Higher Morale in Elders Associated With Lower Rates of Depression
Older people with higher morale than their peers have lower rates of depression 5 years later, a population-based study has shown. The results could hold clues for how to protect those most at-risk for the blues as they age, according to researchers. (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Authors: Helen Jones Source Type: news

When the Snake Oil Salesman Knocks on Your Door
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

Dementia Prevalence Increased in Heart Failure Patients
NEW ORLEANS — Elderly patients with heart failure had a significantly increased prevalence of both dementia and mild cognitive impairment, compared with similar people without heart failure, in an analysis of data collected from more than 6,000 U.S. residents enrolled in a long-term observational study. (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Authors: Mitchel L. Zoler Source Type: news

Gains in Nursing Home IT Sophistication Greater Than Expected
Although health care reform efforts nationally have included innovations in health care information technology (IT), the focus has tended to be on hospital systems and their affiliates, with nursing homes remaining an afterthought. That ’s according to the authors of a new report that shows how, despite their secondary status in the health care IT revolution, nursing homes have made some unexpected strides in how they are advancing in the digital age. (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Authors: Helen Jones Source Type: news

ADT Not Associated With Increased Risk of Dementia
Treatment with androgen deprivation therapy (ADT) was not associated with an increased risk of dementia in a large, population-based study, according to investigators. (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Authors: Roxanne Nelson Source Type: news

The Role of Attitude, Culture in Long-Term Care Hospitalization Rates
Whether a long-term care facility faces high hospitalizations rates for residents could be a matter of attitude on the part of both the clinical and the support staff, according to a recent small qualitative study. (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Authors: Helen Jones Source Type: news

More to Quality Care Than Rehospitalization Rates
Some years ago, my nursing home administrator and I met with the chief executive officer of the local hospital, whose idea was to start directing hospital patients to “preferred” nursing homes. “But, but, but,” I sputtered, “you have to give people choice! That’s illegal!” He replied, “Dan, you’re a fool” (a phrase all too frequently said to me, and unfortunately in many cases appropriately so). It turns out I really didn’t understand — he was talking about informed choice, the hospital’s plan to identify the best homes in the area and partner wi...
Source: Caring for the Ages - February 28, 2017 Category: Health Management Authors: Daniel Haimowitz Tags: The Board Room Source Type: news

Elderly Trauma Patients Do Well in Non-ICU Wards
CORONADO, CA — When elderly patients are appropriately triaged, they can be selectively admitted to non–intensive care wards with acceptable outcomes, results from a single-center study showed. (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Authors: Doug Brunk Source Type: news

Alzheimer ’s Candidate Drug Aducanumab Moves to Phase III
SAN DIEGO — The antiamyloid antibody aducanumab significantly reduced amyloid brain plaques in Alzheimer’s disease patients who entered a second year of therapy in an open-label extension trial. (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Authors: Michele G. Sullivan Source Type: news

Dying for Dollars
The headline read, “How tens of thousands of patients who weren’t actually dying wound up on hospice care.” This appeared in the Washington Post on Sept. 15, 2016. The reason, according to this article, was that “hospice companies earn more by recruiting patients who aren’t actually dying.” As a result of this revelation, the Office of Inspector General “has investigated and is investigating hundreds of hospice fraud schemes.” (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Authors: Jerald Winakur Tags: Meditations on geriatric medicine Source Type: news

Implications of the Final Rule on Psychotropic Medication Use
The final rule for long-term care facilities participating in Medicare and Medicaid programs was published by the Centers for Medicare& Medicaid Services on Oct. 4, 2016, as “Medicare and Medicaid programs; reform of requirements for long-term care facilities.” It is also referred to as the long-term care “Mega-Rule” (www.gpo.gov/fdsys/pkg/FR-2016-10-04/pdf/2016-23503.pdf). The three phases of these regulations have an implementation date of Nov. 28 in 2016, 201 7, and 2019. (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Authors: Jeanne Manzi Tags: LTC Pharmacy Source Type: news

