Much has been written about the documented dangers of prescribing antipsychotic drugs to elders diagnosed with dementia. This off-label use of these powerful drugs are often prescribed to "manage" "behavioral problems." Several of these commonly used drugs have had Black Box warnings from the Federal Drug Administration (FDA) for years. Those warnings include things like increased risk of death, stroke, and heart attack. There are numerous other unpleasant side effects from the use of any antipsychotic.
I have addressed this issue here at this blog several times. If you are new to the topic, those links are provided below.
But first, hear Marilyn's wonderful success story, a story that reflects good nursing, good doctoring, and a good life for all those blessed to live in a place like Perham Living!
Marilyn wrote this just weeks agoabout the decreased use of antipsychotics at Perham Living in Perham, MN. where she served as Director of Nursing and was highly instrumental in initiating and implementing that nursing home's journey to Culture Change.
Marilyn Oellfke:
We at Perham Living saw a significant impact on the use of anti-psych meds with the implementation of the households. If we think about it, the household model meet all or most of the principles of dementia care: quiet setting of home; no distracting noises like overhead paging; normal conversations; and a routine that is based upon the resident's desires - rise at will, eat when and where the resident wants to, bath when the resident chooses and is ready, etc.
I think the fact that the residents are able to sleep better at night helps also. The resistance to care behaviors we used to see all but went away with the household routine. We went from 17% to 3% use of anti-psych meds and have maintained that rate since 2005. (Emphasis mine.)
We also spent time teaching the nurses not to call the physician with the first sign of behavioral symptoms - often the physician's first response (sometimes with the nurses urging) was a med. They look for the cause of the behavior "what are they trying to tell us" and modify the care plan. We also work with a Geriatric Psych NP who is very conservative when it comes to meds.
We find that it takes residents who are admitted with behavior issues a period of time to adjust - sometimes meds are needed initially - but once the resident is responding, we begin looking at how we can reduce and ultimately eliminate them. The few residents that we do have on meds are R/T a psych diagnosis requiring them.
FYI: Perham Living is a 96 bed skilled facility with 6 household of 16 residents each. We do not have designated memory care areas - all households are safe and prepared to meet the needs of residents with dementia. We have never had a separate dementia care unit and wanted to create a place where all residents could age in place without having to move because of change in diagnosis. It works well for us.
http://www.providencewomen.blogspot.com/2013/01/selling-well-being-in-pill.html
http://www.providencewomen.blogspot.com/2012/12/would-you-give-your-mother.html
http://www.providencewomen.blogspot.com/2012/10/information-about-psychoactive-drugs.html
http://www.providencewomen.blogspot.com/2012/10/are-you-advocate-for-someone-living-in.html
http://www.providencewomen.blogspot.com/2012/08/when-are-antipsychotic-medications.html
http://www.providencewomen.blogspot.com/2009/09/drugs-and-dementia-care-unnecessary.html
Monday, April 22, 2013
Thursday, April 11, 2013
Where is Perham Minnesota?
Tuesday’s post noted the meaningful ritual around death and dying at Perham Living, a nursing home that operates with the resident as the center. Not the schedule, not the task, not the staff, the resident. This is the essence of Culture Change. It turns the “normal” ( actually a system that is lethal to staff and residents) way of running things on its head. That’s why a whole new understanding of the role and exercise of leadership is of foremost significance. It too is turned on its head. Really, it’s transformation. Seeing things with new eyes. My goodness, this sounds like Easter! Transformative culture change DOES generate new life for residents and staff! And it is budget neutral!
So where is Perham? It is a small town in western Minnesota. Perham Hospital was originally owned and operated by the Franciscan Sisters of Little Falls, MN. Many years ago the Sisters turned the hospital over to the county who still owns and operates the hospital and the retirement complex.
I visited Perham Living when it was offered as an onsite visit (and 6 CEUs!) opportunity of the 2006 Pioneer Network Conference. The nursing home was five years into it transformation from a mni-hospital model of a nursing home to HOME. An interesting question and even more fascinating answer was part of an interactive discussion period:
“Do you have a short-term rehab program?”
“Yes.”
“How many do you presently have in that program?”
“None presently. However, a very high percentage of individuals who come for short-term rehab choose to continue to live at Perham rather than exercise their option to return home.”
