Ecumen Lakeshore Residents Sing the Praises of Opera

The residents at Ecumen Lakeshore in Duluth are discovering the enchantment of opera, thanks to the passion and knowledge of residents Jay Amato and Patricia Richard-Amato.

Jay and Pat suggested the idea of viewing operas on film to their fellow members of The Lakeshore Readers — the Ecumen Lakeshore book club.  After reading 70 books together in seven years, book club members were open to new ideas, but even Jay and Pat were surprised by how popular the opera series has become.

"I have been very gratified by the number of residents who have appreciated something new and different at Lakeshore," said Jay. "I have had many appreciative comments from people who are getting exposure to the opera."

Residents of Ecumen Lakeshore now have the opportunity to view a new opera each quarter.  On June 18 the group saw Gaetano Donizetti’s Opera, L’ Elisir d’ Amore (The Elixir of Love) and applauded enthusiastically.  Residents stayed for discussion, h'ordeuvres and wine following the showing.

The events are open to any resident at Ecumen Lakeshore, even those who are unfamiliar with the opera. Each viewing begins with Jay briefing viewers on highlights to watch for, music and background information about each opera.

“Residents at Lakeshore come from all walks of life,” said Lakeshore Chaplain Alice Olson, who is also a member of the book club.  “Events such as our book group and the opera provides us with both sharing life experiences, continuing to learn and have new experiences.  The arts and literature feed us both mentally and spiritually.”

                                                                                                               


Senior man and woman having coffee at table seen through window

Star Tribune Editorial Calls for Awakenings Funding and Expansion Nationwide

A Star Tribune lead editorial on April 5, 2014, said Ecumen Awakenings dementia care program is “effective and compassionate” and “should become the standard of care across the nation as baby boomers swell senior ranks.”

The Star Tribune cited the Leading Age Excellence in Dementia Care Award given last month to Awakenings, which is a pioneering approach to caring for those with Alzheimer’s and other dementias without the use of highly sedating psychotropic drugs.

Noting that less than 2 percent of private philanthropic dollars in Minnesota go to programs for seniors, the Star Tribune editorial urged private foundations to acknowledge the coming age tsunami and help fund expansion of the Awakenings care model nationally. 


Duluth News Tribune Tells the Ecumen Awakenings Story

In today’s Duluth News Tribune, reporter John Lundy gives a sensitive and compelling account of how Awakenings works to calm dementia without drugs.  Shelley Matthes, RN, Ecumen’s director of quality improvement, tells Lundy: “Our job is to identify things that bring people to a place of peace and joy.”


Ecumen Medical Consultant Dr. Tracy Tomac: A Psychiatrist Blazing New Trails in Dementia Care

New Ulm, Minn., 18 years ago:  The bus from the nursing home moves through the below-zero snowy prairie to the clinic where a freshly minted young doctor has just started practicing.  The bus attendant unloads the elderly patients in their wheel chairs and rolls them, one by one, into the clinic. 

The doctor, a Mayo resident in psychiatry, feels well equipped to handle this, newly armed with a prescription pad and an abundance of optimism.  The attendant quickly scampers away, and the doctor approaches the patients, who are in various stages of dementia.  Each one has an envelope, attached by a pin, to their sweaters. 

The doctor opens the first envelope and the note says: “Always gets agitated in the early afternoon.”  The next envelope: “Cries out in the night.”  A few short words about each patient, and that’s it.

Without anyone ever saying a word to her, the doctor understood the expectation: Fix this with a pill.

And Dr. Tracy Tomac said to herself: “This is not going to work.” 

What she intuitively knew then, and what she now knows with considerable experience, is that you rarely “fix” an elderly person with dementia with a pill.  Medication obviously has a place, but it’s not the be-all and end-all.  And as she would soon see firsthand, it can often hurt more than it helps.  Just as giving antibiotics at the first sign of a cold could be overreacting, so could giving antipsychotics or antidepressants at the first sign of agitation.

“But back then,” Dr. Tomac says, “this was just how medicine was practiced on nursing home patients.”

Early on, she decided it was not how she was going to practice. When she started rounding at a nursing home for elderly nuns, she started to understand her options.  This was a close, supportive community able to give her lots of information about each patient. She was learning that truly knowing patients and their history could be a more powerful tool than the prescription pad.

Dr. Tomac soon moved to Winona, Minn., and her new job allowed for even more rounding at nursing homes — something she loved.  Also, she was fascinated by the culture of caregiving in small-town Minnesota.  Everyone knew everyone.  Nurses and other caregivers were taking care of their friends and neighbors, and the background they had about each patient gave the doctor rich diagnostic information.  Caregivers were like extended family, and Dr. Tomac was beginning to see how crucial “knowing the patient” as an individual is to practicing psychiatry the way she wanted to do it.  She saw how important relationships were to the patients.  Connecting on a personal level had a healing power all its own.

