4/13/2015. I am the former Director of the CMS Division of Nursing Homes. I am not currently a CMS official; I work as a contractor for CMS.

Transcription

1 Alice Bonner, PhD, RN, FAAN Northeastern University May 6 th, 2015 Photo:Alex Tenappel I am the former Director of the CMS Division of Nursing Homes. I am not currently a CMS official; I work as a contractor for CMS. This handout is intended for use by this audience only. Please do not distribute. After the presentation the participant will be able to: 1. Identify 2-3 non-pharmacological approaches to individuals with dementia that have been successfully implemented during the CMS National Partnership Discuss the role of leadership in engaging with the state coalition to improve dementia care Describe at least 2 ways to use data to track and trend improvements in AP medication use and dementia care, using the Advancing Excellence medication management tools and resources 1

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3 Sixth leading cause of death Over 5.2 million people currently living with Alzheimer s in the U.S. Includes 200,000 under age 65 with early-onset 1/3 seniors dies with dementia Almost two-thirds of people with Alzheimer s are women Cost of over $214 billion Predicted to be over 16 million people by 2050 Unsustainable cost of 1.2 trillion There is no cure. At this time, there is no treatment to cure, delay or stop the progression of Alzheimer's disease. FDA-approved drugs may temporarily slow worsening of symptoms for about 6 to 12 months, on average, for about half of the individuals who take them. Non-pharmacological approaches are the cornerstone of managing the disease 3

4 Connect across provider types within each community Take the initiative don t wait for an invitation Use existing resources Hospital Engagement Networks (HENs) State Coalitions to Improve Dementia Care Quality Improvement Networks (QINs, formerly QIOs). National Nursing Home Quality Care Collaborative (NNHQCC) change package Advancing Excellence Local Area Networks for Excellence (LANEs) Create the change you want to see! Model the attitudes and behaviors you would like to see in your staff Be visible Send a clear, consistent message about your organization s philosophy around dementia care Ask questions ( what do you need from me? What is most broken what needs to be fixed first? How can we be the best at getting better? ) Help staff embrace measuring improvement Take action but don t try to do everything all at once. Start with small steps but keep going! 4

5 Dan Cohen, social worker, innovator Preferences for Everyday Living Inventory (PELI) for person-centered care Part of Advancing Excellence suite of tools and resources Quantity, quality and staffing related to therapeutic recreation, activities Initial assessment when individuals with dementia are admitted, reassessment; engagement of the resident and family Focus on care team coordination Advancing Excellence Medication Management Tool PELI (previously mentioned) Consistent assignment tool Having the same caregivers makes a difference! Staff stability High turnover may lead to higher antipsychotic medication use and lower scores on PELI. It may also put facility at risk of deficiency citations on surveys, risk of more complaints from residents, families 5

6 AE Medication Tracking Tool Dementia Care Focused Surveys Four states so far Report available at Enrollment-and- Certification/SurveyCertificationGenInfo/Downloa ds/survey-and-cert-letter pdf Follows current guidance at F309 and F329 Emphasis on interviews, observation and record review 6

7 DON leadership hard stop at the door Collaborate with prescribers, medical director Support role of consultant pharmacist Engage with families, direct care staff Encourage direct care staff (CNAs and TR) to take on leadership roles with respect to dementia care Require root cause analysis and review of every case in which someone with dementia is on an antipsychotic Consistent staffing Music Pet therapy Exercise Social interaction Patient-centered care Reduction in overall AP use Enhanced use of I care plans and individualized interventions 7

8 Maintaining consistent staffing Family resistance to removing antipsychotic medications for residents with dementia Physician resistance to gradual dose reduction of antipsychotics for residents with dementia Transforming staff thinking to create more home-like interventions In 2013, 15.5 million caregivers provided over 17.7 billion hours of unpaid care Valued at more than $220 billion The vast majority of caregivers are women Caregivers had over 9.3 billion in additional health care costs of their own 60% of caregivers rate the emotional stress of caregiving as high or very high; more than 1/3 report symptoms of depression 8

9 Get involved! Help raise awareness Find out how to help in your community Photo: Alex Tenappel 9