Michele Laughman is a health insurance specialist in the Division of Nursing Homes at the Centers for Medicare & Medicaid Services (CMS). At CMS, she coordinates the National Partnership to Improve Dementia Care in Nursing Homes, which was established to improve the quality of care provided to individuals with dementia living in nursing homes; deliver health care that is person-centered, comprehensive and interdisciplinary; and protect residents from being prescribed antipsychotic medications. Prior to joining CMS, Laughman served as a program specialist with the Carroll County (MD) Department of Citizen Services and Carroll County Bureau of Aging. Laughman received her bachelor’s degree in social work with a minor in sociology from Bloomsburg University.
Tell us a little about the mission of the National Partnership to Improve Dementia Care in Nursing Homes.
The Centers for Medicare & Medicaid Services (CMS) established the National Partnership to Improve Dementia Care in Nursing Homes in 2012. The Partnership employs a multidimensional approach, including public reporting, partnerships and state-based coalitions, research, training for providers and surveyors, and revised surveyor guidance to empower and build upon the efforts of organizations across the country.
The Partnership seeks to optimize the quality of care and quality of life for residents of America’s nursing homes by improving care for all residents, especially those with dementia. It promotes rethinking approaches to dementia care, reconnecting with people using person-centered care approaches and restoring good health in nursing homes. While the initial focus of the Partnership was on reducing the use of antipsychotic medications, the larger mission is to enhance the use of non-pharmacologic approaches and person-centered dementia care practices.
In November, the Partnership announced a goal to decrease antipsychotic use by 15 percent in high-use nursing homes by 2019. What steps are you taking to achieve this goal?
The Partnership’s mission to improve care through the use of non-pharmacologic approaches has remained unchanged. CMS is committed to finding new ways to implement practices that enhance the quality of life for people with dementia, protect them from substandard care, and promote goal-directed, person-centered care for every nursing home resident.
Currently, our efforts are focused on a 15 percent reduction in antipsychotic medication use by the end of 2019 for those facilities that continue to have high rates of use — which are often called “late adopters” — while encouraging those nursing homes with low rates of antipsychotic medication use to continue their efforts.
I believe the success of the Partnership stems from the hard work and dedication of the State Dementia Care Coalitions, Quality Innovation Network – Quality Improvement Organizations (QIN – QIOs), CMS Regional Offices and countless stakeholders across the country. They have worked to provide resources, education, training, outreach and technical assistance to nursing homes in an effort to improve care and reduce the inappropriate use of antipsychotic medications. We are so appreciative of all their efforts. Our work with the late adopters will involve continued collaboration with our partners, building upon the extensive work that has already been accomplished.
Additionally, CMS has launched the Civil Money Penalty Reinvestment Program (CMPRP), a three-year effort to drive improvements in quality of care for nursing home residents. This effort is funded by the federal portion of civil money penalties to conduct activities that support and protect nursing home residents, and will build on other CMS initiatives, such as the Partnership.
How are Quality Innovation Network – Quality Improvement Organizations (QIN – QIOs) working with the Partnership to reduce the usage of antipsychotics?
The work of the QIN – QIOs closely aligns with the Partnership. Voluntary stakeholder coalitions, referred to as State Dementia Care Coalitions, organize Partnership activities in each state. These activities vary but can include facilitation of coalition meetings, outreach to nursing homes, and organization of conferences and workshops. Currently, 36 state coalitions are led or co-led by their QIN – QIO.
Beyond the reduction in antipsychotics, how else has the Partnership enhanced the use of non-pharmacologic approaches and person-centered dementia care practices?
Implementation of the Reform of Requirements for Long-Term Care Facilities and accompanying interpretative guidance incorporates both the use of non-pharmacologic approaches and person-centered care for all nursing home residents, including residents living with dementia. Federal requirements pertaining to behavioral health services and pharmacy services specifically touch on these topics and discuss the process of using person-centered, non-pharmacologic approaches to care prior to the prescription of antipsychotic medications, unless doing so would be contraindicated. It also discusses the importance of monitoring for efficacy and potential adverse side effects for care approaches, both non-pharmacologic and pharmacologic.
Additionally, CMS continues to conduct Focused Dementia Care Surveys, first initiated in 2014, to assist in determining compliance with areas such as quality dementia care, the use of non-pharmacological approaches and the utilization of antipsychotic medications. These focused reviews examine the process for prescribing antipsychotic medications and assess compliance with other federal requirements related to dementia care practices in nursing homes. These surveys were initiated to gain new insights about ways to more efficiently and accurately identify and cite deficient practices.
Are there any new or soon-to-be-released dementia care resources for health care stakeholders?
The Partnership has partnered closely with the National Nursing Home Quality Improvement Campaign to develop and maintain a resource and tool repository related to dementia care. This repository, which is supplemented regularly, includes information for individuals living with dementia, care partners and professionals in the field.
Additionally, the Hand in Hand training series, previously released in 2012, is currently under revision and will be released this year. The revisions of this training pertain to changes in the Reform of Requirements for Long-Term Care Facilities guidance.
Anything else you would like QIO News readers to know?
The Partnership, in collaboration with the Quality Assurance Performance Improvement program, has facilitated many national provider calls through the Medicare Learning Network (MLN). These calls are recorded and transcribed, and can be accessed by visiting the MLN National Provider Calls and Events website and searching for “dementia.”