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Tennessee Works to Improve Dementia Care

Monday, September 24, 2018 | 12:42pm

NASHVILLE – The Tennessee Department of Health is working with partner agencies to improve care for those living with dementia. One vital part of this effort is the ongoing work to reduce unnecessary use of antipsychotic medications among residents living with dementia within Tennessee nursing homes. As a result of these efforts, Tennessee nursing homes have successfully reduced antipsychotic medication use to a rate of 15.7 percent of residents, moving Tennessee up from 49th to 29th in the nation for improvement in this area.

“We are proud of the work that has gone into this important milestone in helping improve comprehensive care for Tennesseans living with dementia,” said TDH Commissioner John Dreyzehner, MD, MPH. “We value our work with Tennessee’s long-term care facilities and other partners that is enhancing the quality of life for people living with dementia and helping promote person-centered care for all of Tennessee’s nursing home residents.”

In 2012, the Centers for Medicare and Medicaid Services announced the National Partnership to Improve Dementia Care in nursing homes. The goal was to reduce unnecessary antipsychotic medication use among long-stay nursing home residents living with dementia by 15 percent by the end of 2013 and seek further reductions in subsequent years. In 2012, Tennessee nursing homes had the highest antipsychotic drug use rate in the Southeast at 30.1 percent of residents, with the national average being 23.8 percent. Tennessee nursing homes have now successfully reduced that rate to 15.7 percent, dropping below the regional average of 15.9 percent.

Culture Change
TDH in collaboration with stakeholders including the Tennessee Health Care Association, QSource, TennCare, The Eden Alternative and other culture change advocates partnering as the Tennessee Advancing Excellence Coalition has been instrumental in this effort. In October 2012, the TDH Office of Health Care Facilities, working within the coalition, applied for federal funding for a project titled “Dementia Beyond Drugs” to conduct training symposiums across the state. This impactful training provided nursing home staff members, health care providers, the Long-Term Care Ombudsman, state agency surveyors, legislators and other quality of care/quality of life advocates with tools and knowledge to effectively evaluate residents prescribed anti-psychotic medications and offered facility staff members proven methods for managing behaviors resulting from reduction of these drugs.

"Working together, we've improved the quality of life for more than 3,500 elderly Tennesseans," said Beth Hercher, quality improvement advisor for Qsource, Tennessee’s quality improvement organization. "We've worked with 250 nursing facilities in the state to develop self-directed, high-functioning teams to achieve systemic improvement and continue to lower the use of antipsychotic medications in long-term care."
Vanderbilt University subsequently applied for civil monetary penalty funding from TDH for a project to reduce antipsychotic drug use in skilled nursing facilities through web-based staff training. Vanderbilt partnered with Qsource to identify facilities with low Centers for Medicare and Medicaid Services Star Ratings to promote quality assessment and performance improvement. The project implemented six webinars in 30 nursing homes across the state and successes were published in The Gerontologist in 2017.

Two additional CMP-funded projects in Tennessee are now underway to address antipsychotic drug use. The Tennessee Eden Alternative Coalition is beginning the third year of their project to reframe dementia through person-centered practices to improve the care and lives of residents living with dementia. Tennessee Technological University is beginning the “Music and Memory” program to assist nursing homes in the Upper Cumberland region in becoming Music and Memory Certified Care Organizations, improving person-centered care and physical, cognitive and emotional functioning of residents diagnosed with Alzheimer’s or other dementias.

The Tennessee Department of Health was one of five public health agencies awarded a small grant in 2017 to promote cognitive functioning and address risk reduction factors associated with cognitive decline, dementia and Alzheimer’s disease. TDH is working in collaboration with the Alzheimer’s Association, the Association of State and Territorial Health Officials and the Centers for Disease Control and Prevention. In addition to the creation of an “Alzheimer’s Disease and Brain Health” resource and information webpage, TDH developed a cognitive health toolkit to enhance awareness among public health professionals and created a brief titled 2019 Healthy Aging Brain Brief and Strategies for Action: Alzheimer’s and Other Dementias to raise awareness of brain health and potentially modifiable risk factors for reducing cognitive decline and to inform action in public health programming.

Opportunities for improvement still exist within all health care settings. Fortunately for nursing homes in Tennessee, the CMP fund offers additional opportunities to aid these important efforts. TDH is dedicated to ensuring implementation of projects to further reduce antipsychotic medication use and other efforts to enhance health as we age. For more information on applying for CMP funds to enhance the quality of care and quality of life of nursing home residents in Tennessee, please visit the CMP reinvestment website https://www.tn.gov/health/health-program-areas/nursing-home-civil-monetary-penalty--cmp--quality-improvement-program.html.  

Learn more about the CMS National Partnership to Improve Dementia Care and efforts to reduce antipsychotic medication use in nursing homes at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/National-Partnership-to-Improve-Dementia-Care-in-Nursing-Homes.html. 

Learn more about healthy aging at https://www.tn.gov/health/cedep/environmental/healthy-places/healthy-places/health-equity/he/healthy-aging.html.

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