Glucose-Lowering Drugs Linked to Increased Fracture Risk in Patients With Diabetes
Researchers in Denmark have concluded that use of glucose-lowering sulfonylureas and glitazones within 90 days increased the risk for hip fractures in elderly patients with type 2 diabetes. (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Authors: Jason Harris Source Type: news

The High Cost of Cutting Corners on Care Plans
Mr. H, an 80-year-old black man, was admitted to a skilled nursing facility for rehabilitation after undergoing an open reduction, internal fixation to repair a broken left hip. Mr. H had several comorbidities, including type 2 diabetes, dementia with behavioral disturbance, diabetic retinopathy, diastolic heart failure, and a recent urinary tract infection. (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Authors: William C. Wilson Tags: LEGAL ISSUES Source Type: news

Study Shows No Connection Between Orthostatic Hypotension and Recurrent Falls
Results from a small prospective observational cohort study of Dutch nursing home residents found that orthostatic hypotension (OH) was not a causative factor for falls. (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Authors: Jason Harris Source Type: news

CMS Issues Guidance FAQs for Wandering and Exit-Seeking Behavior
The Centers for Medicare& Medicaid Services recently posted a FAQ sheet on guidance for wandering and exit-seeking behavior in Medicaid recipients in home and community-based settings (HCBS). The criteria requires HCBS institutions to facilitate the independence and decision-making of beneficiaries. These FAQs include guidance for provider-controlled settings with memory care units. In summary: (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Authors: Helen Jones Source Type: news

Sigma 1 Agonist Presses Forward After Positive Results in Small Alzheimer ’s Trial
SAN DIEGO — A novel Alzheimer’s disease drug candidate appeared to stabilize cognition and function over 57 weeks in a small, early-phase, open-label trial. (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Authors: Michele G. Sullivan Source Type: news

How to Help a Grieving Grandparent
Medical director and geriatrician David Smith, MD, CMD, talks about how to help an elder loved one through the grieving process when they suffer a loss. (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Tags: Caring Source Type: news

Journal Highlights From the March Issue of JAMDA
Individuals who have cognitive frailty — that is, frailty along with cognitive impairment but not dementia — have a much greater risk of functional impairment, impaired quality of life, and mortality, according to a longitudinal study in Singapore. (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Source Type: news

News From the Society
The Core Curriculum on Medical Direction has always received great reviews from participants, but that never stopped Society staff and Core faculty from seeking ways to improve, update, and enhance it. Recently, they have moved more of the program online — now more than 90% — to make it more convenient and affordable to complete. (Source: Caring for the Ages)
Source: Caring for the Ages - February 28, 2017 Category: Health Management Source Type: news

The Nurse Practitioner ’s Evolving Role in PA/LTC
Jodi Dobslaw, CRNP, is making rounds in the memory care unit at Masonic Villages in Elizabethtown, PA. Her easy compassion and rapport with the residents mirror those of her colleague and facility medical director J. Kenneth Brubaker, MD, CMD, and it is clear why they are popular with everyone. She walks into one room where the resident is slumped in a chair, who barely acknowledges Ms. Dobslaw ’s cheery greeting and is mostly unresponsive as she begins her exam. The older woman answers most questions with a nod or a grunt, but Ms. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2017 Category: Health Management Authors: Joanne Kaldy Source Type: news

Closing Keynoter Turns Curiosity Into Quality Care
Curiosity may have killed the cat, but it led scientist, researcher, author, and speaker Marc Milstein, PhD, to some important discoveries, and in many ways it guides his career on a daily basis. Coming from a cellular/molecular biology background, he started out in breast cancer research. “We discovered a protein that suppressed breast cancer was also involved in learning and memory. It piqued my interest in the concept that areas of the body are connected in ways we don’t yet know or understand. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2017 Category: Health Management Authors: Joanne Kaldy Source Type: news

