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Caring Is Purpose in Life for 2018 Medical Director of the Year
Eric Hasemeier, DO, CMD, is one of those rare individuals who from an early age has sought after his purpose in life. He always felt an obligation to help others and to make a difference in people ’s lives. (Source: Caring for the Ages)
Source: Caring for the Ages - March 29, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

Society Weighs in on Proposed Budget
The Trump administration recently released its fiscal year (FY) 2019 budget. The budget signifies the Administration ’s priorities and can set the stage for future policymaking by Congress. Congress’ process for federal spending for FY 2019, which begins on Oct. 1, 2018, would normally include a budget resolution to set topline spending numbers, but that is not expected to occur this year. Instead, the biparti san budget deal that was recently reached will set the topline numbers for the Appropriations Committees to work from as they craft the appropriations bills. (Source: Caring for the Ages)
Source: Caring for the Ages - March 29, 2018 Category: Health Management Source Type: news

When Hugging You Is Bugging You
Not long ago, I attended a professional meeting with a predominantly physician attendee list. I was a little surprised to see a colleague — a well-respected palliative care doctor — sporting a large “No Hugs” button, which I’d never seen before. (Source: Caring for the Ages)
Source: Caring for the Ages - March 29, 2018 Category: Health Management Authors: Karl Steinberg Tags: on my mind Source Type: news

US Physicians Susceptible to Emotional Exhaustion in PA/LTC
Physician burnout has been well documented overall, but how do physicians who work in the post-acute and long-term care settings fare? (Source: Caring for the Ages)
Source: Caring for the Ages - March 29, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

Living and Practicing With Uncertainty
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - March 29, 2018 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

ED Visits on the Rise for People With Dementia
Emergency department (ED) visits in the last year of life for people with dementia are common and increasing in the United Kingdom, according to a retrospective cohort study linking clinical and administrative data. (Source: Caring for the Ages)
Source: Caring for the Ages - March 29, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

Study: Diabetes Monitoring Falls Short in Individuals With Alzheimer ’s Disease and Related Syndromes
Individuals with Alzheimer ’s disease and related syndromes (ADRS) were significantly less likely to receive basic diabetes monitoring — and were more likely to experience diabetes complications — than those without ADRS in a longitudinal observational study in France. (Source: Caring for the Ages)
Source: Caring for the Ages - March 29, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

Statins in PA/LTC Patients With Diabetes: Is This Quality?
SUPD? Have you heard this acronym before but have no idea what it stands for? Is it short for What ’S UP Doc? Or a short-order cook’s abbreviation for Soup of the Day? In the Medicare world, SUPD stands for Statin Use in Persons with Diabetes. It is a quality measure that relates to cardiovascular disease and was endorsed by the Pharmacy Quality Alliance (PQA) in 2014. This measure evaluates the percentage of patients who were dispensed a medication to treat diabetes and who also received a statin medication. (Source: Caring for the Ages)
Source: Caring for the Ages - March 29, 2018 Category: Health Management Authors: Jeanne Manzi Tags: LTC Pharmacy Source Type: news

Clinician Turns Nursing Home Life Into Music
I hope that you will get to know just what it ’s like (Source: Caring for the Ages)
Source: Caring for the Ages - March 29, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

Strength in Numbers? Ins and Outs, Pros and Cons of Virtual Groups
While the Merit-based Incentive Payment System (MIPS) creates questions and headaches for practitioners, its evolution continues. Virtual Group (VG) reporting is a new option for solo/small practices to use, and the Centers for Medicare& Medicaid Services continues to make changes as the feedback, concerns, and recommendations pour in from various audiences. (Source: Caring for the Ages)
Source: Caring for the Ages - March 29, 2018 Category: Health Management Authors: Rod Baird Tags: Practice Management Source Type: news

