Imagine waking up in an unfa­miliar room sur­rounded by strangers telling you what to do. On top of the con­fu­sion you feel, you are also in severe pain and cannot find the words to describe it nor the trust to even want to. For many res­i­dents of the nation’s 15,600 nursing homes, this sce­nario is the daily reality, and many of them react with behav­iors that clin­i­cians often find dif­fi­cult to manage.

Approx­i­mately 50 per­cent of the nursing home pop­u­la­tion suf­fers from dementia, said Alice Bonner, an asso­ciate pro­fessor in the Bouvé Col­lege of Health Sci­encesSchool of Nursing. While evi­dence sug­gests that anti-​​psychotic med­ica­tions are inef­fec­tive at best and often have serious side effects, many nursing home res­i­dents are still treated with these drugs.

Antipsy­chotics may seem to help because they sedate some patients,” said Bonner, who joined the fac­ulty this fall. “But there are better ways to pre­vent and treat con­fu­sion and com­bative behavior.”

Bonner would know. In 2011—as director of the Divi­sion of Nursing Homes at the Cen­ters for Medicare and Medicaid—she helped estab­lish the National Part­ner­ship to Improve Dementia Care, a public-​​private ini­tia­tive focused on the overuse of antipsy­chotic medications.

Her work with the CMS team and col­leagues from around the country is highly regarded; she recently received both the John Mackey Award for Excel­lence in Dementia Care from Johns Hop­kins Uni­ver­sity and the Cer­noria Johnson Memo­rial Advo­cacy Award from the National Con­sumer Voice for Quality Long-​​Term Care.

In Bonner’s view, the best strate­gies for helping people with dementia live more com­fort­ably range from envi­ron­mental mod­i­fi­ca­tions and daily rou­tine adjust­ments to music and aro­matherapy. “Most impor­tant,” she said, “care­givers need to try to under­stand behav­iors as a form of com­mu­ni­ca­tion. The patient is trying to com­mu­ni­cate but may be unable to express what he or she needs or wants.”

Bonner’s health­care career began in the 1990s, when she worked as a nursing home clin­i­cian. She noted that she was imme­di­ately inspired by the long-​​term care nurse’s power to make pos­i­tive changes in their patients’ lives.

According to Bonner, every dementia patient requires a nuanced form of care. They don’t just live in nursing homes—family mem­bers and home­care workers also treat dementia patients living at home or in assisted living facil­i­ties around the country, Bonner explained, noting that “researchers need to figure out the best strate­gies for the best out­comes in these dif­ferent settings.”

The National Part­ner­ship, which Bonner co-​​chaired for two years before coming to North­eastern, tar­geted dementia’s mul­ti­modal nature. She helped estab­lish broad coali­tions in every state, bringing together doc­tors, nurses, con­sumers, fam­i­lies, gov­ern­ment agen­cies, and advo­cates, all of whom approached dementia from a dif­ferent angle and added unique takes on solutions.

The part­ner­ship also focused on pro­viding quality training for facility leaders who, in turn, train their own employees in best practices.

In just two years, the ini­tia­tive helped improve some of the lowest per­forming facil­i­ties by up to 30 per­cent while national rates of antipsy­chotic use dropped by 11.4 per­cent. Though impres­sive, Bonner said experts need to create better mea­sures for com­paring var­ious non-​​pharmacological dementia care strate­gies to deter­mine which are most effec­tive for indi­vidual res­i­dents. “If you change ten things in a person’s envi­ron­ment, you need to under­stand which of those changes are influ­encing better out­comes,” she explained.