Approximately one in four Wisconsin residents with dementia are cared for in a facility-based setting -- a nursing home or assisted living facility. As of March 31, 2015, Wisconsin nursing homes reported 13,842 residents, or 51 percent of their total resident population, as having Alzheimer’s disease or a related dementia. Based on national statistics, approximately 40 percent of assisted living facility residents also have dementia. Facilities provide care for people at all stages of the disease.
Nursing homes and assisted living facilities are regulated by the Wisconsin Department of Health Services’ Division of Quality Assurance (DQA). DQA licenses and certifies facilities and conducts periodic regulatory reviews. DQA has a variety of tools to use when problems are found. It may require the provider to submit and comply with a plan of correction, obtain consultation or pay a fine. Concern about the potential for regulatory violations and enforcement remedies has created a barrier that prevents some facilities from admitting residents with challenging dementia-related behaviors.
Address Barriers that Deter Some Facilities from Admitting and Providing Ongoing Care for Residents with Dementia Who Exhibit Challenging Behaviors:
- Develop strategies and best practice guidelines to address the causes of regulatory violations relating to challenging behaviors.
- Seek federal flexibility for nursing homes that adhere to best practice guidelines.
Continue to Improve the Quality of Dementia Care in Facility Settings:
- Implement the Music & Memory Program in nursing homes and other settings.
- Encourage the use of alternative interventions in place of antipsychotic medications for managing behavior in people with dementia.
- Disseminate information on promising dementia care practices.
- Explore incentives for facilities that adopt best, or promising practices, and demonstrate positive outcomes.
Promote Dementia-Friendly Facility Design:
- Identify and encourage facilities to adopt design elements proven to support dementia care.
- Provide financial incentives to encourage facilities to undertake dementia-capable design projects.
Provide Consumers with Information Needed to Make Informed Decisions about Facility-Based Dementia Care:
- Develop a consumer information program in which providers can voluntarily share information about their dementia care programs.
- Publicize availability of the information.
- Implemented the Wisconsin Music & Memory Program in 250 nursing homes, supported Music & Memory facilities by hosting monthly webinars featuring experts in the field of Alzheimer's and other dementia, as well as technical assistance and the opportunity for peer-to-peer support.
- Reduced the use of antipsychotic medication in nursing homes. A report by the Centers for Medicare and Medicaid Services (CMS) as part of its National Partnership to Improve Dementia Care in Nursing Homes shows Wisconsin ranked sixth lowest in the nation in antipsychotic medication use among long-stay residents in nursing homes in the first quarter of 2016. Wisconsin’s rate has declined almost 33% since the first quarter of 2011, when the National Partnership started reporting on this measure.
- Conducted a series of visits to nursing homes and hospitals to learn about best practices and challenges, and to solicit provider recommendations on how to improve care for persons with dementia. January 2015.
- Published two reports identifying what facilities can do to provide good care, meet the needs of the residents and avoid the type of violations that typically result in enforcement action: Assisted Living Strategies to Enhance Resident Care, September 2014 and Nursing Home Strategies to Enhance Resident Care, June 2015.
- Approved a Modernization Rate Incentive award for a Milwaukee skilled nursing facility to develop a capital project specifically designed to support positive care outcomes for residents with dementia. April 2015.
- Published Antipsychotic Medication Dose Reduction Resources, June 2015.