Dr. Tomac was captivated by the remarkable life stories of these determined, courageous people who had struggled through the Great Depression and World War II, and she saw how relevant these stories were as dementia progressed and communication skills declined.  Dementia patients often were more connected to the past than the present, and behavioral episodes often were directly related to a person’s history.  For example, patients who walked incessantly around the nursing home may have had careers requiring constant on-the-job walking.

The patients’ many engaging stories of hardship and triumph reminded Dr. Tomac of her Great-Grandmother Flo who had come to America from Wales in 1920 — with nothing — and carved out a vibrant, productive life.  When Grandma Flo was in her 80s, Tracy was just a kid and would travel from Texas to visit her in Pasadena, Calif., during the summer. Grandma Flo was the “original little old lady from Pasadena,” always on the go.  “She was a role model for active aging,” Dr. Tomac says.

Grandma Flo never regarded herself as old and was a serial volunteer at local nursing homes.  As an octogenarian, she would say without a trace of irony, “Hey, Tracy, let’s go visit the old people.”  Even then, Tracy loved going to the nursing homes.  As the cute little kid, she was the center of attention.

And now, in rural Minnesota, Tracy Tomac, the psychiatrist, was still the center of attention in the nursing home — now because she had the prescription pad.  The nurses called all the time asking the doctor to give patients something to help them sleep, something to calm them down, something to stop their outbursts.  “Give them something” was a constant refrain.

What Dr. Tomac started to do was give them close attention.  Like the time an elderly woman with dementia was screaming in the night, every night, that there were “baby heads” flying around in her room.  Give her something, please, the nurse asked.

Dr. Tomac went into the room, sat on the bed and tried talking to the woman.  And something caught her eye.  She left the patient, went to the nurse, and offered this prescription: “Change the bedspread.”

While in the room, she noticed that the bedspread had a vivid design of “peach cabbage roses.”  The  head-like design  could easily transform into “baby heads” to a person with dementia, with limited sensory input.  “With dementia, the mind does the best it can with the sensory input it has,” she explains.  “The mind takes whatever input it gets and tries to fill in the blanks.”

Removing the bedspread worked.  Sure, a sedating drug may have worked too — but most likely with unnecessary side effects.

And there were more situations like this— enough to make Dr. Tomac think medication should not always be the first tactic.  She was convinced, but the nurses weren’t.  She knew she needed to some way persuade them, since they were the “boots on the ground” who she depended on for crucial diagnostic information.

So Dr. Tomac tried the educational approach.  She would hold seminars at care centers over lunch and talk to staff about how to analyze the cause of behavioral outbursts and manage difficult behaviors without drugs.  But this was slow going.  Really slow.

“Once I was in a place for about two years, people would start to trust me,” she recalls.  “Then I would begin to notice that the approaches I was advocating started to be fed back to me. Nurses would start telling me about a patient’s issues, then would say: “But I don’t think medication is necessarily called for in this situation.”

Dr. Tomac was now working at St. Luke’s Hospital in Duluth and rounding at nursing homes in the area.  In 2008, while visiting what is now Ecumen Scenic Shores in Two Harbors, Minn., she met an Ecumen nurse manager named Eva Lanigan.  They were “kindred spirits.”  Eva had attended a workshop about the dangerous side effects of antipsychotic drugs on elderly people.  When she looked around the care center, she saw too many patients in a drug-induced fog and wanted to do something about it. 

Dr. Tomac was just the doctor to see about that.  Together, they started going through residents’ charts, one by one.  What drugs were they on?  Were all the drugs necessary, given the diagnosis?  What could they do to slowly wean the patients off the drugs?

This was the beginning of the Ecumen Awakenings program — two women determined to give elderly dementia patients a better quality of life.  They went to work creating a collaborative program with the patients, the doctors, the care team and the family to replace sedation with an integrated, holistic program of care.  They just did it—patiently and systematically with a clear vision of the outcome they wanted—but with no blueprint from official sources and with no certainty that it would work. 

As their collaboration progressed, Eva began to formalize the program.  The entire staff of Ecumen Scenic Shores — including housekeepers, cooks and dining room servers — received training in methods to calm residents when they became agitated, using non-pharmaceutical techniques like redirection, exercise, activities, music, massage and aromatherapy. The staff was taught how to listen to residents and enter their reality, responding to them without insisting on facts that those with dementia can’t grasp or won’t recall.

