| Long Term Care In The Pacific Northwest | https://www.providermagazine.com/Issues/2011/Pages/0911/On-The-Road_0911.aspx | Long Term Care In The Pacific Northwest | <div id="__publishingReusableFragmentIdSection"><a href="/ReusableContent/4_.000">a</a></div><p><img width="283" height="529" class="ms-rteImage-2 ms-rtePosition-2" src="/Issues/2011/PublishingImages/0911/OTR_8.jpg" alt="" style="margin:10px;height:225px;" />The natural beauty that is the Pacific Northwest is obvious to the eye, with rolling views of mountain ranges seemingly at every turn in a drive around Portland, Ore. Mount Hood lies to the east of town and Mount Saint Helens and Mount Ranier north into Washington, making the region a dictionary definition of the word scenic.</p>
<p>Oregon is where <em>Provider </em>Senior Editor Patrick Connole spent most of his time for this edition of On the Road, looking at how the state is handling budgetary pressures and with it provider reimbursement rates for the Medicaid program. Providers here, like elsewhere, keep one eye firmly glued on what lies ahead for payment, while at the same time continuing to care for residents in the most efficient way possible in a sluggish economy.</p>
<p>Van Moore, senior vice president for Westcare Management based in the Oregon capital of Salem, operates two facilities in the state. He says the leadership of the Oregon Health Care Association (OHCA) has fended off deep Medicaid cuts, at least for the short term.</p>
<p>“OHCA and Jim Carlson [association president] have done a stellar job for us. In this year that everybody has suffered with huge cuts, nursing homes were held harmless [with no cut],” Moore says.</p>
<p>"This is recognition by the legislature of the importance of long term care, not only the work we do for our frail and elderly but the amount of jobs we provide.”</p>
<p>Oregon’s legislature will revisit the provider reimbursement rates for nursing care next year, and if the economy does not mend faster, there could be debilitating results, he says.</p>
<div>“If revenue falls short, we could be looking at as much as a 19 percent cut in rates next year [July 1, 2012, to July 1, 2013],” Moore says. </div>
<h3 class="ms-rteElement-H3">Money Matters Impact Business</h3>
<div>Westcare operates the 51-bed Myrtle Point Center skilled nursing facility, which lies along the Oregon coast region. The company also has been contracted by the Veterans Care Centers of Oregon to operate the Oregon Veterans Home in The Dalles, Oregon. That facility has 150 beds.</div>
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<div>The general sentiment with providers like Moore is that state residents are taking their time in moving family members to long term care because of the uncertain economy.</div>
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<div>“People get laid off from their jobs, and when they think of ways to make ends meet, they look at mom and dad and delay decisions until they are physically unable to take care of their family anymore. This really harkens back to the pre-Johnson [President Lyndon Johnson] days before Medicaid, when more families were nuclear and took care of their own,” Moore says.</div>
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<div>The unique nature of providing nursing care in Oregon is that the state is a flat reimbursement state, a fact that Moore says dissuades the building of new facilities. </div>
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<div>“Since I moved here 22 to 23 years ago, I think there have been three standalone nursing homes built in the state,” he says, adding that the flat $212 per day Medicaid reimbursement does not incentivize the building of new buildings. </div>
<h3 class="ms-rteElement-H3">Oregon In Search Of Health Care Solutions</h3>
<div><img width="207" height="200" class="ms-rteImage-2 ms-rtePosition-2" src="/Issues/2011/PublishingImages/0911/OTR_3.jpg" alt="" style="margin:10px;width:157px;height:118px;" />Betsy Johnson, state senator for the 16th district in Oregon’s legislature and owner of a helicopter business, is intently interested in health care for her constituents, serving on the Oregon Health and Sciences University Foundation and the Oregon Senate Ways and Means Committee.</div>
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<div>She founded a helicopter company that ferried members of the U.S. Geological Survey back and forth to the Mount St. Helens site after the eruption in 1980. Her motto is, “your wallet, we haul it,” she jokes.</div>
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<div>Johnson says policymakers are eager to reform the state’s health care system. Oregon Gov. John Kitzhaber (D), a former emergency room doctor, recently signed into law changes to the Oregon Health Plan meant to coordinate care and reduce costs. </div>
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<div>The state faced an $860 million budget gap between available funds and costs for the Oregon Health Plan. Reduced provider reimbursement rates and increased hospital provider taxes will make up most of the deficit, with the remainder paid for by the reorganized health plan. </div>
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<div>The governor said the goal is to get state residents better care at lower costs.</div>
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<div>Johnson says the new law is a start but more “meat will go on the bones” of the measure when the legislature reconvenes in February. </div>
<h3 class="ms-rteElement-H3">Avamere Seeks Growth Amid Uncertainty</h3>
<div>A major player in the provider community in Oregon is the Avamere Family of Companies. Based just south of Portland in Wilsonville, Ore., Avamere ranked 38th in the Provider magazine Top 50 Largest Nursing Facility Companies in 2011, with more than 2,400 beds. Avamere also ranked 39th in the magazine’s Top 40 Largest Assisted Living Companies, with a total assisted living occupant capacity of 573.</div>
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<div><img width="174" height="257" class="ms-rteImage-2 ms-rtePosition-1" src="/Issues/2011/PublishingImages/0911/OTR_2.jpg" alt="" style="margin:5px 10px;width:171px;" /><br>Rick Dillon, president of Avamere, says the company has 4,500 employees, 3,500 in Oregon alone. In many of the locales where Avamere has facilities, they are the largest employer in town, he notes. Dillon sees what is going on at the statehouse in Salem and in the U.S. Congress in Washington, D.C., as major concerns for his employees and his residents.</div>
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<div>“It has been so difficult to plan ahead when you don’t know what you are going to be paid,” Dillon says.</div>
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<div>Echoing Moore, he says long term care providers were fortunate in the last go-round, when the state decided to “flat-fund” skilled nursing and assisted living. There was, however, a $3 per day increase from July 1 in the provider tax.</div>
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<h3 class="ms-rteElement-H3">Assisted Living Holds Its Own </h3>
<div>Many assisted living facilities have seen potential clients take to the sidelines waiting for improvement in the housing market, says Nicollete Merino, Avamere regional director of operations.</div>
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<div>“Individuals that might need assisted living may well have sold their homes in previous times, but a lot of people can’t sell their homes now,” she says. So, with the economy the way it is many people in need of care put it off until later, when their health may weaken as they grow older.</div>
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<div>This results in a cascading effect. Assisted living becomes more like what a nursing facility used to provide in the way of care and services, and nursing facilities become more about sub-acute care.</div>
<div>The level of care and need for assistance in assisted living is growing every year, Merino says.</div>
