Two years ago, 38 percent of the residents at a southwest Kansas nursing home were on anti-psychotic drugs — one of the highest medication rates in Kansas, a state with one of the highest rates in the nation.
The sedatives are intended only for people with serious mental illness, but are sometimes used to calm people with Alzheimer’s and dementia, even though the drugs increase the risk of falls, heart attacks and other deadly events.
After learning how far out of the norm their facility was, administrators at High Plains Retirement Village at Kearny County Hospital reduced their anti-psychotic rate to almost zero in 18 months, by training their staff to control misbehavior in other ways.
“We definitely knew we needed to do something different,” said Mary Chipley, the retirement home’s director of nursing.
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And other nursing homes are following their lead.
After years as one of the worst states when it comes to using dangerous medications to sedate people, Kansas showed marked improvement in the latest federal data released last month by the National Partnership to Improve Dementia Care in Nursing Homes.
In the first quarter of 2018, the percentage of long-term nursing home residents on anti-psychotics in Kansas was 17.4 percent — the state’s lowest rate since the partnership started tracking it in 2011 and down from a high of 26 percent.
Improvements at the end of 2017 and beginning of 2018 pushed Kansas to 38th in the country, after being tied at the bottom with Oklahoma and Mississippi as recently as 2016.
“I have to say I’m pleased but also left wondering — what is different now that for the past two reporting quarters Kansas is showing reductions after climbing steadily worse in national rankings for years,” said Mitzi McFatrich, executive director of Kansas Advocates for Better Care.
Greater public awareness might be playing a role.
McFatrich’s group launched a campaign last year for stronger informed consent rules for nursing home residents and their families before anti-psychotic drugs can be dispensed. It resulted in a bill that didn’t become law, but got a hearing in the Kansas Legislature.
The Star also reported extensively on the issue last year, compiling a public database that listed anti-psychotic use rates for individual nursing homes in Kansas. And the national nonprofit Human Rights Watch published a report in February on improper use of the drugs that spotlighted Kansas and five other states.
Nursing home trade associations and administrators have also launched their own education efforts.
Deb Zehr, the president and CEO of LeadingAge Kansas, said 34 of the nonprofit nursing homes her organization represents are now under 10 percent for anti-psychotic use.
“In my experience Maya Angelou was right: Good people do better when they know better,” Zehr said.
LeadingAge Kansas and Washburn University have applied for state funding to launch a comprehensive training program with on-site assistance for nursing home staff.
Zehr said doctors are also becoming more cognizant of the federal guidelines on anti-psychotic use for people with dementia.
Nursing home groups have long said that’s a key part of the equation, as many residents come into their facilities already on the drugs. An AARP report published earlier this year found that improper prescribing of anti-psychotic drugs is growing for seniors with dementia who live outside of nursing homes, even as it dips for those inside facilities.
Missouri’s nursing homes have not seen the same improvement over the last two years and were worse than Kansas’ in the latest data.
Missouri’s anti-psychotic use rate declined steadily from 26.1 percent in 2011 to 18.5 percent in mid-2016. But it has remained there or even higher since, and at 18.6 percent it’s now fifth worst in the nation, ahead of only Oklahoma (19.5 percent), Alabama (19.4 percent), Illinois (19.3 percent) and Mississippi (18.8 percent).
Lorraine Phillips, a University of Missouri Sinclair School of Nursing professor, has studied the issue in that state. She and four colleagues published a research paper earlier this year that found that the fewer nurses available per patient, the more likely anti-psychotics are to be improperly prescribed.
“There are other major factors that are associated with receipt of anti-psychotics in persons who don’t have a qualified diagnosis, but staffing is one of them, for sure,” Phillips said in a phone interview. “And staffing is something that can be changed.”
Benjamin Anderson, the CEO of Kearny County Hospital, said it wasn’t a change in staffing that drove his home’s reduction, but a change in culture.
He said when the nursing home staff found out during an inspection that it had one of the highest anti-psychotic use rates in the state, it prompted some soul searching.
“When it was brought to our attention, then we had to ask the crucial question: ‘Are we OK with this?’” Anderson said. “We concluded as a team we were not OK with it.”
So the facility launched a multi-part plan to fix it. Nurses were required to get permission from Chipley before asking a physician for anti-psychotic medications for a resident.
Consultants were brought in to train staff on how to handle difficult behaviors without medication, by getting to know residents’ histories and personalities and what kinds of food or music they find comforting.
Anderson said the change wasn’t easy, but it was worth it.
“At the end of the day, these are our family, these residents,” Anderson said. “These are our friends and neighbors. They’re the most vulnerable among us and we have a responsibility to avoid harm if at all possible.”