A new CMS proposal includes bundled payment models for cardiac care and an extension of the existing bundle for hip joint replacements to include hip and femur fractures.
Occupancy rates in long term care facilities are dropping, and managed care rates are falling, even as the number of managed care residents is growing in skilled nursing care centers. Federal reimbursement programs are moving away from fee-for-service to value-based payments. Regulations, codified to improve safety or other aspects of quality, are typically expensive for long term care providers to implement, and come at a time when providers are continuing to be forced to cut costs.
It’s an exciting time to be involved in research because there is now the opportunity to combine traditional clinical effectiveness research with patient-centered outcomes research.
As the U.S. population ages, health providers and administrators in assisted living, skilled nursing, and post-acute care centers will need actionable strategies in place to manage the pain, stiffness, and limitations of activity caused by arthritis.
Fortunately, today a movement begun in 2012 by the Centers for Medicare & Medicaid Services (CMS) and health care groups representing the long term/post-acute care profession has made significant progress in reducing the use of antipsychotics as a first-line treatment for managing residents diagnosed with dementia. But there is still a long way to go.
Long term and post-acute care community members took to Twitter last night to share some thoughts on President Obama’s final State of the Union address.
Researchers are honing in on what creates one of many troubling symptoms of Alzheimer’s disease: psychosis. In a recent Journal of Alzheimer’s Disease article, Canadian psychiatrist Corinne Fischer at St. Michael’s Hospital and her team report that poor blood circulation caused by cerebrovascular disease and abnormal protein deposits called Lewy bodies may be the culprits.
Be careful what you think: The right attitude may help you avoid Alzheimer’s disease, according to two recently published studies.
Caregiving is a 24/7/365 job. To stay on top of everything, many caregivers—personal and professional—are turning to apps on their smartphones.
Always on the move, Bill Thomas, MD, is a man with a mission: to challenge conventional views on aging. Provider recently caught up with Thomas at a sit-down discussion with students from The Erickson School at the University of Maryland, Baltimore County.
NASA brought the public Tang and freeze-dried ice cream. Now biotechnology is returning the favor to both the space industry and to elder care through the advent of 3D-printed meals.
When it comes to matters of the heart, men and women age differently, according to a study recently published online in the journal Radiology. These findings suggest that gender-tailored treatments may be needed for age-related heart failure.
Caregiver and tech organizations have formed a Caregiver Council to raise awareness and to help address the needs and services of family caregivers.
The Centers for Medicaid & Medicare Services (CMS) held a teleconference meeting Wednesday for long term and post-acute care (PAC) providers that gave a basic overview of the timelines involved in implementing the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 as well as additional learning and public commentary opportunities. It also hinted that other health care programs, such as hospice, outpatient rehabilitation, and telehealth may eventually be incorporated into the act.
Long term care providers that currently or in the future plan to partner with large physician practices may need to pay heed: Private preferred provider organizations (PPOs) that do not have many competing practices in the area often charge higher prices for many common medical procedures compared with PPOs that have a lot of regional competition, according to a new study published in the October issue of Health Affairs.
Long term and post-acute care (LTPAC) workers report the lowest influenza vaccination rates compared with all health care workers, according to data from the Centers for Disease Control and Prevention (CDC).
The rampant prescription of antibiotics for conditions that don’t necessarily merit them is creating a whole new generation of antibiotic-resistant bacteria. The struggle to stem the overreliance on antibiotics doesn’t begin and end with physicians, however. It takes cooperation across the entire continuum of care.
ICD-10 is coming. But providers and CMS may not be completely prepared for its implementation, some advocates and government watch groups say.
A pervasive yet elusive symptom among patients with Alzheimer’s disease—aggression—may soon have a targeted drug combo that works just as well as antipsychotics but without their dire side effects, reports a study in this week’s edition of the Journal of the American Medical Association.
Turns out there’s more to worry about middle age spread other than creeping numbers on the scale: A recent article in Molecular Psychiatry says that those who pack on the pounds in middle age face a higher risk of earlier onset and greater severity of Alzheimer’s disease.
Aging is more than reaching a number—it also involves body and mind. For decades researchers have been under the impression that these aspects of aging move in the same direction. Those who are more physically fit are more mentally acute, and vice versa. But the current findings are more complicated.
In 2013, there were about 40 million family caregivers taking care of their loved ones. If they were paid the prevailing wage for their efforts, it would be worth some $470 billion, according to an analysis by AARP.