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<div>“We are seeing many Medicaid clients in our buildings. More and more are coming in on Medicaid, probably around 30 to 40 percent,” she says.</div>
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<div>The changes in the type of care taking place in assisted living affects who works in a facility. </div>
<div>“It does make for changes for who works in the buildings. Five or six years ago you didn’t have to deal with something like bladder issues, it was walking around with a walkie-talkie. So, you are getting a different type of caregiver, more direct-care oriented,” Merino observes.</div>
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<div>Better training has also resulted from this higher level of care with a lot of additional educational requirements in Oregon, she adds. </div>
<h3 class="ms-rteElement-H3">Oregon Firm Ties Aerospace To Long Term Care</h3>
<div>The Pacific Northwest is known for being home to the cutting-edge technology of the aerospace industry, feeding off the long-time presence of Boeing Corp. and scores of related firms fulfilling the supply needs of a business in which the United States remains a world leader.</div>
<div> <img width="268" height="355" class="ms-rteImage-2 ms-rtePosition-2" src="/Issues/2011/PublishingImages/0911/OTR_4.jpg" alt="" style="margin:10px;height:202px;" /><br>At a time the government is transitioning the health care system into one based on providing high-quality care at low cost, and demanding providers measure their results in achieving these goals, it is firms like Scappoose, Ore.-based Low-G Technologies that are positioning themselves for this changing environment.</div>
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<div>Low-G is a privately held company that makes the Low-G® Skin Pressure Protection System, an overlay for beds that aids in the prevention of pressure ulcers, a constant threat to the well-being and even survival of residents in nursing facilities. The technology used in the overlay comes from the materials and knowledge acquired from a separate aerospace company (Oregon Aero) that the founders of Low-G have run for decades and that provides seating, helmet padding, and other related products for clients, including the U.S. military. </div>
<h3 class="ms-rteElement-H3">From Pilots To Nursing Residents</h3>
<div>At the start of the first Gulf War, the wide-scale adoption of aerial refueling for U.S. military combat aircraft was started. The average mission length for many air crew members was extended from an average of 90 minutes to more than eight hours. </div>
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<div>Pilots in turn started to exhibit serious pain and discomfort from the longer missions, with some developing pressure ulcers caused by aircraft seats and flight helmets. These injuries would often leave aircraft crew members off-duty for months at a time to deal with the problem.</div>
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<div>This problem sounds all too familiar to nursing care providers.</div>
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<div>Around 11 percent of nursing facility residents experienced a pressure ulcer in 2004, according to a study for the National Center for Health Statistics. The cost of treating an individual pressure ulcer ranges from $5,000 for a Stage I to $70,000 for a Stage IV.</div>
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<div>The total annual cost to hospitals nationally for the treatment of pressure ulcers is hard to quantify but ranges from $2.2 billion to $10 billion. The Agency for Healthcare Research and Quality said in 2006 there were 503,300 hospitalizations with pressure ulcers noted as the injury in the diagnosis.</div>
<div>In more stark terms, people’s lives are lost to pressure ulcers.</div>
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<div>The national Pressure Ulcer Advisory Panel reports that as many as 60,000 people die every year as a direct result of pressure ulcer complications. That is roughly equivalent to a 767 airliners crashing each day. </div>
<h3 class="ms-rteElement-H3">It Starts In Scappoose</h3>
<div>The facility at the Scappoose airport contains the brains of the operation, with designers and machine operators piecing together a number of products, all focused on keeping the body comfortable and healthy.</div>
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<div>“We are in the business of preserving human tissue,” says Casey Dennis, who acts as director of marketing and client support for Low-G. He adds that what makes the firm’s bed overlay unique is its origin in a high-tech world where performance has always been measured by keeping air crews at ease under the most trying of conditions.</div>
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<div>Nursing care is well-accustomed to trying conditions as well, with residents often in a bed for long periods, creating friction on the skin, along with fermenting heat and moisture in the process.</div>
<div> <img width="472" height="214" class="ms-rteImage-2 ms-rtePosition-1" src="/Issues/2011/PublishingImages/0911/OTR_5.jpg" alt="" style="margin:10px;width:284px;" /><br>From a broader perspective, a bed overlay is not a cure-all for the state’s budgetary challenges, but it could play a role in reducing costs while bolstering an Oregon company and growing jobs in a tough economy, lawmaker Johnson says. “We are eager to advance the innovation economy [in Oregon].” </div>
<h3 class="ms-rteElement-H3">Making The Case For more acute Care</h3>
<div>The picture in Oregon looks similar to many states: a large population of elderly and frail in need of care in an increasingly more acute state of health. The state is trying to figure out how to revamp its programs to meet these needs in the lowest-cost environment as possible, while caring for increasing demands brought on by federal health care reform.</div>
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<div>The common denominator is quality care and low cost, from provider to lawmaker to manufacturer, that is the driving force, the mantra of a new age. Bringing some high-tech help from the world of flight may be one way to help stem the tide. </div>
<p> </p> | The natural beauty that is the Pacific Northwest is obvious to the eye, with rolling views of mountain ranges seemingly at every turn in a drive around Portland, Ore. Mount Hood lies to the east of town and Mount Saint Helens and Mount Ranier north into Washington, making the region a dictionary definition of the word scenic. | 2011-09-01T04:00:00Z | <img alt="" src="/Issues/2011/PublishingImages/POTR_logo_rollup.jpg" style="BORDER:0px solid;" /> | Policy | Column | 9 |
| Residents, Staff Attest To Quality | https://www.providermagazine.com/Issues/2011/Pages/0911/Residents,-Staff-Attest-To-Quality.aspx | Residents, Staff Attest To Quality | <div><img width="427" height="1030" class="ms-rteImage-2 ms-rtePosition-2" src="/Issues/2011/PublishingImages/0911/MIV_supp.jpg" alt="" style="margin:5px;width:245px;height:330px;" />Myths, legends, proverbs, and folklore—each nation, community, and profession uses them to dress up its history, filter reality, and color facts. Whether benign or malignant, they permeate all aspects of modern health care, nowhere more so than in long term care and nowhere as negatively as in nursing facility care.</div>
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<div>Along with the prevalence of stories about the long term care profession, there is also an astounding amount of data. It is with the intent of discovering the true narrative of nursing facilities today that the team at My InnerView has developed the “2010-2011 National Survey of Consumer and Workforce Satisfaction for Nursing Facilities” (National Report).</div>
