the team has access to other health care professionals such as psychiatrists, behavioral psychologists, and clinical experts. Case studies
The stories of Marjorie and Louise (names have been changed) show the real-life effects this program can have. Marjorie’s team discovered that some of her behavioral problems were caused by her fear of incontinence. Antipsychotic drugs had failed to stop the behaviors. So her care team went beyond medications to get to the core of her anxiety and help restore her personality. Using talk therapy and interventions, engaging family members, building her self-confidence, stopping antipsychotic medications, and re-introducing exercise into her life have made an enormous difference. She’s eating and sleeping again, which has led to a new, healthy state of calm. Marjorie is awake and living, and her family shares the happiness she can still convey. Louise was taking too many tumbles—tripping over her own
feet, swaying and losing her balance, or simply running into furniture in her nursing home. Her care team scrutinized her medications and decided to discontinue her antipsychotic and antianxiety medications. As those two medications were phased out, she became steadier on her feet and felt more confident. Louise began engaging more in the community around her, helping set tables and clearing clutter from the nurse’s station. Her husband noticed she was more awake and responsive during his visits. She was even able to resume attending regular church services with him. Alzheimer’s disease will continue to claim more and more of Louise’s abilities, but for now, her family has a more alert Louise to enjoy and cherish. Measuring outcomes
Hard data support the positive effects of the Awakenings program. At the end of the threeyear Awakenings initiative grant, we will have measured several outcomes with an “at-risk” component that will result in a rate
decrease from the Minnesota Department of Human Services if outcomes goals are not met. First, on average, we intend that the collaborative of 15 nursing homes will achieve a 20 percent improvement over the baseline in the Minnesota risk-adjusted quality indicator “prevalence of antipsychotics without a diagnosis of psychosis.” (That translates to a 10 percent decrease the first year and 5 percent decreases in each subsequent year.) Since Awakenings was introduced in late 2010, the collaborative has improved 62 percent over that baseline. Second, we also anticipate a 6 percent improvement rate over baseline in the Minnesota Department of Human Services (DHS) Quality of Life Survey in two domains: Meaningful Activities and Relationships. The DHS Quality of Life surveys started in October 2011 and results will be forthcoming. Both the scale and innovation of Awakenings make it unique. We are retooling the entire approach to care, replacing a fragmented approach often
found in health care today with a holistic, integrated approach centered on the individual. The program builds on practices that have been proven through research, applying them in the real world of long-term care. In the process, we are radically changing the culture of medication use in nursing homes. A relationship-care approach like Awakenings can bring many of the estimated 27,000 Minnesota nursing home residents who are on antipsychotic drugs increased empowerment, vitality, joy, and dignity. Physicians will have backup from a team of professionals who provide accurate assessments to help assure proper diagnosis, documentation, and prescribing of psychotropic and other medications. More information about Awakenings, including a list of the Ecumen nursing homes now using this approach, is available at ecumen.org/aging-resources. Laurel Baxter, MA, RN, is the Awakenings project manager at Ecumen, based in Shoreview, Minn.
