Search Results for: antipsychotic drug use

July 6, 2015 Admin

When and How to Taper Antipsychotics for Nursing Home Residents: Lessons from Wisconsin

Douglas Englebert, Pharmacy Practice Consultant for Wisconsin’s Department of Health Services

Can personalized playlists help care organizations to reduce reliance on antipsychotics to manage behavioral and psychological symptoms of dementia? Research is ongoing in Wisconsin to answer that very question.

Two years ago, Wisconsin’s Department of Health Services (DHS) introduced MUSIC & MEMORY® in 100 nursing homes across the state. In a second phase in 2014, DHS expanded the program to bring Music & Memory to an additional 150 nursing homes.

Wisconsin initiated the personalized music program as a non-pharmacological intervention strategy for nursing homes that complements the CMS Partnership effort to reduce use of antipsychotics for residents diagnosed with dementia.

Before the state’s Music & Memory Program, across all nursing homes in the second quarter of 2013, 17.4 percent of residents were taking antipsychotics; a year later, use had declined to 14.6 percent. In fall 2014, Wisconsin moved from tenth to fourth place among all 50 states in the national initiative to reduce use of antipsychotic drugs in nursing homes.

Researchers at the University of Wisconsin, Milwaukee, are currently completing a study of whether the reduction can be attributed to Music & Memory. More specifically, they are seeking to determine the precise impact of personalized music as a viable alternative to these medications, which may often cause significant, undesirable side effects for people with Alzheimer’s and other forms of dementia.

A Framework for Planning Antipsychotic Dosage Reduction

While definitive research is still underway, Douglas Englebert, DHS’s pharmacy practice consultant, has been encouraged by positive observations from nursing home professionals about the benefits of personalized music as an alternative to antipsychotics. Those anecdotal reports have prompted Englebert to respond to the next set of pressing questions from the field: When is it appropriate to taper residents off their antipsychotics, and what is the best method?

Basically, he says, it depends on the individual. There are no definitive protocols for tapering off antipsychotics offered by pharmaceutical companies or approved by the Food and Drug Administration. However, two fundamentals are essential to developing any plan:

1) Define why the antipsychotic is being administered and how success should be measured.

“Up front, before the drug is first administered, you need to have a good discussion about whether the medication is going to be effective,” says Englebert. “That means you have to define what success is and when to expect it to occur. And if it doesn’t work, then you go to dose reduction.”

Wisconsin requires written, informed consent for treatment with antipsychotics in nursing homes. But use of these medications doesn’t always originate when someone moves into a long-term care setting. Individuals may already be on the drugs when they arrive, to manage behaviors while they still lived at home or in assisted living. Or the drugs may have been prescribed during a hospital stay.

For example, Englebert says, someone may be hospitalized for a surgical procedure and put on antipsychotics to manage hallucinations from anesthesia. But unless a physician writes a stop order post-discharge, a medication that was only intended for use over two or three weeks may still be part of the individual’s regimen six months later.

“If someone is admitted to a nursing home on antipsychotics, you need to immediately evaluate the need to use the medication,” he says. “We’re focused on training and education about that. The antipsychotic may have been completely appropriate while the person was hospitalized, but not for long-term use.”

A clearly defined reason for administering the antipsychotic, as well as agreed-upon measures of success, are essential for proper assessment of drug effectiveness and informed decisions about alternative treatments. For any dosage tapering protocol, it’s also very important to be able to distinguish among side effects, withdrawal symptoms and the behaviors that originally triggered use of the drug.

“With these medications, dose reductions can lead to side effects or adverse effects becoming more pronounced,” says Englebert. “The person may experience shaking and other similar symptoms that are side effects—which should not to be confused with a return to the original behavior.”

2) When it’s deemed appropriate to discontinue antipsychotics, reduce dosage slowly.

Because each individual’s biology and circumstances are unique—and because many factors affect the decision to taper off antipsychotics—Englebert promotes a go-slow approach to dosage reduction.

He’s seen successful results from a variety of protocols, ranging from a 25 percent dosage reduction each week for four weeks (an approach promoted in the UK, which has made antipsychotic reduction for Alzheimer’s patients a high priority) to a 5 percent dosage reduction weekly or 10 percent reduction biweekly.

Managing side effects of dosage reduction is only part of the mix. Social or environmental factors also play a significant role. In fact, Englebert says, successful antipsychotic reduction is as much a process of winning the trust of family and staff as it is managing the individual’s physiological and psychological response to the change in medication.

