Helping Older Adults With the Ageless Challenge of Substance Abuse
Alcohol and other drug abuse is a problem at any age. But for people in their 60s and 70s with substance abuse issues, “we have to think about clinical issues differently,” according to David W. Oslin, MD, professor at the University of Pennsylvania. (Source: Caring for the Ages)
Source: Caring for the Ages - July 1, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

Congratulations to Dodd and Pattee Award Recipients
GRAPEVINE, TEXAS — Each year, AMDA – the Society for Post-Acute and Long-Term Care Medicine honors leaders who follow in the footsteps of its founding fathers. This year, the William Dodd Founder’s Award went to Paul Katz, MD, CMD, and the James Pattee Award for Excellence in Education went to Jeffery Burl, MD , CMD. (Source: Caring for the Ages)
Source: Caring for the Ages - July 1, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

Medical Decisions: Who Should Get to Decide?
Medical decision-making can be very complicated. With so many options and high-tech interventions, it ’s no wonder patients and their families can become overwhelmed and bewildered when faced with choices in light of serious illness. Our job, and really our sacred duty, is to help patients and families understand not just the options being presented but also their probable benefits and burdens in the context of their current medical condition, their prognosis, and their lifelong values and goals. (Source: Caring for the Ages)
Source: Caring for the Ages - July 1, 2018 Category: Health Management Authors: Karl Steinberg Tags: on my mind Source Type: news

What Is a Good Death?
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - July 1, 2018 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

How We Underestimate the Arts in Long-Term Care
We need an ongoing focus on nonpharmacological approaches for effective interdisciplinary care in the post-acute and long-term care setting. From Parkinson ’s disease to dementia care, a mere focus on medications cannot lead to the results we seek. Research has shown that interdisciplinary strategies based on the arts may provide an innovative answer to the need for high-quality care. The ability of the arts to connect individuals of all ages, profes sional and ethnic backgrounds, and diverse cultures make them a natural approach for revolutionizing care in various geriatric settings. (Source: Caring for the Ages)
Source: Caring for the Ages - July 1, 2018 Category: Health Management Authors: Anne Basting Tags: Innovation in PA/LTC Source Type: news

Multifaceted Interventions Needed for Complex Medical Landscape
GRAPEVINE, TEXAS — In her presentation at Saturday’s General Session at AMDA – the Society for Post-Acute and Long-Term Care Medicine’s Annual Conference, Joan Teno, MD, MS, said she wanted to “shine a light on the things we need to think about as we look ahead” at the future of health care. (Source: Caring for the Ages)
Source: Caring for the Ages - July 1, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

Oral Health Provides Clues to Behavioral Changes
GRAPEVINE, TEXAS — An 87-year-old nursing home resident with advanced dementia and self-inflicted lacerations on her hand due to repetitive biting was eventually found to have peri-implant mucositis — a condition that is likely to become more common in long-term care as the use of dental implants continues to ri se. (Source: Caring for the Ages)
Source: Caring for the Ages - July 1, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

Ready to Go: Guidelines and Toolkit for UTI Management
GRAPEVINE, TEXAS — New diagnostic and treatment algorithms for suspected urinary tract infection (UTI) — and a toolkit for implementation — have been pilot-tested and are soon to be analyzed and more widely disseminated as part of the IOU (Improving Outcomes of UTI Management in LTC Facilities) study, David Na ce, MD, MPH, CMD reported 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 - July 1, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

The Importance of Medical Director Engagement in Organizational  Learning
High-performing health care organizations that achieve superior outcomes all share a core feature: a learning culture. Building a strong learning culture begins with physicians, who play a critical role in creating a learning environment in an organization. Specifically, medical directors in long-term care facilities can help drive a culture of organizational learning when they engage in staff education, both through formal in-service training as well as informal “just-in-time” learning opportunities. (Source: Caring for the Ages)
Source: Caring for the Ages - July 1, 2018 Category: Health Management Authors: David Gifford Tags: AHCA PERSPECTIVE Source Type: news

A Resident ’s Right to Appeal a Facility-Initiated Discharge
On May 12, 2016, Mrs. D was admitted to an acute care facility after she was found collapsed in her home, unresponsive, covered with melenic stool, and with dried blood around her mouth. She could not provide a history, and her daughter (her caregiver) was unavailable. She was noted to have possible upper gastrointestinal bleeding, rhabdomyolysis (from a fall), and a urinary tract infection (UTI). She was hydrated aggressively, and her rhabdomyolysis and kidney injury resolved. Her upper endoscopy examination showed severe esophagitis and Barrett ’s esophagus. (Source: Caring for the Ages)
Source: Caring for the Ages - July 1, 2018 Category: Health Management Authors: William C. Wilson Tags: lEGAL iSSUEs Source Type: news

