Parkinson's Disease vs Parkinsonism as a Result of Aging
Parkinson ’s Disease is a condition characterized by degeneration of the nigrostriatal pathways resulting in marked bradykinesia. Studies have reported that nearly 25% of Medicare beneficiaries with Parkinson’s Disease reside in long-term care facilities (LTCFs). Residents of LTCFs are older and may also have other age-related mobility disorders. It is important for providers to know that Parkinsonism symptoms can also occur as a result of natural aging and will not respond to standard therapy for Parkinson’s Disease. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Karun Badwal, Karun Badwal, Ali Ahmad, Shanojan Thiyagalingam, Anupum Chandra Source Type: research

Pilonidal Sinus or Non-healing Pressure Ulcer?
New or worsening changes in skin integrity and pressure ulcers are a reportable quality measure in skilled nursing facilities (SNFs). Their management requires comprehensive evaluation for predisposing and precipitating factors and comorbidities that may impede healing. A thorough history and clinical examination is an essential first step in this process. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Shanojan Thiyagalingam, Shanojan Thiyagalingam, Anupam Chandra, Karun Badwal, Ali Ahmad Source Type: research

POA Pickle: How to handle POA Resignation in LTC
Advance care planning can be challenging in the long-term care setting, especially in patients with cognitive impairment. This case presentation provides an example how the interdisciplinary facility team including administrator and medical director successfully navigated an ethical dilemma. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Ellen W. Kaehr, Ellen W. Kaehr Source Type: research

Reducing Unnecessary Antibiotics for Bilateral Cellulitis
We present a case of bilateral lower leg swelling and redness in a patient with peripheral vascular disease with venous stasis that was mistakenly diagnosed as cellulitis and treated with five courses of antibiotics over a period of 18 months. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Aaiza Aamer, Aaiza Aamer, Ilia Bernstein, Ravneet Sandhu, John Naumovski Source Type: research

The Carrot Battle: An Acupuncture Wonder
Chronic pain is among the most common reasons for seeking medical attention. In the United States, 1 in 5 adults had chronic pain in 2016 and it is estimated to cost over $500 billion annually in direct medical costs and disability. It is a prevalent problem among residents in the nursing home. Non-pharmacologic therapies are the most preferred treatment for chronic pain as pharmacological therapies, such as opioids, have proven to be less effective and associated with numerous side effects among older adults. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Shyam Kolangara, Shyam Kolangara, Jade Kim, Xiangrong Shao Source Type: research

The Frequent Faller in Long-Term Care: Listen to the Resident for the Answer!
Falls are common in long-term care residents, often multifactorial. Our case highlights recurrent falls in a resident with comorbidities, assumed to be from his diseases, although he expressed frankly that the cause was different. Paying attention to his complaint ended his falls. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Thiravinvamalai Dharmarjan, Leili Shahgholi, Padmawathi Murakonda, Thiravinvamalai Dharmarjan Source Type: research

The Impact of a Geriatric Medicine Consultation on the Decision for a Percutaneous Endoscopic Gastrostomy Tube in a Geriatric Patient
This is the case of a 94-year-old female with a prolonged hospitalization for a small bowel obstruction complicated by multiple intubations and dysphagia leading to a recommendation for a percutaneous endoscopic gastrostomy (PEG) tube for enteral feeding. Geriatric medicine was consulted and an unnecessary PEG tube placement was avoided. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Andrea J. Landi, Andrea J. Landi, Alexander Sasha Rackman Source Type: research

The Right to Refuse: Ethical Issues in Capacity Assessment for Older Adults With Aphasia and Possible Dementia
Cerebrovascular accident is a common diagnosis in the rehabilitation and long-term care setting and can be associated with deficits in both language and cognition. Because capacity assessment requires a patient to both understand the decision in question and express a choice, it can be particularly challenging to determine capacity in patients with aphasia. Complex medical decision-making and use of healthcare proxies in this setting require careful navigation of patient needs, goals, and rights. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Rose Onyeali, Rose Onyeali, Emily Fessler Source Type: research

The Role and Influence of Culture in End-of-Life Care
End-of-life care is often assumed to be similar across cultures, countries, religions, and the ethnic background. Its concept and understanding is as varied as the cultures and religions it represents. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Janaki Samaraweera, Janaki Samaraweera, Josephine Gomes Source Type: research

