Last month, I wrote about an National Public Radio series concerning overmedicating nursing home residents. This second entry from the NPR series is based on reporting concerning training opportunities the State of Texas is offering to decrease that state’s use of antipsychotic medications in nursing homes. According to NPR, antipsychotic drugs “can be deadly” for older people with Alzheimer’s or other forms of dementia. “The Food and Drug Administration has given these drugs a black box warning, saying they can increase the risk of heart failure, infections and death. Yet almost 300,000 nursing home residents still get them.”
The story points out that in Texas: “More than a quarter of nursing home residents there still get antipsychotic drugs” despite a national effort to reduce the use of such medicines. The state is “playing catch-up” by having training sessions. In one such seminar, nursing home workers and administrators are being taught an approach known as “individualized care. The idea is that if nursing home employees know enough about a resident, they can figure out the reason behind challenging behavior and deal with it without resorting to antipsychotic drugs.”
Frankly, I am at a loss as to why such “training” is necessary. Isn’t it common sense that the more a nursing home worker knows a resident, the more likely it is they will have insight as to what is “bothering” a resident and causing him or her to act out? Although this training is good in theory, it does, of course, depend on retaining nursing home workers for longer periods of time so they can get to know the residents. According to a 2009 study conducted by the American Health Care Association: “The retention rates among Staff Registered Nurses, Licensed Practical Nurses and Certified Nurse Assistants ranged from 48 to 52 percent. The turnover rate for all nursing facility employees was 40 percent. The turnover rate for Certified Nurse Assistants was higher than other nursing staff, at 47 percent.” If around one-half of the staff who interacts with residents on a daily basis leaves the facility each year, can “individualized care” actually work in the real world?
Staff retention is key to the proper care of nursing home residents and decreasing the use of antiphsychotic medication as a “chemical restraint” for nursing home residents who suffer from Alzheimer’s or other types of dementia. Are the corporations who run the facilities taking adequate steps to retain good staff? That is a question to be left for another day.