Letter In Response to Tips to Avoid Being Sued
Dear Drs. Galik and Stefanacci, AMDA — The Society for Post-Acute and Long-Term Care Medicine has been a strong proponent of team-based care for older adults. The Society has supported collaborative relationships among attending physicians and nurse practitioners (NPs) and physician assistants (PAs) in long-term care facilities, advo cated for voting membership in the Society for NPs and PAs, has NPs on both the board of directors and the Foundation board of directors, and has included them as members of the numerous working committees (e.g., Education, Conference). (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2019 Category: Health Management Source Type: news

ALFs, Meds, and Transitions
There is a well-known association between transitions of care and medication-related problems, notably in the form of adverse drug events. Although we have limited evidence-based information on this topic in assisted living facilities (ALFs), some of what we ’ve learned from transitions of older adults to nursing homes provides useful insight into what we can expect. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2019 Category: Health Management Authors: H. Edward Davidson Tags: Caring Transitions Source Type: news

Shared Learning for Better Outcomes
“Caring Collaborative” is more than the catchy title of our regular editors’ column for Caring for the Ages — it is meant to be a guide for our work. Today’s post-acute and long-term care (PALTC) environment requires a caring collaborative among a range of disciplines to be successful. Thi s is so very different than the past PALTC environment with its fee-for-service, acute care, siloed focus, which was typically run by community physicians who worked independent of other disciplines. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2019 Category: Health Management Authors: Elizabeth Galik, Richard Stefanacci Tags: Caring Collaborative Source Type: news

Innovative Lessons in Leadership
Practitioners are already beyond busy addressing all the clinical and regulatory demands on them. So why should they take the time to hone their leadership and management skills? Michael Wasserman, MD, CMD, president of the California Association of Long Term Care Medicine (CALTCM), suggested during a recent On-The-Go podcast for AMDA — The Society for Post-Acute and Long-Term Care Medicine that practitioners increasingly are expected to take leadership roles, so these skills are essential. “We are delivering clinical care to the most complex population in history, and more care is being pushed from acute-care ...
Source: Caring for the Ages - October 1, 2019 Category: Health Management Authors: Joanne Kaldy Source Type: news

PALTC Steps Up Strategies to Attract Nurses
Enrollment in nursing schools is up as more people — men and women alike — see this as an exciting field where they can have a rewarding career and job security. However, while nursing schools are attracting more students, too few of their graduates are choosing to practice in post-acute and long-term care (PALTC). As a result, a perfect storm i s brewing: a rapidly growing over-65 population, a large number of nurses nearing retirement age, and not enough students choosing this specialty. PALTC communities and their team leaders are scrambling to find creative ways to attract more nurses. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2019 Category: Health Management Authors: Joanne Kaldy Source Type: news

Putting Together Pieces of Trauma-Informed Care Puzzle
Phase 3 of the revised Medicare and Medicaid Requirements of Participation for long-term care, which will go into effect next month, require skilled nursing homes to provide “trauma-informed care (TIC),” an approach to care that factors in the pervasive nature of trauma and establishes safe and nurturing environments where residents won’t be retraumatized. However, the Centers for Medicare& Medicaid Services haven ’t yet provided guidance on this directive, so trying to comply may feel like completing a jigsaw puzzle without all the pieces. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2019 Category: Health Management Authors: Joanne Kaldy Source Type: news

UTI Management: It ’s All in the Culture
A new study covering almost all nursing home residents in Ontario, Canada, has shown highly variable urine culturing rates across facilities and a strong association of culturing with antibiotic use and Clostridioides difficile infection — a diagnostic “cascade effect,” the authors reported. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2019 Category: Health Management Authors: Christine Kilgore Source Type: news

Recognizing Excellence
It is a cardinal fact that if one wishes to perpetuate any given behavior, then that behavior needs to be rewarded. A simple “thank you” or “you made a difference in the care of me or my loved one” from a family or resident is always welcome for those of us in the post-acute and long-term care (PALTC) continuum. Even better, a mention by a meaningful person in the facility (a colleague, the director of nurses, the administrator, or others) that you made a great diagnosis, started a meaningful program, or touched the life of a resident in a positive way makes the week better and brings a smile to you...
Source: Caring for the Ages - October 1, 2019 Category: Health Management Authors: James E. Lett Tags: Our Foundation Source Type: news