“Say we have five residents on antipsychotics in one facility,” he says. “They’re all making progress on non-medication alternative treatments, but you can’t reduce all of their medications at once. Staff may feel they do not have the staffing to manage behaviors should they reoccur. Or the families may not be open to it. Maybe they’ve tried in the past and failed, and they’re afraid of trying again.”

He suggests starting with one individual whose family or staff is receptive to the idea. Once that person successfully tapers off the antipsychotic, another family may become open. In addition, he says, it’s important to consider staffing levels when scheduling a dosage reduction. Pick a time when extra staff are available, maybe when there are extra activities scheduled, to try the first dose reduction, so that enough help is around if the individual needs support.

Dosage reduction plans also depend on the specific medication, how the dose can be manipulated, and basics such as whether the tablet can be cut. And, of course, any reduction in antipsychotics depends on the successful adoption of a non-medication alternative, such as personalized music playlists.

Leadership is Key to a Reduction in Antipsychotic Use

Variation in rate of antipsychotic use across care organizations depends on many factors—nature of the resident population, culture of care, staff attitudes, preferences of attending physicians. But the most important factor leading to successful antipsychotic reduction is leadership.

“The facilities with the greatest success have leaders that have pushed for it,” says Englebert. “When those leaders leave, that push can leave with them. We want to be sure to build this awareness into the culture of all our facilities, so our success can continue.

“Our goal is for each person to have the best quality of life. If the antipsychotic isn’t working, get rid of it.”

For more information, see Wisconsin DHS’s Antipsychotic Medication Reduction Resource.

Founded in 2010, MUSIC & MEMORY® is a non-profit organization that brings personalized music into the lives of the elderly or infirm through digital music technology, vastly improving quality of life.

November 14, 2014 Admin

MUSIC & MEMORY® Helps Wisconsin Nursing Homes Reduce Antipsychotic Use

When Wisconsin’s Department of Health Services (DHS) decided to implement Music & Memory’s personalized music program in 100 long-term care facilities in September 2013, officials were hopeful that the initiative would improve residents’ quality of life. But they had no idea just how significant the improvements might be.

One year later, the evidence is persuasive: Wisconsin has moved from tenth to fourth place among all 50 states in a national effort to reduce use of antipsychotic drugs in nursing homes. The Music & Memory program is one of the alternatives to medications implemented by Wisconsin nursing homes to reduce unnecessary prescribing of antipsychotic drugs to residents. Before the state’s Music & Memory initiative, across all nursing homes in the second quarter of 2013, 17.4 percent of residents were taking antipsychotics; a year later, use had dropped to 14.6 percent.

According to DHS’s Kevin Coughlin, the 100 nursing homes represent about a quarter of all facilities in Wisconsin. “The initiative is pulling the whole state in a positive direction,” he says. “We were really amazed.”

A Positive Change for Nursing Home Residents

While DHS officials say they can’t yet definitively attribute all of the progress to the Music & Memory program, they believe personalized music has played a significant role in efforts to reduce antipsychotic use and improve residents’ lives.

Research, in partnership with the University of Wisconsin-Milwaukee, is underway to provide a rigorous assessment of program benefits for residents.

Even before the data were published, evidence of the program’s success persuaded DHS Secretary Kitty Rhoades to champion Music & Memory, not only across Wisconsin, but also to her state executive counterparts nationwide. “Touring the facilities that were implementing the program, she was very moved to witness the positive impact on residents,” says Coughlin.

Expanding to Another 150 Care Facilities

Response to Music & Memory at the facility level has been so enthusiastic that DHS is bringing the program to another 150 long-term care facilities this fall. Funding for Music & Memory’s certification program comes from the Centers for Medicare and Medicaid Services (CMS) Civil Monetary Penalties fund, comprised of financial penalties for accreditation shortfalls. Organizations within states can tap those funds for nursing home improvements.

Following Wisconsin’s lead, Ohio and Utah are launching their own statewide Music & Memory initiatives, and other states are expressing significant interest in bringing personalized music to their long-term care facilities.

Wisconsin’s Music & Memory initiative is part of a broader effort, spearheaded by Secretary Rhoades, to become “dementia capable.” Coughlin says DHS priorities include making dementia training programs more affordable and accessible, creating and supporting dementia-friendly communities, improving options for individuals with dementia to live at home, and adapting facility physical environments to needs of those with dementia.

Assisted Living Memory Care Units Following Suit

While the program targets nursing homes, it has had a ripple effect for other long-term care settings in the state. According to John Sauer, president and CEO of LeadingAge Wisconsin, “We’ve seen many members expanding Music & Memory into their assisted living memory care units.” LeadingAge represents non-profit, faith-based and some government long-term care facilities, of which about half were involved in the first phase of the Wisconsin initiative.

