Belmont Manor Nursing and Rehabilitation Center is a 135 bed, family-owned and operated skilled nursing facility. The facility opened in 1967 and offers both short-term and long-term care for residents with a variety of needs. The facility also has a special unit dedicated to care for residents with Alzheimer’s and other types of dementia.

The facility has a good reputation for handling individuals with behavioral issues. As a result, local hospitals will frequently send psychiatric referrals. Belmont Manor also receives admissions from Assisted Living Centers, with a good portion of these admissions being individuals on antipsychotic drugs.

In April 2016, the antipsychotic use at Belmont Manor was observed to be high, and the facility embarked on a mission to reduce its reliance on medication use. The staff held a meeting to assess the current environment and determined the antipsychotic rate to be 21.15%. To determine the root cause of the high rate, in January 2017, Belmont Manor administrators added person-centered care as a new QAPI goal. A 10-member leadership team was assembled to help construct a list of possible causes and worked with CNAs to implement a new approach. Some of the successful solutions include:

• Providing continuing education to residents, families, staff, medical directors and nurse practitioners
• Creation of “Get-To-Know-Me Tool”. The tool is used on every resident, and collections information on favorite hobbies, places traveled, favorite sports teams, and items of interest. The tool helps create trust between the family and staff and offers care staff valuable information that can help motivate residents when problem behaviors surface
• Residents who are admitted with a dementia and/or a psychiatric diagnosis and have been prescribed an antipsychotic are placed on a gradual dose reduction (GDR) at day 14. Although some families have been reluctant to start GDR, staff is trained to work closely with the family and provide reassurances
• Reducing excessive noise and distractions to create a more calm, peaceful environment. These holistic environmental strategies have noticeably reduced agitation and problem behaviors
• A full-time activities staff has been hired in the dementia unit. The staff offers sensory activities, massage, and fitness classes
• An “Appreciation Board” where staff can add stickers thanking fellow workers. The approach helps spread positivity and reinforces the family culture

When CNAs discover a new successful approach, they are encouraged to speak with a manager, who will then share with other staff and the leadership team.

The collected efforts of the Belmont Manor facility staff have resulted in the successful implementation of numerous approaches which has raised the quality of living, happiness, and positivity among the staff and residents. The efforts have also lowered the rate of antipsychotics from 21.8% to 16.3%. Efforts to lower the rate are ongoing, and it’s clear that everyone at Belmont Manor is been benefiting from the outcomes of this important project.

Source: Healthcare for New England