Hip Fracture With Resistance to Care
Mrs. B is a 100-year-old white female with a history of dementia, squamous cell carcinoma to the bilateral lower extremities, and venous insufficiency. She is no longer able to verbally express her opinions or desires, although she recognizes familiar faces and engages with others. She requires minimal assistance with transfers and ambulates with a front-wheeled walker. She is resistant and combative with care (usually hitting staff), especially during dressing, bathing, and transferring. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2019 Category: Health Management Authors: Barbara Resnick, Paige Hector Tags: Interdisciplinary Team Source Type: news

Back to the Bedside
The Dover Park Hospice in Singapore asked me to visit their hospice to observe how they had adapted Namaste Care, a program I had developed for people with advanced dementia. Originally it was a small group program for nursing homes, but now it has expanded and can be found in care homes and hospice organizations all over the world. On the first day of my visit, I was asked to observe a Namaste Care session. Five social workers were giving five patients hand massages. The room was perfect — very lovely and homelike — and calming music was playing. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2019 Category: Health Management Authors: Joyce Simard Tags: We Are PALTC Source Type: news

Don ’t Miss These Events
Annual Conference (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2019 Category: Health Management Source Type: news

Help to Improve Documents Provided to SNFs
Your input is requested for an ongoing project of the ECRI Institute. The Institute is currently evaluating the usability of discharge documents generated by electronic health record (EHR) systems that are intended to communicate clinical information about acute care visits to long-term care providers (specifically skilled nursing facilities) for geriatric patients. The researchers at the Institute have developed a few questions about your experiences with EHR-generated discharge documents. Your input will provide a valuable real-world perspective on the challenges faced by clinicians in the long-term care setting when usi...
Source: Caring for the Ages - October 1, 2019 Category: Health Management Source Type: news

News From the Society
It ’s not too early to start planning for AMDA — The Society for Post-Acute and Long-Term Care Medicine’s 2020 Annual Conference, set for April 2–5 in Chicago, IL. The Program Planning Subcommittee is putting together another outstanding program. As always, there will be two days of exhibits, s tate chapter activities, social events, and networking opportunities. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2019 Category: Health Management Source Type: news

Impermanence and Loss
Although it is a beautiful time of the year, autumn is a season where impermanence is especially apparent and losses abound. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2019 Category: Health Management Authors: Karl Steinberg Tags: On My Mind Source Type: news

Love in the Time of Dementia
For my mother and father, (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2019 Category: Health Management Authors: Jerald Winakur Tags: Meditations on Geriatric Medicine Source Type: news

Measurement, Meretricious Metrics, and Mishegas
Dear Dr. Jeff: When I started my position as medical director, the only paperwork that I was required to submit was a timesheet. When our facility became part of a chain, a job description was created to include an evaluation of my performance based on facility quality metrics. Then rehospitalization rates and pharmacy budget targets were added as performance measures, followed by medical staff compliance with mandatory in-services, risk management, antibiotic stewardship, and customer satisfaction ratings of medical care. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2019 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr Jeff Source Type: news

Journal Highlights From the October Issue of JAMDA
The presence of an ombudsman can result in worse deficiency outcomes during annual surveys of nursing homes, according to a retrospective secondary data analysis. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2019 Category: Health Management Tags: Journal Highlights Source Type: news

CMS To Loosen Some Phase 3 Requirements
On July 16, 2019, the Centers for Medicare& Medicaid Services proposed revisions to some Phase 3 requirements scheduled to be implemented on November 28, 2019. The proposed revisions were open for a public comment period until September 16, 2019, and they could change in the final regulation. They will be available online at www.federalregister.gov. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2019 Category: Health Management Source Type: news

Chicken Soup and Vitamin C: Not Enough to Fight Off the Flu
Richard Stefanacci, DO, MGH, MBA, AGSF, CMD, coeditor of Caring talks about how to keep the flu from striking this winter and what to do if it does. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2019 Category: Health Management Tags: Caring Source Type: news

In This Issue
Caring ’s new coeditors in chief talk teamwork and sharing in their first Caring Collaborative column. 2 (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2019 Category: Health Management Source Type: news

Baby, You Can Drive My Patient: Uber and Lyft Make Strides in Medical Transportation
CareMore Health, a network of integrated medical clinics that serves 150,000 patients across the United States, has long faced the usual challenges of getting patients to appointments. The neediest patients, such as elders and those with chronic conditions, often didn ’t show up on time or at all. (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Authors: Randy Dotinga Source Type: news

