Flu, Pneumococcal Vaccination Rates on the Rise
Jane Martin, RN, director of nursing for a small skilled nursing facility in rural Georgia, has won a major immunization coup. In a community that has no hospital, no public transportation services, and only one medical office served by nurse practitioners — a community where getting vaccinations has traditionally “not been a top priority” — her facility, Treutlen Health and Rehabilitation, has achieved a near-perfect flu vaccination record for its patients and its staff in the last 8 years or so. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

Dysphagia Diets and Terminology Go Global
Dysphagia is a worldwide health issue, with approximately 8% of the world ’s population experiencing some difficulty in swallowing. If left untreated, a number of negative outcomes can occur, including malnutrition, dehydration, aspiration, and even death. Although effective strategies have been developed to treat dysphagia, there is still considerable confusion regardi ng the classification of foods and beverages that meet the criteria for varying stages of dysphagia. Due to the global nature of today’s health care environment, clinicians need to find common ground for prescribing and interpreting the foods an...
Source: Caring for the Ages - October 1, 2018 Category: Health Management Authors: Phyllis Famularo Source Type: news

Scars of a Lifetime
Trauma-informed care figures largely in the final phase of the revised Requirements of Participation for nursing homes, which will be implemented in November 2019. The notion of being sensitive to people who have suffered significant trauma is certainly a good idea, although it hardly seems necessary for us, as presumably already compassionate, humanistic health care workers, to have a specific mandate on this. Most of us don ’t need to take a class to know that being mindful of the sensibilities of others, in the context of whatever physical and emotional scars they may bear, is a good strategy both at work and in l...
Source: Caring for the Ages - October 1, 2018 Category: Health Management Authors: Karl Steinberg Tags: on my mind Source Type: news

UTI Diagnosis and Management Require Formal Protocols
Inappropriate antibiotic prescribing for urinary tract infections (UTIs) stems largely from inappropriate use of diagnostic tests, but there are additional factors at play — mainly incorrect antibiotic choice, excessive duration of therapy, and inappropriate dosing, said Muhammad Salman Ashraf, MBBS, at the AMDA – The Society for Post-Acute and Long-Term Care Medicine Annual Conference. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

Communicator or Shill?
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2018 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

Facilitating Out-of-the-Box Solutions
Health care systems are facing resource constraints, with the post-acute and long-term care field facing perhaps the most pressure. Unfortunately, not much relief is in sight: there are worsening shortages of skilled and competent staff and no projected significant increases in reimbursements. AMDA – The Society for Post-Acute and Long-Term Care Medicine, as a leader in PA/LTC, is redefining its role in these resource-constrained times. In addition to offering our members high-quality education and much-needed advocacy, one of the Society’s aims is to create efficiencies and value through innovation. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2018 Category: Health Management Authors: Arif Nazir Tags: Innovations in PA/LTC Source Type: news

Transitions in Assisted Living
“I can’t go back home. I can barely walk. How am I going to get around in my apartment?” said a frantic Mrs. S as we sat in a meeting at the skilled nursing facility where she had been receiving care over the last 3 weeks. She turned desperately to the physical therapy team, who politely told her, “We can extend your stay another 2 days, but unfortunately you continue to have difficulties with ambulation after your fall. We are worried about your safety at home alone.” The team went on to discuss the status of her progressive chronic medical conditions, which had prompted two hospita lizations...
Source: Caring for the Ages - October 1, 2018 Category: Health Management Authors: Christian Bergman Tags: caring transitions Source Type: news

Staffing Assistance Needs Rise With Increasing Resident Obesity
New research has demonstrated an increase in the need for extensive staffing assistance with reported activities of daily living (ADLs) when residents ’ body mass index (BMI) increases. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

What You Need to Know About Disaster Planning
Timothy Gieseke, MD, CMD, whose nursing facility survived California wildfires, shares tips about planning for emergencies. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2018 Category: Health Management Tags: Caring Source Type: news

Disability, Aging, and Obesity: Are We Prepared?
Obesity is an emerging global public health crisis that affects all age groups. Obesity has received far less attention as it relates to aging — even though it represents a growing public health policy issue with huge financial implications. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2018 Category: Health Management Authors: Shenbagam Dewar Source Type: news

Journal Highlights From the October Issue of JAMDA
Errors with patient medications are a common occurrence in nursing homes, according to a retrospective observational study in Quebec, Canada. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2018 Category: Health Management Source Type: news

New and Improved Foundation at Work for You
This year I was able to announce changes that are making the Foundation for Post-Acute and Long-Term Care Medicine a dynamic force and an important resource for all providers in post-acute and long-term care, residents, families, and the LTC industry. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2018 Category: Health Management Authors: Barbara Resnick Source Type: news