Wet, Wacky, Wobbly, and WILD: Disinhibition as an Outcome of Post-traumatic Hydrocephalus
Post-traumatic hydrocephalus (PTH) or secondary normal pressure hydrocephalus (NPH) are common complications that follow traumatic brain injury (TBI). PTH clinical features are similar to NPH and can be characterized by a triad of gait apraxia, cognitive deficits, and urinary incontinence. Symptoms may progress to psychomotor slowing, dementia, and the need for institutionalized care. Additionally, patients with TBI often experience a loss of impulse control, aggressive behaviors, and personality changes. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Hemal Patel, Hemal Patel, Lauren Mazzurco Source Type: research

2020 Annual Conference Oral Presentations
A Deep Dive into Urinary Tract Infections (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Source Type: research

Avoid the ER! Using Simulation-Based Mastery Learning to Teach Common Procedures Needed in Post-Acute Care
The objective of this study is to evaluate the effectiveness of a post-acute care procedures course that uses simulation-based mastery learning to teach gastrostomy tube removal and replacement, tracheostomy tube replacement, knee joint aspiration and injection, and basic suturing. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Sara Bradley, Sara Bradley, Jeffrey Barsuk, Vanessa Ramirez-Zohfeld, Theresa Rowe, Katherine O'Brien, Dwayne C. Dobschuetz, Ruqayyah Muhammad, Lee Lindquist Tags: Education Source Type: research

Choosing Wisely in Post-Acute and Long-Term Care: Evaluating internal medicine residents knowledge gaps
In 2013, the Choosing Wisely Campaign launched 5 recommendations pertaining to the care of patients in the post-acute and long-term setting. This was done in an effort to educate clinicians, patients, and other providers about potentially inappropriate medical tests and procedures in this setting. In 2015, the list was expanded to 10 recommendations. Internal medicine (IM) residents (PGY 1, 2 and 3) were surveyed at our institution in 2014 (1 year after the release of the initial 5 recommendations) to assess their understanding of the Choosing Wisely recommendations. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Ariadne Panagiotou, Ariadne Panagiotou, Keerti Sharma Source Type: research

ECHO ™-Skilled Nursing Facilities: Telementoring for Nurses in Skilled Nursing Facility Leadership Positions
It is common for nurses with limited specialized training in geriatrics to care for older adults at skilled nursing facilities (SNFs). In SNFs on the south side of Chicago, prior needs assessments have identified a gap in knowledge in geriatrics topics. To address knowledge gaps, we utilized the Extension for Community Healthcare Outcomes (ECHO ™) model to provide case-based, interdisciplinary geriatrics medical education and telementoring, at no cost, to nurses in leadership positions at SNFs across Chicago’s South side. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Lauren J. Gleason, Lauren J. Gleason, Michelle Martinchek, Stacie Levine, Monica Long Source Type: research

Impacts of UTI Protocol Initiation on Long-Term Care Nursing Staff
Concerns of urinary tract infections (UTI) are widespread in long-term care (LTC) settings. Non-specific symptoms can lead to unnecessary testing and inappropriate antibiotic use. There have been numerous protocols developed to standardize diagnosis of UTIs, including the McGeer criteria. At our LTC facility, we initiated a modified McGeer criteria for ordering urinalyses (UA) and culture. Our project examines the knowledge retention of the complexities of urinary tract symptoms and the comfort level of nursing staff when communicating with providers. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Yoon H. Kim, Yoon H. Kim, Ujjwala Seetha Bhagavatula, Lauren W. Mims, Neema Sharda, Mamata Yanamadala Source Type: research

Staff Education on a Urinary Tract Infection Algorithm in a Skilled Nursing Facility
A nation-wide initiative has been established for antibiotic stewardship in an effort to reduce over-treatment and over-diagnosis of infections. In our Skilled Nursing Facility (SNF), there are minimal guidelines for ordering urinalyses (UAs) in patients suspected of urinary tract infections (UTIs). Chart review demonstrated that UAs were ordered without systematic guidelines. We designed a project to educate SNF staff on a diagnostic algorithm adapted from McGeer criteria for UTIs (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Ujjwala Seetha Bhagavatula, Ujjwala Seetha Bhagavatula, Mamata Yanamadala, Neema Sharda, Yoon H. Kim, Lauren W. Mims Source Type: research