Make the Payer a Player on the Transition Team
In today ’s complex world of medicine, patient care has evolved from being the sole responsibility of the physician and members of the interdisciplinary team to now including the “payer” — the insurance provider. The payer has become a driver of improved outcomes: setting benchmarks, creating provide r objectives for higher quality care, and reducing total medical expenditures. At a recent AMDA – the Society for Post-Acute and Long-Term Care Medicine Transitions of Care meeting, the subcommittee discussed whether the payer also influenced a patient’s transition to the skilled nursing fac...
Source: Caring for the Ages - March 29, 2018 Category: Health Management Authors: Damien Doyle Tags: caring transitions Source Type: news

Lawsuit Challenges Mandatory Flu Shot
A county-run nursing home has been sued by the federal government alleging employment discrimination after a certified nursing assistant (CNA) claimed she had been forced to receive a  flu vaccination over her religious objections. (Source: Caring for the Ages)
Source: Caring for the Ages - March 29, 2018 Category: Health Management Source Type: news

How CMS Helped a Telemedicine Company Get Its Footing
Potentially avoidable hospitalizations are defined by the Centers for Medicare& Medicaid Services as hospitalizations that could have been avoided because the condition could have been prevented or treated outside of an inpatient hospital setting. Approximately 25% of all hospitalizations are considered potentially avoidable; nearly half of these come from nursing facilities, and they cost CMS approximately $8 billion annually. (Source: Caring for the Ages)
Source: Caring for the Ages - March 29, 2018 Category: Health Management Authors: Steven M. Handler Tags: Innovations in PA/LTC Source Type: news

Red Flags Suggest the Blues May Be More Than a Gray Mood
David Smith, MD, CMD, talks about how to identify mental illness in older adults and how to get them the right treatment right away. (Source: Caring for the Ages)
Source: Caring for the Ages - March 29, 2018 Category: Health Management Tags: Caring Source Type: news

Journal Highlights From the April Issue of JAMDA
Frailty research has come a long way, yet many challenges remain for investigators, clinicians and policymakers, Philip D. Sloane MD, MPH and Matteo Cesari MD, PhD, say in an editorial in this month ’s JAMDA. (Source: Caring for the Ages)
Source: Caring for the Ages - March 29, 2018 Category: Health Management Source Type: news

News From the Society
Physicians need practice management professionals as partners who understand the business of medicine, the relationship between the practice of medicine and profitability, how to document, track, and analyze data, and how to free their practitioners to do what they do best — care for their patients. To help practitioners survive and even thrive in the new world of value-based medicine, quality improvement, and partnerships across settings, the Society established a Practice Group Network (PGN), and it isn’t too late to be a part of this important initiative. (Source: Caring for the Ages)
Source: Caring for the Ages - March 29, 2018 Category: Health Management Source Type: news

Alternative Payment Models Evolving but Still Elusive in Post-Acute and Long-Term Care
As the health care payment landscape continues to shift dramatically at a rapid pace, leaders at AMDA – the Society for Post-Acute and Long-Term Care Medicine have worked hard to ensure that post-acute and long-term care is at the forefront of achieving the so-called triple aim. By now, everyone is probably familiar with the goal to shift from fee-for-service to a more value-driven model. This rap id move toward value-based care has not slowed with the new administration, and there is no indication it will. (Source: Caring for the Ages)
Source: Caring for the Ages - March 1, 2018 Category: Health Management Authors: Alex Bardakh Source Type: news

Pride of Recognition Continues for Top Docs
While AMDA — the Society for Post-Acute and Long-Term Care Medicine has represented the nursing home medical director since the 1970s, the role of a facility’s medical directors has historically been a better kept secret than Superman’s alter ego. If you asked a resident or family member to name the medi cal director, you might get a blank stare as an answer. So in 2006, the Society established the Medical Director of the Year Award to help showcase the medical director as the PA/LTC facility’s clinical leader and recognize outstanding physicians who are innovative, visionary, and set high standar d...
Source: Caring for the Ages - March 1, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

