Caring Communication: Connecting with Practitioners, Staff for Quality Outcomes, Happy Patients
Several years ago, Caring for the Ages introduced this column to help encourage the best possible communication between practitioners and patients/families in post-acute and long-term care on a wide range of topics. We gathered a prestigious group of patient advocates, practitioners, and family members to craft a column that would meet this goal. The result was Caring for Consumers. This month ’s column, authored by long-time contributing writer Joanne Kaldy, whose mother was an assisted living facility and nursing home resident, focuses on how to keep the communication channels open and working. (Source: Caring for the Ages)
Source: Caring for the Ages - December 1, 2018 Category: Health Management Tags: Caring Source Type: news

Journal Highlights From the December Issue of JAMDA
Staff training can lead to improved oral hygiene and denture care among nursing home residents, a study from the University of North Carolina at Chapel Hill found. (Source: Caring for the Ages)
Source: Caring for the Ages - December 1, 2018 Category: Health Management Source Type: news

Destination, Atlanta: Annual Conference Offers the Best of PALTC Medicine
Registration is now open for AMDA  — The Society for Post-Acute and Long-Term Care Medicine 2019 Annual Conference, set for March 7-10 in Atlanta, GA. Many practitioners, such as Firas Saidi, MD, CMD, have already signed up. As Dr. Saidi, the conference’s first registrant, said, “I’ve been attending the annual conference fo r over 10 years. It’s the only place I can get relevant, up-to-date information in the post-acute and long-term care space. There’s always something interesting happening, always something out of the box and innovative. (Source: Caring for the Ages)
Source: Caring for the Ages - December 1, 2018 Category: Health Management Source Type: news

Don ’t Miss These Events
Website: https://paltc.org/core (Source: Caring for the Ages)
Source: Caring for the Ages - December 1, 2018 Category: Health Management Source Type: news

Giving to “Our Foundation”
All of us practicing post-acute and long-term care medicine are confronted with a lot of information and data. But it is up to us, using everything we know, see, and feel, to make decisions about patient care. Our job is to think both broadly and specifically about what is needed for the optimal well-being of the person whose care is entrusted to us. At the end, salient facts and impressions are key to the decisions we make. (Source: Caring for the Ages)
Source: Caring for the Ages - December 1, 2018 Category: Health Management Authors: J. Kenneth Brubaker Source Type: news

Special Editor ’s Announcement: Giving Thanks for Change
It ’s November, and Thanksgiving is right around the corner. America has a wonderful tradition of setting aside a specific holiday — and if you’re lucky a nice 4-day weekend — to celebrate gratitude for all the things we have in our lives to be thankful for. Thanksgiving is a time to take stock , to reconnect with family and friends, to stop and smell the roses (or the turkey or the wood fire), to reminisce about old times and those we have lost, and to appreciate how fortunate and blessed we are. (Source: Caring for the Ages)
Source: Caring for the Ages - November 1, 2018 Category: Health Management Authors: Karl Steinberg Tags: on my mind Source Type: news

Dementia Interventions: From Past to Present
In this issue of Caring for the Ages, several articles about dementia prevention and care for individuals with dementia are being republished. In looking back at these articles, I ’m reminded of how few answers we have in terms of the best approach to care. Moreover, I anticipate that there really is no best answer but rather a smorgasbord of approaches and ways to prevent, screen for, and treat dementia. What works, or is best for one individual may simply not work or be b est for another. (Source: Caring for the Ages)
Source: Caring for the Ages - November 1, 2018 Category: Health Management Authors: Barbara Resnick Source Type: news

Calling All State Chapters
When I call, state chapter leaders wonder if they really want to answer their phones. “Yes, it’s Mary Evans calling, asking that you please do your utmost to join me in not only evangelizing about the Foundation for Post-Acute and Long-Term Care Medicine’s Futures Program, but also that you raise money and send a check.” (Source: Caring for the Ages)
Source: Caring for the Ages - November 1, 2018 Category: Health Management Authors: Mary Evans Source Type: news

I Don ’t Belong Here — I Want to Go Home
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - November 1, 2018 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

Let ’s Work Together to Make This Flu Season a Better One for PA/LTC Residents
Flu season is officially here, and once again I find myself surprised by the tenacity of the old (and new) myths about the flu shot. (For instance, one that recently moved into the “myth” column is that people with egg allergies shouldn’t get the flu shot.) However, unless we’re prepared to have a repeat of last year’s flu season, which was particularly brutal for the frail older adults living in nursing homes and other post-acute and long-term care settings, we need to take steps now to get ready. (Source: Caring for the Ages)
Source: Caring for the Ages - November 1, 2018 Category: Health Management Authors: Christopher E. Laxton Tags: LEGAL ISSUES Source Type: news

Pharmacists IMPACT Patient Care – an overview of the IMPACT Act
On September 18, 2014, Congress passed the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act), and the bill was signed into law by President Obama on October 6, 2014. This law requires the submission of standardized data by long-term care hospitals (LTCHs), skilled nursing facilities (SNFs), home health agencies (HHAs), and inpatient rehabilitation facilities (IRFs), and it establishes a quality reporting program (QRP) for SNFs. (Source: Caring for the Ages)
Source: Caring for the Ages - November 1, 2018 Category: Health Management Authors: Jeanne Manzi PharmD Tags: LTC Pharmacy Source Type: news