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<div>This rapidly expanding repository of data offers ample evidence that complements both legend and practical wisdom to better understand the long term care industry and the insight to be gained from the voice of its customers and employees.</div>
<div>While our analyses have led to several discoveries and more than a few surprises, we will focus on only a couple of interesting points in this brief article, highlighting what the data tell us about some of the most important, and often most misunderstood, parts of the story—the perceptions of residents, their families, and employees from approximately 5,500 nursing facilities. The full National Report contains a more in-depth and comprehensive compilation of information about the voice of residents, families, and caregivers, as well as data-driven insights about the long term care profession. </div>
<h3 class="ms-rteElement-H3">Residents, Families Rate Nursing Facilities Favorably </h3>
<div>One fact about nursing facilities is indisputable and has been reaffirmed year after year by a variety of sources: Residents and families hold their nursing facilities in high regard.</div>
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<div>The My InnerView national data repository includes resident and family feedback on 22 areas of experience across three broad categories, including quality of life (safety, privacy, dignity, choice, and other aspects of well-being), quality of care (staff and care practices in regard to adequacy, competence, and a caring attitude), and quality of services (meals, laundry, maintenance, and more).</div>
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<div>The responses pose a direct challenge to a negative popular belief about nursing facilities. Four out of five families and an even greater proportion of residents rate their nursing facilities as “Good” or “Excellent” (see Chart 1). Similarly, in overwhelming numbers, both families and residents say they would recommend their nursing facility to others as an “Excellent” place to receive care (see Chart 1). </div>
<div><img src="/Issues/2011/PublishingImages/0911/MIV_supp_chart1.gif" alt="" style="margin:10px;" /><br><br>And for the most part, this high praise remains consistent throughout the resident’s stay (see Chart 2).<br><img src="/Issues/2011/PublishingImages/0911/MIV_supp_chart2.gif" alt="" style="margin:10px;" /><br></div>
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<div>Such soaring accolades, so out of step with popular preconceptions, have engendered doubts at times. The message of the customer has often been sidelined by skeptics as uninformed or compromised. But skepticism loses its credibility when faced with the power of simple evidence. </div>
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<div>First, it is unconscionable to question the authenticity of nearly 150,000 families and almost 100,000 residents who voluntarily responded to the survey, answered it privately, and were promised confidentiality by an independent third party conducting the survey.</div>
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<div>Second, responding families were far from being uninformed and unengaged; two out of three had visited multiple nursing facilities before choosing one for their relative and, after placement, four out of five families visit their relative at least weekly. We also can gain insights from the data about what drives satisfaction, which further reinforces the importance of looking to information rather than anecdotes. For both families and residents, the top two factors that influence the likelihood to recommend a facility are the competency of staff and the care (concern) of staff. Clearly, employees are another key piece of the puzzle to better understand the true picture of the nursing facility profession. </div>
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<h3 class="ms-rteElement-H3">Commitment Of Caregivers</h3>
<div>Unfortunately, a Google search on nursing home quality will result in references to more negative information than positive. Directly and by implication, nursing facility staffs are routinely depicted in all-too-familiar negative stereotypes—detached, apathetic, uncaring, and abusive. But the question remains, what evidence supports the common belief that nursing facility staffs provide unloving care?</div>
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<div>Popular opinion may give these caregivers a bad reputation, but evidence supports that beneficiaries of their care have a considerably different view. In rating 22 areas of experience on a Poor to Excellent scale, residents and families score caregivers with much higher than a passing grade across the board. </div>
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<div>Families and residents agree on two of the strongest areas of performance among nursing facility staffs: the respect that they demonstrate and the quality of care provided, specifically by registered nurses (RNs) and licensed practical nurses (LPNs) (see Chart 3).</div>
<div> <img class="ms-rtePosition-3" src="/Issues/2011/PublishingImages/0911/MIV_supp_chart3.gif" alt="" style="margin:10px;" /><br><br>These caregivers also have a higher level of overall job satisfaction and a greater opinion of their employers, both as a place to work and as a place to receive care, than uninformed observers might imagine (see Chart 4). For both certified nurse assistants (CNAs) and RNs, the attentiveness and concern (care) of management rank as the top two drivers that affect the likelihood to recommend the facility as a place to work. As an indication of the value that nurses and CNAs place in their work and their commitment to residents, 85% of RNs and 86% of CNAs rate the sense of accomplishment associated with their jobs as Good or Excellent. </div>
<div> <img class="ms-rtePosition-3" src="/Issues/2011/PublishingImages/0911/MIV_supp_chart4.gif" alt="" style="margin:10px;" /><br><br>This data point, especially partnered with families’ and residents’ rating of the care (or concern) of the staff (88% and 89%, respectively, for combined Excellent and Good scores), debunks the myth that nursing facility staffs are detached from the importance of their role and from the residents and other customers that they interact with on a daily basis. </div>
<h3 class="ms-rteElement-H3">Conclusion</h3>
<div>The consumer age has demystified the sacred, the mysterious, and the forbidden in religion, politics, and professions. All of us cling to some beliefs and practices and often resist testing them against evidence. But as data become more available and more accessible, rationality challenges dogma and questions the authority of tradition. We may be inching toward a data-driven, evidence-based approach to life.</div>
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<div>Respect for facts, pursuit of evidence, and grounding practice on proven protocols—this is the heart of the evidence-based approach. By listening to caregivers, it is possible to tune in to the perspectives of the communities at the heart of long term care and better inform decisions for organizational success. </div>
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<div>By listening to our customers, we understand their messages and formulate proper responses that will put us on a definite road to evidence-based excellence.</div>
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<div><em>This article was written by Vivian Tellis-Nayak and Christine Lang of My InnerView (<a href="http://www.myinnerview.com/"><font color="#0072bc">www.myinnerview.com</font></a>), a division of National Research Corp. and an applied research company that promotes evidence-based management practices in U.S. senior care organizations.</em> </div>
| Myths, legends, proverbs, and folklore—each nation, community, and profession uses them to dress up its history, filter reality, and color facts. Whether benign or malignant, they permeate all aspects of modern health care, nowhere more so than in long term care and nowhere as negatively as in nursing facility care.
