Time to Get Serious

November 13, 2014
Dr. Allen Power

This article first appeared on ChangingAging.org. Visit the site for more articles and insight into the art of aging.

I didn’t make it to the Gerontological Society of America conference this week, but McKnight’s reports that a study was presented highlighting the frequent episodes of “resident-on-resident mistreatment” in nursing homes, affecting as many as 20 percent of those residents every month. The “acute urgency” of the problem was stressed in the talk.

Meanwhile, after speaking at the Centralina Annual Aging conference today in Charlotte, an attendee brought a perfect example of the above issue to my attention. A person living with dementia had walked into another person’s room in the middle of the night, asking for her mother. The other person told her that her mother was dead, and to get out of the room. An altercation ensued and a hip was broken. What would I do about that?

This certainly describes a crisis situation, a case of tempers at the boiling point. But it was likely brewing long before the above event occurred. Just as water needs to be on the burner for some time before it can boil, such altercations often arise in environments where the “heat has been turned on for some time.” And what causes that heat? It could be a combination of many things.

Perhaps various operational shortcomings had been in play, such as chronic rotation of care partners, staff entering people’s rooms without warning, or the frequent use of negative verbal and nonverbal language causing a decreased sense of security. Perhaps those care partners were not well trained in how to support people with changing cognition, or did not have the flexibility and autonomy to support them as they needed. Perhaps the organization’s leaders had cut several corners, reducing resources and support in pursuit of the bottom line.

My bottom line is that this situation did not simply appear at that moment, out of the blue. As the GSA presenter stated, we do have an emerging crisis here. However, the fault, dear Brutus, is not in the dementia, but in ourselves. What we have, first and foremost, is a crisis in care.

Another conversation I had today brought this point home further. An attendee mentioned having watched the Bathing without a Battle DVD, which contains an astounding “before-and-after” video of a woman being bathed—first in the usual, institutional way, and then in a more enlightened manner. In the first scene, she is swearing, shouting, and striking out at multiple people. In the second, she is calm, happy, and even tender toward the care partners.

My comment was, “Did you notice something? The woman’s dementia didn’t go away. She wasn’t the one who changed in that video—we were the ones who changed!” Our willingness to change our approach made the difference.

While I try to avoid “I told you so” blog posts, it is worth mentioning that I wrote a recent article for McKnight’s (9-22-14), in which I cautioned that our attempts to reduce antipsychotic drugs would soon become problematic if we have not also learned how to care differently. And the chickens are starting to come home to roost.

CMS’ recently-released 2nd quarter figures of antipsychotic use have slightly improved to 19.4 percent nationally, but a state-by-state analysis shows that many, if not most states’ numbers have leveled off, or even ticked up slightly over the past few quarters. It appears we are reaching a floor, or at least a ledge. We have plucked all the low-hanging fruit, stopped the easily-discontinued drugs. Do we have what it takes to break through to the next level?

I believe most organizations do not. There has been far too much lip service to being “person-centered” without truly embracing all that it entails. Too many glossy coats of paint and slick marketing ads, and too little innovative education for those who provide hands-on support.  Too much of the same-old-same-old, without doing the hard work of shifting operations to truly create a new culture of care. And the emerging demographics around dementia are swamping us, because we didn’t take “culture change” seriously.

This is our crisis. Do we have what it takes to truly transform the lives of those we serve, or will we cling to our inadequate systems of care? Will we finally invest in the education and resources to help our care partners succeed, or will we fall back on blaming the disease, the regulators, the lawyers, or anyone else we can find? Do we have the courage to change, or will we continue to hide our heads in the sand?

Turning down the burner doesn’t happen overnight. It takes a steady progression of philosophical and operational shifts. Time to get serious.

2 Comments. Leave new

A wonderful post, Al. I could not agree more.

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Jacqui Sinclair
November 15, 2014 4:54 am

There are many challenges and I find that having real relationships with the people I work with, and a genuine commitment to the Domains of Well-being is the solution. I was recently accused of stealing a watch by one resident, and of forcing another to have a ‘frothy’ hairstyle – and I was surprised that sitting down and talking them through events only increased their agitation. I read though the notes I’d taken during their Well-being assessments and could understand what had happened. It really helped because I am only human – and their accusations hurt me. It made me think about our junior carers – and how often this happens to them – and how we expect them to shrug it off!

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