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Dementia care standards unveiled for nursing homes

Massachusetts nursing homes that advertise specialized Alzheimer’s and dementia care units will be required to provide workers with at least eight hours of initial training to care for such residents, and four additional hours annually, under proposed rules unveiled Wednesday by state regulators.

The rules would also require all licensed nursing homes, and not just those with special dementia units, to provide dementia-specific training for all direct-care workers, which include medical directors, nurses, social workers, dietary aides, therapists, and activities staff.

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Regulators said it was important to mandate the training at all facilities because roughly 60 percent of nursing home residents have some form of dementia.

“In nursing homes with both traditional units and [special care units], direct care staff may float between the units to cover vacant shifts or help during an emergency, and thus all workers must be trained on how to provide optimal care to all residents,” Dr. Madeleine Biondolillo, director of the state public health department bureau that regulates nursing homes, wrote in a memo to the Public Health Council.

The council, an appointed body of academics and health advocates, met Wednesday to review the proposed rules. The council is expected to vote on them later this fall, after a public hearing slated for September 18 at 1:30 p.m. at the Department of Public Health, 250 Washington St., Boston.

State lawmakers last year approved legislation that would establish minimum standards for dementia care units, after years of lobbying by patient advocates who said a loophole in Massachusetts law allowed nursing homes to advertise special units without any special training for their workers. The new law required the state health department to craft the regulations.

Biondolillo said in an interview that her department met with nursing home industry leaders and patient advocates, in addition to studying dementia care rules nationwide, while developing the Massachusetts regulations. She said eight hours of initial dementia-care training reflects the median number of training hours nationally. Most other states require such training -- anywhere from 4 to 40 hours.

“This is a population of [patients] who have historically struggled, and the behaviors related to dementia are challenging,” Biondolillo said. “This gives us the opportunity to put in play the best practices in a very fair way that everybody would be adhering to, and we think it will make a difference in the outcome of these residents.”

Nursing homes would have 90 to 180 days after the rules go into effect to complete the initial staff training.

The rules would also require all dementia care units to provide a minimum of eight hours of formal activities per day, seven days a week, and also provide activities overnight, on an “as-needed basis” for residents who may need them.

Advocates have said that too often nursing homes do not provide appropriate activities for residents with dementia, and that can exacerbate agitation and wandering, two hallmark challenges with these patients.

Another issue addressed by the rules is the physical design of special-care units. Specialists say that proper design can ease agitation, confusion, and difficult behaviors. The rules require lighting that minimizes glare and shadows, and also finishes on floors, walls, and ceilings that lessen glare. They also mandate flooring that does not include visual patterns that might confuse residents.

Overhead paging systems, often jarring to dementia patients, will be prohibited in special-care units.

“We know that these types of interventions really make a difference,” Biondolillo said. “This is giving us an opportunity to set standards and measure the outcomes.”

Kay Lazar can be reached at klazar@globe.com. Follow her on Twitter @GlobeKayLazar.
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