| 2011-09-01T04:00:00Z | <img alt="" src="/Issues/2011/PublishingImages/0911/MIV_supp_thumb.jpg" style="BORDER:0px solid;" /> | | Column | 9 |
| 2011 AHCA/NCAL Annual Awards | https://www.providermagazine.com/Issues/2011/Pages/0911/2011-Annual-Awards.aspx | 2011 AHCA/NCAL Annual Awards | <div>The American Health Care Association and the National Center for Assisted Living proudly announce the 2011 Volunteers of the Year—Adult, Young Adult, and Group; NCAL Administrator and Noble Caregiver of the Year; Assisted Living Nurse of the Year; Assisted Living Week Programming Award; Developmental Disabilities Hero of the Year; and Not-for-profit Community Benefit Program of the Year. The individuals who have earned this recognition give the greatest gift of all—time spent with and for others.</div>
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<h2 class="ms-rteElement-H2B">Doyle Smith, Adult Volunteer of the Year</h2>
<div>“Doyle Smith is a man of service,” says Jack Whitaker, executive director of Willow Health Care, which oversees a network of senior services and housing, including the 90-bed Mountain View Healthcare, Mountain View, Mo., where Doyle volunteers.</div>
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<div>What does Doyle do to earn such accolades? Just about everything asked of him, it seems. “Anything you need or want done, Doyle is there,” says Mountain View Administrator Roy Pace, RN. </div>
<div> <img class="ms-rteImage-2 ms-rtePosition-1" alt="Doyle Smith, Adult Volunteer of the Year" style="margin:15px 10px;" /></div>
<div style="text-align:left;">At Mountain View, Doyle does what everyone should do—listen, care, and give a helping hand. He can be a baker, server, grounds keeper, friend, transporter, shopper, and fundraiser extraordinaire. </div>
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<div>As president of the volunteer program, Doyle spreads the volunteer spirit communitywide and not just to his friends, but to local businesses and organizations like the Veterans of Foreign Wars, of which he is a member. Doyle’s nomination form for this award read like a yearly summary of a facility’s activities program, with events too numerous to list. When it comes to what the residents think, there is no hesitation: Lucille McAlister says Doyle is a “very kind man and can converse on almost all topics.” </div>
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<div>Buster Davis says, “Doyle could be fishing or hunting, but he chooses to hang out with us old folks.” </div>
<div>Blanche Cook thinks Doyle can cook burgers and hot dogs really well, but his pancakes are the best!” </div>
<div style="text-align:right;">–Tom Burke</div>
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<h2 class="ms-rteElement-H2B">Robin Aman, NCAL Administrator of the Year</h2>
<div style="text-align:left;">Robin Aman exemplifies the qualities of a committed and heartfelt administrator of an assisted living community, successfully leading her staff in enriching the lives of their residents. </div>
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<div style="text-align:left;">Located in Stevenson, Wash., Rock Cove Assisted Living is a nonprofit, affordable assisted living community for seniors and individuals with disabilities. </div>
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<div style="text-align:left;">Rock Cove residents benefit from Aman’s love and dedication to the greater community. “When someone moves in, we don’t just help tend to their needs, we adopt them as family,” she says. </div>
<div style="text-align:left;">Aman is currently working on a grant to enhance Rock Cove’s intergenerational program between local school students and her residents. She tries to keep the residents active in the community, whether it’s Easter egg hunts, an annual wine-tasting fundraiser, or taking residents out to judge the Christmas tree lights. Thanks to Aman, every Stevenson town event involves the Rock Cove residents.</div>
<div style="text-align:left;"><img class="ms-rteImage-2 ms-rtePosition-2" alt="Robin Aman, NCAL Administrator of the Year" src="/Issues/2011/PublishingImages/0911/SA_Robin-Amin.jpg" width="434" height="514" style="margin:15px 10px;width:356px;height:308px;" /><br>Within Rock Cove, she works with residents to involve them in meaningful activities and adventures. For example, she took a resident on a hot air balloon ride for a 90th birthday celebration. She’s taken an 87-year-old-resident to a horse ranch so the resident could go horseback riding after not having ridden for 20 years.</div>
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<div style="text-align:left;">“This award is not something that is earned by one person; it is earned together as a team,” Aman says. “I have the most wonderful team of staff that work hard and well together to achieve great things. I know my staff commitment toward our residents comes from their hearts. </div>
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<div style="text-align:left;"> “There are challenges every day, but I believe in tackling them with a smile and a positive attitude,” she says. “There is nothing we can’t accomplish together.”</div>
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<div style="text-align:left;">Aman loves her life’s work at Rock Cove. “To see the tears of joy in residents’ eyes and make them sparkle again is so heart warming. </div>
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<div style="text-align:left;">“They make my life complete,” she says. “So to be recognized for our hard work, fun, and dreams is an accomplishment beyond my expectations.” </div>
<div style="text-align:right;">–Lisa Gelhaus</div>
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<div><div><h2 class="ms-rteElement-H2B">Eugene Ring, Noble Caregiver in Assisted Living</h2></div></div>
<div style="text-align:left;">During the day, Eugene Ring is the Heritage at Dover’s (Del.) environmental engineer. In the summertime, he might be grill master, and at Christmas time he’s Santa Claus.</div>
<div style="text-align:left;"><img class="ms-rteImage-2 ms-rtePosition-1" src="/Issues/2011/PublishingImages/0911/SA_Eugene-Ring.jpg" width="264" height="396" alt="" style="margin:15px 10px;height:176px;" /><br>Ring received the award because he has demonstrated outstanding person-centered care that contributed to the well-being of his colleagues and residents. His former supervisor, Executive Director Vickie Cox, gives him great praise.</div>
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<div style="text-align:left;">“In the five years Eugene has been with us,” Cox says, “he has improved the well-being and overall morale of this community with his everyday outgoing attitude, demonstration of initiative, and by going above and beyond his regular duties.”</div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">For instance, every year he hosts residents and staff for an annual picnic at his home. He started a resident men’s group and takes the male residents out to breakfast once a month. </div>
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<div style="text-align:left;">Ring builds wooden cases for residents and staff to display their handmade quilts and helps them move furniture when he’s supposed to have a day off. He responds to residents’ alarms going off and calms their fears without complaint, Cox says. </div>
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<div style="text-align:left;">Ring has implemented changes within the residence that increased residents’ safety by removing hazards that could cause them to fall.</div>
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<div style="text-align:left;">Ring’s outstanding demonstration of customer service extends to his co-workers. For example, he performs home repairs for co-workers who can’t afford to hire someone. He helped a co-worker’s widow with her vegetable garden, which delivers locally grown vegetables to residents and staff. </div>
<div style="text-align:left;">“His work is his life, his life is his work,” Cox says. </div>
<div style="text-align:right;"> –Lisa Gelhaus</div>
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<h2 class="ms-rteElement-H2B">Rachel Ellis, NCAL Assisted Living Nurse of the Year</h2>
<div style="text-align:left;">Rachel Ellis is assistant administrator of resident care at Gardens at Osage Terrace, a 45-unit assisted living facility in Bentonville, Ark., that serves seniors with low incomes who are Medicaid-eligible. </div>
