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

Lessons Learned About Teamwork, Successful Change From QI Award Winner
If the Foundation for Post-Acute and Long-Term Care Medicine ’s Quality Improvement and Health Outcomes (QIHO) Awards had a face, it might be that of Marian McNamara, RN. She and her colleagues have received this honor four times in the last 5 years, and Ms. McNamara embodies the innovation, creativity, passion, and teamwork that the award was designed to e mpower. (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Source Type: news

Don ’t Miss These Events
Core Online Fall Early Bird Deadline (Source: Caring for the Ages)
Source: Caring for the Ages - August 1, 2018 Category: Health Management Source Type: news

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