Grant funded project to improve care and training in nursing facilities
Dr. Janet Hahn, from the Center for Gerontology and the School of Interdisciplinary Health Programs, is leading a project totaling nearly $325,000 that will provide behavioral consultation and services to aging people with cognitive impairment at skilled nursing facilities in Michigan.
The goal of the project is to use behavioral analysis to help older adults with cognitive impairment improve their quality of life and to reduce the use of medication to manage BPSD - the behavioral and psychological symptoms of dementia, which include wandering, agitation, disruptive vocalizations, etc. Other goals include improving nursing facility staff knowledge and abilities, and developing training modules and leadership support that can be used by other skilled nursing facilities.
"Training the staff at these locations is key to the sustainability of the outcomes," said Hahn. "Utilizing a 'train the trainer' approach, we can train supervisors at these facilities so they can train their staff effectively, and show them skills like data collection and effective implementation of behavior protocols which can help maintain the effects."
Once the trainings implemented through the study are proven effective, they will be expanded and adopted at other sites to create sustainable opportunities to provide quality care.
The project is led by Dr. Hahn, a social gerontologist with extensive experience studying nursing home culture change and the quality of long term care services. The project team consists of doctoral, masters and undergraduate level behavior analysts with advanced training in working with aging populations, under the direction of Dr. Jonathan Baker from the Department of Psychology.
The goals of the project are a 50 percent decrease in verbal and non-verbal agitation, a 50% decrease in BPSD as measured through direct observation, and reductions in dosage or number of psychotropic medications.
This will be a three year project. In year one, the intervention will be implemented in one skilled nursing facility. In years two and three, four other facilities will be added to implement the program. Project staff will evaluate effective training tools and evaluate the aspects of organizational culture that lead to effective implementation of the program.
The Omnibus Budget Reconciliation Act (OBRA) of 1987 included the nursing home reform act, which mandated that behavioral interventions be used before chemical or physical restraints when dealing with behavioral issues in long-term care settings serving older adults. However, staff in skilled nursing facilities still struggle to develop appropriate behavioral interventions and evaluate the effectiveness of such techniques.
Participants in this study will directly benefit from receiving state of the art, non-pharmacological interventions that have been shown to reduce the need for and use of psychotropic medications.
The Michigan Department of Health and Human Services awarded the grant for $324,830 as part of its Civil Monetary Penalty program, which uses a portion of funds collected from facilities that do not maintain compliance with certain federal requirements. The CMP program aims to improve the quality of life for individuals living in nursing facilities.