Utilizing the Huddle for Meaningful Conversations about Goals of Care and Advance Directives
Oftentimes, the conversations that are needed the most to understand patient care goals, especially in the context of serious illness or end of life, are often not talked about. Patients ’ goals of care and advance directives tend to happen too late or are avoided. Early discussions about goals of care are associated with better quality of life, can avoid non-beneficial medical care, and more importantly, improve family outcomes. At our hospital in rural Missouri, we proactively c ommunicate goals of care in our regular clinical care processes. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Erika Leung, Erika Leung, Hirshell Parker Source Type: research

A Multidisciplinary Process to Improve Quality Indicators in a Veterans Affairs Community Living Center
Quality Indicators (QIs) are an important part of Long-Term Care Quality improvement initiatives and 1 of 3 domains of the overall star rating developed by Centers for Medicare/Medicaid (CMS). At the Corporal Michael J Cresencz Veterans Affairs Community Living Center (CLC), a 120-bed Long-Term Care institution in Philadelphia, PA, we were scored a 1-star facility on CMS standardized quality indicators. The administrative and clinical teams felt we were better than this and undertook an initiative to study and hopefully improve the indicators. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Mary T. Hofmann, Mary T. Hofmann, Ruby Love, Marcia A. Francis, Elizabeth A. Corkery, Oludamilola Ogunnubi Tags: Quality Improvement Source Type: research

Addressing Population Health Care Transitions by Utilizing Swingbed Post-Acute Care
Ste Genevieve County Memorial Hospital (SGCMH) has a swing bed hospital-based program for Transitional Care (skilled nursing). Recently, SGCMH implemented an innovative care model, standardized triage process, and collaboration with select tertiary care centers to transition patients into a short-term skilled nursing program. The Transitional Care goal is to address needs of patients who are being discharged from acute care, but are not ready or safe to go home. Patient acuity is often too great for nursing homes or discharge to home. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Erika Leung, Hirshell Parker, Erika Leung Source Type: research

AI Predicts Post-Acute Care Need
Discharge delays due to non-medical reasons are important causes of unnecessary extended inpatient lengths of stay that contribute to rising costs and strained bed capacities. Appropriate post-acute care (PAC) placement is a critical component of discharge planning that helps reduce readmissions. However, PAC placement could be a significant cause for discharge delays at many hospitals. Presently most hospitals rely on an interdisciplinary care transition team composed of nurses, doctors, physical and occupational therapists, inpatient/outpatient and community-based care coordinators, financial counselors, and psychologist...
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Jacqueline Naeem, Jacqueline Naeem Source Type: research

An Integrated Healthcare Model for our County's Most Vulnerable Patients: Making an Impact with PACT (Post-Acute Care Transition)
Safe hospital discharge remains a high priority for maintaining quality of care in medical systems. The PACT initiative grew from a growing need to care for a challenging population - patients who are hospitalized for complex medical conditions but cannot be safely discharged. Known as non-acute patients, they are some of the highest utilizers of our medical system and often require a multi-disciplinary effort to appropriately address their psychosocial needs, medical complexities, and care coordination. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Claire Rai, Claire Rai, Huy Ngo, Michelle V. Flores, Raymond Chan, Maria Cutaran, Lauren Schmidt, Pamela Sebastian Source Type: research

Association Between Patient-Tailored Case Management Initiative and Outcomes in Subacute Rehabilitation Facilities to Decrease 30-day Hospital Readmissions for Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease (COPD) will become the 3rd leading cause of death worldwide in 2020 and is currently the 3rd leading cause of hospital readmissions in the US. In October 2014, the Centers for Medicare and Medicaid Services (CMS) introduced penalties followed by bundle payments for care improvement initiates in patients hospitalized with an acute exacerbation of COPD (AECOPD). Fragmented care across settings cause readmissions for COPD. A patient-tailored case management initiative mitigated 30-day hospital readmissions at Sub-Acute Rehabilitation (SAR) centers. (Source: Journal of the American Medical...
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Deborah A. Granata, Deborah A. Granata, Moira Kendra, Stephanie Chiu, Michael Squillante, Donna Watridge, Carol Vargas, Paul Owens Source Type: research

Creating an Age-Friendly Health System: Lessons learned for the Post-Acute Care Setting
With health systems growing in size and complexity, older adults who seek medical care are forced to navigate the difficult terrain of the emergency room (ED), possible hospitalization and/or re-hospitalization, and skilled nursing facility (SNF) rehabilitation before returning home. With each transition, patients experience different providers, settings, medications, and medical needs. Additionally, patients and providers experience a lack of communication, inadvertent medication errors, and lost information. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Anna Liggett, Anna Liggett, June M. McKoy, Sara Bradley, Katherine O'Brien, Dwayne C. Dobschuetz, Lee Lindquist Source Type: research