Society Updates Influenza Vaccination  Recommendations for Health Care Personnel
Flu season is fast approaching. The 2017-2018 season was especially brutal for older adults, especially nursing home residents. Post-acute and long-term care (PA/LTC) settings such as nursing homes are a particularly dangerous environment for flu outbreaks for a variety of reasons, including the close quarters, the complex medical conditions and weak immune systems of the residents, and the frequent contact with multiple caregivers. (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2018 Category: Health Management Source Type: news

Don ’t Miss These Events
Montreal, Quebec, Canada (Source: Caring for the Ages)
Source: Caring for the Ages - October 1, 2018 Category: Health Management Source Type: news

Assisted Living Summit Addresses Changing World of Care for Older Adults
AMDA – the Society for Post-Acute and Long-Term Care Medicine held its third National Assisted Living Summit during the Society’s Annual Conference. This summit, in partnership with the Center for Excellence in Assisted Living (CEAL), brought together industry leaders, providers, physicians, and thou ght leaders. The participants took part in an all-day session to identify challenges and determine how best to provide care via an integrated care model. As the residents entering assisted living (AL) communities are becoming increasingly frail and medically complex, the challenge of providing patie nt-centered car...
Source: Caring for the Ages - September 1, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

Experts Highlight Best Practices for Managing Incontinence
Four experts addressed evidence-based recommendations for assessing and treating urinary and fecal incontinence among older individuals in the PA/LTC setting at AMDA – the Society for Post-Acute and Long-Term Care Medicine’s Annual Conference. (Source: Caring for the Ages)
Source: Caring for the Ages - September 1, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

(Not Enough) Labor Day
Another summer has come and gone, and they certainly seem to be whizzing by faster all the time. I remember in my grade school years how summer vacation seemed to just last forever, even though it was always over too soon. I hope all our readers took some time to do something vacation-ish this summer. And now we are back to the grind. (Source: Caring for the Ages)
Source: Caring for the Ages - September 1, 2018 Category: Health Management Authors: Karl Steinberg Tags: on my mind Source Type: news

Each One Teach One
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - September 1, 2018 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

CMS Finalizes Plans  for Pay Hike, Less Regulation
Regulatory changes impacting post-acute care facilities for fiscal year 2019 are expected to increase reimbursements while reducing bureaucratic burden, according to federal health officials. (Source: Caring for the Ages)
Source: Caring for the Ages - September 1, 2018 Category: Health Management Authors: Whitney McKnight Source Type: news

Regulatory and Litigation Risks of Elopement
Elopements place nursing homes and assisted living facilities at great risk. When a resident exits the building undetected and the individual is unsafe to be out of the facility environment without supervision, it is very dangerous for the resident. The resident is alone in an uncontrolled environment and he or she lacks the skills and/or mental capacity for self-protection. Elopements have resulted in resident deaths, significant injuries and exposure to extreme heat and cold. Facilities can be the subject of negative national new stories related to resident elopements, be the subject of malpractice lawsuits and receive s...
Source: Caring for the Ages - September 1, 2018 Category: Health Management Authors: Janet K. Feldkamp RN Tags: LEGAL ISSUES Source Type: news

Proxies ’ Perception of Prognosis Impacts End-of-Life Care in Advanced Dementia
In a cohort of nursing home residents with advanced dementia, the proxies ’ estimate of a resident’s prognosis was moderately accurate, and their perception of a resident having fewer than 6 months to live was associated with a decreased likelihood of the resident experiencing burdensome interventions. (Source: Caring for the Ages)
Source: Caring for the Ages - September 1, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

Growing a Geriatric Emergency Department
The concept of the geriatric emergency department is well developed after more than a decade of evolution, and at least nine EDs throughout the country are now accredited by the American College of Emergency Physicians (ACEP) as part of the first wave of geriatric ED accreditations. (Source: Caring for the Ages)
Source: Caring for the Ages - September 1, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

Nursing Home Culture Influences Hospice Utilization
What determines whether an eligible nursing home resident receives hospice care? Familial reluctance and financial disincentives can play a role in hospice underutilization, but so can staff attitudes about end-of-life care. (Source: Caring for the Ages)
Source: Caring for the Ages - September 1, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

Improving Oral Care in Nursing Homes May Reduce Pneumonia Rates
Preliminary results from a cluster randomized controlled trial have shown the potential of a mouth care program to curb the rates of pneumonia in the nursing home setting. Philip D. Sloane, MD, MPH, of the University of North Carolina at Chapel Hill, presented his group ’s findings at AMDA – the Society for Post-Acute and Long-Term Care Medicine’s Annual Conference. (Source: Caring for the Ages)
Source: Caring for the Ages - September 1, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

