IMPLEMENTATION OF A DEMENTIA CARE PROJECT TO REDUCE UNNECESSARY MEDICATIONS ACROSS MULTIPLE CARE SETTINGS

As part of federally and state-funded evaluations, we utilized a case-study approach to examine the internal and external implementation context of a comprehensive dementia care project aimed at reducing unnecessary medications across nursing homes (NH) and assisted living centers (AL) within a large senior housing chain in Minnesota. Non-pharmacological interventions included exercise, aromatherapy, individualized activities, a holistic interdisciplinary team approach, dementia education, and targeted daily interactions with enrolled residents. Semi-structured interviews were conducted with 60 staff members and project leaders from within 15 NHs and 14 ALs during in-person site visits and telephone interviews. Although respondents in both settings described similarities in facilitators to success (dedicated project leaders, corporate support, education) and barriers (staff and family buy-in initially), there were also differences across settings. Because the NHs implemented the initiative first, staff in AL could see the benefits of the program before needing to make change themselves, which facilitated buy-in. However, ALs struggled with fewer nursing staff and less control over resident medications. While the project required staff to provide the 1:1 interventions, an initial challenge, efficiency in the NH was realized over the project period as residents became more independent with care and activities. Use of psychotropic medications in project NHs decreased by 59%, accompanied by a decrease in behavioral symptoms. However, evidence of reduced medication use in AL was harder to measure and, ultimately, no change was observed by the end of the project period. We will discuss respondent experiences regarding translating project implementation across care settings.