Customized Music Therapy to Deprescribe Psychotropics in a Skilled Nursing Facility
A significant proportion of skilled nursing facility residents hold at least 1 psychiatric diagnosis. Newer, revised Centers for Medicaid and Medicare Services (CMS) definitions, regulations, and limits regarding psychotropic use in skilled nursing facilities necessitate novel solutions for non-pharmacologic management of behavioral symptoms arising from conditions commonly seen in this setting. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Jamie E. Bass, Hyungseok Oh, Jamie E. Bass Source Type: research

Digital Hand Hygiene Audit: Impact on Compliance and Quality Outcomes
Hand washing has been established as the single most effective way to significantly reduce the transmission of infections within healthcare facilities. Rising higher complexity of patients, multi-drug resistant infections, and increasing need for broad spectrum antimicrobial therapies have been well documented at post-acute and long-term care settings. Proper hand washing education and organized hand hygiene audit tools could have a great impact on reducing the spread of infections, decreasing the utilization of antimicrobials, and achieving overall good patient outcomes. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Madhu Murthy, Madhu Murthy, Megan Crosser Source Type: research

Effect of an Electronic Face-to-Face Certification Form on Home Healthcare Services Start Date and 30-Day Rehospitalizations and Emergency Room Visits
Patients who transition from hospital to skilled nursing facilities (SNF) frequently require home healthcare (HHC) services upon discharge to home. The certifying physician must document that he or she, or an allowed non-physician practitioner (NPP), has had a face-to-face encounter (FTF) with the patient to document patient ’s homebound status and need for skilled services, and sign the plan of care. Given that a university-affiliated home health care agency (U-HHC) and the university-affiliated providers caring for patients in SNF share the same electronic health record, incorporating the electronic FTF to the usua...
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Ana Montoya, Karen A. Neeb, Ana Montoya, Li Zhu, Navasuka Kumar, Mohammed Kabeto, Andrzej T. Galecki Source Type: research

Effects of Participation in Tremble Clefs by Individuals with Parkinson ’s Disease on Voice-Related Quality of Life
Parkinson ’s disease (PD) is a multifaceted condition that impacts a wide range of functions, including speech. The effect of loss of communication ability creates a cascade of effects which includes decreased participation in social events, social isolation, and potentially depression. If improvements in v oice occur, the cascade can be diverted. A physiological basis, as well as research evidence, supports use of singing to improve voice of those with PD. The implementation of a choir for those with PD has the potential to provide a socially engaging intervention, which is cost effective. (Source: Journal of the Am...
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Phyllis M. Gaspar, Phyllis M. Gaspar, Katie Westberg, Leah Einbode, Tiffany Burich Source Type: research

Evaluating the Effects on Hospital Encounters After Implementing After-Hours Telemedicine Visits in a Senior Living Facility
Hospitalizations from senior living facilities result in complications, morbidity, and Medicare expenditures of over 1 billion dollars annually. Lack of after-hours, on-site physician availability in these facilities may contribute to avoidable emergency department (ED) visits and hospitalizations. Often, when unable to evaluate a patient visually, the on-call provider may opt to send the patient to the ED for further evaluation. This, in turn, puts patients in an unfamiliar, noisy environment, increasing rates of delirium and causing a significant stress burden on the patient, not to mention costs incurred during the enco...
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Natalie Christian, Natalie Christian, Rebecca King-Mallory, Russell Blackwelder Source Type: research

Hypoglycemia Protocol Institution at SNF/LTC facility
The geriatric population is at high risk of severe low blood glucose (LBG) events due to diminished homeostatic mechanisms, especially on hypoglycemic medications. Moderate to severe LBG events in these patients can contribute to behavior changes such as agitation, change in level of consciousness, disruption of sleep, instability and increased risk of myocardial infarction, stroke and falls. Rapid recognition and appropriate treatment and prevention of LBG and recurrences can reduce risk for hospitalization in the geriatric population. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Pamela A. Tetro, Pamela A. Tetro Source Type: research

