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Dementia Work Group

In early 2012, the Centers for Medicare and Medicaid Services (CMS) established the National Partnership to Improve Dementia Care in Nursing Homes in response to an Office of the Inspector General (OIG) report underscoring the high use of atypical antipsychotic medication for “off-label” indications among nursing home residents.  CMS and its partners are committed to finding new ways to implement practices that enhance the quality of life for people with dementia, protect them from substandard care and promote goal-directed, person-centered care for every nursing home resident.  The Partnership promotes a multidimensional approach that includes public reporting, state-based coalitions, research, training and revised surveyor guidance.  Since the launch of the National Partnership, significant reductions in the prevalence of antipsychotic use in long-stay nursing home residents have been documented.  The National Partnership continues to work with state coalitions and nursing homes to reduce that rate even further.
 
Recently, CMS established new national goals for reducing the use of antipsychotic medications in long-stay nursing home residents by 25 percent by the end of 2015, and 30 percent by the end of 2016.  These goals build on the progress made to date and express the Partnership’s commitment to continue this important effort. CMS plans to monitor the reduction of antipsychotics, as well as, the possible consequences, review the cases of residents whose antipsychotics are withdrawn to make sure they don’t suffer an unnecessary decline and add the antipsychotic measure to the calculations that CMS makes for each nursing home’s rating on the agency’s Five Star Quality Rating System. Additional information about the National Partnership can be found by visiting the download files listed below. Questions may be directed to dnh_behavioralhealth@cms.hhs.gov.
 
CMS will continue to monitor the progress of each state in their efforts to reduce the use of antipsychotic medications among nursing home residents.  The current antipsychotic rates for each nursing home in our state can be found at the Nursing Home Compare website (www.medicare.gov/NursingHomeCompare). La. has remained one of the states with the highest use of antipsychotics in the nation since the initiative began.
 
In response to the CMS initiative, in July 2013, LEADER was asked by CMS to form a Work Group  in Louisiana who could develop a strategy for working with nursing homes to reduce their antipsychotic use. The Louisiana Dementia Partnership Work Group  was formed and is made up of 27 interested partners who share a common interest in seeing the reduction of the use of antipsychotics in our state. A list of these partners on the can be found on the LEADER website under “Dementia Partnership”.
 
In July, 2014, the Work Group  developed an action plan to put in place specific goals for reducing the antipsychotic use in our state and are in the process of completing the action plans for fiscal year 2014-2015.  The action items that have been scheduled/completed to date include; 1) State Survey Agency (SSA) emailing/blast faxing a letter signed by the Director of the SSA to all nursing homes giving an update on current status of Louisiana Nursing Homes and the use of Antipsychotics.  This letter included facility data, updates on the initiative, ongoing efforts by the partnership, SSA plans for increased oversight, references to resource material through CMS, QIO, AE, and an announcement of a webinar on use of the Toolkit for Improving Dementia Care in NHs; 2) SSA sending a memo to all nursing home providers regarding the incorporation of the Hand in Hand toolkit into the required dementia training; 3) conducting statewide workshops to educate providers and practitioners on the details of the CMS initiative and regulatory aspects; 4) the distribution of useful resources/tools to assist facilities to implementing changes in current practice; 5) the opportunity for open dialogue to discuss the barriers faced with antipsychotic reductions; 6) Alzheimer’s Services of the Capital Area providing dementia training and distributing “Recollection Collection Kits” to nursing homes in the Baton Rouge, Lafayette, New Orleans, and Slidell area with the highest rate of antipsychotic medication use for residents with Dementia; 7) Quality Insights Quality Innovation Network (of which eQHealth Solutions in Baton Rouge is a member), will present a webinar to provide instructions on the use of a “Toolkit for Improving Dementia Care in Nursing Homes”. The toolkit will be available for you online at HTTP://WWW.QUALITYINSIGHTS-QIN.ORG/RESOURCES.ASPX, in an effort to assist all nursing homes in reducing the unnecessary use of antipsychotics; 8) piloting a method to address and eliminate off-label use of antipsychotics through a collaborative project which consisted of onsite consultation with five volunteer nursing homes in our state who had higher use rates of antipsychotics.  As a result of this collaborative effort, a step by step guide to antipsychotic medication reduction was developed and will be given to with all nursing facilities, along with a laminated pocket guide and algorithm that can help to identify the risks and benefits of antipsychotic medication for people with dementia. On May 28, 2015, a pilot workshop was held in New Orleans to review the findings of the collaborative project; and 9) LEADER will be updating the link to the Dementia Work Group Project resource page that is more user friendly and will maintain up-to- date information.
 
Fiscal year 2015-2016 action plans for the Work Group will begin July 1,2015. The Work Group  is pooling all available resources to work together to remove the identified barriers to success.  Some of the action plan items that you can look forward to this next fiscal year include: 1) Health Standards Section will schedule face to face meetings with those facilities identified with a high percentage of antipsychotic use to discuss efforts being made to address any potential off-label use of these medications. Resources will be offered as needed; 2) Statewide workshops are being organized and presented by members of the partnership workgroup to educate providers on identified coding errors on MDS, Drug Regimen Review Process, successes of the collaborative pilot project, and an overview of non-pharmacological interventions to address behaviors related to an unmet need or distress; 3) A joint training for surveyor supervisors and nursing home clinical leaders will be held. Given that eliminating off-label use of antipsychotics represents a significant change in the standard of practice, this training will be provided to learn about the why and how of doing so, including ways of individualizing care;    3) Statewide workshops will be presented to clinicians and pharmacists on the dangers of antipsychotic use in people with dementia; 4) LNHA will be working to bring in speakers at their Fall Conference to address some the issues in regard to antipsychotic use in nursing homes. Notifications of all partnership activities will be sent via email to all nursing homes administrators. We strongly encourage the participation of all nursing homes at these events; 5) Identify practices/strategies employed by facilities who have reduced their use significantly and who are representative of most of the facilities in the state; 6) Promote the use of education programs focused on non-violent crisis intervention that is a mandatory requirement for staff in BMH settings; 7) Conduct workshops across the state to educate families/consumers about the inappropriate use of antipsychotics; 8) Meet with the Hospital Association to discuss transition of care for residents who have received care between settings.
 
The Work Group  and LEADER would like to commend those nursing homes who have worked hard within their homes to eliminate the inappropriate use of antipsychotics.  Data comparisons are being reviewed using CMS and DHH data and have shown that many of our facilities are making progress in the downward direction.