An Alarming Trend
Alarms have gotten much more attention in the last few years as a patient safety intervention, and they seem to have far more opponents than proponents. I ’m not talking about alarms that alert an intensive care unit nurse of a critically low oxygen saturation or dangerous arrhythmia. I am referring to devices like bed alarms, tab alarms, pressure sensor pads, chair alarms, and the like. As a fall and injury reduction measure, alarms have essentiall y become the new equivalent of physical restraints or antipsychotics in the way they have been demonized. (Source: Caring for the Ages)
Source: Caring for the Ages - March 1, 2018 Category: Health Management Authors: Karl Steinberg Tags: on my mind Source Type: news

Creating a Home Space and a Safe Place
What does it take to give nursing home residents a true feeling of home? Dutch researchers have found that the architecture and interior design of a facility can have a profound impact — and in a new research article, they offer checklists and design guidance for creating this sense of home. (Source: Caring for the Ages)
Source: Caring for the Ages - March 1, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

Pilot Program Zeroes in on SNF Mental, Behavioral Health Care
The number of nursing home residents with either primary or comorbid substance use disorders (SUDs) is on the rise — while the average age upon admission is getting younger — according to a consultant tasked with training medical professionals and paraprofessionals to meet the needs of this growing demographic. (Source: Caring for the Ages)
Source: Caring for the Ages - March 1, 2018 Category: Health Management Authors: Whitney McKnight Source Type: news

Study: APRNs More Than Capable of Handling Medication Reviews
Advanced practice registered nurses (APRNs) who have a strong presence in nursing homes are uniquely positioned to conduct medication reviews for long-stay residents, according to a cross-sectional descriptive study conducted as part of the Missouri Quality Initiative (MOQI). (Source: Caring for the Ages)
Source: Caring for the Ages - March 1, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

RAISE Family Caregivers Act Signed Into Law
In a display of bipartisan support, Congress passed and President Trump signed the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act. (Source: Caring for the Ages)
Source: Caring for the Ages - March 1, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

Making Sense of Dementia Screening
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - March 1, 2018 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

All ’s Not Fine in the Nursing Home
Federal guidance issued to state survey agencies last summer is expected to reduce inconsistencies in the issuance of civil monetary penalties (CMPs) and to curb what the nursing home industry has decried as a growing and unreasonable use of retroactively applied per-diem fines. (Source: Caring for the Ages)
Source: Caring for the Ages - March 1, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

Culture Change: Pioneer Network Forges New Partnerships
My name is Penny Cook, and I am the new president and chief executive officer of Pioneer Network. Many of you know Pioneer Network as a leader in changing the culture of long-term care. Our 21-year-old organization began with a group of “pioneers” who wanted to transform nursing homes from historically institutional environments to real communities where people live full, enriching, and dignified lives. (Source: Caring for the Ages)
Source: Caring for the Ages - March 1, 2018 Category: Health Management Authors: Penny Cook Tags: Pioneer perspective Source Type: news

Inadequate Nurse ’s Notes Lead to Lawsuit
Mrs. H was a 71-year-old long-term resident of a skilled nursing facility. Her medical history was significant for severe malnutrition, pneumonia, urinary tract infection, and brittle diabetes mellitus. She was unable to ambulate and required assistance with multiple activities of daily living. She had a history of variable cognitive deficits and of refusing treatment and medications, including her insulin. Most of her 6-year residency was uneventful, with a handful of hospitalizations for shortness of breath and diabetic ketoacidosis. (Source: Caring for the Ages)
Source: Caring for the Ages - March 1, 2018 Category: Health Management Authors: William C. Wilson Tags: LEGAL ISSUES Source Type: news

A Call for Health Care for All
Unlike in other developed countries, health care is not an explicit legal right in the United States, nor is it guaranteed by our Constitution. But is it a moral right? What does our history tell us? Have our values as a nation changed? Will they change in the future? And what about those of us who work in health care? What is our obligation to those who cannot afford care? (Source: Caring for the Ages)
Source: Caring for the Ages - March 1, 2018 Category: Health Management Authors: Jonathan Evans Tags: Medical ethics Source Type: news

