8 Tips to Avoid Being Sued in the Nursing Home: Attorneys Offer Expert Insight on Improving Care and Avoiding Lawsuits
LOS ANGELES — Don’t feel like you have to provide perfect care, but do make sure you’re responsible and responsive. And always — always! — be honest, even when you think you’re in trouble. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Authors: Randy Dotinga Source Type: news

10 Years of INTERACT: The Push for Better SNF Care
Ten years ago, Joseph G. Ouslander, MD, a geriatrician at Florida Atlantic University (FAU), published the findings of a pilot project that tested tools and strategies to help nursing home staff reduce potentially avoidable hospitalizations. The six-month quality improvement project in Georgia led to a 50% reduction in overall hospitalizations in three nursing homes selected based on their high hospitalization rates (J Am Med Dir Assn 2009;10:644 –652). (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Authors: Christine Kilgore Source Type: news

Non-Motor Symptoms of Parkinson ’s Disease Are More Common Than Most Think
Non-motor symptoms — and fluctuations in these symptoms — are a surprisingly common and often disabling part of life for residents with Parkinson’s disease (PD), said Julie Gammack, MD, CMD, at the annual conference of AMDA — The Society for Post-Acute and Long-Term Care Medicine in Atlanta, GA. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Authors: Christine Kilgore Source Type: news

Sleep Apnea: Problems and Solutions
Sleep-disordered breathing is a common but underrecognized problem in the post-acute and long-term care (PALTC) setting, with an estimated prevalence of 25% to 50%. It ’s also common in patients with congestive heart failure (CHF) — with either reduced or preserved ejection fraction — and it worsens with both CHF exacerbation and the progression of CHF severity. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Authors: Christine Kilgore Source Type: news

An Ode to the PALTC Clinician
We recently celebrated two days that are near and dear to my heart, but not to as many others as I would hope: the National Day of Recognition for Long-Term Care Physicians and Doctors ’ Day. The initial intent of this piece was to seek your continuing support for the Foundation for PALTC Medicine. However, in the spirit of these two “holidays,” I feel the need not to ask you for anything, but to give to you today. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Authors: James E. Lett Source Type: news

It ’s Not What You Think: Questions to Ask at Discharge
“Back in the hospital again?! Impossible! I sent her home with information, handwritten instructions, and spoke to her for some time regarding how to take her medications and follow up. She smiled when I asked if she understood everything and said, ‘Yes!’ After all that, she did not take her m eds as directed or return to the office as scheduled. I just don’t know how to overcome noncompliant patients!” (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Authors: James E. Lett Tags: Caring Transitions Source Type: news

Developing an Appetite
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr Jeff Source Type: news

Insomnia and Alcohol Use in Assisted Living
Mrs. G is an 80-year-old white female who has lived in assisted living for several years. She scores 24 on the Saint Louis University Mental Survey (SLUMS), indicating that she has some mild cognitive impairment, and she is independent with bathing and dressing, although she needs encouragement to shower and to change clothes regularly. She is often anxious, as exhibited by her repeated requests for help in the evenings, and she has made multiple complaints of vague pain, shortness of breath, and difficulty sleeping. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Authors: Barbara Resnick, Paige Hector Tags: Interdisciplinary Teams Source Type: news

Don ’t Miss These Events
Website: https://paltc.org/webinars (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Source Type: news

Journal Highlights From the June/July Issue of JAMDA
Increasing numbers of patients are referred to skilled nursing facilities, or SNFs, following discharge from the hospital. A new model, however, can help predict as early as the day of admission which patients are likely to require discharge to a SNF, according to a retrospective cohort study. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Tags: Journal Highlights Source Type: news

News From the Society
The Patient Driven Payment Model (PDPM) will take effect on October 1, 2019. This not only represents a major change in how skilled nursing facilities are reimbursed; it also will significantly impact the dynamic between clinicians and the facilities they serve. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Source Type: news

Out With The Old, In With The New
July is almost here, the month that begins the medical year. July 1 is the day the new interns start their rotations at the hospital, perhaps not the best time to be in the hospital if you can avoid it. It ’s also the day my mother died in a local (Carlsbad, CA) nursing facility 10 years ago, after a remarkable, agonizing, exquisite 17 days with no food or fluids where my three adult siblings, other loved ones and I shared the bedside vigil and many fond reminiscences for much longer than we’d ant icipated. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Authors: Karl Steinberg Tags: On My Mind Source Type: news