They started in the early spring of 2009 and by early fall that year, ALL inappropriate antipsychotics were discontinued and antidepressants were reduced by 30 percent.  Ecumen Scenic Shores was no longer a quiet place.  It had literally come alive.  Residents who had been immobile began participating in balloon volleyball.  People who had not spoken in years were becoming more verbal.  Residents were smiling and participating in sing-alongs.

The dramatic results prompted Ecumen to start exploring ways to make Ecumen Awakenings more widely available.  Laurel Baxter, RN, an Ecumen quality improvement nurse now retired, was appointed to formalize the program so that it could be replicated in all 15 of Ecumen’s nursing homes. The State of Minnesota awarded Ecumen a performance incentive grant — essentially venture dollars to support innovation in long-term care— which financed the implementation.   Carefully monitored results showed dramatic reductions in the use of antipsychotic medications and dramatic increases in alertness, mobility, and laughter, more restful sleep, fewer falls, enhanced verbal ability, singing, ability to exercise, and reductions or eliminations of erratic mood swings, hallucinations and outbursts.

On March 17, 2014, Ecumen received national recognition for Awakenings, winning the LeadingAge Excellence in Dementia Care Award.

Coming out of this Awakenings collaboration, Dr. Tomac is now a medical consultant to Ecumen, helping nurses and other caregivers stay abreast of the latest developments in care and helping Awakenings continue to grow and evolve as it is expanded to assisted living communities.  The consultancy is  a way for Dr. Tomac  to stay in touch with her geriatric interests, now that she has made a career change and moved to Regions Hospital in Saint Paul, Minn. 

She currently works as an inpatient hospital psychiatrist treating adults. She finds surprising similarities in treating hospitalized patients  and nursing home patients, particularly in an institutionalized setting with patients who have perhaps experienced many losses — particularly loss of control over their environments.  All age groups are struggling to make sense of their worlds, she says, and their perceptions may be altered by mental illness or dementia.

She finds that the elderly are in a way easier to diagnose since they have a long history.  If you can understand that biography, treatment options are much clearer.  Younger patients' lives are more of a "work in progress,” she says, “and we have the opportunity to try to help the patient change the trajectory.”

 "An elderly person with dementia or a psychiatrically ill inpatient is just trying to make sense of the world and get their needs met, just like all of us." says Dr. Tomac.

Regardless of age, Dr. Tomac’s approach is this: Accept people where they are.  Talk with them, not to them. Try to put yourself in their place.  Figure out what’s causing their fear and anxiety.  Look at the entire environment, not just at the person.  And look for the unmet needs.  Yes, sometimes a drug is the answer.  In cases of severe mental illness, prescription drugs can give people their lives back.  But dementia is something else entirely .  Rather than see the behavior of dementia as purposeless and disease-driven activity to be managed with drugs and restraints, we can see it as an attempt to cope with real problems that often can be dealt with by changing the patient’s environment.

Looking way back to those early days in New Ulm, Dr. Tomac says she knows everyone was just trying to do the best they could with the tools and knowledge they had at the time.  Like everything else, the practice of medicine and the culture of care evolve. Ecumen’s nurses now frequently recite the mantra: “When we know better, we do better.” They now know a much better way of care than using chemical or physical restraints.

Likewise, new doctors coming to rural Minnesota now will be practicing on a whole different landscape.

Last year, the American Psychiatric Association issued an advisory saying anti-psychotic medications should not be the first treatments doctors think of when dealing with dementia in elderly persons, and this year the American Geriatrics Society issued a similar one.  Plus, the Centers for Medicare & Medicaid Services now have a national campaign focused on reducing the use of antipsychotics in nursing homes. 

Doctors, nurses and patients all have experienced awakenings.

 

Read The New York Times 2011 story on the beginnings of Awakenings at this link.


St. Paul Pioneer Press Highlights Ecumen Awakenings for Excellence in Dementia Care Award

 In a recent Opinuendo column the St. Paul Pioneer Press highlighted Ecumen’s Excellence in Dementia Care Award, a national honor received last week in Washington, D.C.  Here’s what the Pioneer Press wrote: 

On stage with a legend

Two nurses from Ecumen, a Shoreview-based nonprofit senior housing and services provider, shared a stage this week in Washington, D.C., with music legend Glen Campbell and his family.

They received awards at an Alzheimer's-awareness event, the Great Minds Gala -- Ecumen's Shelley Matthes and Maria Reyes for a program that uses nonpharmaceutical approaches to improve patients' quality of life, and the singer and his family for advocacy for continued research, education and support for those suffering with the disease.