The state’s substantive commitment to making personalized music available to long-term care residents means “it’s being woven into the fabric of best practices,” says Tom Hlavacek, executive director of the Alzheimer Association’s Southeastern Wisconsin chapter. “Coming from the state, it’s being taken very seriously.” To help participating facilities expand their programs, his chapter sponsored iPod donations at this fall’s annual Walk to End Alzheimer’s, with collections at each walk site.

Those iPods will help to meet growing demand for the program. While the first round of 100 nursing homes began the Music & Memory initiative with equipment for 15 residents at each site, more than half of the facilities have now expanded their programs to include more residents.

“We’re very serious about person-centered services in long-term care,” says John Sauer. “Music & Memory gives us another tool to walk the walk.”

February 20, 2014 Admin

Improving Resident Quality of Life: How Music Favorites Helped Reduce Antipsychotic Use at New York’s Coler-Carter SHNF

Margaret Rivers, Associate Executive Director, and Ron Becker, Director of Therapeutic Recreation, with a resident at Coler-Carter

Margaret Rivers, Associate Director for Patient Services, and Ron Becker, Director of Therapeutic Recreation, with a resident at Coler-Carter SHNF

The elderly Asian woman stood by the nurses’ station, tapping her fingers on the counter in time to music playing on her iPod. That’s interesting, thought Head Nurse Milana Leviyev. Curious about what the resident with dementia might be trying to communicate, Leviyev found a portable piano keyboard and placed it before her.

To everyone’s astonishment, the resident began to play. Leviyev brought her and the keyboard into a community room, and this elderly Asian woman, who didn’t speak a word of English and had never before indicated to anyone at Goldwater Specialty Hospital & Nursing Facility that she was a musician, commenced playing for her fellow residents. The tune was How Much Is That Doggie in the Window? Everyone sang along.

“We have so many stories like that,” says Margaret Rivers, Associate Director for Patient Services at Coler-Carter Specialty Hospital & Nursing Facility (formerly Coler-Goldwater) in New York City. Adopting the MUSIC & MEMORY® personalized music program for dementia residents in late 2011, Coler-Carter currently has 69 of their 425 dementia residents using iPods at the Coler campus on Roosevelt Island.

Family and staff play an integral role in selecting appropriate music, notes Rivers. All work together to identify songs that will reflect a resident’s cultural background, language, favorite genre and artists—increasing the odds of tapping good memories.

Global Review of Antipsychotics Leads to Significant Reduction

The MUSIC & MEMORY® program has played an important role in the facility’s ongoing efforts to improve quality of life for residents, as well as to reduce use of antipsychotics.

Beginning in 2009, says Dr. Ravindra Amin, Chief of Psychiatry, “We began a global review of our use of antipsychotics, with a goal of determining how we could reduce unnecessary use.”

Behavioral and psychological symptoms of dementia can include restlessness, aggression, delusions and anxiety, commonly treated with antipsychotics in nursing homes, despite significant side effects. In March 2012, the federal Centers for Medicare and Medicaid Services announced a national initiative to reduce unnecessary use of antipsychotics among nursing home residents by 15 percent.

Multiple Interventions Include MUSIC & MEMORY®

The facility’s multi-intervention approach included staff training focused on how to manage resident behaviors, when to use antipsychotics, when not to use them and when to eliminate them entirely. Dr. Amin says MUSIC & MEMORY® was woven into that process as another intervention.

Between January 2011 and June 2013, use of antipsychotic drugs among the facility’s dementia residents dropped from 38 percent to 13 percent, well below the national and New York State averages of 23 percent and 20.5 percent, respectively. That accomplishment earned the facility a Grand Prize at the New York City Health and Hospitals Corporation’s Patient Safety Expo 2013.

Majority Improved Behaviors with Personalized Music

A year after the personalized music program had been in place, nurses were surveyed to assess its effectiveness. “Nursing perceptions are key to assessing how the residents are doing,” says Dr. Amin.

Asked if the residents had shown any behavior improvements while listening to their iPods, the nurse respondents reported that about 30 percent showed a lot of improvement, 40 to 45 percent showed some improvement, and the rest showed no change.

In short, says Dr. Amin, “For the majority, it made a positive difference. Even as residents with dementia suffer from a substantial loss of memory, music tinkers with deep-seated emotional memories and brings about soothing and healing.”

