California Coalition for Person-Centered Care

Formed in 2006, the California Culture Change Coalition (CCCC) empowered California nursing homes to be models of quality of care for both staff and residents. In 2017, CCCC became the California Coalition for Person-Centered Care to expand their focus to include all senior living environments. Implementing culture change and person-centered care practices in all senior living environments can have a powerful impact on the daily life of residents as well as the daily life of staff who work in these facilities. The California Coalition for Person-Centered Care actively promotes the principles of culture change and person-centered care, including:

  • Close relationships between residents, family members, staff, and the community
  • Work that supports and empowers staff to respond to residents’ needs and desires
  • Management that enables collaborative decision making
  • Resident care and activities that are directed by the resident
  • A living environment that is designed to be a home rather than an institution
  • Systematic processes that are comprehensive and measurement-based, and that are used for continuous quality improvement.

 A Brief History

The California Culture Change Coalition (CCCC) really began in June 2005, when four Californians attended the Pioneer Network’s St. Louis Accord and came back with a plan. This was followed by the “Drive Improvements in Nursing Home Care” Caravan in August of 2005 engineered by Lumetra, California’s then Quality Improvement Organization, partnering with Dr. Bill Thomas, founder of the Eden Alternative the Green House Model. The Caravan attracted the interest of providers and other stakeholders. The group then formed a steering council that grew into the California Culture Change Coalition in August 2006 and incorporated as a 501(c)(3) non-profit in February 2007.

In 2017, CCCC became the California Coalition for Person-Centered Care to expand their focus to include all senior living environments.

Structure and Funding

California Culture Change Coalition dba California Coalition for Person-Centered Care is incorporated as a 501(c)(3) nonprofit organization with a Board of Directors that is composed of representatives from all areas of the long-term care community including resident advocates, skilled nursing providers, labor unions, quality improvement organizations, and state and federal regulators.

We are funded through in-kind donations from supporting individuals and organizations; CMP and other grant funding; and revenue from educational programs.

Accomplishments

The California Coalition for Person-Centered Care strives to connect older people to person-centered care wherever they reside or receive care. Here is a snapshot of some of the accomplishments. Every year, the Pioneer Network (www.pioneernetwork.net) reports on each state’s culture change success.

Grants

The California Coalition for Person-Centered Care (as CCCC) received a Civil Monetary Penalty (CMP) grant of $500,000 over a two-year period of time for the program titled “California Partnership to Improve Dementia Care and Reduce Unnecessary Antipsychotic Medication Drug Use in Nursing Homes”. This grant was approved March 2014 to facilitate the California Partnership to Improve Dementia Care (CA Partnership).

Resources

The California Coalition for Person-Centered Care (CCPCC) offers training for senior living staff with tools and resources for the culture change journey. 

Reports

The report, “Improving Nursing Homes: Impact of the California Culture Change Coalition” was prepared for the California HealthCare Foundation, works as a catalyst to fulfill the promise of better health care for all Californians. Download the Report

Since its inception in 2006, the California Coalition for Person-Centered Care has made many strides to implement person-centered care and culture change in senior living environments throughout the state. Our cause is driven by energetic and passionate people who want to make an impact on the lives of California’s elders and the individuals who care for them.

What is Culture Change?

"Culture change" is the common term that applies to an international movement for the transformation of older adult care, particularly in nursing homes but relevant to all senior living environments, based on person-centered and person-directed values and practices where the voices of older adults and those working with them are not just respected, but elevated. Leading models of culture change employ comprehensive and all-encompassing person-centered standards within three main platforms:

  • ·       Physical
  • ·       Organizational
  • ·       Care practices
  • ·       Environment
  • ·       Family and community
  • ·       Leadership and workplace

Older adults in senior living environments, along with senior care staff, are empowered to employ person-centered values of:

  • ·       Choice
  • ·       Dignity
  • ·       Respect
  • ·       Self-determination
  • ·       Purposeful living

What are the Benefits of Person-Centered Care?

Culture Change Journey: Getting Started

Resources

This section offers tools and resources for senior care staff and leaders that will help improve the lives of residents, increase staff satisfaction and create meaningful and deeper relationships between staff and residents. New items are added frequently, so be sure to check in every few weeks.

Best Practices

Bathing

Bereavement and Loss

Consistent Assignment Implementation Kit

This Implementation Kit uses a 10-step process that is fast and sustainable. It guides you through three meetings for fast-track implementation. The Kit describes what to cover in each meeting and which action steps to do between meetings. This kit is designed to help you implement consistent assignment in your facility in as little as four weeks.

Dining

Eden Alternative

·       Brochure: Eden Alternative Overview

Environment

·       PowerPoint: Bringing Home to the Nursing Home

·       Practical Strategies to Transform Nursing Home Environments Manual

Knowing the Resident

·       This resident assessment tool has a section on Preferences for Customary Routines and Activities

Medication

·       Dementia and Medicines: What you need to know

·       Medication Pass

Non-pharmacological Approaches

·       Video: Person-centered Care and Activity Resources

Tools

·       Worksheet: Assessing your culture change “language”

·       Worksheet: IDT Observations

·       Form: POLST

Leadership and Staff: Learning strategies and best practices

·       Change Strategies: How to make the change

·       Creating a Learning Organization

·       Learning Circles: Organizing a facilitated discussion

·       Benefits of Teamwork

·       PowerPoint: Creating Community through Re-creation 

FAQS

Person-centered care is a "buzz" word surrounding senior care professionals. It seems everyone is talking about it – Quality Improvement Organizations, CMS, Ombudsman and trade associations. Unfortunately, if you ask ten people what person-centered care means, you are likely to receive ten different interpretations. As a result, there are many questions regarding person-centered care. See the questions and a link to answers below.

1. Is the purpose of Person-Centered Care to move from the medical model to social model?

(This myth may be foundational to why the spread of person-centered care innovations have been so slow. Such a message turns off physicians, nurses, pharmacists and other clinical practitioners. Senior living facilities are licensed to provide quality medical care. Thus, such a message confuses professionals.)Answer: The goal is to move from institutionalized care to individualized care. At its essence, individualized care is foundational to good clinical care. The literature clearly supports the link between psychological well-being and physical ailments. Therefore, the person-directed care model is more holistic in nature. The goal is quality of life and quality care.

2. Is Culture change all about improving residents’ quality of life?

Certainly, the focus is on individualizing care for each resident. But culture change is an approach that positively affects everyone associated with the organization. In addition, the innovations are not one-dimensional they are multi-dimensional. Nursing homes are fragile, complex eco-systems. Thus achieving any positive outcome such as enhanced resident quality of life requires success in multiple areas of the organization.

Culture change improves residents’ and caregivers’ quality of work life. Care that de-humanizes the elder also de-humanizes the caregiver. The innovative changes associated with implementing person-directed care strike at the root cause of staff instability in LTC. The new leadership paradigm focuses on enhancing staff satisfaction through recognition, education and empowerment.

3. Does Culture Change costs a lot of money to implement (i.e. building renovation)?

No. This myth stems from the misguided notion that culture change only involves environmental, physical changes. The fact is that implementing individualized care requires changes in many different domains: care practices, workplace practices, leadership and the physical environment. 

