I share the concerns expressed in your February 5, 2018 article “Human Rights Watch Finds Nursing Homes Overmedicate Dementia Patients,” and I want to add an important perspective to this dehumanizing situation.
As an occupational therapist who has specialized in dementia care and worked in nursing homes and assisted living facilities for almost 30 years, I am currently the president of Dementia Care Specialists, an organization training and preparing health professionals to work with individuals with dementia. Together with our parent company, the Crisis Prevention Institute, we are committed to preparing care providers with the knowledge and skills needed to protect the most vulnerable in our society.
Elders living in nursing homes and assisted living facilities are vulnerable because they are compromised physically and/or cognitively; many have a cognitive impairment caused from Alzheimer’s disease or a related dementia. As such, they are dependent upon others to provide care in a manner that maintains their dignity, safety and quality of life while experiencing the highest level of function possible.
The excessive use of antipsychotic drugs to control these behaviors is well-known, as are the horrific side effects and consequences associated with these drugs, such as premature death, falls or sedation restricting the ability to engage in leisure or social activities. The practice of using drugs first to address signs of anxiety or verbal and physical agitation must subside.
In the 1980s, a campaign was launched to reduce the use of physical restraints in our nursing homes. This initiative was much needed, but I believe this movement has had some impact on the rise of chemical restraint use. Because the dementia-related behaviors weren’t better understood, addressed or reduced, antipsychotic drugs were used. In a way, we were replacing physical restraint with chemical restraints.
With increasing populations of individuals with Alzheimer’s disease and related dementias and younger residents with mental illness in our nursing homes and assisted living facilities, anxious, agitated and aggressive behaviors are occurring more often. The primary methods that have been used to keep everybody “safe” during behavior escalation and crisis situations – both physical and chemical restraints – have rightfully been under scrutiny. But what’s happening now to correct past mistakes and meet the requirement to eliminate or extremely reduce their use?
Nurses, therapists, nursing assistants and social workers aren’t trained and prepared to prevent, recognize and respond to these behavior expressions; simply put, health care facilities’ in-house training and education obtained at preparatory institutions have not kept up with the needs of these vulnerable individuals. Often, I see nursing homes and assisted living facilities’ staff trying to do the best they can with what they have, but a true solution must include proper education and preparation of our health care professionals.
Preparatory education, especially for those working in senior care, should always include training on how to work with people at all stages of dementia, including detailing how to prevent, recognize and respond to very common behavior situations. In our training programs, we teach care providers to recognize dementia-related behaviors as a communication of an unmet want or need. Behaviors such as screaming, resisting care, hitting or throwing objects may all be communicating signs of distress, such as being cold, hungry, frightened or lonely.
It makes no sense to send care providers into these situations without the proper tools. It’s unfair to everybody involved.
As we are facing an Alzheimer’s disease epidemic with the number of people with dementia rising rapidly, we must lower the use of antipsychotic drugs to give the most vulnerable in our society the dignity they deserve. Mandatory training in preparatory programs for all health care professionals is key to solving this rising problem. It gives care providers the tools needed to do their job and keep everybody safe. Looking forward, we need to consider government funding to help train health care professionals in behavior intervention strategies, as we have done with great success for special education teachers working in our schools.
Our elders and our care providers are at risk. Let’s work together to put a comprehensive solution in place to make the world a better and safer place for our vulnerable elders with dementia and the ones that care for them.
Founder and President of Dementia Care Specialists, a division of Crisis Prevention Institute