A Multidisciplinary Approach to Fall Reduction in a Skilled Nursing Facility Wins the Howard Guterman Best Poster Award
The Howard Guterman Best Poster Award was presented at the 2019 annual conference of AMDA — The Society for Post-Acute and Long-Term Care Medicine to a research team led by Tiffany Rose, NP. At the conference, Ms. Rose, a nurse practitioner from Wake Forest University Baptist Medical Center in Winston-Salem, NC, presented a poster titled, “Fall Reduction Program in a Skilled Nursing Facility: A Multidisciplinary Approach.” (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Authors: Anna Boyum Source Type: news

Year in Review: Applying Top Research to the Practice of PALTC Medicine
The Year in Review keynote address during the opening general session of the annual conference of AMDA — The Society for Post-Acute and Long-Term Care Medicine stood out as a source of clinical insight applicable across a broad range of conditions managed by post-acute and long-term care (PALTC) practitioners. The address covered 10 recently published studies selected as controversial or able to af fect the direction of future research and clinical practice. Each of the three presenters covered several studies, asking specific clinical questions to help the audience put the data in the PALTC context. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Authors: Anna Boyum Source Type: news

Telehealth Advances Provide Innovative Solutions to Complex Resident, Facility Needs
The pressure has been mounting for skilled nursing facilities to prevent avoidable hospitalizations, and a statistic from the Centers for Medicare& Medicaid Services (CMS) explains why. According to CMS, among Medicare-Medicaid enrollees in long-term care facilities, 45% of hospital admissions could have been avoided. And these hospitalizations, in addition to increasing expenditures for CMS and SNFs, can have dire consequences for residents. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Authors: Brian Ellis Source Type: news

Deprescribing: A Systematic Approach to Downsizing Your Drug Regimen
Daniel Haimowitz, MD, FACP, CMD, a Pennsylvania-based multifacility medical director, talks about deprescribing done right. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Tags: Caring Source Type: news

The Journey to Deprescribing Isn ’t Always a Smooth Road
“This is important to me and to many geriatricians: the point of deprescribing is that we can do something,” said Daniel Haimowitz, MD, FACP, CMD, who spoke on this topic at the live AMDA On-The-Go podcast at the annual conference of AMDA — The Society for Post-Acute and Long-Term Care Medicin e. He noted that when people fall prey to polypharmacy in the community, “we can do good things for them when they come to our care. We can improve their quality of life.” (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Authors: Joanne Kaldy Source Type: news

Grade School Genie Makes Wishes Come True for Nursing Home Residents
At first glance, Ruby Kate Chitsey may seem like your average 11-year-old girl. She goes to school, spends time with her family, and plays with her pets. But this fifth grader has raised more than $100,000 to touch the lives — and hearts — of nursing home residents in her state and beyond. She is anything but average. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Authors: Joanne Kaldy Source Type: news

From Sleeplessness to Slumber: Person-Centered Approach to Insomnia
Speaking at a session during the AMDA - The Society for Post-Acute and Long-Term Care Medicine ’s annual conference, “Sleeplessness in the Nursing Home,” Ariel Cole, MD, FAAFP, CMD, admitted that she doesn’t always feel completely effective at managing sleep. “My name is on some [pill] bottles; that causes my chagrin,” she said. But she added that a patient’s first day in the nu rsing home is not the time to take that person off the sleep medication he or she has been taking for years. Ultimately, she suggested, addressing sleep problems in residents is not about “absolutes,&...
Source: Caring for the Ages - June 1, 2019 Category: Health Management Authors: Joanne Kaldy Source Type: news

In This Issue
Caring ’s long-time editor-in-chief shares his parting thoughts as the magazine enters a new phase. 2 (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Source Type: news

Meet New Society President Arif Nazir
Arif Nazir, MD, CMD, chief medical officer for Signature HealthCARE, is the Society ’s president for 2019-2020. Dr. Nazir shared his thoughts and insights on his new role in an exclusive video available online at https://paltc.org/publications/meet-society%E2%80%99s-new-president. Here are some excerpts of the Q&A with Dr. Nazir: (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Source Type: news

