use of Person-Centered Dementia Care Practices:

  • Therapists can try alternative treatments and non-drug approaches first – including treatment for pain:
    • Can ensure accurate assessment of pain in residents with cognitive impairments
      • Poorly managed pain can result in adverse behavior reactions and lead to unnecessary use of psychotropic medications
  • Therapists can develop an interdisciplinary and comprehensive process for determining and addressing resident behaviors/reactions
    • Negative patient behaviors due to pain, fear, boredom, inability to express an unmet need, loss of sense of self, inappropriate expectation from caregivers: i.e. patient does not have the cognitive ability to understand/carry out instructions
      • Therapy can assess and determine patient’s best ability to function and then make recommendations to caregivers to reduce negative resident reactions, as well as maintain the dignity and self-worth of the resident by helping them function to the best of their ability. Blue Sky’s MIND Program does this.
      • Therapy can develop Functional Maintenance Programs with specific recommendations for activities that are meaningful to the resident. Blue Sky’s MIND Program does this.

Blue Sky Therapy’s MIND program is a unique program designed to improve the family’s understanding of dementia and each caregiver’s ability to best care for those with dementia. Development of a customized plan that includes techniques for adapting each person’s environment and specific care approaches can reduce negative resident reactions, as well as maintain the dignity and self-worth of the resident by helping them function to the best of their ability.

While there are significant challenges to reducing the use of antipsychotics in skilled nursing facilities, providing therapy, such as Blue Sky’s MIND program, can help to not only reduce the usage but can also address the full range of issues a resident with dementia may be incurring. Also, by providing this extra level of care to patients with dementia, skilled nursing facilities can increase their Long Stay Quality Measure rating and their overall Star Rating.

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