You do not have to renovate a building to achieve culture change. Some environmental enhancements can be achieved with a very small investment. A good starting point of the culture change journey is in the domain of workplace practices and changes associated with the way staff are treated each day.

4. Is there one Culture Change model for every nursing home?

No prescription fits every facility. If you have seen one nursing home you have seen one nursing home. Each facility is unique. Leaders should study the different models but refuse to get bogged down trying to select the perfect model. A better approach is for a facility is to start anywhere but just be sure to start. In addition, many facilities on the journey of culture change are using the principles of a few of the models and some of their own innovations.

The culture change models such as Eden, LEAP or HATCH are all excellent and share more similarities than differences. Yet, the key to successful implementation of any model remains imbedded in the complex process of organizational change.

5. Administrators/Executive Directors must understand Culture Change before implementing it?

No. All it takes are a few committed leaders within an organization to begin the implementation of person-directed care. Some administrators may need some time before experiencing a paradigm shift.

Administrators do not need an epiphany before beginning. Change can be difficult for everyone including an Administrator. An Administrator will see the results and will not be able to deny the success. Be sure to measure every change. Collect baseline data, implement changes and measure the data throughout. Create confidence from the data not just inspirational words.

6. Does it really take five years before you bear the fruits of culture change?

No. Positive results can be achieved in months. Culture change is a journey that does not lend itself to specific timeframes. However, it does not take five years before you see results. Some changes can result in dramatic improvements within months. For example, many facilities that have switched from rotating staff assignment to consistent assignment have seen a decline in falls, pressure ulcers, staff absenteeism and staff turnover.

7. Do Department of Health surveyors support these changes?

Yes. The true intent of the OBRA regulations is person-directed Care. F279 calls for a holistic, individualized approach to - “…attain or maintain highest practicable physical, mental and psychosocial well-being of each resident.” Some surveyors have become institutionalized just as some providers have. It is not the Department of Health surveyors who are holding back culture change.

All across the country, surveyors are proving to be receptive to educational programs that show how these innovative, individualized care practices and system changes result in clinical improvements and enhanced quality of life for the residents. The key is to bring regulators into your culture change story. The best approach is to keep them informed of your changes so that they are not surprised when they walk into the facility.

Dementia Care for Professionals

Reduce the use of antipsychotics in nursing homes and other senior living environments 

Training Tools, Resources and Information for Professionals

California has marshaled an active response to the urgent issue of inappropriate antipsychotic medication use among older adults with dementia. In August 2012, the Centers for Medicare & Medicaid Services Region IX (CMS) and the California Department of Public Health (CDPH), together with a diverse group of Stakeholders, launched the California Partnership to Improve Dementia Care and Reduce Unnecessary Antipsychotic Medication Drug Use in Nursing Homes (“Partnership”). The Partnership was formed to develop a collaborative action plan for improving dementia care and reducing the inappropriate use of antipsychotic medication in California nursing homes.

Through generous CMS CMP funding and a contract through the California Department of Public Health, the California Partnership to Improve Dementia Care was able to prepare this online toolkit. Below you will find resources and additional tools that have been reviewed and/or created by staff of the California Culture Change Coalition and the Education Workgroup of the California Partnership to help reduce the use of antipsychotics in nursing homes.

In this section, professionals will find training tools, resources and information specifically for: 
Nursing Home and Other Senior Living Staff and LeadersPhysicians and PrescribersOmbudsman and Surveyors. You will also find general information on Best PracticesInformed Consent and Resources to best reduce the inappropriate use of antipsychotic medications. There are also resources especially geared toward residents and families, and a glossary of terms to assist consumers.

 Press Release: CCPCC Offers Information on Eliminating Unnecessary Use of Antipsychotics

Questions or Comments? Please contact us at: info@leadingageca.org 

Senior Living Staff Information Guides and Handouts

Informative guides, tools and materials for senior living staff working in dementia care

ANTIPSYCHOTICS

BEHAVIORS


COMMUNICATION
Tips for Successful Communication at all Stages of the Disease

DOCUMENTATION GUIDELINES
Tip Sheet: Psychotropics: Indications for Use, Documentation Guidelines, and Monitoring Possible Behaviors and Side-effects

INFORMED CONSENT
Questions and Answers Regarding Informed Consent, Psychotropic Drugs, and Nursing Home Residents

MDS 3.0 QUALITY MEASURE
MDS 3.0 Quality Measure Users’ Manual Version 7.0
Includes quality measure specifications for “Residents Who Receive an Antipsychotic Medication” measures

NON-PHARMACOLOGICAL APPROACHES
Table: 
Review of Non-pharmacologic Approaches for Treating Behavioral and Psychological Symptoms of Dementia, Kolanowski, A., & Van Haitsma, K.
Table: 
Efficacious and Feasible Non-pharmacological Approaches for Behavioral and Psychological Symptoms of Dementia, Kolanowski, A., & Van Haitsma, K.
  

TOOLS

BEST FRIENDS™ APPROACH
Drawing from the Best Friends™ Series of resource books, these handouts serve as tools to employ principles of culture change

CONSISTENT ASSIGNMENT
While it has been proven to be a foundational first step in moving facilities from an institutional model of care toward a person-centered model, it may be difficult to get started. Access consistent assignment tools and materials below.
 

Recipes for Staffing Transformations

DINING EXPERIENCE
Access to resources to make a resident’s dining experience in a nursing home more person-centered

Recipes for Dining Transformation

ENVIRONMENTAL CHANGES
Access implementation resources to make environmental changes within a nursing home

Recipes for Environmental Change

MEDICATION TRACKING
Medications, when used appropriately, can help promote the resident’s highest capable mental, physical, and psychosocial well-being. Medications used inappropriately can compromise a resident’s well-being and even cause death. Ensuring that residents receive medications that are needed and appropriate for their medical condition is a critical component of safe and effective care.

Medication tracking tool

Assessment Tool: Antipsychotic Use in Dementia

PERSON-CENTERED CARE
Use this Advancing Excellence 
tracking tool to actively better assess a resident’s promotion of choice, purpose and meaning on a daily basis.

Trainings and Webinars

WEBINAR | PERSON-CENTERED CARE AND ACTIVITY SERVICES
This pre-recorded webinar provides best practice care resources for activity service professionals serving individuals who are living with dementia. The learning objectives of this tool emphasize putting the person before the situation, understanding the disease process, knowing the resident, creating an engaging environment, cultivating best practice programming, using activity as an intervention and developing a person-centered care plan.
Watch

2017-2018 WEBINAR SERIES | CHALLENGES OF DEMENTIA CARE

Webinar I: Agitation, Might Be Pain

Elizabeth Landsverk, MD, ElderConsult

​This pre-recorded webinar provides an overview of how to assess for pain and identify appropriate interventions through case examples. Learning objectives include assessment for pain in dementia residents, identifying interventions and medical treatment options to help alleviate pain, utilizing resources and best practices on pain management for dementia residents and assessment to determine if treatment was effective and how to identify possible side effects.

Download handout

Watch

HAND-IN-HAND TOOLKIT

The mission of the Hand in Hand training is to provide nursing homes with a high-quality training program that emphasizes person-centered care in the care of persons with dementia and the prevention of abuse.