Give Me an ‘R’ — Cheerleaders on Rocky Road to Rural Health
GRAPEVINE, TEXAS — Wyoming-based medical director Cynthia Works, MD, CMD, came to her session at AMDA – the Society for Post-Acute and Long-Term Care Medicine’s Annual Conference wearing her high school cheerleader uniform. It was a metaphor for her role as a physician leader who needs to cheer, support, encou rage, and inspire her team at the rural nursing home. But it also was a reminder that rural communities are very close-knit, with practitioners and staff who often grew up among their residents and families. (Source: Caring for the Ages)
Source: Caring for the Ages - July 1, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

Collaboration Is the Best Medicine
Teamwork in long-term care has been studied extensively for more than 3 decades, and in health care there has been significant progress in defining team requirements. A 1999 Institute of Medicine (IOM) report led to the development of the TeamSTEPPS program, developed by the Agency for Healthcare Research and Quality (AHRQ) (Team STEPPS 2.0 for Long-Term Care, http://bit.ly/2LGAzAM). (Source: Caring for the Ages)
Source: Caring for the Ages - July 1, 2018 Category: Health Management Authors: Jeanne Manzi Tags: LTC PHARMACY Source Type: news

Long-Term Care Dollars Moving Back Home
GRAPEVINE, TEXAS — 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, MPP, said 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 1, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

The Many Roles of the Social Services Professional
Robin Bonifas, PhD, associate professor at the Arizona State University School of Social Work and author of Bullying Among Older Adults: How to Recognize and Address an Unseen Epidemic, talks about the roles of the social services designee or social worker in post-acute and long-term care settings. (Source: Caring for the Ages)
Source: Caring for the Ages - July 1, 2018 Category: Health Management Tags: Caring Source Type: news

Diagnosing and Treating Apathy in Dementia
GRAPEVINE, TEXAS — Apathy is often the first sign of dementia, but diagnosing the condition apart from depression can be tricky, according to a presenter 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 - July 1, 2018 Category: Health Management Authors: Carey Cowles Source Type: news

Journal Highlights From the July Issue of JAMDA
The Care Plan Checklist for Evidence of Person-Centered Approaches for Behavioral and Psychological Symptoms Associated with Dementia (BPSD) is a reliable and valid tool for evaluating care plans for individuals who exhibit BPSD, according to a study conducted among 137 individuals in 14 nursing homes. (Source: Caring for the Ages)
Source: Caring for the Ages - July 1, 2018 Category: Health Management Source Type: news

Don ’t Miss These Events
Contact: Registrar (Source: Caring for the Ages)
Source: Caring for the Ages - July 1, 2018 Category: Health Management Source Type: news

Reducing Polypharmacy to Reduce Fall Risk: It ’s Complicated
It sounds like common sense: If you ’d like to reduce the risk of falls in vulnerable populations, try weaning patients off drugs that boost the risk of falls. But an analysis of the existing research has suggested the true picture may be more complicated. (Source: Caring for the Ages)
Source: Caring for the Ages - July 1, 2018 Category: Health Management Authors: Randy Dotinga Source Type: news

Mahajan Named 2018 Choosing Wisely Champion
Dheeraj Mahajan, MD, FACP, CMD, has long been committed to quality improvement and seeking opportunities to maximizing care for post-acute and long-term care patients everywhere. So it is no surprise that Dr. Mahajan was recently selected as a 2018 Choosing Wisely Champion. (Source: Caring for the Ages)
Source: Caring for the Ages - July 1, 2018 Category: Health Management Source Type: news

Shark Tank Competition Highlights Innovation in PA/LTC
GRAPEVINE, TEXAS — The competition among the four finalists was fierce, but in the end two sharks emerged victorious from a yearlong battle of innovation staged by AMDA — the Society for Post-Acute and Long-Term Care Medicine’s Innovation Workgroup, and showcased at the Annual Conference. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Authors: Carey Cowles Source Type: news

Filkin Lecturer Urges New Look at Thriving
GRAPEVINE, TEXAS — Thriving meshes well with excellent clinical care, according to Eleanor McConnell, PhD, associate professor and director of the Geriatric Nursing Center of Excellence at the Duke University School of Nursing. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

Inclusivity Is a Virtue
We recently received a thoughtful letter from Susan Martin, MSN, NP-C, of Aurora, IN, that contained many kind observations about Caring for the Ages as well as some constructive criticism. Our Editorial Advisory Board used Ms. Martin ’s letter as a springboard for some robust discussion, and we are grateful for the feedback she shared. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Authors: Karl Steinberg Tags: on my mind Source Type: news

FDA to Reevaluate Safety of Parkinson ’s Psychosis Drug
Amidst reports of safety concerns involving pimavanserin, a drug approved to treat psychosis symptoms among patients with Parkinson ’s disease, the Food and Drug Administration stated it has begun reassessing the safety of the drug. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

