Prototype Checklist for Nonpharmacologic Strategies in Nursing Home Dementia Care

The Centers for Medicare and Medicaid Services recommend that nursing homes use nonpharmacologic approaches as the first-line treatment for behavioral and psychological symptoms of dementia (BPSD). However, nursing homes face significant challenges in implementing nonpharmacologic strategies, from identifying the underlying cause of BPSD to selecting the most appropriate nonpharmacologic strategy. An effective strategy must be aligned with each resident's unique symptoms, capabilities, and preferences, but it must be done with limited staff and resources in a complex care environment. To address the challenge confronting nursing home physicians and staff, we offer a prototype checklist that streamlines decision-making, by prompting staff to document residents' symptoms, nonpharmacologic strategies attempted, and outcomes. In creating the checklist, we drew on insights from qualitative interviews with nursing home staff and physicians, and systematic reviews of existing literature. In our interviews, nursing home staff and physicians consistently highlighted the importance of a person-centered approach to managing BPSD. Our proposed checklist incorporates this into a tool to help staff identify effective interventions based on each resident's specific needs and circumstances.