Behavioral Health Disorder Diagnosis Decreases Access to High-Quality Facilities
Post-acute patients diagnosed with a behavioral health disorder are more likely to enter low-quality nursing home facilities and less likely to enter high-quality facilities than those without the diagnosis, according to study results in the American Journal of Geriatric Psychiatry. (Source: Caring for the Ages)
Source: Caring for the Ages - September 1, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

The Role of the Certified Nursing Assistant: Caring on the Front Line
Maureen D. Carland, MA, RN-BSN, NHA, administrator of the Maine Veterans Home-Scarborough, talks about the certified nursing assistant ’s role in post-acute and long-term care. (Source: Caring for the Ages)
Source: Caring for the Ages - September 1, 2018 Category: Health Management Tags: Caring Source Type: news

Mobility Impairment An Underappreciated Health Care Epidemic
Compared with cognitive impairment, mobility impairment affects a similar number of the elderly and requires a comparable level of care, yet it receives far less attention, according to a presenter at AMDA – the Society for Post-Acute and Long-Term Care Medicine’s Annual Conference. (Source: Caring for the Ages)
Source: Caring for the Ages - September 1, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

Journal Highlights From the September Issue of JAMDA
Individuals with dysphagia have an increased risk of mortality, especially when the dysphagia is accompanied by weight loss, researchers from Germany report. (Source: Caring for the Ages)
Source: Caring for the Ages - September 1, 2018 Category: Health Management Source Type: news

Society Invites Submissions for Second Annual Shark Tank Competition
PA/LTC medicine is an interdisciplinary art, populated by passionate, creative professionals, as well as a proving ground for innovation. To recognize and promote innovation, the Society introduced its first Shark Tank Competition during the 2018 Annual Conference. Modeled after the popular television show in which individuals present their business ideas and models to a panel of successful entrepreneurs, this is a unique opportunity for innovators to share their ideas with the largest national audience in PA/LTC. (Source: Caring for the Ages)
Source: Caring for the Ages - September 1, 2018 Category: Health Management Source Type: news

Don ’t Miss These Events
Website: http://pamda.org/category/events/ (Source: Caring for the Ages)
Source: Caring for the Ages - September 1, 2018 Category: Health Management Source Type: news

The Power of Process Improvement
In an effort to curb the “madness of data insanity” in health care, a presentation at the 2018 AMDA – the Society for Post-Acute and Long-Term Care Medicine Annual Conference challenged the attendees to consider a different approach to statistics, one that emphasizes statistical thinking. (Source: Caring for the Ages)
Source: Caring for the Ages - September 1, 2018 Category: Health Management Authors: Paige Hector Tags: board room Source Type: news

Facilities Create Notable Niche With Special Care Programs
As post-acute and long-term care medicine continues its move from traditional fee-for-service to value-based medicine, the business of PA/LTC has become everyone ’s business. Increasingly, providers see specialty care units or programs — from wound and cardiac care to respiratory management — as a way to improve outcomes for patients with complex care needs, to increase referrals, and to create new revenue streams. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

Collaborative Quality Improvement Project Aims to Improve Pain Management  in PA/LTC
A collaborative quality improvement (QI) project to improve pain management for nursing home residents is changing outcomes through facility-specific interventions, ranging from changes in health records and electronic documentation to more structured comfort care rounding and consistent use of pain scales. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

The Readmissions Conundrum: How (and What) Are We Doing?
It ’s been a good 6 years since the Centers for Medicare& Medicaid Services started wielding the stick called HRRP, the Hospital Readmissions Reduction Program, designed to encourage hospitals to improve discharge planning and reduce unnecessary acute care rehospitalizations. In 2012, the 30-day readmission rate for Medicare beneficiaries was around 19%, and it was thought that many of these readmissions were potentially avoidable. The penalties started at a maximum of 1% of a hospital ’s total Medicare A payments, and initially considered only the diagnoses of heart failure, acute myocardial infarction, an...
Source: Caring for the Ages - August 1, 2018 Category: Health Management Authors: Karl Steinberg Tags: on my mind Source Type: news

Building Community Palliative  Care
The Center to Advance Palliative Care, in collaboration with the National Coalition for Hospice and Palliative Care, has launched an initiative to build a comprehensive inventory of community palliative care programs across all service settings — including home, office/clinic, and long-term care. AMDA – the Society for Post-Acute and Long-Term Care Medicine is supporting this important project. The Society believes it will make it easier for patients, families, caregivers and practitioners to find local resources to meet their needs. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Source Type: news

Behavioral Health Disorder Diagnosis Decreases Access to High-Quality Facilities
Post-acute patients diagnosed with a behavioral health disorder are more likely to enter low-quality nursing home facilities and less likely to enter high-quality facilities than those without the diagnosis, according to study results in the American Journal of Geriatric Psychiatry. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

