Toolkit_Capture300As part of our Tools You Can Use series, we like to feature new products and resources that improve the health of older Americans. In this installment, two researchers share a free toolkit that provides evidence-based resources for staff in senior living communities promoting non-pharmacologic strategies to address behavioral and psychological symptoms of dementia.

The toolkit, presented by Ann Kolanowski, PhD, RN, the Elouise Ross Eberly Professor and director of the Hartford Center of Geriatric Nursing Excellence, College of Nursing, Penn State, and Kimberly Van Haitsma, Ph.D., a Clinical Health Psychologist with a specialization in geriatrics at the Polisher Research Institute, addresses a huge problem.

More than 5 million Americans are living with Alzheimer’s disease, with the direct costs of their care in 2012 totaling $200 billion, including $140 billion in costs to Medicare and Medicaid, according to the Alzheimer’s Association. The burden of care to family and formal caregivers is equally troubling: 90 percent of people with dementia will hit, scream, become verbally abusive, or resist care at some point.

Unfortunately, a common response to these behavioral and psychological symptoms of dementia has been institutionalization, more rapid functional decline, physical abuse, and of course, medication. My colleague Chris Langston recently blogged about the all-too-frequent use of antipsychotics in long-term care and the harm done (including death) to those with dementia.

Ann Kolanowski, PhD, RN Ann Kolanowski, PhD, RN

Drs. Kolanowski and Van Haitsma tell us more about the team that came together to promote the use of non-pharmacological approaches for these behaviors and the need to create this toolkit.

On March 29, 2012, the Centers for Medicare and Medicaid Services (CMS) launched the Initiative to Improve Behavioral Health and Reduce Antipsychotic Use in Nursing Homes. This national action plan is using a multidimensional approach to reduce antipsychotic use in nursing homes across the country and encourages a person-centered approach to care in these sites. Unfortunately, staff in nursing homes do not feel equipped to implement non-pharmacological approaches and have asked for education on their use with residents who display behavioral and psychological symptoms of dementia (BPSD).

Kimberly Van Haitsma, PhD Kimberly Van Haitsma, PhD

Based on this critical need, we partnered with CMS and convened a national, interdisciplinary group of geriatric behavioral experts who would collaborate on the development of a behavioral health toolkit for staff …. This toolkit was conceptualized as a compendium of peer-reviewed/expert-endorsed existing resources that would assist staff in the implementation of non-pharmacological strategies for BPSD. Further, the toolkit would be readily accessible and include: staff educational programs for non-pharmacological approaches; methods for assessing behaviors; person-centered interventions; and system-wide methods for integrating interventions into the culture of care.

The Toolkit—"Promoting positive behavioral health: A non-pharmacologic toolkit for senior living communities"—is available free of charge at: nursinghometoolkit.com. It contains resources to help staff in senior living communities promote non-pharmacologic behavioral health strategies to address BPSD that frequently occur in long-term care residential settings, especially among residents with dementia.

Who is the Toolkit for?

The Toolkit contains resources relevant to any type of senior living community, including nursing homes, assisted living facilities, and continuing care retirement communities. There is information targeted to professional and paraprofessional staff in all departments, including the executive director, administrators, department supervisors; nurses, physicians, mental health professionals, social workers, and recreational therapists.

What is in the Toolkit?

The Toolkit, developed with support from the Commonwealth Fund and the John A. Hartford Foundation, uses a comprehensive framework that consists of explicating a person-centered philosophical stance, and an overview of evidence-based resources addressing the following major areas:

  • Person-Centered Philosophy. This resource provides a rationale for approaching BPSD behaviors through the lens of person-centered care, including a summary of what types of behaviors are included in the definition of BPSD.
  • Systems Integration issues. A review of systems-level considerations that should be examined prior to initiating any new initiative.
  • Evidence-based leadership and direct care giver education programs. Available education programs that have demonstrated effectiveness in training leaders and direct caregivers on topics relevant to approaching BPSD.
  • Behavior Assessment tools. Available measures to ensure that staff appropriately identifies BPSD.
  • Clinical decision-making algorithms. Strategies ensuring that staff members comprehensively examine the causes of BPSD.
  • Evidence-based approaches to ameliorate or prevent BPSD. Approaches that have been proven to be effective in rigorously designed research studies.
  • Crisis response approaches. Procedures for appropriate responses to acute and emergent behaviors that put the senior or others at risk.

CMS is encouraging a voluntary reduction in the use of antipsychotic drugs in long-term care settings, and I commend all of the dedicated researchers involved in this project for developing a free toolkit that can help equip staff members in senior living communities to meet that worthy goal.

I encourage you to take a look, use, and freely share this valuable resource. Please make this a Tool You Use.

This is the seventh in an occasional series. See other Health AGEnda posts on Tools You Can Use:

Tools You Can Use: A New APProach to Treating Older Patients

Tools You Can Use: Ten Steps for Communicating with Patients about Serious Illness from the Center to Advance Palliative Care (Video)

Tools You Can Use: Detecting Cognitive Impairment During the Medicare Annual Wellness Visit

Tools You Can Use: Preparing a Personal Advance Care Plan

Tools You Can Use: Guidelines for Assessing Patients Facing Surgery

Tools You Can Use: Principles for Treating Patients with Multiple Chronic Conditions