The Globe recently explored the overuse of antipsychotic drugs in nursing home patients with dementia. The two-part series — which included a database of facilities nationwide and their frequency of prescribing antipsychotic drugs inappropriately — prompted a flood of calls to the toll-free Alzheimer’s helpline, 800-272-3900. Readers wanted advice on finding the right nursing home for their loved one, which can be the most heart-rending and perhaps toughest decision that many of us will ever have to make.
I asked Susan Rowlett, manager of care consultation at the Alzheimer’s Association’s Massachusetts/New Hampshire Chapter, to provide some important questions to ask. Here are some key ones she recommending asking yourself and the professionals:
1. What is the percentage of residents in Alzheimer’s Special Care Unit that are on mood-altering medications like antipsychotic drugs? If more than 25 percent of residents are using antipsychotic medications, this may indicate that the Unit relies more on medications rather than behavioral techniques to calm aggressive symptoms, according to the Alzheimer’s Association.
The Globe report winnowed this down further to determine the rate of prescribing antipsychotic drugs to those without psychosis or a related condition — which isn’t recommended by the US Food and Drug Administration for safety reasons. The report found that the national median for using antipsychotics in such patients was 16.7 percent, but you also need to ask about the percentage of residents with behavioral problems in the facility since that can correlate with rates of prescribing these medications. “Some nursing homes may work with those who have higher likelihood of psychiatric problems,” pointed out Rowlett, “while others don’t accept any patients with behavioral challenges.”
2. What feeling do you get when visiting the nursing home? Are the nursing assistants smiling when they do their work? “Sit and watch the staff interact with the residents and count the number of times you see a resident hugged or touched affectionately by the staff,” said Rowlett. Does the staff make eye contact with residents? Do they speak slowly, clearly, and respectfully? If you see a lot of residents sitting by themselves, staring into space, that’s not a good sign.
3. What’s the patient to staff ratio? The Alzheimer’s Association recommends at least one staff member for every five residents from 7 a.m. to 8 p.m. The ratio should be at least one staff member to nine residents for the overnight shift.
4. What are the activities like? Ideally, there should be at least one full-time therapeutic activity person. This person should organize age-appropriate stimulating programs for the mind and body whether it’s music, art, or games. Are the activities geared specifically to the interests of the residents? Does each resident have an activity plan that provides activities that focus on the person’s remaining cognitive strengths and avoid their cognitive weakness?
Safe walking paths outdoors and off-site excursions are also crucial, as well as the appropriate supervision.
5. Does the facility seem different on the weekends? Some nursing homes are notoriously short-staffed on the weekends. Make sure you visit during different times of day and on a Saturday or Sunday. “Taste the food, and talk to other family members who have loved ones there,” said Rowlett.
6. Is there a dedicated Alzheimer’s special care unit in the nursing home? This may be extremely important if a loved one is suffering from dementia. At the very least, a facility should have a staff person specialized in Alzheimer’s care. “Unfortunately there aren’t state regulations for a standard of care that should be delivered to dementia patients” in facilities with special care units, said Rowlett. “We’re fighting to get a bill passed in the Massachusetts legislature.” Here are more details on the bill that would set standards — already implemented as law in 44 other states — for special care units.