Hand-in-Hand Manual
Introduction

Hand-in-Hand Module 1

Understanding the World of Dementia

Hand-in-Hand Module 2
What is Abuse

Hand-in-Hand Module 3
Being with a Person with Dementia

Hand-in-Hand Module 4

Being with a Person with Dementia –
Actions and Reactions

Hand-in-Hand Module 5
Preventing Abuse

Hand-in-Hand Module 6
Being with a Person with Dementia –
Making a Difference

Hand-in-Hand Manual
Glossary of Terms

Hand-in-Hand Manual
Resources Pt. 1

Hand-in-Hand Manual
Resources Pt. 2

For more information, please visit www.cms-handinhandtoolkit.info/ or email cms_training_support@icpsystems.com.

 

OASIS TRAINING MATERIALS
OASIS is a four module teaching curriculum that aims to decrease the use of antipsychotic medication as a means of addressing disruptive behavior amongst nursing home residents with dementia. The curriculum was designed by Dr. Susan Wehry, prior to being appointed commissioner of the Vermont Department of Disability Aging and Independent Living (DAIL), who describes the curriculum as one part of a strategy to transform dementia care in nursing homes in which the focus regarding behaviors shifts from intervention to prevention, with the goal of reducing the inappropriate use of antipsychotic medications.

Curriculum Manual
Module I

Module II

Module III

Module IV

TOOLKIT: STRATEGIES FOR SUCCESS: DEALING WITH DEMENTIA BEHAVIORS WITHOUT DRUGS
The Alzheimer's Association provides this toolkit to help train your staff on successful strategies on how to approach residents living with dementia utilizing non-pharmacological approaches. The toolkit includes an editable slideshow, worksheets and informational handouts for your training needs.

Long-term Care Ombudsman Program

The California State Long-Term Care Ombudsman Program is authorized by the federal Older Americans Act and its State companion, the Older Californians Act. The primary responsibility of the program is to investigate and resolve complaints made by, or on behalf of, individual residents in long-term care facilities. These facilities include nursing homes and residential care facilities for the elderly. The Long-Term Care Ombudsman Program investigates elder abuse complaints in long-term care facilities.


The Office of the State Long-Term Care Ombudsman (OSLTCO) develops policy and provides oversight to the local Long-Term Care Ombudsman Programs. OSLTCO staff confer with State licensing agencies regarding difficult cases, meet with the California Department of Aging Counsel to clarify laws and develop plans for implementing them, define program roles, and provide ongoing statewide Ombudsman training.

The goal of the State Long-Term Care Ombudsman Program is to advocate for the rights of all residents of long-term care facilities. The Ombudsman’s advocacy role takes two forms: 1) to identify and resolve individual complaints and issues by, or on behalf of, these residents; and 2) to pursue resident advocacy in the long-term care system, its laws, policies, regulations, and administration through public education and consensus building. Residents or their family members can file a complaint directly with the local Long-Term Care Ombudsman or by calling the CRISISline. All long-term care facilities are required to post, in a conspicuous location, the phone number for the local Ombudsman office and the Statewide CRISISline number 1-800-231-4024. This CRISISline is available 24 hours a day, 7 days a week to take calls and refer complaints from residents.

The Long-Term Care Ombudsman Program is a community-supported program. Volunteers are an integral part of this program. The OSLTCO and its 35 local Ombudsman Program Coordinators are responsible for recruiting, training, and supervising the volunteer Ombudsman representatives.

Ombudsman services are free and confidential. Contact your local LTC Ombudsman Program for the following resident services:

  • ·           Questions or concerns about quality of care
  • ·           Questions or concerns about financial abuse
  • ·           Suspected physical, mental or emotional abuse of residents
  • ·           Witnessing services for Advance Health Care Directives
  • ·           Requesting an Ombudsman to attend a resident care plan meeting
  • ·           Requesting an Ombudsman to attend a resident or family council meeting

Download the Ombudsman Training presentation
Download the Consumer Guide
Download the Fact Sheet

 

Physicians

Informative guides, training materials, toolkits and websites.

Antipsychotic Medication Reference

Healthcare Quality Strategies, Inc., Delmarva Foundation

5 Things Physicians and Patients Should Question  (Download PDF)
American Psychiatric Association

Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults
American Geriatrics Society 2015 Beers Criteria Update Expert Panel

 

Toolkits

Physician Package
This document was compiled by the National Partnership to Improve Dementia Care in Nursing Homes to provide links to resources and tools for physicians on clinical practice guides, non-pharmacological interventions for dementia, information for physicians to provide to families, data, and evidence-based research.
Download

ElderConsult, a partner of the California Partnership to Improve Dementia Care, helps families who are struggling with medical or behavioral challenges. Family-friendly resources and additional comprehensive information for your families can be found at elderconsult.com and below (Direct source: elderconsult.com):

Webinars & Videos

Antipsychotics and Dementia: Managing Medications
Developed by: Alzheimer’s Australia NSW, in conjunction with Southern Cross Care (NSW & ACT) and the Dementia Collaborative Research Centre.
Watch it
  

Webinar Series: Antipsychotics and Dementia
Developed by: ElderConsult, for the California Partnership to Improve Dementia Care
and the California Coalition for Person-Centered Care
Watch Part 1: Dementia   |   Watch Part 2: Agitation: Behavioral Approach
Watch Part 3: Agitation: Medications
  

Dementia in the Nursing Home  I  Jay S. Luxenberg, MD
Objectives:

  • ·       Understand the value of making a diagnosis of etiology for management of dementia
  • ·       Recognize how describing a troublesome behavior is one of the first steps in managing it
  • ·       Describe the “ABC”s of behavior management
  • ·       Perform a Risk of Harm assessment to be able to correctly determine the risk/benefit ratio of proposed interventions


Best Practices in Dementia Care: Antipsychotic Use   I   Janice Hoffman, PharmD, CGP, FASCP
Objectives:

  • ·       Overview of the role for Antipsychotics in Dementia
  • ·       Explain a best practice for transferring a patient from the acute hospital to a SNF with an antipsychotic order
  • ·       Describe best practice for behavior monitoring with antipsychotic medications
  • ·       Monitor effect and side effects of antipsychotic drugs
  • ·       Identify alternative non-antipsychotic medications

Download handout   I   Watch webinar

A Webinar Series Developed Specifically for Pharmacists
Webinar 1: Tips for Using Antipsychotics in Dementia
Goals:

  • ·       Advocate for delivery of health care that is person-centered and goal directed
  • ·       Advocate for the appropriate use of antipsychotics for BPSD

Watch Part 1


Webinar 2: Tips for Treating Insomnia in the Elderly

Goals:

  • ·       Advocate for delivery of health care that is person-centered and goal directed
  • ·       Advocate for the appropriate use of drugs for insomnia in the elderly

Watch Part 2
Webinar 3: Tips for Treatment of Pain and Anxiety in the Elderly

Goals:

  • ·       Advocate for delivery of health care that is person-centered and goal directed
  • ·       Advocate for the appropriate use of medications for pain and anxiety

Watch Part 3

 

Surveyors

This section includes surveyor training programs, information and resources related to surveying for care of persons with dementia and unnecessary medication use in long-term care facilities. 