Winning Isn ’t Everything, Nor Should It Be
The oft-quoted sports motto, “Winning isn’t everything, it’s the only thing,” often misattributed to Vince Lombardi, was actually first propounded in a slightly different form by Red Sanders, UCLA’s football coach, in 1950 in a physical education workshop at California Polytechnic State University, San Luis Obispo. Bu t Lombardi didn’t seem to mind taking credit for the slogan, and repeated it throughout much of the Green Bay Packers’ string of successful NFL seasons in the 1960s. I am old enough to remember that team in grade school, with Bart Starr at quarterback. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2017 Category: Health Management Authors: Karl Steinberg Tags: on my mind Source Type: news

Reminiscence Therapy Improved Recall of Autobiographical Memory
Reminiscence interventions have been studied for decades, with some evidence of benefit for cognition, mental health, and overall well-being in older adults. But should structured reminiscence programs have a place in long-term care facilities and in the treatment of individuals with cognitive impairment? (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2017 Category: Health Management Authors: Christine Kilgore Source Type: news

Beyond Palliative Care: Collaborating With a Hospice Program
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2017 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

FDA Bans Powdered Gloves
The Food and Drug Administration has banned powdered gloves for use in health care settings, citing “numerous risks to patients and health care workers.” The ban extends to gloves currently in commercial distribution and in the hands of the ultimate user, meaning powdered gloves will have to be pulled from examination rooms and operating theaters. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2017 Category: Health Management Authors: Kari Oakes Source Type: news

Celecoxib: Cardiovascular Risk No Worse Than That of Nonselective NSAIDs
NEW ORLEANS — The cardiovascular safety profile of the nonsteroidal anti-inflammatory drug (NSAID) celecoxib, a selective inhibitor of COX-2, is no worse than those of the nonselective NSAIDs naproxen and ibuprofen, according to a trial reported at the American Heart Association scientific sessions. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2017 Category: Health Management Authors: Susan London Source Type: news

Creating a Better Pathway to Home
Historically, the coordination of care for a patient ’s disposition in the health care continuum has focused on the transition from the hospital back to the home or to a post-acute care facility. Little emphasis has been placed on the transition from the skilled nursing facility back to the community, home, or primary care team. It is clear, however , that there are pervasive concerns regarding transitions from SNF stays. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2017 Category: Health Management Authors: Jennifer L. Carnahan Tags: caring transitions Source Type: news

Live Music Decreased Pain, Improved Mood and Energy Levels in Elderly
Attending chamber music concerts was associated with decreased pain, better mood, and increased energy in older adults residing in long-term care or other assisted living facilities, according to results from a recent study. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2017 Category: Health Management Authors: Helen Jones Source Type: news

Start Preparing Now for MACRA Changes to Come
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaces current value-based performance reporting and establishes a new Quality Payment Program (QPP). QPP essentially creates two pathways forward: the Merit Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). Currently, every physician-led post-acute/long-term care medical group probably knows it is likely enduring a minimum of a 2% Medicare Part B payment cut for 2017. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2017 Category: Health Management Authors: Rod Baird Tags: Practice Management Source Type: news

Palliative Care Through the Eyes of the Family Caregiver
Palliative care is one of the most misunderstood terms in health care. It is often associated with death and dying. It is a concept that needs a makeover. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2017 Category: Health Management Authors: MaryAnne Sterling Tags: Caregiver ’s Perspective Source Type: news

Statins Protect Against Alzheimer ’s in Most Patients
Statins taken to reduce cholesterol also protect most patients against Alzheimer ’s disease, but the decrease in risk varies across different statins and by the patient’s gender and race/ethnicity, according to a report published in JAMA Neurology. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2017 Category: Health Management Authors: Mary Ann Moon Source Type: news

Nurse Practitioners Can Be the MVPs of the Care Team
J. Kenneth Brubaker, MD, CMD, medical director at Masonic Villages in Elizabethtown, PA, talks about the value of the nurse practitioner as part of the care team. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2017 Category: Health Management Tags: Caring Source Type: news

Journal Highlights From the February Issue of JAMDA
Nursing homes, rather than being an endpoint of functional decline, may be able to play a role in its prevention, both in their residents and community dwelling individuals, a task force suggests. (Source: Caring for the Ages)
Source: Caring for the Ages - January 31, 2017 Category: Health Management Source Type: news