Cyberfriends may not be too far off in the distant future for patients with dementia. But research and ethical questions around their use remains.
Enter PARO, a. A robotic seven7-pound baby harp seal that is a $6,000 medical device that is currently being tested with dementia patients. The largest efficacy study to date on this robot is underway in Australia, with its protocol published this month in BMJ Open.
Provider advocates are using the latest data on the continuing success of eliminating unnecessary antipsychotic medicines to push against proposed regulations that the advocates fear will be too much of a blunt instrument.
The Centers for Disease Control and Prevention (CDC) released today in its "Vital Signs" report two mathematical models that confirm the need for more coordination among health facilities and state health departments to curb the rise of antibiotic-resistant bacteria.
Researchers and patients advocates are cautiously optimistic that a new focus on proteins known as amyloids may yet solve the ongoing puzzle of Alzheimer’s disease.
The Centers for Medicare & Medicaid Services (CMS) this week proposed a rule requiring all long term care facilities to establish an antibiotic stewardship program, including antibiotic use protocols and antibiotic monitoring, all further proof of the federal government’s escalated response in the battle against superbugs, malicious microbes that are resistant to these drugs.
Following a cardiac event, each minute without treatment decreases the likelihood of surviving without disability, and survival rates depend greatly on where the cardiac arrest occurs, said the committee that carried out the study and wrote the report titled “Strategies to Improve Cardiac Arrest Survival: A Time to Act.”
The U.S. Food and Drug Administration (FDA) approved the first biosimilar in early March.
A biologic medicine is a large molecule, typically made from living cells and used in the treatment, diagnosis, or prevention of disease.
Moving past the status quo can be difficult, but sometimes rocking the boat can cause a wave of quality improvement that enhances outcomes and reduces costs.
Early last year, the Centers for Medicare & Medicaid Services (CMS) issued a rule that has significant implications for assisted living facilities providing memory care.
CMS says that its goal is to ensure that Medicaid waiver residents receive person-centered care in the most integrated setting possible.
Prevention may not always be the best form of treatment for some people. A recent study in The Journal of The American Geriatrics Society found a serious discrepancy among elders who undergo colorectal cancer screening—the oldest seniors, who are least likely to benefit, are getting screened while many younger seniors are not tested.
Older adults over 75 years with no comorbid conditions should consider taking statins to stave off heart disease, but only if no adverse effects result, says a new study in the Annals of Internal Medicine.
Seniors over 68 years of age who take daily calcium supplements may be at higher risk of developing age-related macular degeneration (AMD), according to a recent study in The Journal of the American Medical Association Ophthalmology.
Studying the last days of thousands of Medicare patients, a five-person research team found that the more commonly hospice was offered in nursing homes, the more hospitalizations for all residents decreased. For every 10 percent increase in hospice “penetration” of nursing homes, the risk of hospitalizations for all residents—those in hospice care and those in other care—fell by almost 5 percent, the researchers say.
The introduction of the American Health Care Association/National Center for Assisted Living Quality Initiative goal of safely reducing the off-label use of antipsychotics caused staff to look at their current practice of responding to behaviors in a unique way.
About 90 percent of flu-related deaths and more than half of flu-related hospitalizations occur in those over the age of 65. New information reveals that more than three-quarters of U.S. flu shots are ineffective, posing a greater risk to the elderly this year.
Data presented at the 2013 Alzheimer’s Association International Conference showed that a diabetes drug may be associated with a reduced risk of dementia. In a study of nearly 15,000 people with type 2 diabetes aged 55 and older, those who started on metformin, an insulin sensitizer, had a much lower risk of developing dementia in comparison with people who started other diabetes therapies.
Clostridium difficile is an anaerobic bacterial spore that may be present in normal bowel flora of about 3 percent of the adult population and over 66 percent of infants, according to Public Health England. When patients are given antibiotics, the normal bowel flora that keeps C. diff in balance is weakened or killed by the antibiotics. That is when C. diff begins to flourish and produce harmful toxins.
Dutch researchers are questioning the notion that more nurses equals better quality of care for long term and post-acute care residents.
Korean researchers believe they may have found a better way to gauge risks for seniors facing surgeries.
More than half of all people who go under the doctor’s knife are 65 years or older.
Another of dementia’s horrible, yet hidden, costs has been exposed as researchers in Canada claim to have found a solid link between dementia and hip fractures.
