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For dementia patients, a focus on personal peace

Leona Larson (left) and her husband, Don, work with Terri Willis, personal care attendant at Ecumen Lakeshore in Duluth, to piece together a puzzle Thursday afternoon. Ecumen Lakeshore’s “Awakenings” program emphasizes less medication and more personal contact for residents with dementia. (Bob King / / 2
Dorothy Sweeney dips her brush into yellow paint to add color to the sun in a scene she’s painting at Ecumen Lakeshore in Duluth. (Bob King / / 2

The woman constantly wandered down the hallways at Ecumen Detroit Lakes senior residence.

While physically fit, she suffered from memory loss, and staff worried that she might wander off.

A few years ago, this woman might have been given psychotropic drugs to modify her behavior, said Shelley Matthes of Duluth, director of quality improvement for Shoreview, Minn.-based Ecumen. Before that, she might have been restrained — tied to a chair.

But at 14 Ecumen facilities, including Ecumen Lakeshore in Duluth, Ecumen Scenic Shores in Two Harbors and the site in Detroit Lakes, Minn., things are done differently now.

“What they discovered was that she had had a mail route,” Matthes said of the Detroit Lakes woman. “She had worked in an office building, but her job was to deliver mail.”

The staff realized that walking the hallways calmed the woman, but they still worried she might become dehydrated, Matthes said. So they set up stops along the way where she could have something to drink or eat, and they let her walk.

“It worked out very well for her,” Matthes said.

Ecumen calls its approach “Awakenings.” The idea is to keep medications for patients with memory loss and dementia to a minimum, and instead use a people-centered approach that identifies and addresses their fears and anxieties.

“When somebody experiences some memory loss, most of the reactions or the … behaviors that they have are related to fear,” Matthes said. “So, our job is to identify things that bring people to a place of peace and joy.”

The program started as a pilot at Ecumen Scenic Shores after Eva Lanigan, then its resident care coordinator, came back from a seminar in 2009 seeking ways to reduce the use of medications. The parent company was impressed by the results, and so was the Minnesota Department of Human Services, which authorized a $3.8 million, two-year grant to expand the program to other Ecumen facilities.

It since has won national recognition. Matthes and Maria Reyes of Superior, the program’s project manager, traveled to Washington, D.C., earlier this month to accept the Excellence in Dementia Care award from LeadingAge, an association of nonprofit aging-services providers, on behalf of the company. They shared the stage on St. Patrick’s Day with the family of Glen Campbell, the country music singer who has been diagnosed with Alzheimer’s disease.

The Twin Ports women were interviewed for a story in the Washington Post, and the program also has been highlighted in the New York Times.

The use of psychotropic medications for memory loss began in the late 1990s and was done with the best intentions, Matthes said.

“We thought that these medications alleviated the symptoms they were having and made them feel better,” she said. “But what we found, and what research has proven, is that these medications don’t do anything to alleviate that anxiety or discomfort that someone with dementia is experiencing. In fact, all it does is dull their ability to express those feelings.”

The medications, which were designed to treat mental-health conditions such as schizophrenia, also come with dangerous side effects, she said.

Families may be dubious at first about reducing or ending a loved one’s use of a drug prescribed by a doctor, Matthes noted.

“It doesn’t take long, though, for people to realize the benefit when they come out of the fog,” she said.

That emerging from a fog-like stupor from the drugs is what gave the program its name.

The program requires additional training for staff, Matthes said, but no extra personnel. It also produces a savings of an estimated $200,000 to $350,000 per month in prescription costs across the facilities that have implemented it.