“We have a resident we’ll call ‘Bill’ who was a photographer, had done a lot of walking in his life and never got up before 10 or 11 a.m.,” she said. He was difficult to deal with when awakened at 7 a.m. — angry and anxious. He also walked throughout the building, setting off alarms and adding to his agitation, she said.
Under the new system, Bill sleeps until midmorning. He is allowed free rein in the building and staffers are instructed to gently guide him back to his floor instead of sounding alarms.
“He’s been fine ever since,” Ledany said. “He doesn’t try to leave — he just liked being able to walk around.”
Other changes at the home include allowing residents to shower at a time they prefer, such as in the evening instead of the morning. Residents are allowed time to feed themselves, even if the process is painstakingly slow. And the residents who long for the days they were once nurses or other types of caregivers are allowed to assist with minor tasks, such as pouring drinks.
O’Keefe said she resisted embracing the new system at first. “I didn’t think this new way could be done, but I have to admit, it works,” she said.
A major bonus — the new system didn’t cost the home more, Katz said.
“We just reallocated the money we had,” Katz said. “For example, we realized that no one was showing up for the entertainment on weeknights so we used that money to pay staff members to offer recreational activities in the late afternoon, when some residents were a little agitated.”
Will other nursing homes follow? Even if they start immediately, the system Buckingham uses will not show immediate results.
Paul Langevin, president of the Health Care Association of New Jersey, noted that the continuing cuts to Medicare and Medicaid funding to nursing homes will exacerbate the overprescribing of antipsychotics. It’s no coincidence, he said, that as Medicare reimbursements for nursing home care have dropped, the use of these medications has exploded.