Researchers from the Betty Irene Moore School of Nursing at UC Davis collaborate with the California Association of Health Facilities (CAHF) on a quality improvement initiative aimed at improving dementia care in skilled nursing facilities. Associate Adjunct Professor Debra Bakerjian and Assistant Professor Elena O. Siegel will conduct independent research in a project aimed at improving dementia care.
Approximately 70 percent of residents with dementia living in nursing homes are reported to have significant behavioral and psychiatric symptoms. Historically, one of the first lines of treatment was antipsychotics drugs, which are now not recommended for residents with dementia. This three-year “CAHF Improving Dementia Care through Music & Memory” project will use iPods to re-introduce nursing home residents to their favorite, personalized music to improve their day-to-day life and determine if familiar tunes can reduce the need for medication and improve their quality of life.
“We are very interested in having a better understanding of whether or not the program can help reduce use of antipsychotics and whether the program is sustainable over time,” Bakerjian explained. “Many short-term studies indicate positive outcomes, but this will be the first comprehensive, 36-month study to determine if it works, how it works and if practices can be sustained for this and other quality improvement programs in long-term care facilities.”
The $1.4 million grant program is funded from civil monetary penalties ― fines collected in California for nursing home violations. CAHF will distribute Music & Memory℠ to 4,500 residents across 300 nursing homes in order to document its effects on reducing the antipsychotic medication for people with dementia. First, the UC Davis team will evaluate if the music program works and how nursing homes implement it.
Second, researchers will independently test two to three Quality Assurance Performance Improvement (QAPI) tools to support implementation of the program. QAPI is essentially a roadmap developed by the Centers for Medicaid & Medicare Services required by nursing homes to improve the quality of life, care and services. Whereas the federal guidelines are broad, Bakerjian and Siegel will tailor them specifically for the music program.
Finally, they will study, document and report on organizational factors present in the success or failure of the adoption and sustainment of Music & Memory℠ in the participating facilities. CAHF leaders and UC Davis researches hope to document the effects of this program and identify ways to help skilled nursing centers sustain the gains they make in all of their quality improvement efforts.
“We look forward to our partnership with two, well-respected UC Davis nurse researchers who have great expertise in the science of quality improvement in skilled nursing settings,” said Jocelyn Montgomery, a registered nurse and CAHF’s lead on the project. “Their work will allow us to examine organizational practices that influence the success or failure of projects such as Music & Memory℠ in the nursing-home setting.”
Bakerjian’s more than 25 years of one-on-one, long-term patient experience, coupled with Siegel’s focus on administrative and managerial leadership in long-term-care settings, bring expertise to quantitatively and qualitatively document the impact of the program and identify strategies to spread and sustain the program as a quality assurance/performance improvement project.
“We both dedicate our careers to improving quality of care and quality of life of older adults in nursing homes, using different perspectives,” Siegel added. “Understanding how the clinical and administrative components of care delivery practices work together is essential to improving quality.”
In the first phase of the study, School of Nursing researchers pilot test the various processes for the study and will consult with CAHF on development of criteria for which facilities are selected. They will then collect data and independently evaluate how facilities are implementing the program and determine the challenges that impede success or organizational structures that foster success. Additionally, Siegel and Bakerjian will develop and test an intervention to support nursing homes in the implementation and sustainability of the MUSIC & MEMORY℠ program. The intervention includes a quality-assurance tool consistent with upcoming regulatory requirements for all nursing homes that care for Medicare and Medicaid beneficiaries.
“We know nursing homes face many challenges with implementing and sustaining quality improvement initiatives, and translating new regulations into practice brings another set of challenges. Our intervention offers nursing homes a practical resource to both translate and integrate the upcoming QAPI regulatory requirement into their everyday work practices,” Siegel said. “This project exemplifies our research goals to support practice and policy efforts to improve nursing home quality and value.”
“California is a microcosm of the rest of the nation in terms of diversity, its population of older adults and the number of nursing homes that operate throughout the state,” Bakerjian added. “As all nursing homes will be mandated to implement QAPI programs, this work will enable us to develop guidelines for this project and many others that may improve quality in the long run.”
The Betty Irene Moore School of Nursing advances health and ignites leadership through innovative education, transformative research and bold system change. CAHF is a professional association representing nursing homes.