Training Programs

CMS Surveyor Training
This online training on the Use of Antipsychotic Medication by CMS Survey and Certification Group for surveyors, includes two modules: Overview of Antipsychotic Medication Use in Nursing Homes, and Surveying for Antipsychotic Medication Use in Nursing Homes. The third installment of the mandatory training addresses how to cite severity and scope and other aspects of deficiency citations in more detail, based on new guidance at F309, Care of Residents with Dementia, and revised guidance at F329.

Learn more

Overview of Antipsychotic Medication Use in Nursing Homes
This program provides background information on the National Partnership to Improve Dementia Care and survey basics related to care of person with dementia and unnecessary medications.

Severity & Scope Guidance - Antipsychotic Medication Use in Nursing Homes
This training will address how to cite severity and scope and other aspects of deficiency citations in more detail, based on new guidance at F309, Care of Residents with Dementia, and revised guidance at F329.

Courses

HAND-IN-HAND TOOLKIT

The mission of the Hand in Hand training is to provide nursing homes with a high-quality training program that emphasizes person-centered care in the care of persons with dementia and the prevention of abuse.

Hand-in-Hand Manual
Introduction

Hand-in-Hand Module 1

Understanding the World of Dementia

Hand-in-Hand Module 2
What is Abuse

Hand-in-Hand Module 3
Being with a Person with Dementia

Hand-in-Hand Module 4

Being with a Person with Dementia –
Actions and Reactions

Hand-in-Hand Module 5
Preventing Abuse

Hand-in-Hand Module 6
Being with a Person with Dementia –
Making a Difference

Hand-in-Hand Manual

Glossary of Terms


Hand-in-Hand Manual
Resources Pt. 1

Hand-in-Hand Manual
Resources Pt. 2

For more information, please visit www.cms-handinhandtoolkit.info/ or email cms_training_support@icpsystems.com.

Medicare Learning Network’s MLN Connects® National Provider Calls
The 
National Partnership to Improve Dementia Care in Nursing Homes and QAPI are partnering on MLN Connects Calls to broaden discussions related to quality of life, quality of care, and safety issues. The National Partnership was developed to improve dementia care in nursing homes through the use of individualized, comprehensive care approaches to reduce the use of unnecessary antipsychotic medications. QAPI standards expand the level and scope of quality activities to ensure that facilities continuously identify and correct quality deficiencies and sustain performance improvement.

Use keyword “Dementia” to filter for topics related to improving dementia care and reducing the use of antipsychotics.

The Survey and Certification Letters are available for download. A more recent list, as well as more information on the National Partnership to Improve Dementia Care, is available here.

Focused Dementia Care Survey Tools
Survey and Cert Letter 16-04 [PDF, 294KB]

2014 Final Report & 2015 Expansion Project – Centers for Medicare & Medicaid Services (CMS) Focused Dementia Care Survey Pilot
Survey and Cert Letter 15-31 [PDF, 161KB]

Focused Minimum Data Set (MDS) and Dementia Care Surveys
Survey and Cert Letter 14-22 [PDF, 131KB]

Interim report on the CMS National Partnership to Improve Dementia Care in Nursing Homes: Q4 2011 – Q1 2014
Survey and Cert Letter 14-19 [PDF, 3MB]

Advanced Copy: Dementia Care in Nursing Homes: Clarification to Appendix P State Operations Manual (SOM) and Appendix PP in the SOM for F309 – Quality of Care and F329 – Unnecessary Drugs
Survey and Cert Letter 13-35 [PDF, 649KB]

Checklist Review of Care and Services for a Resident with Dementia (for use with the Interpretive Guidance at F309)
Surveyor Checklist - Survey and Cert 13-35 [PDF, 273KB]

Release of Mandatory Surveyor Training Program on Care of Persons with Dementia and Unnecessary Antipsychotic Medication Use – Release of Third Video
Survey and Cert Letter 13-34 [PDF, 113KB]

Hand in Hand: A Training Series for Nursing Homes,” on Person-Centered Care of Persons with Dementia and Prevention of Abuse
Survey and Cert Letter 12-44 [PDF, 91KB]

Request to Convey Information: Partnership to Improve Dementia Care in Nursing Homes
Survey and Cert Letter 12-42 [PDF, 294KB]

Informed Consent Toolkit
The California Partnership for Dementia Care provides a variety of resources to support best practices in patient-centered care. The Verification of Informed Consent Form for Antipsychotic Medication in Nursing Facilities and a Guide to Using the Informed Consent Verification Form provide the skilled nursing facility leaders and staff with easy to download, written documentation to verify the patient’s understanding of, and consent to the administration of antipsychotic medication when prescribed by a physician.

What is "informed consent”?
Informed consent is the opportunity for patients to understand and consent to treatment and to engage in partnership with their caregivers, is a critical component of patient-centered care.

While the State of California does not require written informed consent for the use of psychotherapeutic medication obtaining patient consent in writing offers several best practice benefits. 

Written consent:

1.  provides the patient, or their decision-maker, with important information specific to the use of antipsychotic medication in a patient’s particular circumstance;

2.  supports a common understanding between the patient or their representative, the provider, and the skilled nursing staff about the medication, its use and its administration;

3.  creates an opportunity for further communication between the patient or their representative, and the skilled nursing facility staff, strengthening the patient-centered care relationship between these important partners in care.


State law requires that only the prescriber obtain informed consent from a patient or their representative when prescribing psychotherapeutic medication. However, a staff person at the skilled nursing facility is required to verify that consent has been obtained.

To ensure that every patient, or their decision maker, has the best information available about the use of antipsychotic medication, The California Partnership to Improve Dementia Care provides a Verification of Informed Consent Form, as well as a guide to its use.
 

Toolkit Documents

Best Practices

These best practices, supported by the California Partnership to Improve Dementia Care, are key in our effort to improve dementia care and move closer to the goal of ending misuse of antipsychotic medication in all California senior living environments.

Dementia Bill of Rights
Published in the American Journal of Alzheimer’s Care and Related Disorders and Research, the Best Friends™ Dementia Bill of Rights articulates a standard model of providing care for those living with dementia

Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes
To better respond to the needs of residents in senior care living with dementia, the Alzheimer’s Association developed the evidence-based Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes.

Dr. Al Power's Guidelines for Antipsychotic Drugs in Dementia
Dr. Al Power is a geriatrician, author, musician, and an international educator on transformational models of care for older adults, particularly those living with changing cognitive abilities. Here Dr. Power provides preliminary comments, concerns and guidelines on the use of antipsychotic drugs in dementia.

Guiding Principles for Dementia Care
Guiding Principles for Dementia Care, developed by the National Center for Assisted Living, was written to improve the assisted living professional and para-professional staff’s understanding of the complexities of care needed by residents with dementia.

Key Elements of Dementia Care
The Alzheimer’s Association created Key Elements of Dementia Care to define, describe and illustrate dementia-capable care in residential care. Key Elements of Dementia Care is a guide for providers (owners, operators, administrators and hands-on staff) as they develop or enhance existing programs for people with dementia.

National Nursing Home Quality Care Collaborative Change Package
A curated collection of great ideas & practices to create lasting change in your nursing home, this change package is intended for nursing homes participating in the National Nursing Home Quality Care Collaborative led by the Centers for Medicare & Medicaid Services (CMS) and the Medicare Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs), to improve care for the millions of nursing home residents across the country.