Implementation of a Cognitive Stimulation Therapy Program in Long-Term Care
Individuals with dementia who exhibit adverse behaviors are often treated with psychotropic medications despite harmful side effects and recommendations to use non-pharmacological interventions. Cognitive Stimulation Therapy (CST) has consistently been shown to improve cognitive functioning and quality of life (QOL) in individuals with mild to moderate dementia, and reduce the number of adverse behaviors. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Claire E. Regan, Claire E. Regan, Karen Yarbrough, Gloria Lay Source Type: research

Implementation of the Evidence Integration Triangle for the Management of Behavioral Psychological Symptoms of Dementia (EIT-4-BPSD) Intervention in a Nursing Home Setting.
Behavioral Psychological Symptoms of Dementia (BPSD) are described as symptoms of apathy, agitation, inappropriate vocalization, aggression, wandering, and resistiveness to care. Not managing BPSD appropriately can cause an increase in frustration, stress, and burnout amongst staff members, and negatively impacts the health and quality of life for residents with dementia. Psychotropic medications are often administered to residents with BPSD in long-term care facilities and can lead to adverse effects such as an increase in falls, mortality, cardiovascular events, and hospitalizations. (Source: Journal of the American Medi...
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Courtney E. Anderson, Courtney E. Anderson, Karen Yarbrough, Barbara Resnick Source Type: research

Improving End-of-Life Care using the Life Sustaining Treatment Decision Initiative in a Veterans Affairs Community Living Center
In 2018, the Department of Veterans Affairs (VA) implemented the Life Sustaining Treatment Decisions Initiative (LSTDI), a national, multi-pronged program to support clinicians in conducting Goals of Care Conversations (GoCC) with seriously ill Veterans and documenting them using a standardized note and orders template. Addressing GoCC is a crucial part of comprehensive care in LTC facilities and thus Veterans residing in VA nursing homes (Community Living Centers, CLCs) are appropriate recipients of this initiative. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Mary T. Hofmann, Mary T. Hofmann, Ruby Love, Deborah Way, Mary Ersek, Coy Smith, Debra Adrian, Johanne Louis, James McGee, Marjorie Marenberg, Heather Dale Source Type: research

Improving Heart Failure Management in Post-Acute and Long-Term Care: A Pilot Study
Heart failure (HF) is a leading cause of mortality and hospital readmissions in the United States. A large proportion of these patients are readmitted from skilled nursing facilities (SNF). The implementation of quality initiatives, such as staff education, to recognize early measures of clinical instability could improve HF management at these facilities. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Temitope Akinjogbin, Temitope Akinjogbin, Jacob M. Parnell, Mariu Duggan, Ralf Habermann, Susan Bell Source Type: research

Improving Recognition of Abnormal Vital Signs: A Key Area of Intervention for Earlier Sepsis Diagnosis and Management
Sepsis is one of the leading causes of hospital admissions of skilled nursing facility residents and is associated with poor outcomes. Prompt recognition and timely treatment is essential. A key component of early sepsis recognition is the nursing assessment. Hence, it is essential that certified nursing assistants (CNAs) and registered nurses (RN) are able to identify abnormal vital signs (VS) and understand the standard definitions of sepsis and recommendations for initial management. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Zaib Khan, Zaib Khan, Shivani Chopra, Katerina Oikonomou, Daniel Gaballa, Maysoon Agarib, Stephanie Le, Ruth Spinner Source Type: research

Leading The Patient Safety Charge-Keeping Our Patients Wound-Free
Levindale Hebrew Geriatric Center and Specialty Hospital brings together a Long-Term care facility as well as an acute care specialty hospital. Acute care hospital (120 beds). Long Term Care (210 beds). High Risk Patient Population. Chronic Wounds. Multiple Comorbidities. Pulmonary Rehabilitation Services. Coma Emergence Program. Chronic Ventilator Dependent Care. High Intensity Care Unit/Hospital. Brain-Health Units. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Raymond Miller, Barbara M. Quinn, Raymond Miller, Leigh Smith, Damon Jenkins Source Type: research

One Size Doesn ’t Fit All: A Quality Improvement Initiative to Reduce Hypoglycemia in Diabetics in an Acute Rehabilitation Center
Management of diabetes in post-acute settings needs special considerations. Hypoglycemia in the skilled nursing and rehabilitation facilities can lead to readmissions and complications including falls. Current EHR care-sets may not make a distinction between hospital and post-acute settings regarding diabetes management. The current diabetes management care-set in the EHR of our large healthcare system includes checking the blood sugar QID/AC/HS (before breakfast, lunch and dinner, and bedtime). (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Nimit Agarwal, Nimit Agarwal, Sumit Agarwal, Pooja Rangan, Anita Rasheed, Ingrid Okonta, Fan Wu Source Type: research