News From the Society
Last year, the Foundation for Post-Acute and Long-Term Care Medicine (formerly the AMDA Foundation) didn ’t just change its name. It expanded its focus in a way that will significantly broaden its impact beyond attracting practitioners to the field and educating them, and supporting Society initiatives that otherwise would be challenging due to budget limitations. These initiatives include creating a curriculum to support the competencies for PA/LTC practitioners, enabling the development and dissemination of quality measures, and supporting other Society efforts to promote quality PA/LTC medicine and ensure practiti...
Source: Caring for the Ages - January 31, 2017 Category: Health Management Source Type: news

Maintaining a Personal Touch in High-Tech Care
Watch an old rerun of Marcus Welby, MD, and you will be transported to a simpler time, when the physician had all the answers and was known and revered by everyone in the community. The physician didn ’t have to worry about technology, complex regulations, or reimbursement issues; instead, he could focus on caring for patients. (Source: Caring for the Ages)
Source: Caring for the Ages - December 31, 2016 Category: Health Management Authors: Joanne Kaldy Source Type: news

Toto, We ’re Not in Fee-for-Service Anymore: Understanding MACRA and Beyond
It is hard to believe that we spent almost 2 decades trying to repeal the flawed Sustainable Growth Rate (SGR) formula that defined how physicians got paid and now in a blink of an eye we must get used to a whole new way of doing business. The game changing legislation known as MACRA (Medicare Access and Children ’s Health Insurance Program Reauthorization Act of 2015) built on already existing programs and created new ways physicians and other providers will now be getting paid. (Source: Caring for the Ages)
Source: Caring for the Ages - December 31, 2016 Category: Health Management Authors: Alex Bardakh Source Type: news

Dealing With the Post-Election Blues
I admit it: I am not a morning person. As many of my colleagues can confirm, when the Society has meetings on the East Coast, I constantly whine, sharing comments like: “Oh, great! I’m thrilled that you decided to have this meeting at 6:30 a.m. Or, as I like to call it, 3:30 a.m.!” Although I am almost never grumpy when I wake up, it does take me a little time, and a triple-shot latte, to really work up the gusto to face the day. (Source: Caring for the Ages)
Source: Caring for the Ages - December 31, 2016 Category: Health Management Authors: Karl Steinberg Tags: on my mind Source Type: news

CMS to Pay More for Care Coordination, Prevention
Doctors could be paid more in 2017 for care coordination, preventive care, and mental/behavioral health care services. (Source: Caring for the Ages)
Source: Caring for the Ages - December 31, 2016 Category: Health Management Authors: Gregory Twachtman Source Type: news

What It Means When a Resident Wants to Die at Home
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - December 31, 2016 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

Psychotropic Drugs Associated With Increased Risk for Falls
Results from a retrospective observational study conducted in the Netherlands show that patients who are prescribed psychotropic drugs are at a significantly increased risk for falls. Taking psychotropic drugs on a scheduled basis was associated with an almost threefold increase in the incidence of falls. (Source: Caring for the Ages)
Source: Caring for the Ages - December 31, 2016 Category: Health Management Authors: Jason Harris Source Type: news

Legislators Commit to Bipartisan Support of Alzheimer ’s Funding
WASHINGTON — The nation’s political sea change won’t wash Alzheimer’s disease research funding off track, two legislators vowed at a Washington briefing. (Source: Caring for the Ages)
Source: Caring for the Ages - December 31, 2016 Category: Health Management Authors: Michele G. Sullivan Source Type: news

Slavitt to Trump Administration: Keep the CMS Innovation Center
WASHINGTON — Acting Admin-istrator Andy Slavitt has some advice for his successors at the Centers for Medicare& Medicaid Services: Keep the Center for Medicare& Medicaid Innovation, even if you trash the Affordable Care Act. (Source: Caring for the Ages)
Source: Caring for the Ages - December 31, 2016 Category: Health Management Authors: Gregory Twachtman Source Type: news

