Ecumen “Awakenings”: Reducing Antipsychotic Drug Use In Alzheimer's Care

Last Updated
February 28th, 2011

Ecumen is working to change the culture of care in Alzheimer's through its Awakenings Initiative.  Awakenings has been introduced in 15 nursing homes in Minnesota and is working to reduce, where appropriate, the use of antipsychotic drugs.

We at Ecumen take the “innovate” in our tagline very seriously. We’re constantly looking for better ways to empower and honor our customers, whether they live in their own homes, in our senior housing communities or our nursing homes.

A few years ago, when our staff members became concerned about the number of people with Alzheimer’s and other dementia-related diseases being admitted who were on antipsychotic drugs, we started exploring alternative treatments that could provide them a better quality of life. These treatments emphasize human relationships and non-pharmaceutical remedies. In 2009, we piloted these alternative treatments in one of our nursing homes in Two Harbors, Minnesota.

We call this initiative Awakenings, (Frequently Asked Questions here) because it re-awakens residents to physical and cognitive vitality that’s often been severely diminished by an inappropriate use of antipsychotic drugs. We can’t cure Alzheimer’s, but we have learned much more about how to control the aggressive and sometimes violent behaviors that accompany it without using drugs that rob residents of their personalities and energy.

The results of this trial were so remarkable we decided to expand Awakenings to other Ecumen nursing homes across the state. Thanks to a $3.8 million grant from the State of Minnesota’s Department of Human Services, we’re in the process of doing that right now.

America's Culture of Alzheimer's and Memory Care

To help residents with Alzheimer’s lead fuller lives, Ecumen is spurring a major shift in the way antipsychotic drugs are used in nursing homes.

To understand how Awakenings works, you first have to understand the culture of Alzheimer’s care in this country. In many nursing homes, antipsychotic drugs are commonly used to stop problem behaviors that can accompany Alzheimer’s and dementia. For some people, antipsychotic drugs can play an appropriate role. But for many others, they can effectively end life for the still-living.

Long-term use often results in a “zombie” effect, not calming residents but instead stealing their personalities and energy. Antipsychotics have been found to actually worsen cognitive functioning among elderly people with dementia, and speed their decline. In addition, these drugs make elders more likely to suffer a stroke, develop pneumonia, or experience a serious adverse drug effect that leads to hospitalization or even death. These drugs carry a Food and Drug Administration black box warning that elderly people who use them have an increased risk of death.
Yet, more than 20% of American nursing home residents with Alzheimer’s-related illnesses are on such medications. The use of these drugs has skyrocketed in recent years. Medicaid spends more on this class of drugs than any other—including antibiotics, AIDS drugs, or medicines to treat high blood pressure.

Ecumen Introduces A Better Way

When we piloted Awakenings, the entire culture of the Two Harbors facility changed. Instead of the fragmentation found in much of American healthcare, Awakenings took a more holistic approach. Trusted, collaborative teams—“circles of care”—were built around each resident, involving family, professional staff, and the right doctors and nurses who created individually tailored alternative care plans. The focus became human relationships rather than drugs. The team’s goal was to exhaust all other resources before turning to pharmaceutical care.

As residents in the Two Harbors home were weaned off antipsychotics, staff members engaged more with residents, taking them on walks, playing games, and exercising. Certified Nursing Assistants assumed a more important role. Therapies using validation, reminiscence, music, aroma, and pets were employed to improve residents’ physical and cognitive functions.

Within six months, the nursing home had eliminated the use of antipsychotics among all residents, and the use of antidepressants decreased by 30-50%. Before the pilot project, the home was quiet; several residents preferred to stay in bed all day and others sometimes held a far-off, vacant look. Today, it’s not uncommon to walk into the home and see a large group of residents playing a rousing game of balloon volleyball.

Expanding Awakenings To Other Nursing Homes

Based on our success in Two Harbors, and with the help of a $3.8 million state grant, we have formalized and expanded Awakenings to other Ecumen nursing homes across the state, including:

  • Alexandria, Bethany Home
  • Austin, St. Mark’s Lutheran Home
  • Balaton, Colonial Manor
  • Chisago City, Margaret S. Parmly Residence
  • Clarkfield,
  • Clarkfield Care Center
  • Detroit Lakes, Emmanuel Nursing Home
  • Duluth, Bayshore Health Center
  • Grand Rapids, Grand Village Nursing Home
  • Lake Park, Sunnyside Care Center
  • Litchfield, Emmanuel Home
  • Mankato, Pathstone Living
  • North Branch, Ecumen North Branch
  • Park Rapids, Heritage Living Center
  • Pelican Rapids, Pelican Valley Health Center

This is a major, three-year undertaking that involves: 1) recruiting and educating local doctors, 2) hiring project leads and other staff ready and willing to care for residents in new ways, 3) informing and fully engaging families, 4) retraining management staff, and 5) developing systems and procedures to make sure that new methods of care are used instead of or in addition to appropriate prescribed medicines.

At the end of this period, we’ll report our findings to the Minnesota Department of Human Services, as well as the larger medical community. We’re hopeful that Awakenings represents a new Alzheimer’s care “best practice” that can ultimately bring many of the estimated 27,000 Minnesota nursing home residents on antipsychotic drugs new vitality, joy, and dignity. It is innovation, empowerment and honor.

Media Coverage On Ecumen's Awakenings Initiative