Ecumen received the Excellence in Dementia Care Award from Ellen Proxmire, in honor of her late husband, Wisconsin Sen. William Proxmire, who died of Alzheimer's, and LeadingAge, a national association of nonprofit senior services organizations.

Ecumen was honored for its "Awakenings" program, aimed at reducing or eliminating the use of anti-psychotic medications among people with Alzheimer's and related dementias.

The program used behavior modification and other alternative techniques to reduce the use of anti-psychotic drugs by 98 percent in 1,200 patients in 16 nursing homes, according to a Washington Post report, saving $200,000 to $350,000 a month in Medicare and Medicaid spending on the medications and making patients more alert and active.

Patients "just became more alive and more awake, and that's why we called it Awakenings," Matthes told the Post. "It's not stopping the disease's progress, but it's improving the quality of life for the person, and the quality of the family experience, as well."


Ecumen Receives National Award for Excellence in Dementia Care

Ecumen received national recognition as winner of the LeadingAge Excellence in Dementia Care Award presented March 17 at the Great Minds Gala in Washington, D.C.

The award honors Ecumen Awakenings™, a care program that emphasizes managing dementia without highly sedating drugs.  Residents, their families, doctors and care staff all work together to replace traditional drug therapies with individualized techniques that reduce anxiety and difficult behaviors while improving quality of life.

The award was presented by LeadingAge, a national association of nonprofit aging services providers. It recognizes extraordinary leadership in the quest to improve lives of those touched by Alzheimer’s disease and other dementias.   Between 2010 and 2013, Ecumen Awakenings achieved a 97% reduction in the use of psychotropic medications, decreasing dosage or discontinuing use of more than 1,000 of these potentially harmful drugs.

Senator Amy Klobuchar of Minnesota addressed the gala attendees by video and recognized Ecumen as a leader in healthcare innovation. Klobuchar has introduced legislation to increase federal support for Alzheimer’s research and provide tax credits to caregivers. 

Shelley Matthes, RN, Ecumen director of quality improvement, and Maria Reyes, RN, manager of Awakenings, accepted the award. “I often tell my colleagues that when we know better, we do better” Matthes said.  “Awakenings is an evolution of many wonderful, intelligent, kind people who put their heart into this work to learn, to do better, so people’s lives are better.”

Reyes told the gala attendees: “Awakenings exists because of an incredible team of people across Ecumen who have a passion for making lives better. They are doing that work as I speak.”

“Alzheimer's Disease affects more than 5 million people, many of whom are cared for by our members or informal caregivers,” said Larry Minnix, LeadingAge's president and CEO. “We hope that the examples set by this year's honorees highlight the work that is being done to care for those affected while we search for a cure.”

Ecumen shared the stage with country music entertainer Glen Campbell and his family, who received the Senator William Proxmire Award for their advocacy for research, education and support related to Alzheimer’s disease since 2011, when the disease was diagnosed in the country singer. The award is named for the late U.S. Senator, who had Alzheimer’s disease.

Ecumen Awakenings has received media attention for its innovative approach to dementia care from the Washington Post, The New York Times, the Minneapolis Star Tribune and KARE11-TV. 


Great Minds Gala Video: Ashley and Shannon Campbell Perform Tribute to their Father

Ashley and Shannon Campbell, children of legendary country music singer Glen Campbell, gave a stunning performance to cap last night's Great Minds Gala in Washington, D.C. Campbell was honored at the Gala for his and his family's efforts toward continued research, education and support for those living with Alzheimers. Campbell was diagnosed with Alzheimers in 2011, after which he and his family decided to launch a Glen Campbell goodbye tour, giving him a chance to connect with family, friends and fans through music.

Thank you to Leading Age for sharing the video on their Facebook page.

 

 

The Great Minds Gala recognizes LeadingAge members and individuals who have exhibited extraordinary leadership in the quest to improve lives of those touched by Alzheimer's and other related dementias. Ecumen was also an award recipient at the event.


Washington Post Highlights Ecumen Awakeningsâ„¢

Ecumen Awakenings™ is in the national spotlight as the recipient of the Excellence in Dementia Care award from LeadingAge, a national association of nonprofit aging services providers. Washington Post Reporter Tara Bahrampour interviewed Ecumen nurses Shelley Matthes and Maria Reyes about the history, methods and success of the program in this Q & A in the Post.


Ecumen To Receive National Award for Excellence in Dementia Care

Ecumen will receive a national honor March 17 as the winner of the Excellence in Dementia Care Award presented by LeadingAge and EMA at the Great Minds Gala in Washington, D.C.

