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Article
Informed Family Member Involvement to Improve the Quality of Dementia Care in Nursing Homes
University of Massachusetts Medical School Faculty Publications
  • Jennifer Tjia, University of Massachusetts Medical School
  • Celeste A. Lemay, University of Massachusetts Medical School
  • Alice F. Bonner, Northeastern University
  • Christina J. Compher, Healthcare Management Solutions, LLC
  • Kelli Paice, University of Massachusetts Medical School
  • Terry S. Field, University of Massachusetts Medical School
  • Kathleen M. Mazor, University of Massachusetts Medical School
  • Jacob N. Hunnicutt, University of Massachusetts Medical School
  • Kate L. Lapane, University of Massachusetts Medical School
  • Jerry H. Gurwitz, University of Massachusetts Medical School
UMMS Affiliation
Department of Quantitative Health Sciences; Department of Medicine, Division of Geriatric Medicine; Meyers Primary Care Institute
Date
1-1-2017
Document Type
Article
Disciplines
Abstract
OBJECTIVES: To describe the extent to which nursing homes engaged families in antipsychotic initiation decisions in the year before surveyor guidance revisions were implemented. DESIGN: Mixed-methods study based on semistructured interviews. SETTING: U.S. nursing homes (N = 20) from five CMS regions (III, IV, VI, VIII, IX). PARTICIPANTS: Family members of nursing home residents (N = 41). MEASUREMENTS: Family member responses to closed- and open-ended questions regarding involvement in resident care and antipsychotic initiation. Two researchers used a content analytical approach to code open responses to themes of family involvement in behavior management, decision-making, knowledge of risks and benefits, and informed consent. RESULTS: Fifty-four percent of family members felt highly involved in decisions about behavior management. Forty-two percent recalled being asked how to manage resident behavior without medication, and 17% recalled receipt of information about antipsychotic risks and benefits. Sixty-six percent felt highly involved in the process of initiating antipsychotic medication; 24% reported being asked for input into the antipsychotic initiation decision and knowing before the antipsychotic was started. CONCLUSION: Under existing federal regulations but before guidance revisions were implemented in 2013, more than 40% of families reported being involved in nonpharmacological behavior management of family members, but fewer than one in four reported being involved throughout the entire antipsychotic prescribing process. Interventions that standardize family engagement and promote adherence to existing federal regulations are needed. This discussion builds on these findings to weigh the policy options of greater enforcement of existing regulations versus enactment of new legislation to address this challenging issue.
Rights and Permissions
Citation: J Am Geriatr Soc. 2017 Jan;65(1):59-65. doi: 10.1111/jgs.14299. Epub 2016 Aug 22. Link to article on publisher's site
Related Resources
Link to Article in PubMed
Keywords
  • antipsychotics,
  • dementia,
  • family involvement,
  • nursing home,
  • off-label
PubMed ID
27550398
Citation Information
Jennifer Tjia, Celeste A. Lemay, Alice F. Bonner, Christina J. Compher, et al.. "Informed Family Member Involvement to Improve the Quality of Dementia Care in Nursing Homes" Vol. 65 Iss. 1 (2017) ISSN: 0002-8614 (Linking)
Available at: http://works.bepress.com/terry_field/126/