Unlock Your Leadership Potential
For the past 16 years, the California Association of Long Term Care Medicine (CALTCM) has been offering practitioners from all over the country the chance to spend time in an intensive and highly interactive setting with leaders in the field of geriatric medical management. Now it ’s your turn to take advantage of this unique opportunity to become a sought-after candidate for leadership positions by participating in the 17th annual Leadership& Management in Geriatrics (LMG) conference, August 2-3 in Carlsbad, CA. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2019 Category: Health Management Source Type: news

PALTC Practitioners Step Up to Address Opioid Crisis
The United States is in the throes of an opioid crisis. Since 1999, deaths from prescription opioids have more than quadrupled. National organizations such as the Centers for Medicare& Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) are taking action and partnering with post-acute and long-term care practitioners to address the opioid crisis throughout the care continuum. (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Authors: Joanne Kaldy Source Type: news

Person-Centered Care: Are We Really Doing It?
Jim Collins makes the case that “good” is the enemy of “great” in his book Good to Great (New York: Random House Business, 2001). Similarly, in looking at the progress that has been made in bringing person-centered practices to elder care and in changing the culture of aging, I would like to propose that “We’re doing i t” is the enemy of actually “doing it.” (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Authors: Joan Devine Tags: Partner Perspective Source Type: news

Bigger Patients, Bigger Challenges: For Patients of Size, Proper Care Can Be Elusive
When you ’re big, numbers matter. Like the 76 inches of my 83-year-old father’s height versus the 80-inch length of a standard hospital bed. We became well acquainted with these numbers after my dad fell 2 years ago and entered a long cycle of stays at more than half a dozen hospitals and nursing facilit ies. (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Authors: Randy Dotinga Source Type: news

Identifying Malnutrition in PALTC Communities
The risk of protein-energy malnutrition is a concern in older adults admitted to post-acute and long-term care communities. A study using the Mini Nutritional Assessment found that malnutrition was present in approximately 50% of post-acute care admissions and an additional 41% were found to be at risk for malnutrition. In long-term care communities, about 14% of the residents were noted to be malnourished with an additional 53% at risk of malnutrition. (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Authors: Phyllis Famularo Tags: Board Room Source Type: news

State of the Society: A Solid Foundation, A Bright Future
In presenting her “State of the Society” report at the annual conference of AMDA — The Society for Post-Acute and Long-Term Care Medicine in March, outgoing president Cari Levy, MD, PhD, CMD, started with a comment that likely resonated strongly with her audience. She said, “When I came to AMDA in 2002, I fel t as if I had found my people, my family.” She went on to share the organization’s plans for the future and its efforts to support, nurture, promote, celebrate, and care for this “family” and the important work they do. (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Authors: Joanne Kaldy Tags: 2019 Conference Highlights Source Type: news

Meet the 2019 –2020 Society Board
Strong leadership is essential to move organizations forward. AMDA — The Society for Post-Acute and Long-Term Care Medicine’s 2019-2020 Board of Directors features many visionaries and experts who have a track record of embracing challenges and welcoming innovation. Meet the two newest members, who were elected at the annual conference in Atlanta, GA. (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Authors: Joanne Kaldy Source Type: news

Podcast: The State of Geriatric Medicine Education
The AMDA On-The-Go podcast took to the road in March and headed to Atlanta, GA, for the annual conference of AMDA — The Society for Post-Acute and Long-Term Care Medicine. Host Wayne Saltsman, MD, PhD, CMD, went live before an engaged, excited audience who had a chance to see behind the curtain on the planning and technology that goes into this program that has resulted in more than 17,000 downloads to date. “I love doing this. It gives me great joy,” Dr. Saltsman told Caring. “This was our 30th podcast, and I’m learning things all of the time. (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Authors: Joanne Kaldy Source Type: news