<div style="text-align:left;"><img class="ms-rteImage-2 ms-rtePosition-1" alt="Rachel Elis, NCAL Assisted Living Nurse of the Year" src="/Issues/2011/PublishingImages/0911/SA_Rachel-Ellis.jpg" width="185" height="156" style="margin:15px 10px;width:156px;" /></div>
<div style="text-align:left;">“Her everyday work ethic, compassion, empathy, and heartfelt care make a difference in the lives of seniors,” says Kim Goins, administrator of the Gardens. “Anytime you see Rachel with residents, family members, other staff, or physicians, you can tell she is mindful about them.” </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">Ellis’ outstanding compassion and person-centered care was demonstrated when, after a resident’s daughter died, Ellis took the afternoon off and took the resident out for some ice cream just like her daughter used to do. Ellis helped the resident grieve by listening and reminiscing with her. Ellis is often found checking in on residents to make sure things are going well.</div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">“We are so proud because Rachel truly demonstrates leadership qualities that inspire her staff members to deliver care and services that the residents find highly satisfying,” says Donna Childress, executive director of the Arkansas Health Care Association/Arkansas Assisted Living Association. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">Ellis’ commitment to the betterment of others transcends her role as a supervisor into a role model and mentor of staff. “She knows that caring for the elderly, a team must run smoothly, have the desire to work as a unit, be well trained, and have the support they need,” Goins says. “Residents and staff in our community describe her as guiding, outgoing, respected, strong-willed, and a truly rare person.”</div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">“True heartfelt emotions are not something you learn, it is a gift,” Goins says. “Ellis displays this attitude to everyone, and because of that she is an amazing role model, mentor, and supervisor.”</div>
<div style="text-align:right;">–Lisa Gelhaus</div>
<div style="text-align:left;"> </div>
<h2 class="ms-rteElement-H2B">Beth Atkinson, Developmental Disabilities Hero of the Year</h2>
<div style="text-align:left;">Beth Atkinson is the director of person-centered living at Seven Hills Pediatric Center, Groton, Mass. She takes that title very seriously and is an ardent advocate for culture change. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">“Beth seeks out the best in residents and is capable of teaching others to see these qualities as well,” says Holly Jarek, administrator and vice president of this 83-bed facility. So much so that she put the town’s Memorial Day parade on the activities schedule but not just to watch, to participate. </div>
<div style="text-align:left;">One of Beth’s visions, honed over a 22-year career, is to demonstrate that life for her residents is not just about medical care and “medical problems.” Under her guidance, social isolation is a rare thing at Seven Hills. </div>
<div style="text-align:left;"><img class="ms-rteImage-2 ms-rtePosition-2" alt="Beth Atkinson, Developmental Disabilities Hero of the Year" src="/Issues/2011/PublishingImages/0911/SA_Beth-Atkinson.jpg" style="margin:15px 10px;" /><br>That Memorial Day parade, with staff and clients participating, is emblematic of Beth’s focus on community. She knows that parades make everyone feel a sense of belonging and that everybody has a role—including Seven Hills. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">Her goal was to be seen as part of the community, not in a passive role, but as active participants in an important community event. To everyone’s surprise, the facility’s entourage received a standing ovation from spectators that fine May Day and earned a new sense of belonging and of pride. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">There is a lot more to Beth’s tenure at Seven Hills. For example, she originated a facilitywide “Into the Community” program whereby residents go to classes and programs at public schools at least twice a week. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">“Her insight and passion is a major factor in our culture that embraces empowering individuals and families,” says Mary Cassidy, director of education and therapy. “She is a role model for staff, a teacher for many, and a loving and compassionate person.” </div>
<div style="text-align:right;">–Tom Burke</div>
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<h2 class="ms-rteElement-H2B">Maplewood Volunteers-In-Partnership Group Volunteers of the Year</h2>
<div style="text-align:left;">The Cheektowago, N.Y.-based Maplewood facility’s volunteer group, Volunteers-in-Partnership (VIP), includes more than 60 people who collectively give new meaning to the idea of being beacons of hope. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">“Where would we be without them?” says Administrator Scott West. When asked about what the VIPs do, West is definitely not lost for activities: cooking, baking, crafting, playing games, hosting themed parties, holding ethnic dinners, organizing outings, organizing pastoral services, operating the gift shop, pet visiting, friendly visiting, delivering mail and newspapers, and, in general, “ensuring that residents’ wishes come true.” </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">The VIPs give residents voices and choices and encourage residents to think independently. The group sounds so busy, yet David Sortisio, son of a resident, beams. “The volunteers spend quality time with my mom and get her involved. I can’t say how much this means to me,” he says. “They are a great group!” They also provide those same qualities to the staff, along with the pleasure of knowing the “community” is in the house. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">“I consider it a privilege to count them as part of our activities team,” says Debbie Peters, director of activities at Maplewood.</div>
<div style="text-align:right;">–Tom Burke</div>
<div style="text-align:left;"> </div>
<div style="text-align:left;"> </div>
<h2 class="ms-rteElement-H2B">Maple Leaf Health Care Center Not-for-profit Community <br>Benefit Program of the Year</h2>
<div style="text-align:left;">“Life may change, but it never gets old,” is not part of the vision or mission statement at Maple Leaf Health Care Center, Manchester, N.H., but it certainly gives a glimpse into its culture. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">The Maple Leaf program is a bi-monthly Healthcare Wellness Clinic, free to participants, where individuals can access clinicians and general health care services such as blood pressure, heart rate, and weight monitoring. </div>
<div style="text-align:left;"><img class="ms-rteImage-2 ms-rtePosition-1" src="/Issues/2011/PublishingImages/0911/SA_Maple-Leaf.jpg" alt="" style="margin:15px 10px;width:155px;height:117px;" /><br>Program-wise, even after all these years, flexiblity is the watchword for Maple Leaf.</div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">“They have been very responsive designing programs based on resident input, specific need, and general feedback, observes Dick Dunfey, executive director of ElderTrust of Florida, which manages the property. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">Maple Leaf’s staff have the knowledge and resources to incorporate and manage new programs seen as needed. </div>
<div style="text-align:right;">–Tom Burke</div>
<div style="text-align:left;"> </div>
<h2 class="ms-rteElement-H2B">Ponderosa Retirement<br>National Assisted Living Week Programming Award</h2>
<div style="text-align:left;"> </div>
<div style="text-align:left;">Living life is just what the residents of the Ponderosa Assisted Living Community, in Yakima, Wash., did during the 2010 celebration of National Assisted Living Week. Thanks to the residents, family members, and Ponderosa staff, everyone had a good time. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">This recognition means that Ponderosa successfully incorporated the 2010 National Assisted Living Week (NALW) theme, “Living Life,” into their activity plans. </div>