Too Few Patients With Heart Failure Get Palliative Care
Few patients with heart failure receive palliative care, although their condition often warrants it and evidence suggests it ’s helpful, a specialist in geriatrics and palliative medicine told an audience at the 2018 annual meeting of the American Geriatrics Society. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Authors: Randy Dotinga Source Type: news

Revisiting Comfort Care
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

Promising Care Paths Emerge on the Transition Trail
Promising new practices and options are emerging for patients transitioning between emergency departments and skilled nursing facilities or nursing homes, such as averting ED use altogether by treating the patients in place, several speakers reported at the annual meeting of AMDA – the Society for Post-Acute and Long-Term Care Medicine. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

Transitioning to ED: A Difficult but Improvable Process
GRAPEVINE, TEXAS — Although transitioning patients from post-acute and long-term care to the emergency department (ED) remains a challenging scenario for those involved, opportunities exist to improve the process for health care providers and for patients’ outcomes, according to two presenters at the 2018 Annual Conference of AMDA — the Society for Post-Acute and Long-Term Care Medicine. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

Idolatry in Care Transitions
In our current medical reality, movement of increasingly aged, comorbid and frail patients between sites of care is fraught with potential harm. Enhancing care transitions justifiably demands our attention. Witnessing the illnesses of my parents, I made the painful discovery of the gaps and flaws in a health care system I had spent my career believing was the best the world had to offer. More than a decade ago, I made a decision to do whatever I could to make those flaws fewer and the gaps smaller. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Authors: James Lett Tags: Caring Transitions Source Type: news

Rebalancing Arrives in Home-, Community-Based Long-Term Care
States are currently spending 30% to 80% of their Medicaid long-term care expenditures on home- and community-based long-term care compared with institutional long-term care, which means that the long-sought “rebalancing” of long-term services and supports (LTSS) is likely “coming to you,” health policy analyst Virginia Kotzias said at the annual meeting of AMDA – the Society for Post-Acute and Long-Term Care Medicine. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

Medication Reconciliation: A Necessary Process for Patient Safety
Medication reconciliation is the process of determining the most accurate list of medications the patient is taking. Sounds simple, doesn ’t it? However, in more than 25 years as a nurse practitioner (NP) — the majority spent in inpatient settings (hospital, rehabilitation, skilled nursing facility) — I have found medication reconciliation is still one of the most frustrating aspects of patient care. The use of electronic health records to communicate information was supposed to improve the process and patient safety, but I have yet to see this happen consistently. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Authors: Nina Flanagan Tags: NURSES ’ NOTES Source Type: news

ACP Video Tool Does Little to Increase DNH Status in Advanced Dementia
Compared with usual care, an advance care planning (ACP) video did not change the rate of do-not-hospitalize (DNH) directives at 6 months among proxies for nursing home residents with advanced dementia, according to results of the Educational Video to Improve Nursing Home Care in End-stage Dementia (EVINCE) trial. However, the ACP video arm demonstrated an increased rate of documented directives for no tube-feeding during the follow-up period and goals-of-care discussions at 3 months. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

Tributes
William Carlos Williams, MD, born in Rutherford, New Jersey in 1883, trained as a generalist and pediatrician before returning to his home town to practice medicine the rest of his life. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Authors: Jerald Winakur Tags: Meditations on geriatric medicine Source Type: news

Low BP Rarely Triggers Medication Adjustment in VA Nursing Homes
Physicians lowered or eliminated doses of hypertension medications in fewer than 20% of nursing home residents who had fallen after an episode of low blood pressure, a recent study found. The researchers linked drug deintensification in patients with especially low blood pressure to a much lower risk of future falls but a much higher risk of death. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Authors: Randy Dotinga Source Type: news

A Rehabilitation Paradigm for Medically Complex Care
Patients with medically complex conditions present difficult challenges for rehabilitation centers, but St. Mary ’s d’Youville Pavilion in Maine is embracing these individuals with an innovative approach. The 12-room Specialty Care Rehabilitation Suite features specially trained staff caring for patients with medically complex conditions. It is a companion program to the organization’s Transitional Rehab ilitation Center, which has a strong orthopedic focus. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Source Type: news

Who Is the Nursing Home Administrator?
Cynthia Tredwell, JD, administrator of a small, highly-rated nursing home in North Dakota, talks about the role of the nursing home administrator. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Tags: Caring Source Type: news

Caring for Older Patients with Skin Disease Has Unique Considerations
Authors of a “Viewpoint” article published in JAMA Dermatology have asserted that older individuals with skin disease need “unique considerations” for care, while also addressing the principles of geriatric science that permit this more appropriate care. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

Journal Highlights From the August Issue of JAMDA
Falls, a common occurrence in nursing homes, can lead to injuries and result in legal liability for the facility, making prevention all the more important, yet there is often a lack of communication about medication or other factors that may lead to falls and ways to prevent them. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Source Type: news