PALTC Sees Flurry of Legislative and Regulatory Action, but Questions Remain
“Congress has been quite busy,” said Alex Bardakh, MPP, director of public policy and advocacy for AMDA — The Society for Post-Acute and Long-Term Care (PALTC) Medicine, at the start of the annual conference program on “Top Policy Issues in 2019.” And clearly when Congress is busy, so is t he Society. (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Authors: Joanne Kaldy Source Type: news

Time ’s Up Healthcare Sets a Wake-Up Call
“I’ve worked since I was 15, and I’ve experienced harassment. I knew something was wrong, but there wasn’t a name for it, and people didn’t talk about things like that,” said Tiffany Love, PhD, FACHE, GNP, ANP-BC, regional chief nursing officer at Coastal Healthcare Alliance in Rockport, ME. For years, many women had similar experiences. They were victims of sexual harassment or discrimination, but they suffered in silence. Sometimes they confided in someone, only to feel shamed or dismissed. Although women make up over 80% of the health care workforce, there are still many instanc es of...
Source: Caring for the Ages - April 27, 2019 Category: Health Management Authors: Joanne Kaldy Source Type: news

SNF Medical Directors and Clinicians in PDPM Have Vital Role
On October 1, 2019, the Patient Driven Payment Model (PDPM) will change how skilled nursing facilities (SNFs) are reimbursed for post-acute care provided to Medicare A recipients. The major change from the existing Resource Utilization Group (RUG IV) system is the shift in focus from therapy to patients ’ clinical characteristics and services rendered. This is a natural transition because the role of SNFs has evolved over time, from rehabilitation to subacute care for medically complex patients. PDPM separates therapy and nursing as distinct payment drivers and further distinguishes physical ther apy, occupational th...
Source: Caring for the Ages - April 27, 2019 Category: Health Management Authors: Rajeev Kumar Tags: Guest Editorial Source Type: news

New Influenza Drug Brings New Promise
Currently the Centers for Disease Control and Prevention (CDC)recommend that everyone 6 months of age and older receive a flu vaccine every season. Because the influenza virus replicates and mutates frequently, the vaccine often does not contain all the strains that people are infected with. (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Authors: Jeanne Manzi Tags: PALTC Pharmacy Source Type: news

Becoming Informed About Trauma
Dear Dr. Jeff: In preparing for the phase 3 federal requirements that will become effective soon, our facility has been confused regarding a new requirement to provide culturally competent “trauma-informed” care. We don’t understand where CMS is coming from, what is expected of us, what exactly is new about this, or how we can demonstrate compliance. Can you help? (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr Jeff Source Type: news

Journal Highlights From the May Issue of JAMDA
Clinicians should be able to offer appropriate assessment and treatment for individuals who have orthostatic syncope (OS), even those individuals with advanced age and cognitive impairment, researchers from Italy wrote in an editorial in the May issue of JAMDA. Even so, more knowledge is needed. (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Tags: Journal Highlights Source Type: news

Don ’t Miss These Events
Website: https://paltc.org/core (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Source Type: news

Caring, In Your Own Words: Call for Stories
As editors of Caring for the Ages, we often hear from the readers that opinions, news, and advice from their colleagues in post-acute and long-term care (PALTC) is what they value the most in our publication. As we pursue our vision of Caring as the platform for PALTC practitioners to not only read industry news but also connect and share ideas to advance our field, we invite you to lend your voice to Caring by submitting a story on the topic of your choice. (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Source Type: news

In This Issue
Adapting to the radical redesign in payment process will require excellence in collaboration from everyone working in a SNF. 3 (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Source Type: news

News From the Society
The Society ’s House of Delegates (HoD) tackled a full agenda at its meeting during the organization’s recent annual conference in Atlanta, GA. The group reviewed a number of items and passed the following: (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Source Type: news

Comment on: New Influenza Drug Brings New Promise
For the treatment of influenza, a full course of therapy ranges in price and is approximately the following, based on recent www.goodrx.com pricing (as of April 5, 2019). When comparing the prices of these agents, note that they will vary depending on dosage form, age, weight, renal function, and other factors for the patient. (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Authors: Karl Steinberg Source Type: news

How to Go From Wide Awake to Sweet Dreams
Caring for the Ages editor-in-chief Karl Steinberg, MD, CMD, HMDC, talks about insomnia — how to prevent it and how to address it. (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Tags: Caring Source Type: news