Staff Morale Gets a Boost, Too

Not only has the MUSIC & MEMORY® program improved quality of life for residents with dementia and contributed to a reduction in use of antipsychotics, but also it has made a huge difference in staff morale.

“Residents are often agitated when they receive care, such as bathing or a morning routine,” says Margaret Rivers. “The music brings them back to a place in their lives that had good memories.” When residents are more relaxed, “staff are able to spend more social time with the residents. They feel uplifted.”

Dr. Amin adds that staff morale also gets a boost when caregivers feel they are being heard by leadership and that their concerns and daily challenges on the floors are validated. “To the extent that personalized music reduces difficult behaviors, when staff perceive those behavior problems have been reduced, it helps them, as well,” he says.

Measurable success with MUSIC & MEMORY® is prompting facility leadership to explore other uses of iPods. Rivers says they are considering expanding the program to help patients with traumatic brain injuries, as well as patients on ventilators, a specialty at the new Henry J. Carter hospital in Harlem.

Dr. Amin sums it up succinctly: “There’s no limit to what you can do to improve resident quality of life.”

April 2, 2013 Admin

A “Strong Intervention”: How Personalized Music Helped Lemon Grove Cut Antipsychotic Use in Half

Whenever Judy Ely sits down with a new resident at the Lemon Grove Care Center to learn about his or her favorite foods, she also asks about a different sort of preference: What kind of music do you love?

Director of Dietary Services for the San Diego long-term-care and rehabilitation complex, Ely is the driving force behind the 152-resident facility’s Music & Memory iPod program.

“I speak to our residents every day,” says Ely. “I know how much it would mean to me, to be able to hear my personal music favorites if I lived here. The iPod program is part of our company’s ongoing efforts to make a positive difference in the lives of our residents.”

50 Percent Reduction in Use of Antipsychotics

Lemon Grove’s personalized music program is also part of the organization’s response to an initiative by the Centers for Medicare and Medicaid Services (CMS) to improve the lives of nursing home residents by reducing the unnecessary use of antipsychotic drugs for individuals with dementia. Launched in March 2012, the CMS initiative called for a 15 percent reduction in off-label antipsychotic drug use by the end of the calendar year.

Lemon Grove has far surpassed that goal, reducing use of antipsychotics by 50 percent in 2012. According to Toni Alexander, Director of Nursing, the Music & Memory personalized music program is a “strong intervention,” one of several initiatives that have contributed to the care facility’s ability both to reduce dosage levels as well as the number of antipsychotics taken by individual residents with a wide variety of mental health issues. She adds that use of these medications at Lemon Grove continues to decline.

Judy Ely concurs that iPods loaded with residents’ personal favorites definitely seem to be making a difference in antipsychotic use. “Gradual dose reductions are more successful with the personalized music than without,” she says.

“A Powerful Antidote to Depression”

The Music & Memory program’s success at Lemon Grove caught the attention of the California Association of Health Facilities (CAHF), which made a video last year to promote it. CAHF is part of a collaborative with CMS and the California Department of Public Health to reduce the unnecessary use of antipsychotics in nursing homes. This year’s goal is a 30 percent reduction by June 2013.

“CAHF supports this unique program,” says CAHF’s Deborah Pacyna. “Music, especially personalized music, is a powerful antidote to depression and loneliness and a comfort to many of our residents.”

Reaping the Benefits of Personalized Music

Ely received her training through Music & Memory’s Webinar Certification Program, after she heard an activities consultant describe the benefits of personalized music. She built Lemon Grove’s music library using existing CDs from the activities department and iTunes downloads as well as borrowed music from a variety of sources.

With 50 iPods acquired for the facility as a benefit of the training program, Ely now has two dedicated volunteers–a former classical music DJ and an expert in scoring screenplays–who help her to develop personalized playlists for residents.

The benefits are quite striking.

To cite just one example, Ely brightens as she tells the story of a new elderly resident whose health issues have impaired her ability to interact with the world.

“She used to work in Los Angeles,” says Ely. “In the ’50s, she loved to go to the Palladium with her husband.” There they danced to the champagne music of Lawrence Welk. The woman also sang in her church choir and remembers her grandparents waltzing to a Norwegian melody when she was a small child.

Volunteers Play Key Role in Program’s Success

“She was pretty agitated at first,” says Ely. “But as my volunteer spoke with her, she remembered many details about her childhood.”

From that conversation, the volunteer developed suggestions for a personalized playlist that included Welk’s tunes, religious favorites and even some Norwegian folksongs that recalled the waltz the woman used to hear at her grandparents’ home.