The Ties That Bind: When Families Intervene in Resident Care
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

Louisiana Nursing Home Residents Escape Mass Evictions
A divided Louisiana Senate voted 27-10 to back a state operating budget of more than $28 billion that would make steep cuts across state government to protect health programs for the elderly and disabled. The budget approved on May 15 will protect nursing home residents from evictions and keep Louisiana ’s safety-net hospitals from closure. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Source Type: news

Guterman Poster Winner Highlights SNF Residents Discharged With Disability
GRAPEVINE, TEXAS — Physical therapist Allison Gustavson, PT, DPT, set out to determine the functional profile of a typical heterogeneous skilled nursing facility population and found that most patients are being discharged back to the community with severe disability, risk for falls, and other adverse events. “A re we setting patients up for failure?” her award-winning poster asked. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

There ’s Joy in the PA/LTC Journey, Says Outgoing Society President
GRAPEVINE, TEXAS — In her address at the Friday morning General Session at AMDA – the Society for Post-Acute and Long-Term Care Medicine’s Annual Conference, Society Immediate Past President Heidi White, MD, CMD, welcomed new members and stressed how the Society has responded to continuing changes in PA/LTC. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Authors: Carey Cowles Source Type: news

Keynoter: We Are the Change We ’ve Been Waiting For
GRAPEVINE, TEXAS — The field of post-acute and long-term care is “at the edge of a transformational cliff,” keynote speaker Cheryl Phillips, MD, CMDR, president and chief executive officer of the Special Needs Plans Alliance, told her audience at AMDA – the Society for Post-Acute and Long-Term Care’s Annua l Conference. “The earth underneath us is shifting, and ignoring change will have its own consequences.” (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

Make Deprescribing Facility-Specific, With Thoughtful Communication
GRAPEVINE, TEXAS — Participants in a survey conducted in 2017 at AMDA — the Society for Post-Acute and Long-Term Care Medicine’s Annual Conference said they were likely to strongly agree that deprescribing can improve residents’ quality of life and prevent transfers to the emergency department and hospital, reduce administrative time and burden, and reduce the cost to the resident, Steven M. Handler, MD, PhD, CMD reported at this year’s conference. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

Polypharmacy Screening Tools
GRAPEVINE, TEXAS — A variety of tools may be used to help screen for polypharmacy and implement evidence-based deprescribing practices in the post-acute and long-term care setting. At AMDA — the Society for Post-Acute and Long-Term Care Medicine’s Annual Conference, Kamal Wagle, MD, MPH, CMD, of the University of Indiana School for Medicine, presented the following “toolbox” for deprescribing. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Source Type: news

Telemedicine Moves From Niche to New Normal
GRAPEVINE, TEXAS — In a world where there is a shortage of practitioners and specialists, as well as tight budgets and growing pressure to keep patients out of the hospital, telemedicine increasingly is a promising tool to enable quality, cost-effective care. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

Are Your Processes and Systems Sabotaging Your Person-Centered Practices?
I recently had the privilege of exhibiting for Pioneer Network at AMDA – the Society for Post-Acute and Long-Term Care Medicine’s Annual Conference, as well as presenting a session, “Pioneer Network: Helping You Find the Processes to Support Your Passion,” with Jonathan Evans, MD, CMD. I thoroughly enjoyed it, and I was very encouraged to hear the many referenc es to person-centered care in the sessions I attended as well as in the many conversations I had with other attendees. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Authors: Joan Devine Tags: Pioneer Perspective Source Type: news

Review: Scant Research Into Frailty in Post-Acute Care
A new scoping review found limited research into understanding and addressing frailty in post-acute care (PAC). The review suggested more investigation is needed to build on mixed results from intervention studies, and the investigators have proposed the creation of a comprehensive approach to frailty in this population. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Authors: Randy Dotinga Source Type: news

Journal Highlights From the June Issue of JAMDA
Patients with chronic heart failure warrant noninvasive monitoring with communication technology apps vs. invasive implant-based telemonitoring, a New York study concluded. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Source Type: news

Senior Care Pharmacist: Specialized in Medication Management
Care for older Americans is a team sport involving physicians and other practitioners who have special expertise caring for this population. In the coming months, watch for columns about these different team members. This month Al Barber, PharmD, CGP, talks about the role of the senior care pharmacist. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Tags: Caring Source Type: news

The Catastrophic Transition
“Why won’t my hands stop shaking (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Authors: Wayne S. Saltsman Tags: caring transitions Source Type: news

Webinar Promotes Win-Win Care Planning Talks
The idea of having a difficult conversation with someone where they may get upset or angry can make you tense and anxious just thinking about it. This is certainly true of many practitioners when it comes to conversations with patients and families about end-of-life and advance care planning. If you missed the May 9th Society webinar on this topic, you can still access the archived program online, and, as always, this program is free for Society members. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Source Type: news