Getting Beyond Blaming Staff: A Facility Example
A telephone rings in a nursing home, far, far away: (Source: Caring for the Ages)
Source: Caring for the Ages - March 1, 2018 Category: Health Management Authors: Paige Hector Tags: board room Source Type: news

Atrial Fibrillation: A Common Irregularity with Effective Solutions
Caring for the Ages Editor in Chief Karl Steinberg, MD, CMD, HMDC, talks about atrial fibrillation and how this condition can be managed successfully. (Source: Caring for the Ages)
Source: Caring for the Ages - March 1, 2018 Category: Health Management Tags: Caring Source Type: news

Journal Highlights From the March Issue of JAMDA
Individuals who take antipsychotic or antidepressant medications or benzodiazepines have a higher risk of falls, according to a systemic review and meta-analysis by researchers in Amsterdam, the Netherlands. (Source: Caring for the Ages)
Source: Caring for the Ages - March 1, 2018 Category: Health Management Source Type: news

News From the Society
The Society ’s 2018 Medical Director of the Year will be named at the Annual Conference in Grapevine, TX, this month. This prestigious award, established in 2007, recognizes individuals whose vision, passion, leadership, knowledge, and commitment take patient care in the facilities they serve as medical direc tors to exceptional levels of quality, excellence, and innovation. Each year, facility staff and their team leaders identify and nominate experienced medical directors who are certified medical directors, Society members in good standing, proven team and clinical leaders, effective communicators, an d involved i...
Source: Caring for the Ages - March 1, 2018 Category: Health Management Source Type: news

New Survey Process Features Retooled Regulations, F-Tags
The new federal Long-Term Care Survey Process began Nov. 28, 2017, with a main objective of ensuring residents ’ needs are met, they are kept safe, and they can attain or maintain their highest possible level of well-being. It is designed to address the lessons learned from traditional and quality indicator survey (QIS) processes, including best practices and opportunities for improvement, quality of life/ care issues, and hot-button topics such as antibiotic stewardship. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

Easing Regulations May Do More Good Than Harm
As with so many things I see on the internet, and in traditional media these days, I am ambivalent about reports that there will be less regulatory enforcement in nursing homes in the next year or so under our current administration. Don ’t get me wrong: I am a big proponent of appropriate scrutiny of our facilities, and I strongly believe the facilities that behave badly should be held accountable. There’s no doubt in my mind that some kind of process to monitor (and ideally to improve) the care given to the vulnerable resident s of our facilities is necessary. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2018 Category: Health Management Authors: Karl Steinberg Tags: on my mind Source Type: news

Feeding in Dementia: There ’s a Better Way
For many providers of nursing care in the elderly, the mandate for feeding patients with dementia is a simple one: Get food in them. If you run into a problem, figure it out. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2018 Category: Health Management Authors: Randy Dotinga Source Type: news

Meet the New Boss … Same as the Old Boss?
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2018 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

Recipients, Staff Provide Insights on Person-Centered Care
New data have been published detailing person-centered care from the perspectives of recipients and staff, shining a light on the role and impact of preference and choice. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

Dysphagia and Pneumonia Linked, but Don ’t Always Go Hand in Hand
Nurses and other health care providers should focus more attention on dysphagia as a risk factor for nursing home-acquired pneumonia (NHAP), researchers reported in a recent issue of Geriatric Nursing. However, some experts recommend that practitioners focus on more global means of managing NHAP risk factors. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

Reflections on the Transition Home: The SNF Discharge Summary
You say you ’re sending discharge summaries, but we never receive them. Nursing homes don’t do discharge summaries, do they? These common concerns from community primary care physicians (PCPs) have been difficult for me to answer as a post-acute and long-term care physician. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2018 Category: Health Management Authors: Wayne Saltsman Tags: caring transitions Source Type: news

