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Dementia: Facility-Based Long-Term Care

About one in four Wisconsin residents with dementia are cared for in a facility-based setting, such as a nursing home or assisted living facility. As of March 31, 2015, Wisconsin nursing homes reported 51% of their residents as having Alzheimer’s disease or a related dementia. Based on national statistics, about 40% of assisted living facility residents also have dementia. Facilities provide care for people at all stages of the disease.

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Nursing homes and assisted living facilities are regulated by the Wisconsin Department of Health Services’ (DHS) Division of Quality Assurance (DQA). DQA licenses and certifies facilities. It also holds periodic regulatory reviews. DQA has a variety of tools to use when problems are found. They may require the provider to:

  • Submit and comply with a plan of correction.
  • Obtain consultation.
  • Pay a fine.

Some facilities are concerned about possible regulatory violations and enforcement remedies. As a result, some of them won’t admit residents with challenging dementia-related behaviors.

Dementia State Plan partners have identified steps that may encourage facilities to admit people with dementia who have challenging behaviors. Below are strategies we’ve created, and our progress so far.

Strategies

Address the things that keep some facilities from admitting and providing care for residents with dementia who have 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 use 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.
  • Educate providers on promising dementia care practices.
  • Explore incentives for facilities that adopt best, or promising practices, and show positive outcomes.

Promote dementia-friendly facility design:

  • Identify and encourage facilities to adopt design elements shown to support dementia care.
  • Provide financial incentives so facilities will undertake dementia-capable design projects.

Provide consumers with information they need to make informed decisions about facility-based dementia care:

  • Develop a consumer information program so providers can share information about their dementia care programs.
  • Make information widely available to the public.

Milestones completed

  • Implemented the Wisconsin Music & Memory Program in 250 nursing homes. Supported Music & Memory facilities via monthly webinars featuring experts in the field of Alzheimer’s disease and other dementia. Gave technical assistance and the opportunity for peer-to-peer support.
  • Reduced the use of antipsychotic medication in nursing homes. A report by CMS (Centers for Medicare & Medicaid Services) 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 gone down almost 33% since the first quarter of 2011. That’s when the National Partnership first reported on this measure.
  • Made a series of visits to nursing homes and hospitals to learn about best practices and challenges. Asked for provider input on ways to improve care for persons with dementia. January 2015.
  • Published a report identifying what facilities can do to provide good care and meet the needs of the residents. Also identified how they can avoid the type of violations that typically result in enforcement action. Nursing Home Strategies to Enhance Quality of Life for Residents with Dementia (PDF). June 2015.
  • Approved a Modernization Rate Incentive award for a Milwaukee skilled nursing facility. This will help develop a capital project designed to support positive care outcomes for residents with dementia. April 2015.

For more information

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Questions about the State Dementia Plan? Email dhsdementiawebmail@dhs.wisconsin.gov.

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Have a question about the State Dementia Plan? Send us an email at dhsdementiawebmail@dhs.wisconsin.gov.

Last revised January 3, 2023