Her response was enthusiastic: “She was so happy,” says Ely. “She said, ‘Oh, this is the music that I like!’”

Ely is buoyed by her volunteer team and support from many staff members throughout the facility who help her to find music and learn about new resources. Most of all, she treasures her interactions with residents. “We’re scoring their lives,” she says.

The time commitment is both manageable and well worth the benefits. “It’s all about being kind, taking the time to be kind,” she says. “Music enables that time. I’ve learned so much. It’s an amazing gift.”

Photo Credit: xomiele via Compfight cc

Want to bring personalized music to residents in your care facility? Please download Music & Memory’s free guide, Making the Case for Personalized Music: A Guide for Elder Care Professionals.

Founded in 2010, Music & Memory® is a non-profit organization that brings personalized music into the lives of the elderly or infirm through digital music technology, vastly improving quality of life.

December 4, 2018 Admin

The Soothing Power of Music for People with Dementia—and Their Families, Too

Forrest with sons Greg (L) and Steve (R)

As the afternoons grew longer, Forrest would become agitated. He’d tell his son, Steve, in no uncertain terms, to bring him his car—despite the fact that Forrest had Alzheimer’s and could no longer drive. But listening to Elvis and other personal music favorites would enable him to calm down.

“The music would just mellow him out,” recalls Steve of his father’s experience with Music & Memory at Morning Pointe Assisted Living in Columbia, Tenn. “They could use music instead of his anti-anxiety medications. It all depended on the timing. He would sundown about the same time every day. If they put music on around 4:30 or 5:00, he’d calm down, tap his foot and sing.”

The same was true for Ed, a resident at Louisiana’s Morgan City Health Care Center, who would relax and cease being combative when he listened to his musical favorites. “He didn’t like to be surprised. I think that was the main thing,” says his wife of 56 years, Madelyn. “If the aides would walk in and go to change him, he would grab their arms and hold them real tight. Someone would have to pry his fingers off. He was a gentle giant all his life, but he would do it to me, too. It was the sickness.”

A big man, Ed suffered from dementia brought on by Parkinson’s. But listening to Cajun or Country Western tunes would make all the difference in his moods. “If they would put his earphones on, he’d quiet down and go along with almost anything they wanted,” recalls Madelyn. She adds that, as a result, Ed’s personal music playlist helped his aides to stay safer, too.

Research Supports Non-drug Approaches to Dementia Patients’ Common Symptoms

Forrest and Ed’s experiences with Music & Memory’s personal music program underscore the potential for non-drug interventions to ease dementia-related agitation and aggression. Indeed, in 2015, researchers from the University of Michigan Medical School and Johns Hopkins University concluded, after reviewing two decades’ worth of studies about overuse of psychotropic medications for people with dementia, that “non-drug approaches should be the first choice for treating dementia patients’ common symptoms, such as irritability, agitation, depression, anxiety, sleep problems, aggression, apathy and delusions.”

Study co-author Dr. Helen Kales described overuse of antipsychotics this way: “For many behaviors, it’s kind of like killing a fly with a cannon.”

“The Program Works”

Steve initially doubted the effectiveness of Music & Memory’s personal music program. After watching Alive Inside: The Story of Music & Memory, he was cynical. “I thought they just cut out all the bad stuff so it would be good for marketing. No way the music’s impact could be that instantaneous,” he says. “Until I did it with Dad. The program works.”

The head of a local insurance agency for many years, Forrest was the kind of man who “never met a stranger.” Steve adds, “Even with dementia, he’d try to sell you insurance. He’d be going into the hospital and say when we get done here we’re going to talk about insurance.” Watching his father change from such an outgoing individual who loved people to become angry and agitated when he sundowned was difficult, to say the least.

With his music—Forrest’s all-time favorite was Achy Breaky Heart—he would be more like his old self. “He’d smile more, he was happy,” says Steve. “He was always jovial. You could tell when he was having a bad day. The music would just lighten him up.” Diagnosed with aggressive liver cancer in August of 2017, Forrest died the following February. “Even in his last few weeks, when he wasn’t eating much, he still had the music playing,” says Steve. “He wasn’t as responsive, but I could tell he was loving it because he wasn’t as restless.”

“I Just Want Others to Benefit, as We Did”

Ed’s wife, Madelyn, remembers him as a “gentle giant.”