<div style="text-align:left;"><br>The theme of the first day of NALW events was “Living Life: Family Food Vacation!” Family was celebrated with a kids’ carnival that allowed several generations to share in the experience of watching grandchildren get their faces painted or getting their photos taken behind a face cutout placard. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">Monday’s theme was “Living Life: Our Own Community Involvement!” During lunch, staff hosted a trivia contest about state and local news events. Another trivia game, titled, “Who Are Your Representatives,” featured questions about federal, state, and local lawmakers. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">Ponderosa’s own residents, DeWitt McAbee and Bill McDowell, sang songs afterward. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">“Living Life: Frugally and Financially Responsibly in Order to Live Luxuriously” celebrated how saving money can allow people to enjoy luxuries in life. After a morning scavenger hunt, resident price-watchers showed off their skills in a trivia contest about the best buys of today, food prices, and tax-deductible items. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">The day ended with a lavish social hour and gala dinner.</div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">The week ended with “Living Life: Gratitude to Those Who Serve!” A staff appreciation brunch was held. Women received facial treatments, manicures, or massages, and men took a day trip to the Yakima Flight Museum. </div>
<div style="text-align:right;">–Lisa Gelhaus</div>
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<div style="text-align:left;"> </div>
<h2 class="ms-rteElement-H2B">Braden Stover, Young Adult Volunteer of the Year</h2>
<div style="text-align:left;"><img class="ms-rteImage-2 ms-rtePosition-1" src="/Issues/2011/PublishingImages/0911/SA_BradenStover.jpg" width="323" height="212" alt="" style="margin:15px 10px;height:218px;" /><br>Tag this volunteer a “Rising Star.” In 2007, Braden Stover was named the volunteer of the year at the Clarksburg Nursing and Rehabilitation Center, in Clarksburg, W.V. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">Now, in 2011, at the age of 16, he is the Young Adult honoree at both the state (West Virginia Health Care Association) and national levels. And in between these honors Braden has continued entertaining the residents at the Clarksburg facility, while also advancing his singing and songwriting career, which includes being an American Idol contestant, recording songs in Nashville, and performing at events.</div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">“Despite his success and hectic schedule, Braden still makes time to perform for his second love, our residents,” says Linda Curry, activities director. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">Braden has performed at the facility, guitar in hand, since he was eight years old, and residents nurture and encourage his budding musical career. Not surprisingly, his Sunday afternoon concerts are extremely popular and have helped him hone a style and maturity beyond his years. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">“You could not find a brighter, more active advocate for our residents,” says Phillip Donnelly, executive director of the facility. </div>
<div style="text-align:left;"> </div>
<div style="text-align:left;">Residents Martha and Betty summarize his value to the residents: “He is a wonderful human being who is also talented—and cute!” </div>
<div style="text-align:right;">–Tom Burke</div> | The American Health Care Association and the National Center for Assisted Living proudly announce the 2011 Volunteers of the Year. | 2011-09-01T04:00:00Z | <img alt="" src="/Issues/2011/PublishingImages/0911/SA_Robin-Amin_thumb.jpg" style="BORDER:0px solid;" /> | Quality;Quality Awards | AHCA/NCAL Annual Awards | 9 |
| Acts Of Kindness | https://www.providermagazine.com/Issues/2011/Pages/0911/Acts-Of-Kindness.aspx | Acts Of Kindness | <div>For more than 15 years in Southern California, Arnold Bresky, MD, has been forging the way in dementia research and successfully treating patients, some of them well into their nineties. As an integrative physician, he believes that pills and surgery are necessary but are not sufficient. </div>
<div> </div>
<div>Moreover, he believes in Western medicine, but some of his prescriptions might sound a bit unusual. They include laughter, music, art, dancing, random acts of kindness, and even knitting. </div>
<div> <img width="328" height="699" class="ms-rteImage-2 ms-rtePosition-2" alt="Arnold Bresky, MD" src="/Issues/2011/PublishingImages/0911/Dr-Bresky.jpg" style="margin:10px 15px;width:205px;height:308px;" /><br>His scientific, evidence-based, and durable whole-person-centered care began in Southern California where he treats thousands of older adults who suffer from various forms of dementia. “I marry hope to science,” said Bresky, 71. </div>
<div> </div>
<div> “My methods are preventive in nature and are designed to delay Alzheimer’s disease, which is our national epidemic, and slow the process of cognitive decline through behavior modification.” </div>
<h3 class="ms-rteElement-H3">Connecting Both Sides Of The Brain </h3>
<div>Bresky believes that depression and a lack of meaning and purpose in life are huge factors in cognitive decline. It was this belief that inspired the Hands of Kindness program, which he started within an Alzheimer’s assisted living facility in Pasadena, Calif. He asked his patients to knit blankets for the homeless that would be distributed by the local fire department personnel. </div>
<div> </div>
<div>The results even surprised Bresky. </div>
<div> </div>
<div>The goal of Hands of Kindness is to deliver lovingly handmade knitted or crocheted items by residents of senior living communities to charitable organizations. In the process, connections are made between the seniors’ skills and the recipient adults and children. </div>
<div> </div>
<div>According to the organization’s website, “this humanitarian project will include assistance and cherished moments of giving. It can incur positive change in people as they work together and create fulfilling lives.”</div>
<div> </div>
<div>“Research has shown that working with numbers and patterns can improve cognition,” says Bresky. “The numbers are on the left side of your brain, the patterns are on the right side. What I’m doing is connecting the two sides. It was like my patients were slowly waking up and recognizing where they were. They began smiling more often and laughing. That’s powerful medicine.” </div>
<div> </div>
<div>There are now two chapters of Hands of Kindness, one in Southern California and one in the Fresno area. Bresky hopes that senior facilities across the nation will promote new chapters, which he believes will bring community awareness to the plight of dementia sufferers while easing their symptoms and improving their quality of life by erasing invisibility. </div>
<h3 class="ms-rteElement-H3">Purpose And Pride </h3>
<div>Judi Magarian-Gold heads up the Central Valley chapter of <a href="/Issues/2011/Pages/0911/Start-a-Chapter.aspx">Hands of Kindness</a>. “We started with four assisted living groups in November of 2008,” she says. “Now we have 11.” </div>
<div> </div>
<div>Magarian-Gold’s own mother suffered from dementia but continued to participate in needle crafts. “She was able to remember the motor skills involved and was quick to fix mistakes,” she says.</div>
<div> </div>
<div><img width="236" height="232" class="ms-rteImage-2 ms-rtePosition-1" src="/Issues/2011/PublishingImages/0911/feature_Hands-of-Kindness-2.jpg" alt="" style="margin:10px;" />Bresky says that science has proven that having purpose in life and performing simple acts of kindness can help prevent cognitive decline in older adults and significantly delay the devastating signs and symptoms of Alzheimer’s. “It’s also an outreach to the community,” he says. </div>
<div> </div>
<div>“The needy and sick get handmade caps and blankets, and the community becomes more aware of those who suffer with dementia.”</div>
<div>Magarian-Gold says the program encourages the residents to participate, and while they knit, crochet, and make blankets, they’re also socializing with one another, which, in itself, fosters self-confidence. </div>
<div> </div>
<div>The project also gives the participants a sense of purpose and pride. “Many of them tell me how good it makes them feel to help others,” she says. “The recipients also feel great to receive a handmade item.” </div>
