Program tries a new way to treat seniors with dementia

Sue Hughes and her mother, Addy.
Sue Hughes holds the hand of her 79-year-old mother, Addy, an Alzheimers patient at the Villages of North Branch nursing home -- a participant in Awakenings, an effort by Twin Cities-based Ecumen, the housing nonprofit for elderly, to reduce the use of psychotropic drugs for nursing home patients.
MPR Photo/Dan Olson

Seventy-nine-year-old Addy has lived with Alzheimer's disease for several years. She is calm and appears to be aware of what is going on around her.

She is one of thousands of Minnesota nursing home residents who have been given powerful mood-altering drugs called antipsychotics. Nursing home staffers use the drugs to help manage the behavior of residents with dementia.

But critics say the drugs are also being improperly used to keep patients docile so they require less care and attention. One of the state's largest nursing home owners has launched an effort to reduce the use of these drugs.

Addy's daughter Sue Hughes said her mother's caregivers have cut back on some of the powerful antipsychotics she was being given to manage problem behavior.

"Acting out verbally, physically, refusal to take medication because that would become confusing, 'What is that? What are they trying to give, I don't understand that any longer,' " said Hughes.

Addy, identified only by her first name to protect her privacy, is one of 14 patients in the Awakenings program at the Villages of North Branch, a nursing home north of the Twin Cities. Awakenings is an effort by Ecumen, the Twin Cities-based nonprofit that owns the nursing home, to reduce the use of antipsychotics.

Mick Finn, chief of operations for Ecumen, said the drugs are widely seen as effective tools for behavior management, but he sides with those who regard them as inappropriate for residents.

Registered nurse Alysia Palmer
Villages of North Branch registered nurse Alysia Palmer works with patients, family and nursing home staff to reduce psychotropic drug use among residents.
MPR Photo/Dan Olson

"These are the people when you walk into a nursing home ... [who are] in front of the nurses station, strapped in their wheelchair, slumped over ... [with] very little connection with their environment, either personal or physical environment," said Finn.

Hughes said the drugs given to her mother made her nearly bed-ridden. She had to be fed and moved by staff. But Hughes said reducing the use of drugs has made a difference.

"She is now feeding herself, about 50 percent or more of the time," said Hughes. "And she just seems to be brighter more of the time than she was before."

Registered nurse Alysia Palmer, who leads the Awakenings program at the Village of North Branch, has seen similar results among other patients.

"We would never actually sit [with overly sedated patients] and [ask], 'Are you OK?' and 'What's the matter?' " said Palmer. "... Now ... we're not overly sedating someone, and they're able to sit up now and feed themselves and be more independent."

Palmer's admission is no surprise to Dr. Vic Sandler, a geriatrician and medical director for Fairview Hospital's home and hospice program in Minneapolis. Before that, he was a nursing home medical director.

Sandler said that, while many nursing home workers are dedicated and caring, many are underpaid, poorly trained and deluged with red tape that takes them away from patient care.

"They have to fulfill a tremendous amount of paper regulations, which diverts a tremendous amount of their time and energy," said Sandler.

Dr. Victor Sandler
Geriatrician Dr. Victor Sandler, a former nursing home medical director, says psychotropics, including antipsychotics, are overutilized in nursing homes, even though two-decade-old federal regulations limit -- even prohibit in some cases -- their use.
MPR Photo/Dan Olson

He said it's not unusual for nursing home residents to be on 10, even 20, different medications. A typical response to patient problems is often another prescription.

"If the behavior continues or gets worse, or the patient has side effects, then rather than stop the drug, a lot of times another drug is added," Sandler said.

He said federal regulations limit the use of antipsychotics but they continue to be abused.

According to the Minnesota Department of Human Services, there are more than 27,000 Minnesotans living in nursing homes. Records show 13.5 percent receive antipsychotic drugs, below the national average of 18.5 percent. However, estimates from the Centers for Medicare and Medicaid Services put the national number much higher.

Hughes said her mother's physical and mental decline is heartbreaking, but, with the medication change, Addy's life now is better than it was.

"We were watching her before go downhill, and it was scary and we hated it. We hated her to have to live like that," said Hughes. "But with Awakenings, it's given her an opportunity to live at her best level while having this disease."

Ecumen's Finn said the nonprofit is using a $3.8 million state grant to expand the Awakenings program to 16 more nursing homes. Not using antipsychotics means some nursing home patients require more staff care. He estimates that a typical nursing home might need to add two to four people to its staff because of the extra attention needed for these patients.

It's worth the cost, according to Sandler, a proponent of the Awakenings idea.

"We're not going to need grants from the state to do this," he said. "We'll be able to take it from dollars that in my mind are already wasted on unnecessary care that patients often don't want and doesn't benefit them, and many times leads to complications either from drug therapy or hospital stays."

Ecumen's Finn said the Awakenings program, in its first year, will be evaluated at the end of its three-year grant period.

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