For Madelyn, her husband’s personal playlist markedly improved his quality of life after he had become a flight risk at Morgan City. When first admitted last December, Ed would sit in his wheelchair by the doorway and wait until someone opened the door wide enough to wheel through. “The last time, they found him in the middle of the street, with traffic stopped on both sides,” she says. As a safety precaution, staff placed a brace around Ed’s leg to keep him from rolling his chair, as well as an alarm that would trigger if he came near the door. In turn, Ed became more withdrawn—and combative.

But when he listened to the Cajun music he grew up with, performed by artists like Iry Le Jeune, and Country Western hits by George Jones, Ed’s distress eased. A former welding inspector who ran crews on oilrigs off Louisiana’s Gulf Coast, he had been a man who made friends easily. Madelyn describes him as “always so compliant,” agreeable, willing to accept his limitations as his disease progressed—until he felt confined at the nursing home. Toward the end of his life, the music would also help her to feed him, whereas when agitated, he would turn his back.

Ed died in September. At the wake, Madelyn told her sister that his mouth didn’t look quite right. “That’s because he’s always smiling and laughing,” her sister said. Madelyn laughed and agreed. “He loved people, loved to talk, would walk up to you and introduce himself,” she says. “Music & Memory is a marvelous program. It helped my husband a lot, and me, too. I just want others to benefit, as we did.”

Leadership

Dan Cohen, MSW, is the founding Executive Director of Music & Memory, Inc. He combines an extensive background in high tech training, corporate sales and software applications with social work, specializing in vocational rehabilitation and community service organizing. A former Consultant/Trainer for the U.S. Department of Education, he helped colleges, universities and communities nationwide to apply best practices in community service learning programs. Mr. Cohen also worked for the Long Island Regional Advisory Council on Higher Education, coordinating the efforts of volunteer and community service programs on 17 college and university campuses serving about 200 community agencies. He earned his MSW from Adelphi University, an MA in Professional Studies from Long Island University and a BS in Psychology from Hofstra University.

Cathleen Coté has more than 30 years of management and marketing experience with leading business services companies. For the past 10 years, she has led the human capital practice within Corporate Fuel, a boutique investment banking and advisory firm serving middle market businesses. Prior to this, Cathleen held a senior leadership role at Lee Hecht Harrison, focused on bringing talent development, career management and organizational change consulting to major corporations.Earlier in her career, she directed sales and service for financial printing services market leaders RR Donnelley and Bowne. Cathleen began her career working in the publishing arena for Prentice-Hall and McGraw-Hill; while at Business Week, she developed strategic planning roundtable conferences for CEOs in Fortune 100 companies on economic, regulatory and international business issues.

Cathleen holds a BA from Pomona College and an MSW and gerontology certificate from Portland State University. She also worked in program development at SelfHelp Community Services to create portable assisted living services for NORCs in the NYC metro area.

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Peter Hirsch leads the healthcare practice at OgilvyRED, Ogilvy & Mather’s brand strategy consulting group. He has more than 30 years experience in corporate positioning and reputation risk management. Prior to joining Ogilvy, Peter had his own consulting firm, after positions at other agencies including Porter Novelli in New York and at Edelman Public Relations in New York and Frankfurt where he ran the firm’s German operations. He has written three books about corporate communications, the last of which, Corporate Communications: Critical Business Asset for Strategic Global Change was published in 2014. His column about corporate communications and ethics, Vision & Values, appears six times yearly in The Journal of Business Strategy. He holds a Master of Arts in Modern History and German Literature from Magdalen College, Oxford.

Stephen Johnston is Co-founder of Aging2.0, a global innovation network, and Generator Ventures, an early-stage fund focused on aging and long-term care. Mr. Johnston has spent his career at the intersection of networks and innovation, working for multiple Fortune 500 companies. He is Co-founder of the Innovation Leaders Fund and co-author of Growth Champions (Wiley, 2012), a book about sustainable corporate growth. Mr. Johnston serves on the board of Older Adults Technology Services (OATS), a New York-based nonprofit. He has an MA in Economics from Cambridge University and an MBA from Harvard Business School, where he was a Fulbright Scholar.

Tony Lewis is currently the President/CEO of Cobble Hill LifeCare, the parent company of Cobble Hill Health Center (nursing home) and Your Choice at Home (Certified Home Health Care Agency) and was formerly the Administrator for over 13 years. His wide-ranging career in Health and Social Services began in London, England where Tony received a professional social work qualification from the West London Institute of Higher Education. In New York he acquired a Masters Degree in Health Policy and Management. While in London, Tony developed an expertise in social work and adult day care, specializing in Alzheimer’s care. He established innovative programs for elderly and disabled adults and worked as the director of a non-profit Family Caregiver In-Home Respite Care Agency.