Resources

Recommended readings, websites, films and videos for professionals, family members, caregivers, and care partners.

·       Bayles, K. & Tomoeda, C. (1993). The ABCs of dementia. Tucson, AZ: Canyonlands.

·       Bell, V., & Troxel, D. (2008). The Best Friends book of Alzheimer’s activities (volume two). Baltimore: Health Professions Press.

·       Bell, V., & Troxel, D. (2004). The Best Friends book of Alzheimer’s activities (volume one). Baltimore: Health Professions Press. Bell, V., & Troxel, D. (2003). The Best Friends approach to Alzheimer’s care. Baltimore: Health Professions Press.

·       Bell, V., & Troxel, D. (2001). The Best Friends staff: Building a culture of care in Alzheimer's programs. Baltimore: Health Professions Press.

·       Bell, V., & Troxel, D. (2012). A dignified life. Deerfield Beach: Health Communications.

·       Bourgeois, M. S. (2007). Memory books and other graphic cuing systems: Practical communication and memory aids for adults with dementia. Baltimore: Health Professions Press.

·       Bourgeis, M. S., & Hickey, E. (2009). Dementia: From diagnosis to management- A functional approach. New York: Psychology Press.

·       Bowlby, C. (1993). Therapeutic Activities with persons disabled by Alzheimer’s disease and related disorders. Gaithersburg, MD: Aspen Press.

·       Brackey, J. A. (2007). Creating moments of joy for the person with Alzheimer’s or dementia (4th edition). Indiana: Purdue University Press.

·       Brawley, E. C. (1997). Designing for Alzheimer’s disease: Strategies for creating better care environments. New York: John Wiley & Sons.

·       Buettner, L., & Martin, S. L. (1995). Therapeutic recreation in the nursing home. State College, PA: Venture.

·       Callone, P., Vasilof, B., Brumback, R., Maternach, J., & Kudlacek, A. (2006). A Caregiver's guide to Alzheimer's disease: 300 tips for making life easier. New York: Demos Medical Publishing.

·       Cost, J. K. (2003). Learning to speak Alzheimer’s. London: Vermilion

·       De Klerk-Rubin, V. (2008). Validation techniques for dementia care: The family guide to improving communication. Baltimore: Health Professions Press.

·       Eisner, E. (2013). Engaging and communicating with people who have dementia: Finding and using their strengths. Baltimore, Maryland: Health Professions Press.

·       Feil, N. & de Klerk-Rubin, V. (2012). The Validation Breakthrough (3rd edition). Baltimore: Health Professions Press.

·       Genova, L. (2009). Sill Alice. New York: Gallery Books.

·       Hellen, C. R. (1998). Alzheimer's disease: Activity-focused care. Woburn: Butterworth-Heinemann.

·       Joltin, A., Camp, C. J., Noble, B. H., & Antenucci, V. M. (2005). A different visit: Activities for caregivers and their loved ones with memory impairments. Ohio: Myers Research Center.

·       Kindig, M. N., & Carnes, C. (1993). Coping with Alzheimer’s disease and other dementing illnesses. San Diego, CA: Singular Publishing Group.

·       Larkin, M. (1995). When someone you love has Alzheimer’s. New York: Dell.

·       Mace, N. L., & Rabins, P. V. (2011). The 36-hour Day: A family guide for caring for people who have Alzheimer’s disease, related dementias, and memory loss (5th edition). Baltimore: The Johns Hopkins University Press.

·       Mahoney, E., K., Volicer, L., & Hurley, A. C. (2000). Management of challenging behaviors in dementia. Baltimore: Health Professions Press, Inc.

·       McCone, V. (2003). Butterscotch sundaes: My mom’s story of Alzheimer’s. Sanborn, MN: Autumn Sparrow Press.

·       Moffett, P. (2007). Ice cream in the cupboard. Great Neck, NY: Garrison-Savanna Publishing, LLC.

·       Power, G. A. (2010). Dementia beyond drugs: Changing the culture of care. Baltimore, Maryland: Health Professions Press.

·       Power, G. A. (2014). Dementia beyond disease: Enhancing well-being. Baltimore, Maryland: Health Professions Press.

·       Radin, L., & Radin, G. (2003). What if it's not Alzheimer's? Amherst: Prometheus Books.

·       Robinson, A., Spencer, B., & White, L. (1989). Understanding difficult behaviors. Ypsilanti: Eastern Michigan University Ypsilanti.

·       Ziegler, R. C. (2009). Let’s look together: An interactive picture book for people with Alzheimer’s and other forms of memory loss. Baltimore: Health Professions Press.


 Website Resources

Advancing Excellence in America’s Nursing Homes Campaign

nhqualitycampaign.org
 

Alzheimer’s Association

alz.org
 

Alzheimer's Disease Education and Referral Center

nia.nih.gov/alzheimers
 

The American Health Care Association

ahcancal.org
 

California Advocates for Nursing Home Reform

Includes website dedicated to the Campaign to Stop Chemical Restraints in Nursing Homes

canhr.org
 

California Association of Long-Term Care Medicine

caltcm.org
 

Family Caregiver Alliance

caregiver.org
 

Health Services Advisory Group

HSAG, California’s state QIO, provides tools and resources, including a Change Package for nursing homes,

Dementia Oversight Team Care Options Meetings (DOT.COM) resources and additional tools.

hsag.com
 

Medicare.gov Nursing Home Compare

medicare.gov/nursinghomecompare/
 

Music and Memory

musicandmemory.org
 

The National Consumer Voice for Quality Long-Term Care

theconsumervoice.org
 

The National Ombudsman Resource Center

ltcombudsman.org
 

Pioneer Network

Pioneer Network advocates and facilitates deep system change and transformation in our culture of

aging. They provide a wide array of person-centered care training tools and resources.

pioneernetwork.net
 

University of Iowa – Geriatric Education Center

Includes Improving Antipsychotic Appropriateness in Dementia Patients, a website that includes information

and resources to help clinicians, providers, and consumers better understand how to manage problem

behaviors and psychosis in people with dementia using evidence-based approaches.

www.healthcare.uiowa.edu/igec/IAADAPT


Film and Video Resources

Webinar | Person Centered Care and Activity Services
This pre-recorded webinar provides best practice care resources for activity service professionals serving individuals who are living with dementia. The learning objectives of this tool emphasize putting the person before the situation, understanding the disease process, knowing the residient, creating an engaging environment, cultivating best practice programming, using activity as an intervention and developing a person-centered care plan.

Watch

The Villages of Southern HIlls | A Champion for Change
Leadership and care providers at the Villages of Southern Hills in Tulsa, OK support a national and state initiative to reduce unnecessary antipsychotic medication. In this video, you'll meet Bill, and hear how his providers engaged him in the decision to reduce and ultimately eliminate the antipsychotics he had been on for years.

Developed by The Oklahoma Foundation for Medical Quality NH Learning & Action Network (LAN) team.
Watch it on YouTube 

HBO's The Alzheimer Project

HBO’s THE ALZHEIMER'S PROJECT is a multi-platform series which takes a close look at groundbreaking

discoveries made by the country's leading scientists, as well as the effects of this debilitating and fatal disease both on those with Alzheimer's and on their families. (Direct source: hbo.com)

 

HBO’s The Alzheimer’s Project: Memory Loss Tapes

While there is hope for the future as science gains momentum, millions of Americans are currently affected by the painful and deadly consequences of Alzheimer's. This verité documentary profiles seven people living with the disease, each in an advancing state of dementia, from its earliest detectable changes through death. (Direct source: hbo.com)

 

HBO’s The Alzheimer’s Project: Grandpa, Do You Know Who I Am?