Finnish researchers say they’ve come up with a more intensive, more individualized method to help people recover from broken hips without leaving their homes.
Researchers have developed a novel gene therapy that reverses the loss of memory in mice models with initial stages of Alzheimer’s disease, according to a study published Wednesday in The Journal of Neuroscience.
HCI’s award-winning, self-paced programs—delivered either online or via DVDs or CD-ROMs—are videos that feature interactive activities, interviews with nationally known dementia experts, and simulations of real-life situations facing caregivers. The programs require only basic computer or DVD skills.
A research team says it has found a link between high nursing turnover and deficiency notices from federal regulators, but a veteran Baltimore medical director is challenging the team’s premise as fundamentally flawed.
Provider’s 2014 20 To Watch continues this month with profiles of six honorees who—just as they did last month—shine bright as glittering examples of what’s best in long term and post-acute care today.
I was at the center of a scary incongruity, only hours before surgery. I was at the hospital late Wednesday evening, sporting a confident smile that masked my diffident heart. To combat PD, the docs were to plant a sentinel inside my skull—and I had no clue how my brain would accept its new roommate.
German researchers are challenging what they’re calling the “myth” that a senior’s memory problems are proof of cognitive decline.
Traumatically injured seniors appear to be at a higher risk for death when they’re treated at hospitals that also treat high volumes of younger patients, a new study has found.
Canadian researchers believe they may have found another clue to how Parkinson’s disease ravages the human body after discovering that two genes linked to the disease appear to disrupt a cell’s ability to repair itself.
The poorest elderly were nearly twice as likely to be sent back to the hospital with preventable conditions when they transferred from skilled nursing centers to home- or community-based care, a new study by Brown University researchers has concluded.
Low testosterone and depression each may make it easier for elderly men to fall, a team of Japanese researchers have found.
The Obama administration has formally scrapped the so-called “improvement standard” for care, but the new rules on Medicare eligibility still leave questions open on such matters as therapy and whether contractors will still be held to the old standard.
Long term and post-acute care advocates are taking aim at what they say is the dangerously slow pace of Medicare’s therapy reviews.
Long term care providers are not up to date about the dangers of using antipsychotic drugs to treat dementia, according to a new study.
In April 2013, 40 organizational leaders from the federal and state governments, investment and trade groups, policymakers, health care providers, consumer advocates, educators, and researchers convened in Washington, D.C., to discuss the utility and role of public reporting in assisted living.
More than 80 percent of the attendees believed that additional efforts should be directed toward obtaining, compiling, and disseminating information related to specific services and supports offered by these providers.
Getting everyone on the same page through communication and education is the first step. Then the team can work together—along with the patient and family—to devise an individualized care plan that has the greatest chance of success.
Care centers will have to perform CPR (cardio-pulmonary resuscitation) on stricken elders unless the resident has already signed an advance directive, officials at the Centers for Medicare & Medicaid Services (CMS) announced recently.
Getting a head start on QAPI provides an opportunity for nursing homes to engage workers and enhance resident outcomes and quality of life.
Researchers have canvassed a number of possibilities to explain the persistence of end-of-life hospitalizations, but lean heavily on a regulatory and funding environment where there may be perverse incentives to outsource end-of-life care to hospitals.
British researchers say they’ve come up with a medicine that protects the brains of laboratory mice from decay.
Facilities are now more accountable for the data they transmit on the MDS because of the data references used by state surveyors, policy processes, and payment programs. This is a very expensive and common issue that facilities need to strive to understand, properly manage, and document, especially with regard to the impact of their interventions and programs.
Hospitals and health systems proactively prescreen providers for quality outcomes. What’s more, if you haven’t heard from the hospital and health systems in your area, you should be concerned.
Perception is key when it comes to appropriate pain management in long term care settings, according to a recent study, which sought to identify barriers to pain management in nursing homes.
Stem cells from bone marrow have shown promise in alleviating the effects of stroke, researchers at Central Michigan University have found.
Nursing home staff reduced the improper use of antipsychotic drugs for those suffering from dementia by more than 9 percent in the first part of 2013, the Centers for Medicare & Medicaid Services announced Tuesday.
Long term care residents with dementia deserve comfort, dignity, safety, functional preservation, and prevention of new illnesses.