Arriving in New York in 1991, Tony’s first position was at Cobble Hill Health Center. Starting out as the Director of the Alzheimer’s Program and Community Services, Tony was the guiding force in establishing Cobble Hill Health Center’s highly regarded Alzheimer’s Special Care Unit. Recognizing the need for specialized services for adults with medical and cognitive disabilities Tony established a medical model Adult Day Health Center that was renowned for its innovative bi-lingual programming and compassionate care. Tony has always recognized that new approaches and models of care must evolve to continue to bring a resident/patient centered approach to care.

Tony’s extensive work with caregivers and patients has informed and helped to shape his basic philosophy of care; he strongly believes that service provision should meet individual need and that where change is required, it should be the agency that yields.

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Alexandra Morehouse is currently the Chief Marketing Officer for Banner Health.
Prior to that, she served Chief Brand Evangelist for Kaiser Permanente during the critical implementation of the Affordable Care Act. During that time, Morehouse rolled out strategic communications between consumers, the insurance exchanges and state and local agencies. She was responsible for communications guidelines, advertising, social, mobile and digital media outreach

Prior to her work in the healthcare industry, Morehouse was CMO of the American
Automobile Association, where she oversaw all communications, advertising,
branding, media relations, and employee communications streams. AAA provides
insurance, travel, automotive and financial services to more than 53 million
members.

A featured speaker at national communications conferences, Morehouse has also
served as chair of the Harvard Business School Global Technology Conference and
on the boards of UC Davis ITS, HBS Community Partners, SnapFish, Yerba Buena
Center for the Arts, ODC Dance and Wildcare.

Previously, Morehouse was Chief Marketing Information Officer for Charles
Schwab and Co. She also held senior leadership roles at American Express Travel
Related Services in New York and San Francisco, in the areas of communications
and brand management

Morehouse has been featured in Forbes, Business Week, the Economist and
AdAge. She won the 2015 “Marketers That Matter” award from the Wall Street
Journal and has was been a San Francisco Business Times “Most Influential”
honoree in 2011, 2010 and 2009.

She graduated with high honors from Harvard University and has an MBA from
Harvard Business School.

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Lisa Richardson was both a musician and an engineer (MIT) before receiving her MBA from Harvard University in 1984. She has spent more than 20 years in real estate development. This has given her the freedom to consult to artists and start-ups, as well as perform as a musician.

Joe Schick founded Blue Rock Studio in New York’s SOHO district in 1969. In its heyday, Schick and Blue Rock recorded artists such as Bob Dylan, Bob Marley, Bette Midler, the New York Dolls, and Judy Collins. Throughout the 1970s and 1980s, Schick produced and engineered records in the United States and Europe before serving as Managing Director of Sugarloaf Design, an architectural firm that created recording studios for Stevie Wonder, Kiss, and others. He was also, during that period, the author of the critically acclaimed Hendrix: A Biography (1985), and music and culture editor of Taxi, an international style magazine, as well as numerous other publications. As Senior Writer/Editor and Creative Director, Schick was responsible for establishing corporate communications and strengthening brand identity for the Metropolitan Transportation Authority (MTA), Con Edison, and the New York City Health and Hospitals Corporation (HHC), where he was first Chief of Staff and later (until 2018) Executive Director of HHC’s philanthropic foundation. He introduced Music & Memory to HHC in 2010, ultimately bringing it to that organization’s 11 acute care facilities as well as its five long-term care sites, championing its innovative use in rehabilitation and psychiatric settings, and building supportive relationships in the music community, notably with Grammy-winning colleagues Bryan-Michael Cox and Robert Glasper. in 2016, Schick developed and served as Executive Producer for the award-winning short film Healing with Harmony: A Music & Memory Story.

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Concetta M. Tomaino, DA, MT-BC, LCAT, is Director of the Institute for Music and Neurologic Function (IMNF) and Vice President for Music Therapy at the Beth Abraham Family of Health Services. Internationally known for her research in the clinical applications of music and neurologic rehabilitation, she has worked with IMNF for the past 25 years. With support from Beth Abraham’s leadership and financial assistance from state, federal and private grants, Dr. Tomaino helped lay the groundwork for the creation of IMNF and built a world-class music therapy program at Beth Abraham. She is a past president of the American Association for Music Therapy. She holds a Master and Doctor of Arts in Music Therapy from New York University.