<div> </div>
<div>Karen Everett Watson is a freelance journalist and a certified gerontologist through her company Legacy Letters. She facilitates reminiscence sessions at local assisted living facilities and is also a regular blogger for Cisco & Co., a mature market advertising firm. She may be reached at Watson@softcom.net.</div> | For more than 15 years in Southern California, Arnold Bresky, MD, has been forging the way in dementia research and successfully treating patients, some of them well into their nineties. As an integrative physician, he believes that pills and surgery are necessary but are not sufficient. Moreover, he believes in Western medicine, but some of his prescriptions might sound a bit unusual. They include laughter, music, art, dancing, random acts of kindness, and even knitting. | 2011-09-01T04:00:00Z | <img alt="" src="/Issues/2011/PublishingImages/0911/feature_Hands-of-Kindness-thumb.jpg" style="BORDER:0px solid;" /> | Caregiving;Management;Quality;Culture Change | Column | 9 |
| New York Lawmaker In Touch With Health Care Debate | https://www.providermagazine.com/Issues/2011/Pages/0911/Congressional_Profile_0911.aspx | New York Lawmaker In Touch With Health Care Debate | <p><img width="276" height="1127" class="ms-rteImage-2 ms-rtePosition-1" alt="Nan Hayworth" src="/Issues/2011/PublishingImages/0911/Nan-Hayworth.jpg" style="margin:5px 10px;width:175px;height:263px;" />Even the most experienced lawmakers in Washington realize these are not easy times for making political decisions on how to reduce spending while at the same time preserve the Medicare and Medicaid programs that most Americans view as a sacred trust between the people and government. </p>
<p>For newcomer Nan Hayworth, MD, the freshman Republican representative from upstate New York’s 19th district, these past months have only solidified her belief that solutions exist for maintaining obligations to seniors and at the same time rein in out-of-control government spending.</p>
<p>Indeed, even as a first-termer, she became a leader in this summer’s debt ceiling debate in the House, speaking to the need for solving problems in this current era of charged political rhetoric.</p>
<p>“I didn’t come here with any preconceived notions. I have just concentrated very hard on the job and have been inspired by the fact so many men and women [in the House and Senate] are dedicated to doing the right thing. We have to do what is best for our country as a whole,” Hayworth says, noting the ceiling had to be raised to prevent serious economic consequences, but not paid for by raising taxes.</p>
<p>She voted for her party’s budget proposal last spring, which did not get anywhere in the Senate, to tighten government spending, partly by converting the Medicare program to a premium support format. Under this model, the current Medicare program would be replaced by a system of competing public and private health plans, with the federal government contributing a set amount toward the purchase of Medicare coverage, based on the premiums charged by the different plans.</p>
<p>“The House majority plan preserves Medicare in ways the Accountable Care Act [health reform law] does not,” Hayworth says, noting that the current system puts limits on what providers can be reimbursed for, hurting the ability of doctors to do their jobs while remaining in the program. Medicare losing doctors and making access for seniors difficult is a growing problem, she notes.</p>
<p>An opthamologist by profession, Hayworth is in tune with the health care debate in Congress more than most legislators. She has first-hand experience with caregiving; navigating federal and state reimbursement systems; and dealing with a myriad of medical, labor, and legal issues tied to modern doctoring. “A lot of my patients received Medicare,” she says.</p>
<p>She has definite opinions on the reform law, saying she supported repeal when the House approved such action in January, while at the same time suggesting the goals of the reform effort are worthwhile. “It’s just bad mechanisms” within the president’s plan that make it way too costly, she says, adding, “it costs far more than it will benefit us.”</p>
<p>In her congressional district, health care, and care for the elderly are big issues. She says it is inevitable with the aging of the population as a whole that long term care is a priority issue in Washington. </p>
<p>The daughter of World War II veterans, both father and mother, Hayworth says it is true that the generation that survived the Great Depression and won the war requires proper care in their old age, through programs like Medicare and Medicaid. </p> | The daughter of World War II veterans, both father and mother, Hayworth says it is true that the generation that survived the Great Depression and won the war requires proper care in their old age, through programs like Medicare and Medicaid.
| 2011-09-01T04:00:00Z | <img alt="" src="/Issues/2011/PublishingImages/0911/Nan-Hayworth_thumb.jpg" style="BORDER:0px solid;" /> | Policy | Column | 9 |
| Constructive Approaches to Common Problems in Skilled Nursing Facilities | https://www.providermagazine.com/Issues/2011/Pages/0911/Constructive-Approaches-to-Common-Problems.aspx | Constructive Approaches to Common Problems in Skilled Nursing Facilities | <div><img width="470" height="362" class="ms-rteImage-2 ms-rtePosition-2" src="/Issues/2011/PublishingImages/0911/coverstory.jpg" alt="" style="margin:10px;height:335px;" /><br>The “same old” approach to persistent disease conditions in long term care isn’t good enough any more, experts say.</div>
<div>The patient population in this setting 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. </div>
<div>Expect to see more such innovations, as accountable care and penalties for rehospitalizations and the occurrence of “never events” become the norm and facilities wrestle with cost, coverage, and reimbursement cuts.</div>
<div>At the same time, long term care has entered a new age of technology, clinical discovery, and <a href="/Issues/2011/Pages/0911/Sitting-Down-To-Desktop-Medicine.aspx"><font color="#0072bc">personalized care</font></a> that will have a growing impact on care and outcomes. </div>
<h3 class="ms-rteElement-H3">The New Model</h3>
<div>What kinds of innovations are happening in long term care? “There definitely is an increasing recognition of the need to develop better systems of care,” says Jason Karlawish, MD, professor </div>
<div>of medicine and medical ethics, University of Pennsylvania. </div>
<div> </div>
<div>William Day, DPh, FASCP, president and chief executive officer, Pharmaceutical Consulting Services of America, New Orleans, adds, “As we move to practicing more person-centered care, we increasingly are approaching care from a global perspective. We’re seeing an emphasis on systems that involve all appropriate team members—with the patient at the center—and set goals accordingly.”</div>
<div> </div>
<div>Since the average long term care resident has multiple chronic conditions, it isn’t surprising that he or she also is taking several medications—an average of eight or more. But there currently is a focus on making medications just part of treatment, not the central or main component. Many of the recent innovations have to do with early diagnosis and prevention, Karlawish notes. </div>
<div> </div>
<div>“There will be more vigorous debates in the coming years about whether drugs are cost-effective.” He says, “Professionally, I’m glad that we are having these debates. I think we will look increasingly at patient-reported outcomes; that is, if people taking medications actually do better.”</div>
<h3 class="ms-rteElement-H3">Diabetes: Slipping Away From Sliding Scale</h3>
<div>Formerly the standard of care, prolonged use of sliding scale insulin (SSI) therapy generally is now not recommended in long term care facilities, and practitioners increasingly are moving patients from SSI to basal bolus insulin therapy. </div>
<div> </div>
<div>According to the AMDA—Dedicated to Long Term Care Medicine—“Clinical Practice Guideline on Managing Diabetes in the Long Term Care Setting,” widespread use of SSI results in greater patient morbidity and increased nursing time because patients’ blood glucose levels must be monitored more frequently, and more insulin injections must be given. Additionaly, the patient’s activities and quality of life may be compromised.</div>