Pneumococcal Immunization Standing Order Protocol: A DNP Project
Background Streptococcus pneumonia is a significant cause of morbidity and mortality in adults who are immunocompromised and of advanced age. It is the standard of care to vaccinate all high-risk adults (18-64 years) and adults 65 years and older with 2 pneumococcal vaccines. However, pneumococcal immunization rates remain below the HealthyPeople2020 target goal of 90% nationally and locally. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Alyson P. Shittu, Alyson P. Shittu, Erica Alessandrini Source Type: research

Post Acute Readmissions? Not with your Nurse Practitioner in Charge!
Deaconess Health System developed a post-acute embedded Nurse Practitioner (NP) program in partnered skilled nursing facilities (SNF) to improve patient transitions and coordination of care. This model has improved patient care, lowered 30-day readmission rates, lowered length of stay, and transitioned patients to the next level of care in a safe and efficient manner. This concept has completely modernized and revamped our approach to post-acute strategies and quickly met our health system ACO and population health goals. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Shelly Evans, Shelly Evans, Jaime Redman Source Type: research

Post Fall Process Improvement-An Interdisciplinary Huddle Process
The Sunflower Memory Center Long-Term Care Community Living Center had seen an increase in falls. We recognized that our post-fall process was not optimally implemented or utilized, and the decision was made to explore this element to reduce our fall rates. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Courtney Huhn, Courtney Huhn, Sarah Lueger Source Type: research

Preventing Loss of Independence Through Exercise (PLI É): A Novel Program to Improve Care of Older Veterans in Long-Term Care
At San Francisco Veterans Affairs Health Care System (SFVA) Community Living Center (CLC), most veterans have dementia plus co-occurring mental illness. Many demonstrate distressed behavior that interferes with care. CLC restorative care and mental health staff identified the need to improve engagement of veterans with dementia or behavioral challenges, and improve care partner training. Along with researchers at SFVA, they implemented PLI É, a novel integrative group exercise program for people with dementia. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Maria I. Lee, Lynn Y. Martin, Maria I. Lee, Alirameen Akram, Jennifer Lee, Francesca Nicosia, Deborah Barnes Source Type: research

Reducing End-of-Life Hospitalizations in Long-Term Care: A Team-Based Approach
An increasing number of older adults are spending their end of life in the nursing home, and many are being hospitalized in the last few months of life. This is often unwanted by patients and their families. We hypothesize that identifying patients who are reaching the end of life in the nursing home and having effective communications about their goals of care would lead to care that better aligns with patients ’ preferences. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Mariko K. Wong, Mariko K. Wong Source Type: research

Reporting and Reducing Clostridioides Difficile in Nursing Homes
Clostridioides difficile (C. difficile) definition: “a germ (bacteria) that causes life-threatening diarrhea. It is usually a side-effect of taking antibiotics.” According to the Centers for Disease Control and Prevention (CDC) 2015 report, over 100,000 C. difficile infections (CDI) occur in the U.S. nursing home population yearly. Approximately 29,000 patients died 30 days post-diagnosis of CDI with about 15,000 deaths being directly attributable to CDI; over 80% of mortalities related to CDI happen in residents aged 65 and above. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Lili Deng, Geralann Shields, Lili Deng, Elizabeth Waldman, Dianne McCagg, Julie Banister Source Type: research

Resident and Family Perspectives on Communal Dining in the Nursing Home
Nursing home (NH) residents are at increased risk for malnutrition compared to community-dwelling older adults. Poor nutrition is associated with depression, functional decline, and higher 1-year mortality. Communal dining environments create a social dining atmosphere that increases the amount of food being consumed. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Alexandra Lee, Alexandra Lee, Andrew Mrugala, Kristin Hlebowitsh, Annetta C. San Diego, Milta O. Little, Liza Genao, Gwendolen Buhr Source Type: research