We as a group were pretty amazed. However, it was clear from our tour and conversations that people who live at Perham Living ARE at HOME! That’s the goal!!
So where is Perham? It is a small town in western Minnesota. Perham Hospital was originally owned and operated by the Franciscan Sisters of Little Falls, MN. Many years ago the Sisters turned the hospital over to the county who still owns and operates the hospital and the retirement complex.
I visited Perham Living when it was offered as an onsite visit (and 6 CEUs!) opportunity of the 2006 Pioneer Network Conference. The nursing home was five years into it transformation from a mni-hospital model of a nursing home to HOME. An interesting question and even more fascinating answer was part of an interactive discussion period:
“Do you have a short-term rehab program?”
“Yes.”
“How many do you presently have in that program?”
“None presently. However, a very high percentage of individuals who come for short-term rehab choose to continue to live at Perham rather than exercise their option to return home.”
We as a group were pretty amazed. However, it was clear from our tour and conversations that people who live at Perham Living ARE at HOME! That’s the goal!!
Wednesday, April 10, 2013
A comment from yesterday's blog entry
I enjoyed reading about the dignity quilt and walk of honor that has been established in one nursing home to honor those residents who have died. As a former Department of Health surveyor for long term care, I would often ask the Director of Social Work what was done when a resident passed away. One nursing home places a rose on the pillow of the deceased resident’s bed to honor them. They felt this would be comforting to the resident’s family when they came to their room to pick up their loved one’s personal belongings. A very thoughtful gesture in my opinion.
Cynthia H. Adamowsky, LMSW
Sisters of St. Francis of the Neumann Communities
Director of Aging Services
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Thank you, Cynthia, for sharing your experience. I know how comforting it is for family members and friends of the deceased who come after a death and see that the room is still being honored as a dwelling place, as still holding a special meaning and sacredness.
I have seen other meaningful practices in nursing homes which include – especially in Sisters’ retirement settings – a Scriptural verse or some other signification quotation printed and formatted appropriately and then posted on the door of the recently deceased.
It is so much more sensitive doing things this way rather than the task-oriented approach in which a CNA is assigned the task of clearing the room as soon as the body of the deceased is removed. I have heard of the shock of family members who walk in and find the bed and the room already stripped bare.
Even writing of such a thought-less practice evokes very negative and sad feelings for me. Let’s focus on and implement the actions and practices that reflect thought and sensitivity as well as respect and honor for the deceased, the staff and friends and family members.
Cynthia H. Adamowsky, LMSW
Sisters of St. Francis of the Neumann Communities
Director of Aging Services
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Thank you, Cynthia, for sharing your experience. I know how comforting it is for family members and friends of the deceased who come after a death and see that the room is still being honored as a dwelling place, as still holding a special meaning and sacredness.
I have seen other meaningful practices in nursing homes which include – especially in Sisters’ retirement settings – a Scriptural verse or some other signification quotation printed and formatted appropriately and then posted on the door of the recently deceased.
It is so much more sensitive doing things this way rather than the task-oriented approach in which a CNA is assigned the task of clearing the room as soon as the body of the deceased is removed. I have heard of the shock of family members who walk in and find the bed and the room already stripped bare.
Even writing of such a thought-less practice evokes very negative and sad feelings for me. Let’s focus on and implement the actions and practices that reflect thought and sensitivity as well as respect and honor for the deceased, the staff and friends and family members.
Tuesday, April 9, 2013
Wonderful Things Happening!
Yes, there are wonderful things happening in some nursing homes! The following post is taken from a Web-based group-by-invitation that I belong to. It is a forum open to individuals who have participated in Action Pact’s week-long workshop, “Choreography of Culture Change.”
In this post, Marilyn describes the evolution from awareness to action around the issue of honoring death and dying in a nursing home and supporting those who have lost someone through that death: family members, other residents and staff.
The rituals which which became a tradition at Perham Living reflect staff sensitivity to the reality around them. It reflects a response to “the signs of the times.”
There is no one-size-fits-all in any such significant ritual. What is common in all meaningful practices is the intentional response and value-based philosphy undergirding them. There may be ideas that Marilyn’s article stirs in you. If you have any connection with e! nursing home, you may have experiences of a similar approach. You would enrich us all by sharing them in the comments section or by e-mailing your comments to me so that I can post them. (ilmcdp@yahoo.com)
To the article!