This film tells five stories of children, ages 6-15, who are coping with grandfathers or grandmothers suffering from Alzheimer's disease. Maria Shriver provides commentary and delivers valuable "lessons" for the kids, urging them not to blame themselves for what their grandparents do or say. (Direct source: hbo.com)

 

HBO’s The Alzheimer’s Project: Momentum in Science Parts 1 and 2

This two-hour, two-part documentary takes viewers inside the laboratories and clinics of 25 leading scientists and physicians, who seek to discover what can be done to better detect and diagnose Alzheimer's, delay the onset of memory loss, affect the brain changes associated with the disease, and ultimately prevent Alzheimer's disease altogether. (Direct source: hbo.com)

  

HBO’s The Alzheimer’s Project: Caregivers

Caregivers is a collection of five portraits, each of which highlights the sacrifices and successes made by people experiencing their loved one's gradual descent into dementia. (Direct source: hbo.com)

 

Dementia Care for Consumers

The Use of Antipsychotics
What does this mean for me and my loved one?

This section includes guides and information to help individuals and families further understand why the use of antipsychotic medications to treat a person’s symptoms of dementia is most likely not the safest first choice for care, and includes important information on what you should do to advocate for the best treatment options.
 

Medications and Dementia: An Overview

Dementia is a general term for a decrease in mental ability (memory and thinking) that interferes with daily life. The most common cause of dementia is Alzheimer’s disease, but there are also other dementias, such as vascular dementia or Lewy Body dementia. Dementia can also occur in Parkinson’s disease or Huntington’s disease or in other medical illnesses.

Common symptoms of dementia are having trouble around:

  • ·       memory loss such as forgetting new information, dates or events
  • ·       following a recipe or keeping track of bills
  • ·       following a conversation or taking part in social activities
  • ·       being mixed up about people, places or time
  • ·       poor judgment
  • ·       changes in mood, behavior or personality

The handout below highlights medications that may be given to patients with dementia once this condition has been diagnosed. These medicines may make a difference in a patient’s quality of life.

Reasons why we sometimes consider using medicines:

  • We want to prolong the time a person with dementia can live at home or keep symptoms from advancing so fast.
  • We want to help those with dementia who may have depression or anxiety or other upsetting behavioral symptoms

The Use of Antipsychotics: What is the Issue?
(Original source: )

Antipsychotic medications are potent drugs that may have serious side effects. They are indicated to treat conditions and diagnoses such as schizophrenia. They are not generally used for the treatment of symptoms of dementia.

In the past, the use of antipsychotics to treat people with Alzheimer’s Disease and other dementias was often considered an accepted practice. Now we know that antipsychotic medications that are prescribed inappropriately may be dangerous, especially for the elderly and people with dementia. These medications can have serious, life threatening side effects such as stroke and falls. They may increase the risk of death for elderly residents. There are now national and statewide campaigns to stop their inappropriate use.

These factsheets were designed especially for families and individuals affected by Alzheimer's Disease and other dementia, to help them understand important issues around the use of antipsychotic medications on people with dementia, know what kind of questions to ask and where to go for further help and information.

Fact Sheet: Get the Facts about Antipsychotic Drugs and Dementia Care

Report: Treating disruptive behavior in people with dementia

Why is Ending the Misuse of Antipsychotics Important to Consumers?
(Original source: )

The misuse of antipsychotic medications can harm senior care consumers in many ways. When used inappropriately among senior care residents, antipsychotic medications can:

Place Residents at Increased Risk of Injury, Harm and Death
Antipsychotic drugs, when prescribed for elderly persons with dementia, can have serious medical complications, including loss of independence, over-sedation, confusion, increased respiratory infections, falls, and strokes. Antipsychotics can be deadly; in 2005, the Food and Drug Administration (FDA) issued “Black Box” warnings for antipsychotics stating that individuals diagnosed with dementia are at an increased risk of death from their use and that physicians prescribing antipsychotic medications to elderly patients with dementia should discuss the risk of increased mortality with their patients, patients’ families and caregivers. The FDA has also stated that these medications are not approved for the treatment of dementia-related psychosis, nor is there any medication approved for such a condition.

Be Used as a Chemical Restraint for Residents with Dementia
A chemical restraint is a drug not needed to treat medical symptoms and used because it is more convenient for facility staff or to punish residents. Although the Medicare and Medicaid programs prohibit chemical restraints, antipsychotic medications continue to be used for residents with dementia as a means of behavior control and/or as a substitute for good, individualized care. For this reason, it is important to ensure these medications are being used only when appropriate among residents with proper diagnoses for psychotic disorders.

Worsen Quality of Life and Dignity of Residents with Dementia
Antipsychotics can be so powerful that they sedate residents to the point where they become listless and unresponsive. Residents may be slumped in wheelchairs or unable to get up from bed; they may no longer be able to participate in activities they enjoy or even talk with their loved ones.

Cost All Senior Care Consumers Billions of Dollars
These medications often come with a hefty price tag, so the misuse and overprescribing of antipsychotics in senior care facilities is extremely costly for the Medicare and Medicaid programs as well as for taxpayers. Ending the misuse of these medications among senior living residents would help save health care dollars that could be used to serve beneficiaries. According to the Office of the Inspector General for the Department of Health and Human Services, more than half of atypical antipsychotic medications (a class of antipsychotic medications that work significantly differently from older, previously introduced antipsychotics) paid for in the first half of 2007 by Medicare were incorrectly prescribed and cost the program $116 million during that six-month time period. Ending the misuse of these medications among residents would help save health care dollars that could be used to serve beneficiaries.


Common Antipsychotics Inappropriately Prescribed to Residents
(Original source: )

According to the Office of Inspector General for the Department of Health and Human Services, the three most commonly prescribed antipsychotic medications in 2007 among senior living residents were: Seroquel, Risperdal, and Zyprexa. Other commonly prescribed antipsychotics according to the report included Abilify, Clozaril, Geodon, and Symbyax. Click 
here to read the report.

National Data on Antipsychotic Use in Nursing Homes
The Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare Website
This resource allows users to research data on individual nursing homes, including the percentage of residents receiving antipsychotic medications under the section entitled 'Quality Measures'. It also lists the state average and the national average of antipsychotic use in comparison to each individual nursing home's data.
(Original source: )

Through the 
National Partnership to Improve Dementia Care in Nursing Homes, the Centers for Medicare and Medicaid Services is partnering with federal and state agencies, nursing homes, other providers, advocacy groups, and caregivers to improve comprehensive dementia care. CMS and its partners are 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. The Partnership promotes a multidimensional approach that includes public reporting, state-based coalitions, research, training and revised surveyor guidance.

