Oklahoma House of Representatives
Media Division
January 26, 2004

OKLAHOMA CITY - Detecting and managing pain of the frail and elderly and coping with dementia have caught the attention of a state legislator who has taken a step toward increasing the quality of their remaining years of life.

State Rep. Rebecca Hamilton is spearheading a legislative study at the state Capitol by the House Appropriations and Budget Subcommittee on Health and Social Services.

Hamilton has filed House Bill 2305, which would establish an 18-member Advisory Council on Pain Management. The purpose of the advisory council is to provide advice on pain management policy.

HB 2305 would require recommendations to be forwarded to agencies such as the Oklahoma Health Care Authority, Department of Mental Health and Substance Abuse Services and the state Department of Health, associations relating to hospitals and health systems, nursing facilities and providers associated with assisted living residential care and home health care.

Pain management has been identified as the 'fifth vital sign' among nursing home residents. "It is estimated that 72 percent of nursing home residents have problems with pain," Esther Houser said. "I believe the industry, the regulatory system, the medical and the nursing professions have made strides in the last several years including devising ways to assess pain for those people who have little or no verbal skills left."

Houser is a state long-term care ombudsman for the Oklahoma Department of Human Services Aging Services Division.

She told the legislative panel that 50 percent of nursing home residents have some cognitive impairment and problems assessing their own pain levels. "No one connected the presence of pain with patients who screamed, moaned or thrashed in their beds," she said. "Progress is being made toward identifying when someone has pain, and an intervention as simple as administering Tylenol can relieve some kinds of stress,"
Houser said.

She suggested reviewing information from state agencies, such as the Medical Directors Association, or the licensing board that certifies agencies for Medicaid.

Nationwide, Houser said, focused education for nurses and continuing education for physicians would be a direct approach to pain management.

At the heart of the long-term care system are the certified nurse aides, said Clark Kendall, manager of housing and special projects with the Life Senior Services. Kendall said he is a volunteer for the Oklahoma/Arkansas Chapters of the Alzheimer's Association.

Skills of certified nurses and aides determine the quality of care, he said, but the nursing profession has a high employment turnover rate.

"Inadequate training in how to care for residents with dementia is a primary factor in the turnover of nursing staff."

On average, he said, at least half of residents in nursing homes have some level of dementia, and Alzheimer's disease is the leading cause of dementia.

"Simply put, Alzheimer's destroys brain cells," Kendall said. "In later stages of the disease, there is no memory or comprehension. And it's not uncommon to have the disease for 20 years or longer." It is estimated that four million Americans have Alzheimer's and that includes approximately 70,000 Oklahomans. "Those numbers will increase as the state's 'Baby Boomers' reach their mid-60s and as we lead longer lives
in general," Kendall noted.

He said appropriate training in how to care for dementia patients can be crafted for inclusion in a 75-hour course of study.

"I want to emphasize that without the binding force of legislation, we believe no progress will be made," Kendall said. "Without legislation, the nursing aide profession will continue to experience the frustration of caring for people whose behavior they don't fully understand. Nursing homes will continue to experience high turnovers of
its nursing aide work force. Most importantly, many of our family and friends suffering with dementia will be cared for in an inappropriate and counter productive way."
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Scott Hancock
Media Specialist
Oklahoma House of Representatives
1-800-522-8502 ext 422  ¶ 3:49 PM