Ecumen is receiving the award for its Awakenings program, which over the last five years has significantly reduced the use of antipsychotic drugs on dementia residents in its communities by implementing non-pharmaceutical approaches to managing challenging behaviors associated with dementia.

"Alzheimer's Disease affects more than 5 million people, many of whom are cared for by our members or informal caregivers," said Larry Minnix, LeadingAge's president and CEO. "We hope that the examples set by this year's honorees highlight the work that is being done to care for those affected while we search for a cure."

The awards gala will be held in conjunction with the PEAK Leadership Summit of LeadingAge, the national trade association for not-for-profit aging services organizations, focused on education, advocacy and applied research.  EMA is a nationally recognized leader in dementia and memory related illnesses with its Copper Ridge Model of Care© and The Copper Ridge Institute affiliated with the Johns Hopkins University School of Medicine. It is a leader in the research, education and treatment of dementia and memory related illnesses.

Along with Ecumen will be three other honorees, all selected for their “exceptional leadership in the quest to improve the lives of those affected by Alzheimer's disease and other dementias.”

Country music entertainer Glen Campbell and his family will receive the Senator William Proxmire Award for their advocacy for research, education and support related to Alzheimer’s disease since 2011, when the disease was diagnosed in the country singer. Sharing the award will be film director/producer James Keach and producer Trevor Albert, whose documentary about Campbell's career and experiences with Alzheimer's disease is expected to be released soon.

The award is named for the late U.S. Senator, who had Alzheimer’s disease and lived at an EMA facility. "The Great Minds Gala is the realization of the vision of Ellen Proxmire, wife of the late Senator William Proxmire, who was diagnosed with Alzheimer's disease in 1994 and spent the last 5 years of his life at Copper Ridge," said Jackie Harris, president and CEO of EMA. "We're delighted to bring Ellen's passion for supporting caregivers to a national platform through this partnership with LeadingAge."

The Family Caregiver Award will be presented to Kathy Ritchie of Phoenix, a dementia advocate whose mother has dementia and who writes a blog for young caregivers.

Proceeds from the event will be benefiting the LeadingAge Innovations Fund and the Copper Ridge Institute (CRI) for the creation and advancement of dementia programs.


Annual Conference for People With Dementia and Their Caregivers Set for March 1

 The annual “Meeting of the Minds Dementia Conference” will be held March 1, 2014 from 8:30 a.m. to 4:30 p.m. at the Saint Paul River Center to inform and support people with dementia along with their family and friends and professional caregivers.

Ecumen’s Maria Reyes, a quality improvement nurse who champions the Ecumen Awakenings™ program, will be on a panel discussing how reducing the use of antipsychotic medications in long-term care improves lives.  Ecumen Awakenings is a pioneering approach to dementia care that emphasizes honoring the individual, using non-pharmacological and biomedical techniques, and establishing collaborative care that involves patients, physicians, care professionals, pharmacists and loved ones.

The Meeting of the Minds is organized by the Alzheimer's Association Minnesota-North Dakota Chapter and the Mayo Clinic.  Every year more than a 1,000 participants come together to hear national, regional and local presenters provide education and information on Alzheimer’s and other dementias, including strategies for caregiving, legal and financial planning, and cutting-edge research.

People with mild cognitive impairment or early dementia are encouraged to attend the conference, along with care partners, family and friends.  Recognized experts will conduct breakout sessions on a wide range of topics and exhibitors will provide information on dementia-related products and services.

For registration details and fees and full information on the conference and session topics, go to the Alzheimer’s Association’s conference website.

In addition to the almost 30 breakout sessions, the following presenters will be keynote speakers:

  • Alexander "Sandy" Halperin, DDS, was diagnosed with younger-onset Alzheimer's at age 60. He was relieved to have validation for the cognitive problems that were affecting his professional and personal life. Dr. Halperin has chosen to not allow the disease to define him.  He advocates that dignity, respect and inclusion are gifts worthy to each person, with or without a diagnosis.
  • Bruce L. Miller, M.D., is a professor of neurology at the University of California-San Francisco and directs the UCSF Memory and Aging Center (MAC). He has a special interest in frontotemporal dementia (FTD) and has discovered a subset of patients in whom visual or musical creativity emerges despite the progression of language and social impairment. In other words, when one part of the brain is compromised it may be possible for another part to become stronger.
  • Henry Emmons, M.D., is a psychiatrist who integrates mind-body practices and compassion into his clinical work. His teachings and programs combine movement, nutrition, natural therapies and mindfulness to help restore resilience and rediscover joy.

Ecumen, which has 25 memory care communities in five states, is a sponsor of the Meeting of Minds Conference.  We invite you to stop by our booth.