Providers must provide written warning to Medicare patients that their treatment may not be covered before treatment can begin, the Centers for Medicare & Medicaid Services (CMS) has said in a memorandum.

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.

Some nurses come by these skills naturally, but very few have had formal leadership training. Nurses are better able to step into leadership when directors of nursing (DONs) focus on developing their leadership skills by giving them opportunities to take on new responsibilities and then sharpen the nurses’ skills by providing timely, accurate, problem-solving-oriented feedback in the context of a supportive relationship.

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.

Clinicians know that increased medications often mean a decrease in spit or saliva. Most people don’t realize or value the important role that saliva plays in protecting their teeth and mouths. Various chronic diseases, such as arthritis or stroke, can make it more difficult for elders to clean their mouths. These chronic diseases may result in residents needing assistance with their daily oral hygiene care.

Health care experts are increasingly affirming the importance of oral health as an essential component of overall health. The need for quality-based mouth care does not diminish as a person becomes older, chronically ill, or placed within long term care settings.

A recent survey of nursing homes in Kansas revealed that one-third of residents had lost all of their natural teeth, according to the Kansas Bureau of Oral Health and Oral Health Kansas. The survey, based on a nationally recognized protocol, included 540 Kansas elders living in 20 nursing homes and consisted of a clinical oral health screening and a resident questionnaire.

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).

The final seven of this year’s 20 To Watch illustrate the best of long term and post-acute care. In the third and final round of Provider’s inaugural 20 To Watch feature are two administrators, a director of health management, two chief executive officers, a dementia care program director, and an owner/administrator.