Ecumen “Awakenings”: Reducing Antipsychotic Drug Use

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.

Our brand promise at Ecumen is to “innovate,” "empower," and "honor."  We take that 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. In 2009, 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 care approaches that could provide them a better quality of life. This approach emphasizes human relationships and non-pharmaceutical remedies. We first piloted it at Ecumen Sunrise in Two Harbors, Minnesota. We call this initiative Ecumen Awakenings, (this link contains much more information on this approach) because it helps to re-awaken many residents whose physical and cognitive abilities have often been masked by an inappropriate use of antipsychotic drugs. We can’t cure Alzheimer’s, but we have learned much more about how to control the substantial mood swings or behaviors that can 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.  We also received three-year $3.8 million grant from the State of Minnesota. 

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 nursing home 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 game of balloon volleyball.  Below are some of the media stories on Ecumen Awakenings' beginnings: