• COVID-19 Infection Prevention and Wandering: Can the Two Co-Exist?

    Tuesday, April 28, 2020 | Caralyn Davis, Staff Writer

    In the March 13 revised Quality, Safety, and Oversight (QSO) memo QSO-20-14-NH, the Centers for Medicare & Medicaid Services (CMS) advised nursing homes to restrict all visitors except for compassionate-care situations and to “cancel communal dining and all group activities, such as internal and external group activities.” Adjusting to these changes has been difficult for every nursing home resident, but social distancing is especially hard for residents with dementia who wander and are eased by group activities.

     

    “That’s not who these people are,” acknowledges Teepa Snow, MS, OTR/L, FAOTA, founder and CEO of Positive Approach to Care, a global dementia care services and products company based in Efland, NC. “Nurses are being asked to do the impossible with the inadequate.”

     

    While physicians and physician extenders may be willing to prescribe an antipsychotic medication as an emergency measure in an acute or emergency situation as allowed under F758 (Free From Unnecessary Psychotropic Meds/PRN Use) in Appendix PP of the State Operations Manual, giving residents with dementia antipsychotics to make them immobile not only increases their risk of adverse events, such as cerebrovascular accidents (CVA) and even death, it also increases their risk of respiratory symptoms, including shortness of breath—one of the primary symptoms of COVID-19, points out Snow. “Providers may also consider taking away wheelchairs and other mobility aids. However, doing that puts residents with dementia at greater risk for falls and fall-related injuries, potentially resulting in a trip to the emergency department where they may be exposed to SARS-CoV-2, the virus that causes COVID-19.”

     

    Instead, the goal should be to come up with strategies that make sense, balancing safety and resident needs, says Snow. “Keeping these residents in a small room is highly improbable, so you want to be ready to move forward with some element of safety. You will put residents at risk if you aren’t prepared for the reality that they will come out of their rooms.”

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  • Developing a Restful Environment Action Manual (DREAM) Toolkit From CMS (2/20)

    Tuesday, February 18, 2020 | CMS

    As many as 70% of adults with dementia experience sleep disturbances, which are associated with various negative health outcomes. High quality sleep is necessary for optimal cognitive and physical functioning, especially for residents who already experience cognitive decline due to dementia. The DREAM Toolkit provides educational material and practical tools for nursing home staff to help all residents living with dementia improve sleep quality. Nursing homes can choose from a variety of strategies in the DREAM Toolkit to help improve quality of life and quality of care, especially for residents living with dementia.

    The DREAM Toolkit consists of the following components:

    1) Implementation Guide

    2) Handbook

    3) Sleep Matters Video: https://youtu.be/2Ub55iKej84  

    4) Pocket Guide for Clinical Teams

    5) Sleep Environment Improvement Tool

    6) Resident Preferences Tool

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  • Antipsychotic Medication Use Data Report and Late Adopter Data Report Updated (1/20)

    Monday, January 27, 2020 | CMS

    National Partnership to Improve Dementia Care in Nursing Homes: Antipsychotic Medication Use Data Report (October 2019)

     

    The National Partnership to Improve Dementia Care in Nursing Homes is committed to improving the quality of care for individuals with dementia living in nursing homes. The National Partnership has a mission to deliver health care that is person-centered, comprehensive and interdisciplinary with a specific focus on protecting residents from being prescribed antipsychotic medications unless there is a valid, clinical indication and a systematic process to evaluate each individual’s need. The Centers for Medicare & Medicaid Services (CMS) promotes a multidimensional approach that includes; research, partnerships and state -based coalitions, revised surveyor guidance, training for providers and surveyors and public reporting. 


    CMS is tracking the progress of the National Partnership by reviewing publicly reported measures. The official measure of the Partnership is the percentage of long-stay nursing home residents who are receiving an antipsychotic medication, excluding those residents diagnosed with schizophrenia, Huntington's Disease or Tourette’s Syndrome. In 2011Q4, 23.9 percent of long-stay nursing home residents were receiving an antipsychotic medication; since then there has been a decrease of 40.1 percent to a national prevalence of 14.3 percent in 2019Q2. Success has varied by state and CMS region, with some states and regions having seen a reduction of greater than 45 percent. CMS acknowledges that circumstances exist where clinical indications for the use of antipsychotic medications are present and does not expect that the national prevalence of antipsychotic medication use will decrease to zero. 

     

    National Partnership to Improve Dementia Care in Nursing Homes: Late Adopter Data Report (October 2019) 

    CMS announced that the National Partnership met its goal of reducing the national prevalence of antipsychotic medication use in long-stay nursing home residents by 30 percent by the end of 2016. It also announced a new goal of a 15 percent reduction in those homes with currently limited reduction rates. Nursing homes with low rates of antipsychotic medication use are encouraged to continue their efforts and maintain their success, while those with high rates of use are to work to decrease antipsychotic medication use by 15 percent for long-stay residents by the end of 2019, using the prior baseline rate (2011Q4). These homes have been identified as late adopters.