Outreach Rehabilitation Program Improves the “Chaotic Journey” After Hip Fracture
A 4-week outreach rehabilitation program for nursing home residents after hip fracture repair appears to have provided hope and self-confidence as well as early mobilization and improved activity levels when compared with the usual care after hospital discharge. (Source: Caring for the Ages)
Source: Caring for the Ages - December 31, 2016 Category: Health Management Authors: Christine Kilgore Source Type: news

New Society Workgroup Provides Springboard for Innovation
As you stroll through the hallways of the hotel at a Society annual meeting, you may hear complaints about the ever-increasing hardships of clinical practice. Themes are echoed about patients who are sicker, hospital staff who expect too much from us, and a lack of resources that is increasingly exerting an adverse impact on care. The complaints will then turn to the Affordable Care Act, which has required hospitals and post-acute systems, including the physicians who serve them, to show significant flexibility and adaptability with new electronic health records, new treatment protocols, and many regulatory changes. (Sourc...
Source: Caring for the Ages - December 31, 2016 Category: Health Management Authors: Arif Nazir Tags: Innovations in PA/LTC Source Type: news

Blood Pressure and LDL Lowering in Elderly Do Not Slow Cognitive Decline
NEW ORLEANS — Blood pressure and cholesterol lowering in elderly patients with moderate vascular risk did not prevent cognitive decline in HOPE-3, the large randomized Heart Outcomes and Prevention Evaluation-3 trial, Jackie Bosch, PhD, reported at the American Heart Association scientific sessions. (Source: Caring for the Ages)
Source: Caring for the Ages - December 31, 2016 Category: Health Management Authors: Bruce Jancin Source Type: news

Roam If You Want to: Unlocking Doors for Patients With Dementia
The author of Dementia Beyond Drugs: Changing the Culture of Care and Dementia Beyond Disease: Enhancing Well-Being, G. Allen Power, MD, posted a photo on social media of a door in a dementia unit decorated to resemble the corner of a lovely room with a bookcase and flowers in a vase. At first glance, it is visually appealing. But the truth is, said Dr. Power, it is still a door. Instead of disguising or locking doors to keep people from leaving, “We need to figure out why they want to leave, and we need to think about the needs we’re not meeting,” he said. (Source: Caring for the Ages)
Source: Caring for the Ages - December 31, 2016 Category: Health Management Authors: Joanne Kaldy Source Type: news

Top Regulatory Citations for Nursing Facilities
Recently a significant number of new regulatory requirements were issued by the Centers for Medicare& Medicaid Services impacting the daily operation of Medicare- and Medicaid-certified nursing facilities. With the rapidly changing requirements, clinicians should be proactive in understanding and implementing changes in practices, policies, and procedures, while being mindful of the current top citations being issued by state agencies during the standard survey process. By staying on top of the new requirements, nursing facilities can be prepared to meet survey challenges now and in the future. (Source: Caring for the Ages)
Source: Caring for the Ages - December 31, 2016 Category: Health Management Authors: Janet K. Feldkamp Tags: Legal Issues Source Type: news

Diabetes, Stroke Linked to C. difficile
LAS VEGAS — Diabetes and stroke are risk factors for recurrent Clostridium difficile infection (CDI), with stroke patients at about 10 times the risk of recurrence. (Source: Caring for the Ages)
Source: Caring for the Ages - December 31, 2016 Category: Health Management Authors: Jim Kling Source Type: news

Journal Highlights From the January Issue of JAMDA
Residents of green care farms, which combine agricultural activities with 24-hour nursing care in a small-scale homelike setting, are more involved in domestic and outdoor activities, spend less time on passive activities, and tend to be more socially engaged than residents in other nursing home settings, according to a longitudinal observational study in Maastricht, the Netherlands. (Source: Caring for the Ages)
Source: Caring for the Ages - December 31, 2016 Category: Health Management Source Type: news

Resolve to Help Mom and Dad in 2017
Texas-based physician David Smith, MD, CMD, talks about how to resolve to ensure a happy, healthy new year for your loved one in a post-acute/long-term care facility. (Source: Caring for the Ages)
Source: Caring for the Ages - December 31, 2016 Category: Health Management Tags: Caring Source Type: news