Glossary
When you are learning about dementia care and related issues, you may come across some unfamiliar terms. Below are some frequently used terms.
Access to Terms
The Alzheimer's Association has developed this glossary to help you understand Alzheimer's care and related terms. Access the glossary here.
Antipsychotic drugs are potent drugs that may have serious side effects.They are indicated to treat conditions and diagnoses such as schizophrenia. There are major concerns about the side effects of antipsychotics (including drowsiness, dizziness, unsteadiness, reduced mobility and coherence, increased risk of stroke and heart attack), and there is evidence that they may accelerate the rate of decline in people with dementia, and lead to premature death. They should not generally be used for the treatment of symptoms of dementia, unless accurately assessed by a physician and generally prescribed after all non-pharmacological and pharmacological treatment methods are unsuccessful. Access more info here.
Antipsychotic Drugs
Person-Centered Care
Person-Centered Care, or Culture Change as it is commonly referred to, is a movement that seeks to transform the traditional culture of aging in long-term care from one that is based on efficiency and reimbursement to one that keeps the person at the center of the care planning and health care decision making process. Person- centered care emphasizes a resident’s individuality and values resident self-determination. Person-centered care promotes choice and purpose in everyday life and respect of the changing needs of residents and caregivers. A main principle of resident-centered care is that in order to attain the highest level of well-being a resident must be cared for in a manner in which they are seen as individuals with personal preferences and abilities rather than as a task that needs to be completed.
Your Guide to Choosing A Nursing Home or Other Long-Term Care
Learn more about the best practices of culture change
Informed Consent
Nursing home residents continue to be prescribed antipsychotic medications at a high rate in California and nationwide. According to a recent survey by the Centers for Medicare and Medicaid Services (CMS), approximately one in five nursing home residents are receiving antipsychotic medications in California.
Most California physicians who provide care for residents of skilled nursing facilities are already well aware that under California law, physicians are responsible for obtaining informed consent for the use of antipsychotic (and other psychotropic) medications in nursing homes. For many years, nursing staff in long-term care facilities were permitted to serve as the prescriber’s agent in providing the necessary information to nursing home residents and obtaining informed consent. In 2011, however, the California Department of Public Health (CDPH) revised its interpretation of the law with respect to informed consent to require the physician to personally obtain informed consent for antipsychotics and other psychotropic medications. More info here.
Restraints
Physical Restraints
The Nursing Home Reform Act of 1987 states that residents have the right to be free from physical and chemical restraints that are used for the purposes of disciplining or as a matter of staff convenience. The California Code of Regulations gives residents the right to accept or refuse proposed treatments including restraints. Any medical symptom warranting the use of restraints must be documented in the resident’s medical record, ongoing assessments, and care plan. While there must be a physician’s order reflecting the presence of a medical symptom, ultimately the facility is accountable for the determination of the appropriateness of the physical restraint.
The facility must ensure that the residents’ environment remains as free as possible from accident hazards and that each resident receive adequate supervision and assistive devices to prevent accidents. Too easily, physical restraints can be used as a substitute for individualized care. Physically controlling ones behavior rather than addressing the unique needs of nursing home residents may require less staff effort but is incompatible with quality of life.
Chemical Restraints
Title 22 of the California Code of Regulations, Section 72018 defines a CHEMICAL RESTRAINT as: “a drug used to control behavior and used in a manner not required to treat the patient’s medical symptoms.” All residents have a right to be free from the use of chemical restraints. (42 CFR §483.13(a); 22 CCR §72527(a)(23); 22 CCR §72319), yet, the use of antipsychotic drugs on those with dementia is common practice and often used as an alternative to the needed care of these individuals. Every day, approximately one out of five residents living in skilled nursing facilities across California are being given antipsychotic medications in order to chemically alter their behavior. In 2008, the Food and Drug Administration issued its most serious warning to consumers that the use of antipsychotic medications on persons with dementia may lead to an increased risk of death. Three years later, in 2011, the United States Department of Health and Human Services, Office of the Inspector General analyzed Medicare claims from the first six months of 2007 for atypical antipsychotics for elderly nursing home residents. The findings indicated that out of 1,088,260 Medicare claims for atypical antipsychotic drugs for elderly nursing home residents reviewed, 75 percent were indicated for off label conditions and in the presence of the specified condition in the Federal Drug Administration black box warning. This is an alarming trend in the reliance on antipsychotic drugs as treatment for dementia.