    Nursing homes were identified as late adopters, based upon 2017Q1 data. These nursing homes continued to have a high rate of antipsychotic medication use, their percentage of change from 2011Q4 to 2017Q1 increased or decreased very little, and they remained above the national average in 2017Q1. This quarterly data report is specific to the progress of the late adopters. In 2011Q4, 21.4 percent of long-stay nursing home residents, living in a nursing home identified as a late adopter, were receiving an antipsychotic medication; since then there has been a decrease of 13.7 percent to a national prevalence, among late adopters, of 18.5 percent in 2019Q2. For more information on the National Partnership, please send correspondence to dnh_behavioralhealth@cms.hhs.gov. 

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  • CMS Dementia Care Resources Webpage (10/19)

    Friday, October 25, 2019 | CMS

    CMS has established a Dementia Care Resources page to provide information that was previously housed at the National Nursing Home Quality Improvement Campaign. Additional resources are available through the QIO program.


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  • CMS QSO Memo: Enhanced Oversight and Enforcement of Non-Improving Late Adopters re: Antipsychotic Meds (3/19)

    Sunday, March 3, 2019 | CMS

    • The National Partnership & Identification of Late Adopters – Since 2011, the Centers for Medicare & Medicaid Services (CMS) has seen a reduction of 38.9 percent in long-stay nursing home residents who were receiving an antipsychotic medication. Despite the success of the National Partnership, CMS identified approximately 1,500 facilities that had not improved their antipsychotic medication utilization rates for long-stay nursing home residents, referred to as late adopters. In December 2017, CMS notified these facilities of this identification.

    • Enforcement for A Segment of Non-Improving Late Adopters with Multiple Citations - As of January 2019, there are 235 late adopter nursing homes that have been cited for noncompliance with federal regulations related to unnecessary medications or psychotropic medications two or more times since January 1, 2016, and who have not shown improvement in their long-stay antipsychotic medication rates. If these facilities are determined not to be in substantial compliance with requirements for Chemical Restraints, Dementia Care, or Psychotropic Medications during a survey, they will be subject to enforcement remedies for such noncompliance.

    • Corporate Engagement - CMS is also looking for opportunities to engage with corporate chains that have significant numbers of nursing homes identified as late adopters.

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  • HIV Positive Nursing Home Patients: Changing Characteristics (1/19)

    Tuesday, January 29, 2019 | AHRQ
    Nearly 80 percent of nursing home residents with HIV are prescribed antiretroviral treatments, according to an AHRQ study that provides an updated snapshot of HIV positive nursing home patients in nearly 15 years. Researchers reviewed a nationwide database of Medicare claims linked to nursing home health assessments and prescription dispensing databases, comparing data from 2011-2013 and 1998-2000. Compared with statistics from 1998-2000, researchers found that patients with HIV are entering nursing homes at an average age of 60, as opposed to 44. New admissions had a higher prevalence of viral hepatitis (about 16 percent vs. 8 percent) and anemia (about 31 percent vs. 25 percent), but less pneumonia (about 11 percent vs. 14 percent) and dementia (about 9 percent vs. 21 percent). This population is expected to increase in the coming years as HIV treatments improve. Researchers believe these updated statistics will allow nursing homes to better anticipate the future health care needs of people living with HIV. 
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  • KAER Toolkit: 4-Step Process to Detecting Cognitive Impairment and Earlier Diagnosis of Dementia (1/19)

    Tuesday, January 15, 2019 | National Nursing Home Quality Improvement Campaign
    KAER Toolkit: 4-Step Process to Detecting Cognitive Impairment and Earlier Diagnosis of Dementia from the GSA Workgroup on Cognitive Impairment Detection and Earlier Diagnosis. The KAER toolkit provides an extensive collection of evidence-based, practical and easy-to-use guidance for primary care providers, including clinically-relevant and scientifically supported measurement instruments for detecting cognitive impairment and links to clinical practice guidelines for conducting diagnostic evaluations for dementia.
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  • NNHQIC Sets Dementia Care & Psychotropic Medications Goal (11/18)

    Monday, November 26, 2018 | NNHQIC

    The National Nursing Home Quality Improvement Campaign's new quality goal to improve care for individuals living with dementia focuses on knowing the person, building on strengths, filling days with positive moments, and proactively addressing unmet needs.

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  • Hand in Hand Training Course Update (9/18)

    Friday, September 14, 2018 | CMS
    Section 6121 of the Affordable Care Act of 2010 requires CMS to ensure that nurse aides receive regular training on caring for residents with dementia and on preventing abuse. CMS, supported by a team of training developers and subject matters experts, created this training to address the need for nurse aides’ annual in-service training on these important topics.

    The mission of the Hand in Hand training is to provide nursing homes with a high-quality training program that emphasizes person-centered care in the care of persons with dementia and the prevention of abuse.
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  • 2018 Dementia Care Practice Recommendations (2/18)

    Thursday, February 15, 2018 | Alzheimer's Association
    The Alzheimer’s Association 2018 Dementia Care Practice Recommendations are published in the Supplemental Issue of The Gerontologist via 10 articles providing detail about the specific recommendations, as well as the evidence and expert opinion supporting them.
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