Don ’t Miss These Events
June 28, 2018 (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Source Type: news

Resident Survival Low After Cardiac Arrest in Nursing Homes
At 30 days, survival after out-of-hospital cardiac arrest (OHCA) was 1.7% among nursing home residents, although those who received resuscitation efforts had an increased likelihood of survival, according to the results of a Danish study. (Source: Caring for the Ages)
Source: Caring for the Ages - June 1, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

When Mental Illness and Aging Make Nursing Homes Necessary: What Next?
Do people with chronic mental illness belong in nursing homes? (Source: Caring for the Ages)
Source: Caring for the Ages - April 28, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

Intervention to Reduce Antipsychotic Use May Have Moved Needle
Nursing homes exposed to a comprehensive web-based educational program on the appropriateness of antipsychotic drugs in dementia patients — as well as to the Centers for Medicare& Medicaid Services Partnership to Improve Dementia Care (CMS Partnership) — appeared to have modestly reduced antipsychotic and anticholinergic use without an adverse effect on symptoms, according to a recent evaluation of these programs’ impact. (Source: Caring for the Ages)
Source: Caring for the Ages - April 28, 2018 Category: Health Management Authors: Christine Kilgore Source Type: news

House Committee Seeks Answers Concerning CMS Oversight of Nursing Homes
Four members of the House Committee on Energy and Commerce have written to the Centers for Medicare& Medicaid Services requesting more information on CMS ’s role as overseer of nursing homes. (Source: Caring for the Ages)
Source: Caring for the Ages - April 28, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

Researchers Explore Palliative Approach to Falls in Advanced Dementia
Among individuals with advanced dementia, falls may indicate both the presence of disease and the need for a palliative approach to care, according to findings published in the American Journal of Geriatric Psychiatry. (Source: Caring for the Ages)
Source: Caring for the Ages - April 28, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

In Residents and Staff, Trauma Takes Many Forms
It ’s May, and Memorial Day is right around the corner. For many of us, this holiday is something to celebrate as a tangible proclamation of summer’s arrival. But it’s also a time for reflection and gratitude for the service of our veterans and of our armed forces more broadly. Our fallen soldier s gave their lives to preserve our freedom, and they deserve our solemn appreciation. (Source: Caring for the Ages)
Source: Caring for the Ages - April 28, 2018 Category: Health Management Authors: Karl Steinberg Tags: on my mind Source Type: news

Nearly One in Seven Nursing Home Residents Experiences Dysphagia
Among nursing home residents in Europe and North America, 13.4% experienced dysphagia, with the prevalence varying widely by region, according to results of the nutritionDay project. (Source: Caring for the Ages)
Source: Caring for the Ages - April 28, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

Words Have Consequences
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - April 28, 2018 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

Experts Determine Metrics of Success for Advance Care Planning Initiatives
A multidisciplinary Delphi panel has determined the top-rated outcomes for the evaluation of advance care planning (ACP) initiative success. At the top of the list is care that is received consistent with goals, followed by the patient ’s decision on a surrogate. (Source: Caring for the Ages)
Source: Caring for the Ages - April 28, 2018 Category: Health Management Authors: Brian Ellis Source Type: news

The Poetry in Geriatric Medicine
For the last 30 years I have been writing about my work in geriatric medicine. It is in the poetry where one most clearly hears the human voices — my own and in those to whom I have ministered. The writing has provided me with valuable insights into why I chose medicine, specifically geriatrics, as my life’s work. I believe that the act of writing these poems, of highlighting, of memorializing these experiences, has kept me centered. I h ave also realized that the work of reflecting on my day in and day out doctoring life — whether these experiences be banal, or upsetting, or sublime — has nurtured ...
Source: Caring for the Ages - April 28, 2018 Category: Health Management Authors: Jerald Winakur Tags: Meditations on geriatric medicine Source Type: news

Study Supports Use of New Malnutrition Definition in Older Post-Acute Rehab Patients
A study has confirmed that a new definition of malnutrition helps to detect the condition in deconditioned, older post-acute patients. The researchers also noted a significant link between malnutrition and sarcopenia. (Source: Caring for the Ages)
Source: Caring for the Ages - April 28, 2018 Category: Health Management Authors: Randy Dotinga Source Type: news

Hawaii Sixth State to Allow Medical Aid in Dying
Hawaii Gov. David Ige recently signed HB 2739 — the Our Choice, Our Care Act. The bill gives mentally capable, terminally ill people with 6 months or less to live the option to take prescription medication that enables them to die peacefully in their sleep. (Source: Caring for the Ages)
Source: Caring for the Ages - April 28, 2018 Category: Health Management Source Type: news