Since the launch of the National Partnership, significant reductions in the prevalence of antipsychotic use in long-stay nursing home residents have been documented. The National Partnership continues to work with state coalitions and nursing homes to reduce that rate even further. Recently, CMS established new national goals for reducing the use of antipsychotic medications in long-stay nursing home residents by 25 percent by the end of 2015, and 30 percent by the end of 2016. These goals build on the progress made to date and express the Partnership’s commitment to continue this important effort.

ProPublica's Nursing Home Inspect Website
This resource allows you to search nursing home inspection reports listing deficiencies cited in nursing homes nationwide. You can search by state, severity of the deficiency and by keyword (i.e. "antipsychotic") to find deficiencies related to the inappropriate use of antipsychotic medications in individual nursing homes.

 

Families and Residents

Helping you find the safest treatment options that maintain quality of life for your loved one

This section includes the following information:

Understanding Behaviors: Causes and How to Respond
Alzheimer's disease and other dementias can cause a person to act in different and unpredictable ways. Some individuals with Alzheimer's become anxious or aggressive. Others repeat certain questions or gestures. Many misinterpret what they hear.

These types of reactions can lead to misunderstanding, frustration and tension, particularly between the person with dementia and the caregiver. It is important to understand that the person is not trying to be difficult and that all behavior is communication. (Original source: alz.org)

Please see the attached guides for more information on how to better understand behaviors and how to communicate with someone who is living with dementia.

Behaviors: How to Respond when dementia causes unpredictable behaviors
Communication: Tips for Successful Communication at All Stages of the Disease

You may also click on the links below for more information and suggestions on how to handle behaviors.

Questions to Ask:
What if my loved one is experiencing unpredictable behaviors?
If your loved one living with dementia is experiencing different and unpredictable behaviors, it is important to understand that all behavior has meaning and a reason behind it. For example, behavior may be related to:

  • ·       Physical pain or discomfort (Illnesses, medication, hunger or thirst)
  • ·       Overstimulation (Loud noises or a busy environment)
  • ·       Unfamiliar surroundings (New places or the inability to recognize home)
  • ·       Complicated tasks (Difficulty with activities or chores)
  • ·       Frustrating interactions (Inability to communicate effectively, fear, sadness,or anxiety)

(original source: Alzheimer’s Association)


In general, the following 3-step approach may be used to help identify the causes to common behaviors. If your loved one is living in a nursing home or other long term care setting, you may want to work with your loved one’s care team to use this 3-step approach:

1. Examine the Behavior

2. Explore solutions

3. Try different responses

  • ·       What was the behavior?
  • ·       Was it harmful to the individual or others?
  • ·       What happened just before the behavior occurred?
  • ·       Did something trigger it?
  • ·       What happened immediately after the behavior occurred?
  • ·       How did you react?
  • ·       Could something be causing the person pain?
  • ·       Consult a physician to identify any causes related to medications or illness.
  • ·       What are the needs of the person with dementia?
  • ·       Are they being met?
  • ·       Can adapting the surroundings comfort the person?
  • ·       How can you change your reaction or your approach to the behavior?
  • ·       Are you responding in a calm and supportive way?
  • ·       Did your new response help?
  • ·       Do you need to explore other potential causes and solutions?
  • ·       If so, what can you do differently?

10 quick tips responding to behaviors (alz.org)

1.     Remain flexible, patient and calm.

2.     Explore pain as a trigger.

3.     Respond to the emotion, not the behavior.

4.     Don't argue or try to convince.

5.     Use memory aids.

6.     Acknowledge requests and respond to them.

7.     Look for the reasons behind each behavior.

8.     Consult a physician to identify any causes related to medications or illness.

9.     Don't take the behavior personally.

10.  Share your experiences with others.


Questions to Ask

What if my loved one is prescribed a medication, such as antipsychotics, to treat my loved one’s dementia-related symptoms?
If your loved one is prescribed a medication, such as an antipsychotic, to treat symptoms of dementia or dementia-related symptoms, you may want to ask the following of your loved one’s care team:

  • What is the current care plan for my loved one with dementia?
  • What is the reason for this medication?
  • What are the symptoms that the medication should improve?
  • Did the team attempt to identify the causes of the person’s behavior before using medication to address the symptoms? 
  • Did the team try to use non-medication approaches before trying this medication?
  • What non-medication approaches were tried?
  • How will this medication be monitored and, if possible, reduced?
  • Remember: All nursing homes are required to have a system in place to care for people with dementia. State and Federal inspectors conduct nursing home surveys to ensure that these regulations are followed.

What else can be done? 

To learn more about what you can do to advocate for your loved one, click here or visit theconsumervoice.

 

Did You Know

Physicians are responsible for obtaining informed consent for the use of antipsychotic medications in nursing homes

Most California physicians who provide care for residents of skilled nursing facilities are already well aware that under California law, physicians are responsible for obtaining informed consent for the use of antipsychotic (and other psychotropic) medications in nursing homes. Before administering an antipsychotic medication to a resident, nursing home staff must verify that the prescriber has indeed provided to the resident, or the residents’ legal representative, information about the recommended medication and its effects, so that the resident or legal representative can truly provide informed consent.

Download Fact Sheet
Download Guide

Helpful Websites

theconsumervoice.org
The Consumer Voice represents consumers in issues related to long-term care, helping to ensure that consumers are empowered to advocate for themselves. They are a primary source of information and tools for consumers, families, caregivers, advocates and ombudsmen to help ensure quality care for the individual.


www.alz.org
The Alzheimer’s Association has an online Alzheimer’s and Dementia Caregiver Center with access to information and resources on topics including: daily care, stages and behaviors, safety, support and care options, as well as information on financial planning.

nursinghome411.org
Nursing home consumer resource website from the Long Term Care Community Coalition with resources on antipsychotic medications.

pioneernetwork.net

The goal of the Pioneer Network is to inspire facilities to be resident-centered, less institutional and more home-like. This involves trying to piece together financing from Medicaid, Medicare and private funding sources. The Pioneer Network promotes grassroots activities and new ways of de-institutionalizing services and individualizing care.

  

Oversight Agencies

Health care facilities in California are licensed, regulated, inspected, and/or certified by a number of public agencies at the State and federal levels. These agencies have separate, yet sometimes overlapping, jurisdictions. These agencies are responsible for ensuring long-term care facilities comply with state and federal laws and regulations.

California Department of Public Health (CDPH)
CDPH – Licensing & Certification Division is responsible for licensing Skilled Nursing Facilities (SNFs) and providing inspections to ensure compliance with licensing standards. CDPH, Licensing and Certification Division has District Offices throughout the state.

Contact CDPH, Health Facilities Consumer Information System

​Phone: (916) 558-1784 https://hfcis.cdph.ca.gov/ CDPH – Aide and Technician Certification Section (ATCS) has primary responsibility in the certification of Nurse Assistants, Home Health Aides and/or Hemodialysis Technicians.


Contact ATC
Please note that the Interactive Voice Response Unit (IVRU) is an automated phone number (916) 327-2445, which accommodates a heavy volume of calls. You may leave a voicemail with the message center at (916) 552-8811. It is preferable to FAX information to the CNA/HHA/Certification Unit, FAX (916) 552-8785, or send an email to the CNA email address 
cna@cdph.ca.gov
Mailing Address: P.O. Box 997416, MS 3301, Sacramento, CA 95899-7377

California Department of Social Services (DSS)
DSS – Community Care Licensing Division (CCLD) is responsible for licensing Residential Care Facilities and providing inspections to ensure compliance with licensing standards. CCLD has district offices throughout the state.

