Diane Schoenfeld comes every Friday to the Chaparral House nursing home in Berkeley, Calif. to spend time with her aunt, Lillie Manger.

"Hi Aunt Lill!" she says, squatting down next to her aunt's wheelchair, meeting her at eye level.

Manger is 97. She has straight white hair pulled back in a neat bun today. It's tied with a green scarf, a stylish reminder of the dancer she used to be.

They go together to the dining room to look over family pictures. Manger needs to be reminded who is in them. Including one of herself. "That's me?" she asks. "That's you," her niece confirms.

"Am I supposed to remember?" says Manger.

Schoenfeld smiles at her encouragingly: "I don't know if you're supposed to. It's OK either way."

Manger has dementia. Schoenfeld is her "surrogate decision maker" meaning that legally, she is the person who makes decisions about Manger's health care. Schoenfeld says Chaparral House is the second nursing home where Manger has lived. The first was 45 minutes away, and Schoenfeld wasn't able to visit as often.

At that first home, caregivers recommended antipsychotic sedatives for some of Manger's behaviors, like crying out and outbursts. Schoenfeld wasn't thrilled about the idea but agreed to it, thinking her aunt might get better care if staff members weren't unhappy with her behavior.

Coming Out of a Fog

Two years later, Schoenfeld moved her aunt to Chaparral House to have her closer. By this time, Manger appeared to be in a fog. Eventually, Schoenfeld broached the idea of weaning her aunt from the medication. As soon as they did, she says things turned around.

"I could see her personality again, I was so happy," Schoenfeld said. "My sister came to visit and (Aunt Lill) used my sister's name and clearly recognized her, which we had not seen in the years that she was on the medication. I only wish I had done that sooner."

Schoenfeld says it just didn't feel right to have her aunt sedated. "If a baby is crying, I mean most people will go to a baby and comfort them. They won't try to ignore them and drug them," she says.

KJ Page, administrator of Chaparral House, shares that philosophy. Page says in many cases, dementia patients came to their facility with a prescription to be given antipsychotics half an hour before bath time. Then, a number of years ago, she read a book called Bathing Without a Battle about why it can be such a challenge to bathe dementia patients.

She asks people to imagine putting themselves in the place of the nursing home resident. "A person they didn't know, couldn't recognize, comes to take off their clothes," she says. "Ah! No wonder they're screaming and fighting and kicking!"

Page says after that "Aha!" moment, the staff came to a new agreement. The residents were not out running marathons or engaging in other sweat-inducing activities, so regular showers weren't necessary. Instead, residents would have a regular caregiver do simple sponge baths.

Page says the results inspired further changes.

"It just rolled into what else are they fighting for, and why do we need to have a fight?" Page says, "What can we do to make it easier for people and the staff? And that's how we approached it from there on."

It worked. While Page says antipsychotics do have a place for some people, not one of Chaparral House's dementia patients is currently taking the medications.

Grading Nursing Homes on Avoiding Antipsychotic Drugs

Chaparral House's experience is unusual. In California nursing homes, just over 15 percent of dementia patients are on these drugs. That's far more than advocates say is necessary. But that is actually down from almost 22 percent just three years ago. That's when the federal government began regulating their use for dementia patients in nursing homes. This came in response to several studies warning the medicines had serious risks, including strokes, falls and even death.

The new guidelines stipulate that nursing homes are graded on the percent of their dementia patients receiving antipsychotic medications. That figure becomes part of their rating on Nursing Home Compare, a tool from Medicare that helps consumers compare information about nursing homes.

FULL ARTICLE - http://www.medscape.com/viewarticle/845760 June 01, 2015 BY: Kaiser Health News