PALTC, The Specialty That Dare Not Speak Its Name
Back in the early 1990s, not long after I hired on full-time with what was then Mission Park Medical Group in Oceanside, CA, I began doing utilization review for our group. We had a lot of Medicare Advantage patients — or “senior managed care lives” as the bean counters would refer to them — and we were trying to figure out ways to improve their care while also lowering costs. Our group was paid on a capitated basis, regardless of how extensive (or expensive) the services these patients received were. (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Authors: Karl Steinberg Tags: On My Mind Source Type: news

The Geriatrician and The Singularity
It seems as if everywhere one looks today, one is confronted with the concept of “The Singularity.” I first heard the term in 2005 when I was asked to review Ray Kurzweil’s book, The Singularity Is Near: When Humans Transcend Biology (New York: Penguin). At the time, the mantra of ‘smaller, faster, cheaper’ was on the lips of every high-tech aspirant. Mr. Kurzweil, one of the latter, took hundreds of complementary therapies per day to “reprogram” his body chemistry to live long enough to reach The Singularity. (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Authors: Jerald Winakur Tags: Meditations on Geriatric Medicine Source Type: news

All photos by Robb Cohen Photography & Video
(Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Source Type: news

‘Attend’ the Annual Conference Year-Round
Education sessions at the annual conference are recorded and synchronized with the audio and presentation PowerPoint handouts and are available for purchase. So, if you missed the meeting, you can still “attend” and receive CME/CMD credits. (Source: Caring for the Ages)
Source: Caring for the Ages - April 27, 2019 Category: Health Management Source Type: news

JAMDA 2019 Morley Award Recognizes Research That Changes Lives, Policy
A new award that recognizes especially impactful research in post-acute and long-term care goes to an Australian clinician-scientist who has dedicated her career to inspiring seniors living in rural elder communities to transform their lives through exercise. (Source: Caring for the Ages)
Source: Caring for the Ages - April 1, 2019 Category: Health Management Authors: Anna Boyum Source Type: news

From Cheers to Complications: Is It Okay for Older People to Have a Drink?
Michael Fingerhood, MD, FACP, associate professor of medicine and public health at Johns Hopkins University, talks about older adults and alcohol consumption. (Source: Caring for the Ages)
Source: Caring for the Ages - April 1, 2019 Category: Health Management Tags: Caring Source Type: news

Stopping Eating and Drinking by Advance Directives: Choose Your Injustice
Jim, I have a hypothetical case for you. One of my residents with dementia, let ’s call him Bill, has an advance directive stating that when he no longer has meaningful social interaction, his caregivers should stop giving him food or water. He is now mostly mute, though rarely he may say a word or two. He still eats reasonably well and seems to enjoy mealtimes, occasionally saying “That’s good” when eating ice cream. His agent with POAHC [power of attorney for health care] is his wife, Alice, who also has advanced dementia and can no longer function as his decision-maker but is more verbal than Bil...
Source: Caring for the Ages - April 1, 2019 Category: Health Management Authors: Peter Jaggard, James Wright Tags: Medical Ethics Source Type: news

National Healthcare Decisions Day Promotes Year-Round Conversations
“It’s a good day to plan projects and activities around advance care planning and end-of-life conversations, which can be awkward and stressful,” said Charles Crecelius, MD, PhD, CMD, medical director of Delmar Gardens in St. Louis, MO, about National Healthcare Decisions Day (NHDD), set for A pril 16. “Having a special day for this can take the stigma out of these discussions and enable open, honest, and ultimately productive discourse,” he added. (Source: Caring for the Ages)
Source: Caring for the Ages - April 1, 2019 Category: Health Management Authors: Joanne Kaldy Source Type: news

Serving Selflessly Gives Residents ’ Lives Meaning
Are we seeing the disability or the potential? Residents with challenges such as Alzheimer ’s disease, stroke, Parkinson’s disease, multiple sclerosis, or vision impairment prepare meals and feed the homeless throughout California. (Source: Caring for the Ages)
Source: Caring for the Ages - April 1, 2019 Category: Health Management Authors: Matthew Lysobey Tags: Innovations in PALTC Source Type: news