Contact DSS-CCLD
Department of Social Services, Community Care Licensing Division Statewide Adult & Senior Care Program Office 744 P Street, MS 8-3-90, Sacramento, CA 95814 Phone: (916) 657-2592   
Fax: (916) 653-9335 http://www.ccld.ca.gov/


Medical Board of California
The Medical Board of California is responsible for the licensing and regulation of physicians and surgeons and certain allied health care professions.
Contact the Medical Board of California

The Medical Board of California, 2005 Evergreen Street, Suite 1200, Sacramento, CA 95815California

Toll-Free line1-800-633-2322 Phone: (916) 263-2382 Fax: (916) 263-2944 http://www.mbc.ca.gov/


California State Board of Pharmacy
The California State Board of Pharmacy is a consumer protection agency that regulates the individuals and businesses that dispense, compound, provide, store and distribute prescription drugs and devices and pharmaceutical services to the public or to other health care practitioners, in compliance with state and federal law.
Contact the California State Board of Pharmacy: The Board of Pharmacy, 1625 North Market Blvd, Suite N219, Sacramento, CA 95834 Phone: (916) 574-7900 Fax: (916) 574-8617 
http://www.pharmacy.ca.gov/

California Department of Consumer Affairs (DCA)
The California Department of Consumer Affairs helps consumers learn how to protect themselves from unscrupulous and unqualified individuals and protects professionals from unfair competition by unlicensed practitioners.

Department of Consumer Affairs

Consumer Information Division

1625 North Market Blvd., Suite N112

Sacramento, CA 95834

Phone: (800) 952-5210 www.dca.ca.gov


DCA-Board of Registered Nursing (BRN) regulates the practice of registered nursing and certified advanced practice nurses. The Board exists to protect the health and safety of consumers and promote quality registered nursing care in California.

 Board of Registered Nursing

1747 North Market Boulevard, Suite 150

Sacramento, CA 95834

http://www.rn.ca.gov/

http://www.rn.ca.gov/enforcement/complaint.shtml


DCA-Board of Vocational Nursing and Psychiatric Technicians (BVNPT) protects the consumer from unprofessional and unsafe licensed vocational nurses (LVNs) and psychiatric technicians (PTs). Public protection is the highest priority of the Board in exercising its licensing, regulatory and disciplinary functions.

Board of Vocational Nursing & Psychiatric Technicians

2535 Capitol Oaks Drive Suite 205

Sacramento, CA 95833

Phone (916) 263-7827

http://www.bvnpt.ca.gov/

To file a complaint against an LVN or PT, contact the Enforcement Division at (916) 263-7827; FAX (916) 263-7857, or visit BVNPT-Enforcement http://www.bvnpt.ca.gov/consumers/file_a_complaint.shtml

 

Glossary of Terms

When you are learning about dementia care and related issues, you may come across some unfamiliar terms. Below are some frequently used terms.

Access to Terms

The Alzheimer's Association has developed this glossary to help you understand Alzheimer's care and related terms. Access the glossary here.

Antipsychotic Drugs

Antipsychotic drugs are potent drugs that may have serious side effects. They are indicated to treat conditions and diagnoses such as schizophrenia. There are major concerns about the side effects of antipsychotics (including drowsiness, dizziness, unsteadiness, reduced mobility and coherence, increased risk of stroke and heart attack), and there is evidence that they may accelerate the rate of decline in people with dementia, and lead to premature death. They should not generally be used for the treatment of symptoms of dementia, unless accurately assessed by a physician and generally prescribed after all non-pharmacological and pharmacological treatment methods are unsuccessful. Access more info here. 

Person-Centered Care

Person-Centered Care, or Culture Change as it is commonly referred to, is a movement that seeks to transform the traditional culture of aging in long-term care from one that is based on efficiency and reimbursement to one that keeps the person at the center of the care planning and health care decision making process. Person- centered care emphasizes a resident’s individuality and values resident self-determination. Person-centered care promotes choice and purpose in everyday life and respect of the changing needs of residents and caregivers. A main principle of resident-centered care is that in order to attain the highest level of well-being a resident must be cared for in a manner in which they are seen as individuals with personal preferences and abilities rather than as a task that needs to be completed.
Your Guide to Choosing A Nursing Home or Other Long-Term Care
Learn more about the best practices of culture change

Informed Consent

Nursing home residents continue to be prescribed antipsychotic medications at a high rate in California and nationwide. According to a recent survey by the Centers for Medicare and Medicaid Services (CMS), approximately one in five nursing home residents are receiving antipsychotic medications in California.

Most California physicians who provide care for residents of skilled nursing facilities are already well aware that under California law, physicians are responsible for obtaining informed consent for the use of antipsychotic (and other psychotropic) medications in nursing homes. For many years, nursing staff in long-term care facilities were permitted to serve as the prescriber’s agent in providing the necessary information to nursing home residents and obtaining informed consent. In 2011, however, the California Department of Public Health (CDPH) revised its interpretation of the law with respect to informed consent to require the physician to personally obtain informed consent for antipsychotics and other psychotropic medications. 
More info here.

Restraints

Physical Restraints
The Nursing Home Reform Act of 1987 states that residents have the right to be free from physical and chemical restraints that are used for the purposes of disciplining or as a matter of staff convenience. The California Code of Regulations gives residents the right to accept or refuse proposed treatments including restraints. Any medical symptom warranting the use of restraints must be documented in the resident’s medical record, ongoing assessments, and care plan. While there must be a physician’s order reflecting the presence of a medical symptom, ultimately the facility is accountable for the determination of the appropriateness of the physical restraint.

The facility must ensure that the residents’ environment remains as free as possible from accident hazards and that each resident receive adequate supervision and assistive devices to prevent accidents. Too easily, physical restraints can be used as a substitute for individualized care. Physically controlling ones behavior rather than addressing the unique needs of nursing home residents may require less staff effort but is incompatible with quality of life.


Chemical Restraints
Title 22 of the California Code of Regulations, Section 72018 defines a CHEMICAL RESTRAINT as: “a drug used to control behavior and used in a manner not required to treat the patient’s medical symptoms.” All residents have a right to be free from the use of chemical restraints. (42 CFR §483.13(a); 22 CCR §72527(a)(23); 22 CCR §72319), yet, the use of antipsychotic drugs on those with dementia is common practice and often used as an alternative to the needed care of these individuals. Every day, approximately one out of five residents living in skilled nursing facilities across California are being given antipsychotic medications in order to chemically alter their behavior. In 2008, the Food and Drug Administration issued its most serious warning to consumers that the use of antipsychotic medications on persons with dementia may lead to an increased risk of death. Three years later, in 2011, the United States Department of Health and Human Services, Office of the Inspector General analyzed Medicare claims from the first six months of 2007 for atypical antipsychotics for elderly nursing home residents. The findings indicated that out of 1,088,260 Medicare claims for atypical antipsychotic drugs for elderly nursing home residents reviewed, 75 percent were indicated for off label conditions and in the presence of the specified condition in the Federal Drug Administration black box warning. This is an alarming trend in the reliance on antipsychotic drugs as treatment for dementia.