By Marilyn Oelfke former Drector of Nursing at Perham Living, Perham Minnesota
Perham Living began their culture change journey in 2001. As the households evolved, it became apparent to everyone that we needed to find a way to help family members, the other residents in the households and the staff cope with death. We wanted to treat residents with dignity and respect from the time they entered the home until they left. As relationships grew stronger, the loss of a resident was more difficult for everyone to manage. We had tried to find new ways of addressing the need and nothing seemed to be really effective. Until one day when a household lost two long-time residents within 5 minutes of each other. The families, other residents and staff were deeply affected - something needed to be done....It happened that the first resident to pass away had been lovingly called the "jungle nurse" by her family as she had served in the Korean War. We had a quilt in the living room that had a vine quilted around the edge. Someone took the quilt to the room and placed it over the gray zipper bag that the funeral home typically used. Her body, draped in the quilt, was brought to the living room in the household where a brief prayer was said and everyone had an opportunity to share. When we were ready, everyone escorted her out through the town center to the front door to the waiting hearse. Our new tradition was born - each house now has a dignity quilt for use when a resident dies. The "Walk of Honor" is done on all shifts.
The practice was well received in the community of Perham - we heard many positive comments. The hospital adopted the practice as well. They too use a Dignity Quilt and the Walk of Honor when a patient dies. The Funeral Home staff have been very supportive of the practice and give residents, family and staff as much time as they need to say their "goodbyes".
This may not work in all facilities - it happened so naturally out of a need at the moment and everyone was involved in making it happen. It has made a significant difference for those at Perham Living and certainly worth consideration for other households.
We also have Memorial services for residents if the family wishes. One difference is that the service is prepared and done by the residents and staff in the household.
In this post, Marilyn describes the evolution from awareness to action around the issue of honoring death and dying in a nursing home and supporting those who have lost someone through that death: family members, other residents and staff.
The rituals which which became a tradition at Perham Living reflect staff sensitivity to the reality around them. It reflects a response to “the signs of the times.”
There is no one-size-fits-all in any such significant ritual. What is common in all meaningful practices is the intentional response and value-based philosphy undergirding them. There may be ideas that Marilyn’s article stirs in you. If you have any connection with e! nursing home, you may have experiences of a similar approach. You would enrich us all by sharing them in the comments section or by e-mailing your comments to me so that I can post them. (ilmcdp@yahoo.com)
To the article!
By Marilyn Oelfke former Drector of Nursing at Perham Living, Perham Minnesota
Perham Living began their culture change journey in 2001. As the households evolved, it became apparent to everyone that we needed to find a way to help family members, the other residents in the households and the staff cope with death. We wanted to treat residents with dignity and respect from the time they entered the home until they left. As relationships grew stronger, the loss of a resident was more difficult for everyone to manage. We had tried to find new ways of addressing the need and nothing seemed to be really effective. Until one day when a household lost two long-time residents within 5 minutes of each other. The families, other residents and staff were deeply affected - something needed to be done....It happened that the first resident to pass away had been lovingly called the "jungle nurse" by her family as she had served in the Korean War. We had a quilt in the living room that had a vine quilted around the edge. Someone took the quilt to the room and placed it over the gray zipper bag that the funeral home typically used. Her body, draped in the quilt, was brought to the living room in the household where a brief prayer was said and everyone had an opportunity to share. When we were ready, everyone escorted her out through the town center to the front door to the waiting hearse. Our new tradition was born - each house now has a dignity quilt for use when a resident dies. The "Walk of Honor" is done on all shifts.
The practice was well received in the community of Perham - we heard many positive comments. The hospital adopted the practice as well. They too use a Dignity Quilt and the Walk of Honor when a patient dies. The Funeral Home staff have been very supportive of the practice and give residents, family and staff as much time as they need to say their "goodbyes".
This may not work in all facilities - it happened so naturally out of a need at the moment and everyone was involved in making it happen. It has made a significant difference for those at Perham Living and certainly worth consideration for other households.
We also have Memorial services for residents if the family wishes. One difference is that the service is prepared and done by the residents and staff in the household.
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