What Pains PALTC Clinicians the Most?
On a recent call with the Centers for Medicare& Medicaid Services (CMS), one of the CMS officials asked the leadership of AMDA — The Society for Post-Acute and Long-Term Care Medicine a very broad question: What pains post-acute and long-term care (PALTC) clinicians the most? What are they most concerned about? Without skipping a beat, Society’s leaders answered with their own question: Well, how much time do you have? (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Authors: Alex Bardakh Tags: Public Policy Source Type: news

Caution Ahead! Updated List Tracks Hazardous Drugs in Elderly
LOS ANGELES — The American Geriatrics Society (AGS) released a new version of the AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults in early 2019, and care professionals immediately began poring over its updated recommendations — anything but an easy task. (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Authors: Randy Dotinga Source Type: news

Algorithm Can Aid in End-of-Life Decision-Making for Unrepresented Residents
Determining the management of incapacitated and unrepresented individuals is a distinct challenge health care team members face in the post-acute and long-term care setting, requiring them to shoulder the emotional burden of making end-of-life treatment decisions for these residents. (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Authors: Brian Ellis Source Type: news

Seven Challenges Assisted Living Must Get Right
The assisted living industry is fascinating, and opportunities abound to improve the lives of the fragile elderly. In this unique social setting, a diverse group of individuals is united by their need for assistance with managing their health care. This compels them to make enormous life changes as they embrace a new concept of “home.” (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Authors: Steven Fuller Tags: Guest Editorial Source Type: news

Scheduled Preventive Maintenance
When I am on site for a visit, I talk to communities about the importance of having a schedule to conduct preventive maintenance on various pieces of equipment throughout the organization. Recently I experienced this process firsthand as I boarded a plane. First, the plane had been delayed by weather; then, as we passengers were buckling in, I heard the grounds crew tell the captain those very words: “scheduled preventive maintenance” followed by “it was not done, so this flight is now canceled.” (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Authors: Jean Harpel Tags: We Are PALTC Source Type: news

New Caring Coeditors Followed Different Paths to Same Destination
Elizabeth Galik, PhD, CRNP, and Richard Stefanacci, DO, MGH, MBA, AGSF, CMD, the new Caring for the Ages coeditors in chief, followed different paths to their new role; but their experience, vision, and passion for their profession have brought them together. Their collaboration is the future of Caring, and it promises to be a bright one for readers everywhere. (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Authors: Joanne Kaldy Source Type: news

Overtesting and Overtreating: A Problem With C. difficile
Testing for Clostridioides difficile should be done only for patients who have a new onset of unexplained “true diarrhea,” which means three or more loose stools in 24 hours — unformed stools that take the shape of a collection container, Ghinwa Dumyati, MD, said at the AMDA — The Society for Post-Acute and Long-Term Care Medicine’s annual conference. (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Authors: Christine Kilgore Source Type: news

Practical Tips for Diagnosing and Treating Bacterial Pneumonia in the Nursing Home
A clinical diagnosis of bacterial pneumonia in nursing home residents most often can be treated with a single oral course of antibiotic therapy targeted toward community-acquired pneumonia pathogens, Ghinwa Dumyati, MD, said at the AMDA — The Society for Post-Acute and Long-Term Care Medicine’s annual conference. (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Authors: Christine Kilgore Source Type: news

Surviving Sepsis: Tests, Tools, and Treatments
Sepsis identification and management is as controversial and vexing as ever, but efforts in nursing facilities to identity and track changes in condition, use tools for structured communication, and initiate early management can make an impact, according to a panel of geriatricians and medical directors who addressed this life-threatening response to infection at the annual conference of AMDA — The Society for Post-Acute and Long-Term Care Medicine. (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Authors: Christine Kilgore Source Type: news

New Recommendations to Improve Management of Uncomplicated UTI
Supported by AMDA — The Society for Post-Acute and Long-Term Care Medicine, an effort to improve the diagnosis and treatment of uncomplicated bladder infections in noncatheterized long-term care facility residents is progressing. The results of the 12-month intervention trial are nearing publication, and a tool kit is available on the Society’s website (https://paltc.org/content/iou-toolkit) to cover both diagnosis and empirical therapy for uncomplicated urinary tract infection (UTI). (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Authors: Christine Kilgore Source Type: news