Social Support: Do Familial Interactions and Technology Impact the Social Support of Senior Residents in Assisted Living and Long-Term Care Facilities?
It is critically important to ensure quality care and social support for older adults within long-term care (LTC) and assisted living (AL) facilities. Studies have demonstrated that a higher frequency of visits by family improves the psychosocial status and well-being of residents. Of the limited studies on familial relationships with LTC and AL residents, even fewer studies address the role of modern communication methods. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Jared Mazurek, Jared Mazurek, Jessica L. Kalender-Rich, Jo A. Wick Source Type: research

Survey Readiness for Community Living Centers (CLCs): An Interdisciplinary, Proactive, Modernized Approach.
VA CLCs are surveyed per Centers for Medicare and Medicaid Services (CMS) regulations by the Long-Term Care Institute (LTCI). With the accreditation focus being primarily on The Joint Commission survey process, we found that many at our facility were unfamiliar with the LTCI survey process. In addition, at the start of fiscal year (FY) 18, LTCI took over responsibility for surveying of Life Safety Code regulations for the CLCs in conjunction with the clinical survey. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Courtney Huhn, Courtney Huhn, Sarah Lueger Source Type: research

Telemedicine Post-Surgical Visits for Patients in Post-Acute Settings
Many patients are discharged to post-acute care facilities (PACFs) following surgery. These patients have either had major surgery and require close monitoring and intensive rehabilitation, or have significant medical co-morbidities. Currently they are transported, sometimes at considerable cost, to the surgeon ’s office for post-surgery visits (PSVs). These trips can be painful and uncomfortable. A staff member from the PACF may need to accompany the patient. During PSVs surgeons observe the patient's incision(s), and assess potential complications following surgery, pain, and functional recovery. (Source: Journal o...
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Patrick Coll, Patrick Coll, Rachel Rusnak Source Type: research

The Effects of Therapy Dog Visits on Mood and Well-Being in Nursing Home Residents.
There has been a growing emphasis towards emotional well-being in the care of older adults. This is especially important with regards to residents in a nursing home, where they can often feel marginalized or depressed. The aim of this study is to evaluate the effectiveness of pet-therapy in improving the mood and well-being in this subset of the population. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Ravneet Sandhu, Ravneet Sandhu, Aaiza Aamer, Ilia Bernstein, Anita Chandra, John Naumovski Source Type: research

The Use of Antipsychotic Medications in Veterans in a Veterans Affairs (VA) Community Living Center (CLC)-Based Hospice Unit.
Symptoms of delirium are common in the post-acute care setting, particularly in patients who have dementia or are approaching the end of life. When behavioral measures fail to adequately manage symptoms, there are few alternative options. Antipsychotic medications have long been the mainstay of pharmacologic treatment for delirium, despite a paucity of evidence for efficacy and newer data suggestive of possible harms. Moreover, the use of a new antipsychotic medication in veterans admitted to a short-term rehabilitation center is seen as potentially inappropriate and negatively affects the CMS/Medicare Quality Indicator (Q...
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Emily Fessler, Emily Fessler, Mary T. Hofmann, Oludamilola Ogunnubi, Marcia A. Francis, Deborah Way, Debra Adrian, Erin Haley Source Type: research

Uncovering Errors in Transitions from Hospital to Nursing Home: A Video Telehealth Transitions Conference
Transitions across healthcare settings lead to unintentional errors, rehospitalizations, and mortality, and a key reason is poor communication between care settings. We developed a weekly telehealth videoconference to facilitate a virtual care conference meeting between hospital-based and skilled nursing facility (SNF) provider teams to optimize error-prone transitions. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Elspeth Clark, Elspeth Clark, Aubrey D. Jolly Graham, Julia Bellantoni, Heidi White, Juliessa Pavon Source Type: research

Understanding the Interdisciplinary Care Meeting from a Long-Term Care Resident ’s Standpoint
Interdisciplinary (ID) care plan meetings are a key component of nursing home care in 2019. Initially established as a didactic technique for teaching graduate nurses in the 1930s, the care plan has gone through many iterations to make it what it is today. Today, as part of CMS regulations, each long-term care (LTC) facility must “develop and implement a baseline care plan for each resident” and “…each resident has the right to participate in choosing treatment options and must be given the opportunity to participate in the development, review and revision of his/her care plan.” Based upon ou...
Source: Journal of the American Medical Directors Association - February 27, 2020 Category: Health Management Authors: Chitra K. Hamilton, Chitra K. Hamilton, Mariah Roberston, Michele F. Bellantoni, Alicia Arbaje, Fatima Sheikh Source Type: research