Ann Wyatt specializes in long term care program development, with an emphasis on culture change and creating a culture of retention for front-line staff in nursing homes and home care. Current projects include a collaborative effort between the New York-based Isabella Geriatric Center and Cobble Hill Health Center to develop person-centered care environments. She helped to create the Independence Care System, a managed long term care plan for younger people with disabilities, one of the first in the country. Ms. Wyatt previously served as Associate Director of the Office of Long Term Care at the New York City Health and Hospitals Corporation. She is also a founder of the National Citizens Coalition for Nursing Home Reform. She serves on the boards of the Coalition for the Institutionalized Aged and Disabled, Bronx Independent Living Services, Isabella Geriatric Center and The House for Elder Artists.

Claire Haaga is an accomplished leader of innovations in the nonprofit sector with over 25 years of experience in the affordable and supportive housing, human services, aging and employment fields. Claire spent the early part of her career at the Vera Institute of Justice creating employment programs for ex-offenders including the predecessor to Access-A-Ride, the first paratransit service in NYC for elderly and disabled persons. As the Founder and President for 18 years of Housing & Services, Inc., Claire pioneered the development of nonprofit owned supportive housing in New York City with over $300 million in projects, using diverse financing tools. Claire has spent the last 10 years leading nonprofits in the aging, human service and health fields – -ReServe Elder Services, HealthCare Chaplaincy, and Volunteers of America-GNY.

Medical and Scientific Advisory Council

Peter Davies, PhD, is the Laboratory Head and Director of the Litwin-Zucker Center for the Study of Alzheimer’s Disease and Memory Disorders, an initiative of the North Shore-Long Island Jewish Health System. For more than 35 years, Dr. Davies’s research has been focused on the biochemistry of Alzheimer’s Disease and developing treatments to slow or halt Alzheimer’s progression. His early work was instrumental in the development of the currently approved drugs for Alzheimer’s: Aricept, Exelon and Razodyne. Dr. Davies is a Professor of Neuroscience at Albert Einstein College of Medicine, holding the Judith and Burton P. Resnick Chair of Research on Alzheimer’s Disease. He received his PhD in Biochemistry from the University of Leeds, England.

G. Allen Power, MD, is a board-certified internist and geriatrician, as well as Clinical Associate Professor of Medicine at the University of Rochester. Dr. Power is a Certified Eden Alternative® Educator, a member of the Eden Alternative board of directors and an international educator on transformational models of care for older adults, particularly those living with cognitive illness. His 2010 book, Dementia Beyond Drugs: Changing the Culture of Care, won a 2010 Book of the Year Award from the American Journal of Nursing. Dr. Power serves on the technical advisory panel for the U.S. Center for Medicare and Medicaid Services for their national antipsychotic reduction initiative. He received a 2012 Bellagio Fellowship from the Rockefeller Foundation for his work on innovative responses to global aging and was recently named one of “Five Leaders of Tomorrow” by Long Term Living Magazine. He serves as adviser for Dementia Care Australia, the South Africa Care Forum and Ibasho.

Jules Rosen, MD, is Professor of Psychiatry at the University of Pittsburgh, Chief of Geriatric Psychiatry Services at the University of Pittsburgh Medical Center and Director of the Geriatric Psychiatry Fellowship Program. A nationally recognized expert in geriatric psychiatry, he has authored over 75 peer-reviewed articles. Dr. Rosen’s research interests include pharmacological treatment of behavioral disturbances in dementia and organizational changes in nursing homes to enhance quality of life. He has developed and tested a variety of educational tools to enhance the care of nursing homes residents. Dr. Rosen is also the Director of the Hartford Foundation Center of Excellence in Geriatric Psychiatry Fellowship, Clinician-Educator Track. In 2003 he was named Educator of the Year by the American Association of Geriatric Psychiatry.

Susan Wehry, MD, a board-certified geriatric psychiatrist and advocate for seniors and persons with disabilities, has educated physicians, nurses, medical students, ombudsmen, policy makers and direct care workers from Alaska to Louisiana. A popular speaker, Dr. Wehry keynoted the 2003 and 2006 Annual Meeting of National Citizens’ Coalition for Nursing Home Reform and the 2009 Pioneer Network Conference. She also assisted the Centers for Medicare and Medicaid Services in the development of national web-casts on mental health needs and individualized care planning in nursing homes. In 2011, Dr. Wehry was appointed Vermont’s Commissioner of the Department of Disabilities, Aging and Independent Living. She is committed to the Department’s mission to “make Vermont the best state in the nation in which to grow old—or to live with a disability—with dignity, respect and independence.”