Preparing for Disasters, Assisted Living Communities Balance Protection and Engagement
Safety and independence — many older Americans and their families choose assisted living (AL) communities, or care communities, because they offer this combination of features. However, when disaster strikes, whether it is a hurricane, fire, or active shooter situation, care communities must ensure a balance between prot ection and engagement. “Preparedness should be part of the organizational culture, and everyone — including the residents — needs to be involved,” said Stan Szpytek, the president of Fire and Life Safety, an emergency preparedness consultant to AL communities and other organiz...
Source: Caring for the Ages - November 1, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

The Changing Ethics of Health Care
Health care delivery is changing, and the ethics of health care are changing along with it. Much has been written about how and why health care delivery is changing, driven largely by concerns about escalating health care costs. But far less attention is given to the changing ethics of health care — what the causes are, and what, if anything, can and should be done about it. (Source: Caring for the Ages)
Source: Caring for the Ages - November 1, 2018 Category: Health Management Authors: Jonathan M. Evans Tags: MEDICAL ETHICS Source Type: news

Adult Daughters: Our Nation ’s Front Lines of Caregiving in the Era of Alzheimer’s
In honor of A Day Without a Woman, my friends at Daughters Unite quoted one of my frequent go-to sayings: “If adult daughters went on strike tomorrow, our health care system would collapse.” It’s time I explained why I say this so often. (Source: Caring for the Ages)
Source: Caring for the Ages - November 1, 2018 Category: Health Management Authors: MaryAnne Sterling Tags: Caregiver ’s Perspective 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 - November 1, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

AMDA Podcast Is Your Program
The AMDA On-The-Go podcast, hosted by Wayne Saltsman, MD, PhD, CMD, is fast becoming a popular way for practitioners to get the latest news and research, hear from experts and innovators, and revel in the excellence and energy that is PA/LTC medicine. (Source: Caring for the Ages)
Source: Caring for the Ages - November 1, 2018 Category: Health Management Source Type: news

Prepare for a Successful Informal Dispute Resolution
Editor ’s note: Although this article was written in 2016, the information and advice provided in it remain relevant to the current IDR processes. (Source: Caring for the Ages)
Source: Caring for the Ages - November 1, 2018 Category: Health Management Authors: By Janet K. Feldkamp Tags: LEGAL ISSUES Source Type: news

Nurse Practitioners Build Future Careers on New Foundation
The Foundation for Post-Acute and Long-Term Care Medicine (formerly the AMDA Foundation) Futures program has always been an amalgam of participants in various career stages from all across the country. A few years ago, the program began adding nurse practitioners to the mix. These NPs not only learned about PA/LTC medicine — much of it from the medical director’s point of view — they also shared their perspectives with their physician colleagues. (Source: Caring for the Ages)
Source: Caring for the Ages - November 1, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

Is Diet the Best Prevention Strategy for Dementia?
A number of studies have reported that diet interventions can be an effective strategy for preventing or delaying the onset of dementia in older adults. While the Mediterranean (MedDiet) and the DASH (Dietary Approach to Stop Hypertension) diets have demonstrated cardiovascular benefits in older adults, another reported outcome is a lower risk of Alzheimer ’s disease and cognitive decline. The MedDiet is a cultural-based diet pattern that has been shown to prevent cardiovascular disease, whereas the DASH diet originally was developed to reduce and control blood pressure. (Source: Caring for the Ages)
Source: Caring for the Ages - November 1, 2018 Category: Health Management Authors: Phyllis Famularo Source Type: news

Dr. Smith Goes to Washington: Society Members Unite Legislators With Issues Aimed at Improving Care
On a Thursday in late September, the crowds on Capitol Hill were larger and more energized than usual. The Brett Kavanaugh hearings were being held, the area was crowded with spectators and protestors alike, and people in Washington, DC, were glued to their TVs. In the midst of all this, leaders of AMDA — The Society for Post-Acute and Long-Term Care Medicine arrived on the Hill to meet with legislators and address issues aimed at improving the quality of care for post-acute and long-term care residents. (Source: Caring for the Ages)
Source: Caring for the Ages - November 1, 2018 Category: Health Management Authors: Joanne Kaldy Source Type: news

Journal Highlights from the November Issue of JAMDA
The number of adults aged 65 and older taking five or more prescription drugs has increased by 24% in the last 30 years, which has prompted research into ways to reduce polypharmacy. Deprescription can be successful with certain drug classes — but usually only when there is collaboration with a pharmacist and close follow-up observation. (Source: Caring for the Ages)
Source: Caring for the Ages - November 1, 2018 Category: Health Management Source Type: news

News from the Society
Society member Christopher Joncas, MD, CMD, has only missed one annual conference in the past 20 years. “I sign up right away as soon as registration opens. I’m always excited about the program.” Last year, he was the first registrant for the 2018 conference in Grapevine, Texas. Now he and other members of AMDA — The Society for Post-Acute and Long-Term Care Medicine for whom this conference i s a “must” are signing up for the 2019 program, set for March 7–10 in Atlanta, GA. (Source: Caring for the Ages)
Source: Caring for the Ages - November 1, 2018 Category: Health Management Source Type: news

Don ’t Miss These Events
West Palm Beach, FL (Source: Caring for the Ages)
Source: Caring for the Ages - November 1, 2018 Category: Health Management Source Type: news

Taking the Dread Out of Parkinson ’s Diagnosis
David Smith, MD, CMD, a past president of AMDA  — The Society for Post-Acute and Long-Term Care Medicine and a Texas-based medical director and physician, takes the fear out of Parkinson’s diagnosis. (Source: Caring for the Ages)
Source: Caring for the Ages - November 1, 2018 Category: Health Management Tags: Caring Source Type: news

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