Ensuring a Legacy
We hear it repeatedly with the impending departure of American presidents, particularly those who have served two terms in office: How will I be remembered? What difference did I make? What did I make better? And the specific issue at hand: What will my legacy be? (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Authors: James E. Lett Tags: Our Foundation Source Type: news

Opti-scribing: Consultant Pharmacist ’s Role Under Patient Driven Payment Model
In July 2018, the Centers for Medicare& Medicaid Services (CMS) finalized a new case mix classification model, the Patient Driven Payment Model (PDPM), which will be used under the Skilled Nursing Facility Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay (https://go.cms.gov/2S2lrRR). Beginning October 1, 2019, PDPM will replace the current case mix classification system, the Resource Utilization Group, Version IV (RUG-IV). (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Authors: Jeanne Manzi Tags: LTC Pharmacy Source Type: news

Succeeding Through Failures, Keeping the Growth Mindset
Avoiding an apparently tough challenge that carries an inherently high risk of failure may not always be the best strategy. Failures teach us valuable lessons that may then be applied to tackle the same challenge with a new approach or to address a whole new problem. In Mindset: The New Psychology of Success (New York: Random House, 2006), Carol Dweck, PhD, shares her credible research supporting this approach, referring to it as the “growth” mindset. People and organizations with such an attitude, she argues, are set for more success than those with the “fixed” mindset. (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Authors: Arif Nazir Tags: From the President ’s Desk Source Type: news

What Makes Consumers Satisfied?
Dear Dr. Jeff: Our facility administrator has asked all the “providers” to participate in a chain-wide program to boost “consumer satisfaction.” Our medical team would be happy to participate in quality improvement projects. But most of us object to the paradigm where our patients become consumers of medical care and we become short order cooks in a medical fast food chain, selling drugs on demand while wearing smile buttons. Good care often requires saying “no” to antipsychotics used as sleeping pills, excessive opioids, siderails, antibiotics for foul-smelling urine, Valium prescriptio...
Source: Caring for the Ages - July 30, 2019 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr Jeff Source Type: news

Person-Centered Approaches to Human –Animal Interaction
Across all settings of care we are increasingly focused on using and providing behavioral interventions to optimize health, well-being, and quality of life, to increase physical activity, and to manage the behavioral and psychological symptoms associated with aging. The human –animal bond, defined by the American Veterinary Medical Association as “a mutually beneficial and dynamic relationship between people and animals that is influenced by behaviors essential to the health and well-being of both,” is a behavioral intervention that can address a multitude of clini cal problems. (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Authors: Barbara Resnick Tags: Board Room Source Type: news

Don ’t Miss These Events
Carlsbad, CA (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Source Type: news

Journal Highlights From the August/September Issue of JAMDA
A provider-focused, goal-driven care model can significantly reduce unnecessary — and often unwanted — transfers of individuals from skilled nursing facilities (SNFs) to emergency departments (EDs), according to a prospective cohort study conducted in New Hampshire. (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Tags: Journal Highlights Source Type: news

In This Issue
A new term was recently coined for the actions consultant pharmacists should take under the 2019 PDPM reimbursement model. 3 (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Source Type: news

News From the Society
The AMDA On-The-Go podcast is more popular than ever. Society members and other stakeholders appreciate the opportunity to hear from leading experts addressing the hottest issues — and to listen while driving to a facility, working out, or having a meal. If you haven’t yet become an AMDA On-The-Go aficionado, it’s not too late. Go to https://paltc.org/podcast to listen to the latest episode, or check out the impressive archives of podcasts on a wide range of topics. (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Source Type: news

Comment on: The Most Important Mental Health Issue You ’ve Never Heard Of
(Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Source Type: news

Scammers Are Everywhere: How Can You Stay Safe?
Karl Steinberg, MD, CMD, HMDC, talks about how to protect your loved ones and you from fraud, abuse, and identity theft. (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Tags: Caring Source Type: news

Comment on: Algorithm Can Aid in End-of-Life Decision-Making for Unrepresented Residents
(Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Source Type: news

The Most Important Mental Health Issue You ’ve Never Heard Of
I am the person least likely to talk about emotions — I have bottled up a lifetime’s worth. As a family caregiver for over 20 years, I have been on a seemingly endless roller coaster of emotional stress that has affected me in ways I never imagined. And I suspect I am not alone. (Source: Caring for the Ages)
Source: Caring for the Ages - July 30, 2019 Category: Health Management Authors: MaryAnne Sterling Tags: Caregiver ’s Perspective Source Type: news

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