One month ago on this program, we looked at the problem of widespread use of antipsychotic medications in Texas nursing homes. Texas currently leads the nation in the percentage of nursing home residents who’ve been prescribed antipsychotics.
Mark Haslett: One reason for this seems to be that in too many cases, the drugs aren’t being prescribed appropriately. Seniors with Alzheimer’s disease or dementia often get put on those medications because of the difficult or disruptive behaviors that are a symptom of those conditions. The result – the behaviors decrease or vanish, but the people are left zoned out – sedated. In caregiver terminology, it’s called a “chemical restraint.” However, some people in the medical community in Texas are aware of this problem and are working to fix it. The Texas Health Care Association is a private non-profit that has among its goals the improvement of health care services in Texas. Their president, Kevin Warren, says that a lot of the time, people are already taking antipsychotics before they move to an institutional care facility.
Kevin Warren: These drugs or the medications were started in the community. The family was having difficulty with behaviors with their loved one, they reach out to their physician, their physician prescribes them for this medication, and so the reason that you’re seeing this effort and this push on the national level and the state level to reduce them is, further research has indicated, it doesn’t help with those behaviors like they once believed. Residents are admitted to the facility on the medication, so then there is process by which you have to do what’s referred to as “gradual dose-reduction.” You can’t just immediately take somebody off the medication, because of adverse effects and other issues that may be associated with just dropping them off the medication.
Haslett: Warren says that many residential care providers have been working hard to individualize their treatment plans for people with Alzheimer’s or dementia. And that the only way to do that effectively is to really know the person. And there’s the problem – the person might be so far into their illness that their ability to communicate is impaired. Warren says that most of the time, communication between the family and the care providers is essential in helping the staff learn what methods might work. He had a personal experience that proved it.
Warren: My grandmother, many, many years ago, she’s since passed away, but many years ago, she was living in a skilled nursing facility and she had dementia, and I got a phone call from my aunt asking me, “Kevin, I don’t know what to do with your grandmother. She’s not bathing, she’s resisting care, is being very difficult, and how do I help the facility?” So what I explained to my aunt was, I said, “you know, grandmother used to work in a library, so if the facility has a library or has a room with books that the residents go into read, then go and sit down with grandmother and tell her that the facility needs her to assist them with reorganizing the books and looking to see, because of her experience, if everything is organized correctly. Make her a greater part of the facility, and giving her that sense of purpose, that that may be what she’s longing for.” And sure enough, when I did talk to my aunt following that, it seemed to work, because it gave her a sense of purpose that she was then willing to bathe and come out because she had to be presentable when she was coming out into the rest of the facility and engaging with staff and others.
Haslett: If you have a loved one in a nursing home, communicating with the staff and knowing what’s going on is the best way to help everyone – both your loved one and their care providers. For KETR News, this is Mark Haslett.