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The Commonwealth of Massachusetts

Executive Office of Health and Human Services

Department of Public Health

Bureau of Health Care Safety and Quality

99 Chauncy Street, 11th Floor, Boston, MA 02111










Circular Letter: DHCQ 12-12-581
TO: LTC Administrators and

Director of Nurses

FROM: Madeleine Biondolillo, MD

Bureau Director

DATE: December 10, 2012
RE: Informational Bulletin on the Massachusetts Collaborative for Resident-Centered Care and

the Reduction in the use of unnecessary Antipsychotic medications for Long Term Care (LTC)


The Department has recently convened the Massachusetts Collaborative for Resident-Centered Care with membership consisting of Massachusetts provider associations, Mass Health, the ombudsman program, Maseniorcare, MassleadingAge, Mass Medical Director’s Association, MAHNR and many other interested long term care Stakeholders committed to the goal of resident-centered care. We also seek to support the industry in the mutual effort to reduce the use of unnecessary antipsychotic medications in nursing homes, and eventually other care settings. In this regard, we have taken our direction from the leadership at CMS which launched this effort in 2012 and is working with many technical experts, Advancing Excellence and the national associations in this nationwide effort to promote resident-centered care and increased use of non-pharmacological therapeutic interventions for nursing home residents.

Through the upcoming months we will periodically share with you information to support our mutual efforts toward the goal of refocusing care to be resident-centered. For example, there have been two recent CMS survey and certification memorandums issued concerning this topic:

  • One provides notice to be on the look out for a mailing at your facility of a DVD training series produced by CMS titled “Hand-in-Hand”. This free DVD is being mailed directly to every facility in the country. CMS asks that you use this video series as part of your training curriculum as you further educate staff to care for residents and possibly avoid the use of antipsychotic medications.

  • A second CMS memorandum previously issued but revised 8/31/2012 seeks to inform us of several resources available through the worldwide web which you can access immediately to inform and educate you and your staff on this initiative. This memorandum provides internet links to several organizations websites which contain useful articles, informative slide presentations and training information to support your efforts in providing resident-centered care and reducing unnecessary antipsychotic medications. These links are include:

      • AMDA website at: http://www.amda.com/advocacy/antipsychotic_msg.pdf

      • Leading Age’s information related to the Partnership is located on their website at: http://www.leadingage.org/phillips_antipsychotic_checklist.aspx

      • The Consumer Voice website at: http://www.theconsumervoice.org/sites/default/files/nccnhr/campaign-to-end-antipsychotic-druguse.pdf

The Mass Collaborative for Resident Centered Care has met twice in 2012. At the first meeting the following information was shared:

  • We heard from Maseniorcare’s clinical director, Laurie Herndon speak on the roll out on September 20th of the Oasis program with a statewide training to 100 volunteer nursing homes and all DPH long term care surveyors in this resident-centered approach to working with residents and patients thereby implementing a non pharmacological approach to care. This project is funded through a Civil Money Penalty (CMP) award issued by DPH having obtained CMS approval to underwrite this innovate training to support providers in their efforts to train and work with their staff to be resident-centered in their approach to care giving. This training was held with a day long Presentation on Oasis a Resident-Centered approach to care given by Dr. Susan Weary.

  • The Mass/NH chapter of the Alzheimer’s Association’s Dr. Raia discussed their effort to educate facility staff in collaboration with the Quality Improvement Organization on Habilitation therapy. They are seeking to educate facility staff to better understand the neuro-physiological aspects of Alzheimer’s disease and how to care and support such a resident throughout their life at the nursing home. Dr. Raia has trained many Nursing facilities, the ASAP providers and DPH surveyors in this approach to care. You may obtain additional information on this approach and a wealth of information on Alzheimer’s care at the website: http://www.alz.org/professionals_and_researchers_11176.asp

  • DPH has initiated a regulation development committee to formulate regulations to be issued in 2013 in support of those facilities that wish to establish specialized dementia care units including requirements for training in Alzheimer’s and other related dementia disorders for all facilities who provide care to residents’ with this condition.

The second meeting of the Mass Resident Centered Care collaborative held at which there were three presentations:

  • Vincent Rome a student intern at the Department presented a summary of the data sources available from the American Health Care Association and CMS. Based on CMS data Massachusetts currently ranks among the top ten states in the country for use of antipsychotic medications in Nursing homes. You can learn how your facility compares among other facilities in Massachusetts and the nation by accessing the data available on the CMS nursing home compare website at: http://www.medicare.gov/NursingHomeCompare/search.aspx?bhcp=1

  • The second presentation provided insight from a loving care partner’s perspective. In this presentation before and after admission data, assessments and pictures were presented as evidence of the effects medications had on the patient. Bob, who prior was an alert cognitively intact person. The following medications were administered: Ambien (first given for difficulty sleeping), Trazadone (added for anxiousness) and finally Seroquel (provided for confusion). The speaker explained how within a month of being administered these medications her loved one was now being labeled in the record as confused, demented, resistant to care, and difficult. The story of this man’s experience was titled “Bob’s greatest battle” in reference to his proud veteran history. You can access an excellent YouTube video titled “Youfight4me” composed by this same care partner who is committed to advocating in Bob’s memory on behalf of patients who are being unnecessarily treated with antipsychotics at: http://www.youtube.com/watch?v=J0idT2U_Kxg&feature=plcp

  • The third speaker, Arlene Germaine of Massachusetts advocates for Nursing home reform (MANHR), presented a consumer advocacy perspective on this topic. Referencing the extensive work done by the California advocacy organization now titled Consumer Voice. Arlene made the case of the importance for facilities to insure adequate and well trained staff who communicate with care partners of resident’s and work with family and resident councils to insure the resident’s care partner is included in the interdisciplinary team for determining appropriate non-pharmacological interventions for the resident. You can read more on MANHRs website at: http://www.manhr.org/

  • Additional information shared was the CMS plan to distribute the survey and certification memorandum which will include the new interpretative guidelines for unnecessary medications at F329 and the surveyor worksheet by which to assess for appropriate resident centered care which includes non-pharmacological interventions and avoidance of the unnecessary use of antipsychotic medications. CMS will also issue a mandatory two hour training video for LTCF surveyors which will help surveyors understand how to use a reasonable and responsible approach to surveying on this very important topic. This video will eventually be posted (as are other training videos) on the CMS’s training site at: www.cmssurveyortraining.gov

  • Finally, representatives from Mass health shared that they are working on the Pay for performance project for this state fiscal year. Building on last years efforts to support consistent staff assignment the Mass Health provider committee will be meeting to discuss and identify the quality measures to be used in evaluating which facilities may achieve a P4P grant. One important measure which will be considered is the CMS QM for antipsychotic use for long stay residents. Mass Health will be issuing a bulletin on this in the near future with their final guidelines.

In conclusion, one other important website resource we suggest you visit which includes much information is the Advancing Excellence website which has posted many articles and links to the above topics. The advancing excellence website link is at: http://www.nhqualitycampaign.org/star_index.aspx?controls=dementiaCare

Keep on the look out in the mail for your copy of the DVD series “Hand in Hand”. And begin educating yourselves, your staff in this all important resident care matter and incorporating the important care principles contained in the above referenced resource information.
The Massachusetts Collaborative for Resident Centered Care will hold its next meeting in January, 2013. We will continue to share additional information on this and other topics going forward via the long term care listserv process.

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