Research has shown that interventions designed to provide a wide variety of stimuli can have a significant and positive impact on individuals with Alzheimer’s disease and other cognitive impairments. Additional research also supports multimodal approaches as being the most beneficial in both cognitive and social enhancement.
A study from the Journal of the American Medical Directors Association is ringing alarm bells about what the author sees as an “epidemic overuse” of diuretic drugs among the elderly.
Long term care providers have slashed their use of antipsychotic medications by nearly 6 percent, the American Health Care Association (AHCA) is expected to announce Monday. For AHCA members, the off-label use of antipsychotics fell by nearly 7 percent, the association will say Monday in a conference call with media.
Defending the care of a resident with documented cognitive impairment who elopes is challenging at best. A mere glance outside the front door of most long term care facilities brings to mind the frightening dangers that await a confused resident: extremes in temperature, bodies of water, busy thoroughfares, train tracks, expansive woods, uneven terrain, and wild animals. The consequences to the resident can be devastating.
Dementia will cost some $203 billion in health and long term care costs in 2013, the Alzheimer’s Association reports.
Oral problems experienced by older adults are preventable and can often be detected early. They are not the direct result of aging. Dental caries and periodontal disease are plaque-related, preventable oral diseases. Although these diseases are generally not life-threatening or seriously impairing for most older adults, they can have an effect on the management of medical conditions, general health, nutrition, and quality of life (Blanco-Johnson, 2012).
Meet Whitney Ostercamp, music therapist at Valley Nursing and Rehabilitation Center, in Taylorsville, N.C. Find out what makes Ostercamp a 20 To Watch star.
Meet Christine Reynolds, physical therapist and rehab coordinator at Tendercare of Tawas City, Mich. Reynolds treats her residents like family, colleagues and patients say.
One size doesn’t always fit all. One care plan doesn’t work for everybody, and this is especially true for dementia care. People living with dementia are just that—people. Each and every one of them has a unique personality, life experiences, interests, and preferences.
Nursing home hospitalizations and deaths spiked at least 10 percent during norovirus outbreaks, a new study published in the Journal of the American Medical Association reported Thursday.
“Incorrect weight shifting” was the most likely culprit in senior falls, Canadian researchers have determined. Researchers in British Columbia analyzed video from 227 falls in two separate nursing homes over three years. Seniors who had trouble moving their bodies so that their weight was shifted evenly as they moved accounted for 41 percent of them, followed by tripping or stumbling (21 percent).
Nearly one-third of elderly Medicare patients were spending the last six months of their lives in skilled nursing facilities (SNFs) rather than in hospice care, a new study has found.
G. Allen Power, MD, author of “Dementia Beyond Drugs: Changing the Culture of Care,” proposes a simple yet, for many providers, radical idea: Stop thinking of dementia patients as people with diseases to be treated, and start thinking of them as people with a terrifying, shifted reality who still have lots left to give if their trust can just be earned. Negative attitudes toward people with dementia are a big factor in the combative atmosphere that can arise at times between those with the disease and their caregivers, writes Power in his recent award-winning book.
Trials of a once-promising treatment for Alzheimer’s disease have been scrapped by two pharmaceutical giants after clinical results showed that the drug wasn’t working.
Wounds and pressure ulcers afflicting long term care residents incite visceral reactions in lay persons due to the fragile population served and the misconception that poor care is always the causative factor. In addition, such misconceptions have been known to lead to criminal charges, malpractice suits, and federal regulations to protect this vulnerable population.
Assisted living providers are meeting the challenge with a wide range of strategies and preparations, from the use of tools and protocols to help them better manage conditions associated with readmissions, to enhanced staffing, the adoption of electronic medical records systems, and, in some cases, renovations to accommodate new services and levels of care.
Everyone is talking about antipsychotic use in nursing homes…again. Ever since the Office of Inspector General (OIG) released a report on this issue last year, it has been on the minds of everyone, from administrators and medical directors to nurses and family members.
The CMS initiative, called the Partnership to Improve Dementia Care in Nursing Homes, establishes a goal of reducing the use of antipsychotic drugs in nursing facilities by 15 percent by the end of 2012. This is the same goal set last February by AHCA’s own Quality Initiative.
For-profit, independent nursing homes were less likely to have newly admitted residents fall than their counterparts, a new study by the University of Southern California and Brown University has found.
Anywhere from one in five to two in five nursing facility patients take daily antipsychotic doses that are higher than recommended levels, CMS statistics show. It’s an obstacle to treating patients with dementia, the agency said.