A Diverse and Vital Health Service
Boynton Health Service
Psychiatrist
Welcome to Boynton Health Service >ŽĐĂƚĞĚ ŝŶ ƚŚĞ ŚĞĂƌƚ ŽĨ ƚŚĞ dǁŝŶ ŝƟĞƐ ĂƐƚ ĂŶŬ ĐĂŵƉƵƐ͕ ŽLJŶƚŽŶ ,ĞĂůƚŚ ^ĞƌǀŝĐĞ ŝƐ Ă ǀŝƚĂů ƉĂƌƚ ŽĨ ƚŚĞ hŶŝǀĞƌƐŝƚLJ ŽĨ DŝŶŶĞƐŽƚĂ ĐŽŵŵƵŶŝƚLJ͕ ƉƌŽǀŝĚŝŶŐ ĂŵďƵůĂƚŽƌLJ ĐĂƌĞ͕ ŚĞĂůƚŚ ĞĚƵĐĂƟŽŶ͕ ĂŶĚ ƉƵďůŝĐ ŚĞĂůƚŚ ƐĞƌǀŝĐĞƐ ƚŽ ƚŚĞ hŶŝǀĞƌƐŝƚLJ ĨŽƌ ŶĞĂƌůLJ ϵϬ LJĞĂƌƐ͘ /ƚ͛Ɛ ŽƵƌ ŵŝƐƐŝŽŶ ƚŽ ĐƌĞĂƚĞ Ă ŚĞĂůƚŚLJ ĐŽŵŵƵŶŝƚLJ ďLJ ǁŽƌŬŝŶŐ ǁŝƚŚ ƐƚƵĚĞŶƚƐ͕ ƐƚĂī͕ ĂŶĚ ĨĂĐƵůƚLJ ƚŽ ĂĐŚŝĞǀĞ ƉŚLJƐŝĐĂů͕ ĞŵŽƟŽŶĂů͕ ĂŶĚ ƐŽĐŝĂů ǁĞůůͲďĞŝŶŐ͘ ŽLJŶƚŽŶ͛Ɛ ŽƵƚƐƚĂŶĚŝŶŐ ƐƚĂī ŽĨ ϮϱϬ ŝŶĐůƵĚĞƐ ďŽĂƌĚ ĐĞƌƟĮĞĚ ƉŚLJƐŝĐŝĂŶƐ͕ ŶƵƌƐĞ ƉƌĂĐƟƟŽŶĞƌƐ͕ ƌĞŐŝƐƚĞƌĞĚ ŶƵƌƐĞƐ͕ D Ɛͬ>WEƐ͕ ƉŚLJƐŝĐŝĂŶ ĂƐƐŝƐƚĂŶƚƐ͕ ĚĞŶƟƐƚƐ͕ ĚĞŶƚĂů ŚLJŐŝĞŶŝƐƚƐ͕ ŽƉƚŽŵĞƚƌŝƐƚƐ͕ ƉŚLJƐŝĐĂů ĂŶĚ ŵĂƐƐĂŐĞ ƚŚĞƌĂƉŝƐƚƐ͕ ƌĞŐŝƐƚĞƌĞĚ ĚŝĞƟƟĂŶƐ͕ ƉŚĂƌŵĂĐŝƐƚƐ͕ ƉƐLJĐŚŝĂƚƌŝƐƚƐ͕ ƉƐLJĐŚŽůŽŐŝƐƚƐ͕ ĂŶĚ ƐŽĐŝĂů ǁŽƌŬĞƌƐ͘ KƵƌ ŵƵůƟĚŝƐĐŝƉůŝŶĂƌLJ ŚĞĂůƚŚ ƐĞƌǀŝĐĞ ŚĂƐ ďĞĞŶ ĐŽŶƟŶƵŽƵƐůLJ ĂĐĐƌĞĚŝƚĞĚ ďLJ , ƐŝŶĐĞ ϭϵϳϵ͕ ĂŶĚ ǁĂƐ ƚŚĞ ĮƌƐƚ ĐŽůůĞŐĞ ŚĞĂůƚŚ ƐĞƌǀŝĐĞ ƚŽ ŚĂǀĞ ĞĂƌŶĞĚ ƚŚŝƐ ĚŝƐƟŶĐƟŽŶ͘ ƩĞŶĚŝŶŐ ƚŽ ŽǀĞƌ ϭϬϬ͕ϬϬϬ ƉĂƟĞŶƚ ǀŝƐŝƚƐ ĞĂĐŚ LJĞĂƌ͕ ŽLJŶƚŽŶ ,ĞĂůƚŚ ^ĞƌǀŝĐĞ ƚĂŬĞƐ ƉƌŝĚĞ ŝŶ ŵĞĞƟŶŐ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ŶĞĞĚƐ ŽĨ h ŽĨ D ƐƚƵĚĞŶƚƐ͕ ƐƚĂī͕ ĂŶĚ ĨĂĐƵůƚLJ ǁŝƚŚ ĐŽŵƉĂƐƐŝŽŶ ĂŶĚ ƉƌŽĨĞƐƐŝŽŶĂůŝƐŵ͘
