Addressing Cognitive Impairment

It’s been noted that up to 72% of people in long-term care have some degree of cognitive impairment. It is important to take a proactive approach as we care for our residents that focuses on maintaining processes and the delivery of clinical care has a positive effect on outcomes and quality of life for our residents.

Typical training for rehab professionals takes a deficit-based approach: identify the impairments, and work to correct them.

While this approach works well for orthopedic surgery, stroke rehab, and other conditions, it leaves out many of those with progressive and irreversible conditions, particularly dementia. TMC began to research ways to narrow the gap between training and resident need. We chose the Dementia Capable Care course from Crisis Prevention Institute.

The first step was to train all speech-language pathologists, occupational therapists and occupational therapy assistants. Outcome data was tracked pre-training to establish baselines, and then again at 6 months post training. Quality Measure data was collected from CMS’s Nursing Home Compare tool.

Outcomes have been overwhelmingly positive both anecdotally, and in tracked data.

In just 6 months, improvements were noted across all four of the tracked quality measures within the test sites with 97% of sites showing improvement in at least 1 QM and 75% showing improvement in 2 or more areas.

  • Percentage of long-stay residents whose need for help with daily activities has increased: Decreased by 3.24% in TMC sites. A decrease in this QM signifies residents are able to Maintain their levels independence and functional ability. Nationally, this QM actually increased by 5% so TMC sites have not only outperformed the industry, but succeeded where others have failed.
  • Percentage of long-stay residents who lose too much weight: Decreased by 1.34% in TMC sites. Nationally this QM increased by 6% so again, TMC has demonstrated improvement despite industry trends and has helped residents maintain their weights.
  • Percentage of long-stay residents who received an antipsychotic medication: Decreased 2.49% in TMC sites.
  • Percentage of long-stay residents who received an anti anxiety or hypnotic medication: Decreased 3.15% in TMC sites.
    • Nationally the QMs for both antipsychotic medication and anti-anxiety medications have only decreased 1.45% and 2.38% respectively across this same time period. TMC sites have been able to decrease use of these medications better than the industry average through non-pharmacological approaches to behaviors as taught in the DCC curriculum. It is well documented that psychotropic medications can have dire side effects in people with dementia so the decrease in this QM is important both in cost management, and resident quality of life, and even mortality.

There was also a significant drop in the number of total falls and falls with injury across sites over the last year (July 2017 – July 2018). Based on MDS Quality Measure data, falls with injury were down 16%, while nationally falls with injury increased by 0.6%. With the average cost of a fall with injury being $14,000, this represents a huge cost savings in addition to the improved quality of life for residents.

Both survey feedback and data analysis have indicated the success of the DCC training. While this program represents a large financial investment, the return on investment is significant both in resident and staff satisfaction as well as cost savings tied to improved quality measures.

Dementia touches every aspect of life for the person who has it and the ones who care for them. Together, we can make a difference in the lives of our residents and their families touched by this heartbreaking condition.

Haley Huckabee, M.A., CCC/SLP, is the director of clinical excellence at Therapy Management Corporation (TMC).
Featured in McKnight’s Long Term Care News.