As medications that could be cut back or eliminated were identified, heading the hit list were proton pump inhibitors, multivitamins, iron supplements, calcium supplements, statins, and vitamin D. Multivitamins were an especially salient example of a medication that should not escape scrutiny because they are often prescribed automatically and because a priority on preparing nutrient-dense foods can make them relatively superfluous.
This case study helps to illustrate some of the complex and important issues identified regarding the use of the MDS 3.0 assessment tool, particularly around the psychosocial sections. In this case study, Mr. S, age 80, was admitted as a Medicare SNF-stay resident after hip surgery because of a fall at his group home.
After a hard week at work, many adults look forward to a quiet dinner at a restaurant with a close friend or loved one. However, a peaceful evening can sometimes be interrupted by the crying of a child. Most anyone would be annoyed by this and ask, “Who would bring a child out at this hour of the night to a restaurant like this; it’s not like this is a ‘family restaurant’ where you would expect small children to accompany their parents, this is a formal restaurant!”
This approach would be more equitable, innovative, and care-focused than simply cutting provider rates through Medicare bad debt and other potential payment reductions, AHCA says.
Researchers from the Centers for Disease Control and Prevention (CDC) conducted the study and singled out four drugs and drug classes as the cause of most emergency visits. They are warfarin, oral antiplatelet medications, insulins, and oral hypoglycemic agents. Alone or together, they account for 67 percent of emergency ADE hospitalizations of adults 65 years and older. Warfarin was implicated in 33 percent of cases, lead author Daniel Budnitz, MD, director of CDC’s medication safety program, said.
The reason for the study is that currently available pharmacological and nonpharmacological treatments have shown only modest effects in slowing the progression of dementia. The study’s objective was to assess the impact of a long-term nonpharmacological group intervention on cognitive function in patients with dementia and on their ability to carry out activities of daily living (ADLs) compared with a control group receiving the usual care.
Doctors are stressed out, according to a recent national survey of U.S. physicians. Conducted by Cejka Search, the survey found that the majority of U.S. physicians are moderately to severely stressed or burned out on an average day, with nearly 63 percent of respondents saying their stress has risen moderately to dramatically in the past three years.
More than half of patient deaths in the populations served in nursing facilities result from progressive, chronic illnesses and are, therefore, predictable in their timing. By recognizing the advanced stages of terminal disease, health care professionals (physicians, nurses, physician assistants, and nurse practitioners) can greatly impact the circumstances surrounding their patients’ deaths.
Loud screams echo in the hallway. A nurse’s attention shifts from the chart she was working on to the room from which the screams are coming. She runs toward the resident and provides verbal reassurance, coupled with physical comfort of rubbing his arm and shoulder. The screams cease. The nurse walks away and resumes charting when the screams echo again.
This scenario routinely occurs in long term care settings, with many challenging behaviors such as screaming out, aggression, and sometimes hitting. Such behaviors can increase over time, with staff often habituating a behavior-response pattern.
The patient population in nursing facilities is different than it was 10 or 20 years ago, and so is how such conditions are addressed. Developments and promising trends in treatments, medications, and diagnostics are designed to improve outcomes and increase efficiency.
As the senior population grows, more individuals are seeking elder-specific medical care and treatment. This increased demand has revealed a frightening reality: The medical field is not keeping pace.
A rehab provider successfully lowers hospitalizations through community and hospital collaboration.
New advancements in rehab technology and engineering are aimed at motivating patients to engage in their own therapy and promoting a basic tenet of nearly all physical therapy rehab programs—movement and repetition.
Root-cause analysis and a four-step action plan can improve performance and quality of care following a serious patient incident.
Registered nurses (RNs) are taking center stage lately in some providers’ efforts to combat avoidable hospitalizations. Genesis HealthCare is one example.
A new abilities-based care model optimizes the strengths of individuals with Alzheimer’s disease and related dementias.
Death is unavoidable, but how it happens is becoming a top priority for the long term care community.
A provider’s wellness program champions lower-body strength as one way to prevent injury and boost independence.
Providers are starting to look at offering on-site specialty services.
A medical error-reduction concept borrowed from aviation is ripe for application in long term and post-acute care.
Successful dementia care has many facets, including knowledge, skills, awareness, involvement, and action.
A long term care provider utilizes its pools to create a person-centered program for residents with cognitive impairments.