“We are in the process of trying to grow, to take what we’ve learned here and just try to get better,” said BronxCare Special Care Center’s recreational therapist Jennifer Cross at the final meeting of the Behavioral Health Learning Collaborative (BHLC) on December 12, 2018.  Her words were part of a poster presentation, where staff from each of the nursing homes participating in the BHLC shared outcomes and lessons learned from the BHLC-supported projects they were spearheading.

The year-long BHLC program supported union members and managers in their efforts to engage people with behavioral health issues in ways that maximize safety, autonomy and person-centered care. The Labor Management Project (LMP) and the Continuing Care Leadership Coalition (CCLC) convened staff from nine CCLC-member nursing homes for the program.

The first speaker at December’s meeting was CCLC Director of Government Relations Diane J. Barrett, who encouraged BHLC participants to meet with their elected officials to share outcomes from the collaborative, in order to help the politicians support the work. Ravindra Amin, MD, of Coler Rehabilitation and Nursing Care Center talked about the important reduction in the use of antipsychotic drugs in nursing homes that has taken place over the past decade. He also talked about delirium, which often goes undiagnosed and untreated.  “Delirium is the stealth bomber of medicine,” he said. “It comes unseen and wreaks havoc on families and patients and providers.”

The heart of the day featured presentations by the participants themselves, illustrated by colorful posters showcasing their work. Participants from each nursing home related how they had reduced “behavioral issues” in their homes by personalizing care, addressing pain management, and engaging residents with offerings like pet, art and music therapy.

The presentations all featured ways in which multi-disciplinary teams came together to identify issues and to collectively create solutions. For instance, Mary Manning Walsh staff described how nursing, social work, recreation, and psychology departments all worked together to integrate “dignified care” into all interactions with residents, including assuring that an intake of new and transferred residents includes documentation of their preferences for meals, bathing, television, and so on, “to keep them empowered.”

Personalized care was a theme across initiatives. Jennifer Monarchi, social worker at Ferncliff, described her excitement at previous BHLC seminars when hearing about possible interventions. Ultimately, “it was more a matter of identifying what works for each resident,” she explained. “Because the residents all have their own strengths. And if we emphasize those strengths, it really makes a difference for them.  It’s a much calmer unit… The residents are happier, so the staff are happier, so the residents are happier.”

Karen Harper, director of dementia care for Isabella, said her team also started with learning all they could about each resident’s preferences and patterns of behavior. One of their most effective interventions, she said, was an iPod initiative based on the Music and Memory project. Time and again, she says, people who were agitated calmed down when they were given headsets playing songs that had been chosen just for them.

Some presentations sparked lively conversations about potentially tricky issues, like how to balance resident rights and autonomy with the need to keep everyone safe. In response, the LMP’s Janice Dabney noted: “This is a learning collaborative in real time. You’re going to try something and it’s not going to meet your expectations, and you’re going to try something else and try something else, and that’s the essence of process improvement. I commend all of you for doing this work.”

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