if not leadingage is working to make this happen. >> the short answer is no and that is unfortunate. there is a chasm between hospitals and nursing homes in a variety of problems and i think the appropriate care of dementia is but one of them. the opportunity certainly through some of the new models of integrated care provisions is an excellent starting point. it will take more than meds 11 alone and that is why we are working closely with collaborators such as advancing excellence because we recognize as we provide that basis to learn from people who are doing it well and how to replicate it but also to inform the physicians across the continuing that there are valid and real alternatives. lastly i want to put in an important issue we talked about staff turnover. the alzheimer's association. one thing advancing excellent identified is when you have consistent staffing so when the same person as often possible taking care of the same president of the behavior issues also tend to decline. that is another area that we at leadingage working with advancing excellence are working on bette

cheryl phillips who's the senior vice president of advocacy at leadingage. we thank you all for being here. and now, dr. evans, you may commence. >> good afternoon and thank you, mr. chairman -- [inaudible] although my testimony today is quite personal, i also represent the professional society for long-term care physicians whose mission is to improve the quality of care for seniors. my personal story is this: i'm a doctor who specializes in the care of frail elders. i practice mostly in nursing homes and other long-term care settings where physicians are frequently absent. i do use antipsychotic drugs to treat a small number of patients with longstanding schizophrenia or bipolar disorder. i do not prescribe antipsychotic drugs for treatment of agitation or other behaviors in patients with dementia. we acknowledge the use of these medicines in patients with dementia only as a lost resort and only when all else has been tried and failed which is rare. i and other like-minded doctors face tremendous pressure in all care settings to prescribe medication to make

it will take more than leadingage alone and that's why we are working so closely with collaborators such as through advancing excellence. because we recognize that as we provide a basis of both the learned, let's learn some people are doing it well and how to replicate it, but also to inform the clinicians across the continuum that there are valid and real alternatives. lastly, i want to put an important issue, we talked about steph turner with the alzheimer's association. one thing that advancing excellence has a different is that when you have existing staffing, so that the same person as often as possible taking care of that same residents, the behavior issues also tended to decline. so that's another area that with we at leadingage working with advancing excellence are working on better understanding of staff turnover but also staff consistency, as probably a key quality measure. and that relates to false, pressure ulcers, inserting to behavior management in pursuit with dementia. >> dr. evans, you talked about informed consent. do you believe the best family members of dementia pati