Excess Body Weight Reduces Risk for Mortality in Nursing Home Residents
Nursing home residents who were obese or overweight demonstrated a reduced risk for mortality when compared with those who were normal weight, according to findings from a database of facilities in Europe and Israel. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

Human Voices Wake Us, Part I
First Do (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2018 Category: Health Management Authors: Jerald Winakur Tags: Meditations on geriatric medicine Source Type: news

Quality Counts, but How Do We Really Measure It?
The Merit-based Incentive Payment System (MIPS) program is highly technical, making it difficult for community-based medical groups and most practitioners to understand. Incorporating an intelligent MIPS strategy into a post-acute/long-term care setting is significantly more difficult. Trying to take the technical details of MIPS and discuss them in a way that everyone can understand is a challenge — like trying to translate a thousand-year-old book from ancient Greek into modern English. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2018 Category: Health Management Authors: Rod Baird and Joanne Kaldy Tags: Practice Management Source Type: news

Join the We Are PA/LTC Campaign
The We Are PA/LTC campaign is a public education initiative to raise awareness of the post-acute and long-term care field, the people that practice in it, and the people who live in it and are otherwise affected by it. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2018 Category: Health Management Source Type: news

Survey: Nursing Homes Should Require Flu Shots for All Staff, Patients
The 2017-2018 flu season has been worse than expected, with unchecked pockets of illness and Tamiflu in short supply in some regions of the country. The vaccine was reported to be 10% effective, which, while better than nothing, is much lower than the average 42% effectiveness of past flu vaccines. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2018 Category: Health Management Source Type: news

Are Older Adults a Burden?
Jane, an 88-year-old resident living independently with her husband, John, was brought to the emergency department delirious after an episode of unresponsiveness. She had had a dual-function implantable cardioverter-defibrillator (ICD) and pacemaker implanted several years ago. Although the ICD had discharged properly on two occasions in the past 6 months, interrogation of the device in the emergency department revealed that this time she experienced a 4-minute episode of ventricular fibrillation with several shocks failing to convert her rhythm before the last shock reestablished a paced rhythm. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2018 Category: Health Management Authors: Peter Jaggard Tags: medical ethics Source Type: news

Report: Unless They Improve, Low-Performing SNFs Face Extinction
A new report paints a grim picture of the future for skilled nursing facilities outside the elite high-performing ranks. Trends suggest even the typical SNF may have experienced a negative operating margin in 2017 — a far cry from the healthy income levels of just a few years ago. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2018 Category: Health Management Authors: Randy Dotinga Source Type: news

A Medical Director ’s Perspective: Influencing Rehospitalization Rates
Efforts to reduce hospitalizations often focus on identifying specific clinical conditions that contribute to hospitalizations, particularly those that are considered potentially preventable. Potentially preventable hospitalizations result from exacerbation of clinical conditions such as congestive heart failure, chronic obstructive pulmonary disease, or diabetes in which the exacerbation and hospitalization could have been prevented had optimal care been provided. The theory is that by incentivizing providers to focus on specific clinical categories that are likely to contribute to admissions for preventable reasons, we c...
Source: Caring for the Ages - January 31, 2018 Category: Health Management Authors: David Gifford Tags: AHCA PERSPECTIVE Source Type: news

Know the Signs of Potential Abuse and Neglect
Joanne Kaldy, a contributing writer for Caring for the Ages and daughter of a nursing home resident, talks about abuse and neglect and how to prevent them. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2018 Category: Health Management Tags: Caring Source Type: news

Journal Highlights From the February Issue of JAMDA
Older individuals who are caregivers have a shorter recovery following hip fracture than those individuals who are not, according to results from a study in Switzerland. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2018 Category: Health Management Source Type: news

News From the Society
The Society has established an innovative new Practice Group Network (PGN) to advocate for policies that promote post-acute and long-term care practices that serve the nation ’s frail, elderly, and disabled populations. Specifically, it will focus on the promotion of the practice and the reduction of administrative burdens and penalties that threaten the sustainability of these practices. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2018 Category: Health Management Source Type: news