by Tim Gieseke, MD, CMD

Chair, CALTCM Education Committee

On August 1st, the CDPH sent out the attached ALF advising us of enhanced surveyor oversight for our use of antipsychotics.  In California, we have made significant progress in this area.  As a part of CMS region 9, we have reduced the frequency of antipsychotic use in our long stay residents (>100 days) to 16.7% (excludes schizophrenia, Huntington’s and Tourette’s).  We are the second best region in the country with Alaska #1.

In this letter, facilities with > 20% antipsychotics in long stay residents can expect a Federal Monitoring survey which will include a CDPH pharmaceutical consultant.  As a Medical Director who has experienced surveys that have included a CDPH pharmaceutical consultant, I have found these surveys to have added challenges.  In addition, all facilities will continue to be surveyed on compliance with the CDPH informed consent guidelines.

As our California experience demonstrates, it is possible to safely lower the use of antipsychotics below 20%.  In my experience, facilities that focus on understanding problem behaviors and also use this understanding to enhance non-pharmacologic approaches, have a much higher GDR success rate than those that simply attempt GDRs.  Good resources that support these strategies are available on the California Culture Change website.

http://www.calculturechange.com/Home/PartnershiptoImproveDementiaCare/PartnershipToolkit.aspx

California Culture Change has received a CMS grant to continue the California Partnership to Improve Dementia Care.  Members of CALTCM are a part of this initiative.  After an “in person” meeting later this month, you can expect to receive more guidance and help for assuring the appropriate care of your patients with dementia.

AFL 14-18