It’s been long understood that the most important determinant in whether a nursing home resident receives a psychotropic drug is not her diagnosis, her age, or her presentation of symptoms; rather, it is the facility’s psych drug usage rates. In other words, if a 77 year-old resident with dementia is sent to a nursing home that relies on psych drugs to chemically restrain residents considered “difficult,” she is much more likely to be drugged than if that same resident, with the same clinical presentation, goes to a nursing home that relies on non-drugging options and comfort-focused care to address a resident’s expressions of unmet need. The bottom line is facilities with poor care drug residents more often than facilities with good care and a facility’s drug usage rate is a strong proxy for poor care – the higher the rate, the more likely the care is bad.
A new study from Australia has analyzed the “organizational climate” that contributes to the misuse of psychotropic drugs in nursing homes and found that staffing, managerial expectations, and teamwork are the three most significant dimensions. Lack of adequate staffing and staff training contribute to drugging because workers perceive psych drugs as a tool for reducing their workloads. Chemically restrained residents, the thinking goes, are less likely to have “behavioral disturbances” and less likely to disrupt work tasks. Managerial expectations exert a powerful influence on the use of psych drugs as the nursing staff follow management’s attitude regarding the use of psych drugs versus holistic comfort-focused care. And finally, staff teamwork facilitates the kind of communication and deliberation that enables comfort-focused care as shared observations and skills among the staff produce better understandings of residents’ preferences and needs.
This new study, combined with other studies, demonstrates that providing good dementia care in nursing homes is reliant on having a communicative, functional team of staff and managers, with the will to limit psych drug use and the skills to provide comfort-focused care.