ŽLJŶƚŽŶ ,ĞĂůƚŚ ^ĞƌǀŝĐĞ ŝƐ ƐĞĞŬŝŶŐ Ă WƐLJĐŚŝĂƚƌŝƐƚ ƚŽ ǁŽƌŬ ǁŝƚŚ Ă ůĂƌŐĞ ĂŶĚ ĚŝǀĞƌƐĞ ƉŽƉƵůĂƟŽŶ ŽĨ ƐƚƵĚĞŶƚƐ Ăƚ ƚŚƌĞĞ ůŽĐĂů ĐŽůůĞŐĞƐ͕ ŝŶ ĂĚĚŝƟŽŶ ƚŽ ƚŚĞ ,ĞĂůƚŚ ^ĞƌǀŝĐĞ͕ ĂƐ Ă ƌĞƉƌĞƐĞŶƚĂƟǀĞ ŽĨ ƚŚĞ ŵĞŶƚĂů ŚĞĂůƚŚ ĐŽŶƐƵůƚĂƟŽŶͬŽƵƚƌĞĂĐŚ ƉƌŽŐƌĂŵ͘ dŚĞ WƐLJĐŚŝĂƚƌŝƐƚ ǁŝůů ĂůƐŽ ƐĞƌǀĞ ĂƐ Ă ĐŽŶƐƵůƚĂŶƚ ƚŽ ŽƚŚĞƌ ,ĞĂůƚŚ ^ĞƌǀŝĐĞ ƐƚĂī ŵĞŵďĞƌƐ͕ ĂƐ ǁĞůů ĂƐ ƚŚĞ ĨĂĐƵůƚLJ ĂŶĚ ƐƚĂī ŽĨ ƚŚĞƐĞ ŽůůĞŐĞ ĂŶĚ hŶŝǀĞƌƐŝƚLJ ĐŽŵŵƵŶŝƟĞƐ͘ ůŝŵŝƚĞĚ ĂŵŽƵŶƚ ŽĨ ƉƐLJĐŚŽƚŚĞƌĂƉLJ ǁŝůů ĂůƐŽ ďĞ ŝŶǀŽůǀĞĚ͘ ƉƉůŝĐĂŶƚ ŵƵƐƚ ďĞ WE ďŽĂƌĚ ĐĞƌƟĮĞĚͬĞůŝŐŝďůĞ ŝŶ ƉƐLJĐŚŝĂƚƌLJ͘ ŽLJŶƚŽŶ ,ĞĂůƚŚ ^ĞƌǀŝĐĞ ŽīĞƌƐ Ă ĐŽŵƉĞƟƟǀĞ ƐĂůĂƌLJ ĂŶĚ Ă ƌĞǁĂƌĚŝŶŐ ƉƌĂĐƟĐĞ ĞŶǀŝƌŽŶŵĞŶƚ͘ WƌŽĨĞƐƐŝŽŶĂů ůŝĂďŝůŝƚLJ ĐŽǀĞƌĂŐĞ ŝƐ ƉƌŽǀŝĚĞĚ͘ dŽ ůĞĂƌŶ ŵŽƌĞ ƉůĞĂƐĞ ĐŽŶƚĂĐƚ 'ĂƌLJ ŚƌŝƐƚĞŶƐŽŶ͕ D͘ ͕͘ DĞŶƚĂů ,ĞĂůƚŚ ůŝŶŝĐ ŝƌĞĐƚŽƌ (612) 624-1444͘ ƉƉůLJ ŽŶůŝŶĞ Ăƚ ŚƩƉƐ͗ͬͬĞŵƉůŽLJŵĞŶƚ͘ƵŵŶ͘ĞĚƵ and ƌĞĨĞƌĞŶĐĞ ƌĞƋƵŝƐŝƟŽŶ ŶƵŵďĞƌ 174055͘ dŚĞ hŶŝǀĞƌƐŝƚLJ ŽĨ DŝŶŶĞƐŽƚĂ ŝƐ ĂŶ ƋƵĂů KƉƉŽƌƚƵŶŝƚLJ͕ ĸƌŵĂƟǀĞ ĐƟŽŶ ĚƵĐĂƚŽƌ ĂŶĚ ŵƉůŽLJĞƌ͘
ϰϭϬ ŚƵƌĐŚ ^ƚƌĞĞƚ ^ ͻ DŝŶŶĞĂƉŽůŝƐ͕ DE ϱϱϰϱϱ ͻ ;ϲϭϮͿ ϲϮϱͲϴϰϬϬ ͻ ǁǁǁ͘ďŚƐ͘ƵŵŶ͘ĞĚƵ
DECEMBER 2011
MINNESOTA PHYSICIAN
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