<div> </div>
<div>John Morley, MB, BCh, Dammert professor of gerontology and director of the division of geriatric medicine, St. Louis University, says, “Sliding-scale insulin generally isn’t good for various reasons. You’re really giving someone insulin after the fact.” Hypoglycemia actually occurs more often with SSI therapy than it does using a basal-bolus regimen, he says.</div>
<div> </div>
<div>Reducing waste and unnecessary costs is one driver behind a move away from SSI in long term care. “Many providers now recognize that there is significant waste in the way the insulin vial is “sized.” On average, a facility wastes about 40 percent of the insulin it purchases in vials,” says Fred Wendt, RPh, a long term care pharmacist. </div>
<div> </div>
<div>He explains, “A vial contains 1,000 units, so if you multiply the average 20-unit dose by 28 days [the time period in which an open vial of insulin must be used], you have only 560 units administered. The rest is waste.</div>
<div> </div>
<div>“That’s about a $52 expense per vial, and that’s unconscionable.” This is propelling facilities to look at insulin pens more, says Wendt, because they have 300 units in them. For patients receiving average or less doses of insulin, these can be more cost effective. “The savings are enough to overcome the extra cost associated with needles for the pens,” he says.</div>
<div> </div>
<div>Dennis Stone, MD, CMD, MBA, a chief medical officer in Louisville, Ky., and former president of AMDA, agrees that waste is a big concern. “There is a clear issue with waste, and that is one reason we moved to the pen,” he says. “We expect to save tens of thousands of dollars or more.”</div>
<div> </div>
<div>However, cost isn’t the only issue driving the move to the pen. “It is a wonderful tool for the discharged patient going home,” says Wendt. With an emphasis on effective care transitions and ensuring that patients are not readmitted to the hospital after discharge due to avoidable problems, this is a plus for both patients and providers. </div>
<div> </div>
<div>“We see it all the time—we try to educate patients on insulin administration, and they have difficulty with it. Because the pen is easier to use, it is a confidence builder, especially with geriatric patients who are being discharged home,” Wendt says.</div>
<div> </div>
<div>Since the pens allow for more accurate dosing, they can contribute to better outcomes. </div>
<div> </div>
<div>“Hypoglycemia certainly is a concern with diabetes patients,” Wendt says. While this condition usually is mild and can be treated quickly, it can lead to confusion or dizziness that can result in a fall. At its most severe, hypoglycemia can lead to seizures or coma. It can be fatal. Better control means fewer instances of hypoglycemia and its consequences, Wendt says.</div>
<div> </div>
<div>Morley says that there are situations in which SSI is acceptable. However, Stone notes, “Except in the brittle diabetic and rare other instances, long term use of SSI is just not ‘good medicine.’ It’s not fair to the patient and takes time away from nursing that could be used to address other care needs.”</div>
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<h3 class="ms-rteElement-H3">Reassessing Tight Control</h3>
<div>Another issue gaining attention in long term care is when tight control is appropriate. Morley stresses that tight control of diabetes in elderly patients may not always be an appropriate or realistic goal. In general, in fact, a hemoglobin A1C level between 7 and 8.5 is considered acceptable for most patients, including the elderly, says Morley; and not every patient necessarily should be held to the ideal goal of 7. </div>
<div> </div>
<div>As Stone says, “If I have a younger patient with a 20- to 30-year prognosis, he or she deserves tight control. But if I have an 85-year-old with multiple comorbidities, tight control may not be an appropriate or necessary goal. It really depends on the prognosis.” However, Stone says, “Elevated blood sugar does long-term damage to virtually every organ system in the body. The more patients learn about this, the more the ones with a good prognosis want to keep tighter control.”</div>
<div> </div>
<div>This move away from tight diabetes control in all cases is a big change, but it fits in with the philosophy of person-centered care. “You have to talk to patients about reasonable control, diet, lifestyle, and risks. If looser control doesn’t put them at great risk of hypoglycemia or other problems and he or she wishes to have a piece of cake, the patient’s wishes should be respected. At the same time, those who have had diabetes for years and are used to tight control should be allowed to continue this if they wish to do so,” says Day.</div>
<div> </div>
<div>Wendt agrees that individualized treatment—as part of person-centered care—is key to successful diabetes management. “While a Hemaglobin A1C of 7 is a good standard, a patient might not feel good at this level; so you have to do what is best for him or her,” he says. “Astute clinicians won’t just look at the A1C. They’ll consider the results of eye, foot, and skin exams. If you have a patient with an A1C of 8 who looks good, feels good, and is in generally good condition, why would you foist therapies on them that they don’t want or need?” </div>
<div> </div>
<div>Setting flexible goals also can help with patient compliance, says Wendt. “If you tell a patient with an A1C of 10 that they have to get it to 7 and he or she works really hard and only gets it to 9, that patient is more likely to give up. But if we say, ‘Great—you’re at 9, let’s try for 8,’ this lets the patient celebrate a small victory and is more likely to provide the incentive to keep trying,” he says.</div>
<div> </div>
<div>While older patients with diabetes with better controlled blood sugar are less likely to experience complications such as vision loss, heart attacks, strokes, or kidney failure, a new study seems to support the trend toward looser control. </div>
<div> </div>
<div>Researchers determined that older patients with the lowest blood sugar levels have a slightly higher chance of dying than those whose control is in the normal A1C level of 7-8, according to a 2001 study reported in Diabetes Care. </div>
<div> </div>
<div>While they couldn’t determine whether increased risk of death was related to low blood sugar, the treatments or medications used to control the patient’s diabetes, or other factors, the authors say the data do suggest that aggressive control or treatment isn’t necessarily the appropriate goal for elder patients.</div>
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<h3 class="ms-rteElement-H3">A Personal Choice</h3>
<div>Jonathan Marquess, PharmD, CDE, president of the Institute for Wellness and Education in Woodstock, Ga., says, “For people with diabetes, it is all about individualize, individualize, individualize.” He adds, “The goal is to get diabetes in control and not have huge swings up or down. </div>
<div> </div>
<div>We’re trying to get medications to patients that work more like their bodies’ own insulins and don’t just correct blood sugars reactively. Increasingly, this is a team activity that involves physicians, family members, and patients proactively. They share a common aim of helping the patient feel better and have a better quality of life.”</div>
<div> </div>
<div>Diabetes care also is at the center of recent efforts to improve care transitions. As Marquess says, “There is a greater understanding that patients who come to the nursing home from the hospital on sliding scale need attention. I have more medical directors consulting with me and saying, ‘We’re getting a patient from the hospital on SSI. We will keep him on that for a week, and then we want you to reevaluate.’” </div>
<div> </div>
<div>He adds, “I’m changing many of these patients to basal insulin and having success with that.”</div>
<div>While the approach to diabetes treatment has evolved, new developments may lead to additional changes in the future. For example, an experimental drug designed to improve levels of “good” cholesterol improved blood sugar control in diabetic patients on statins, in one new study by the American Heart Association. While the medication was not as effective in managing diabetes as drugs commonly used to treat that condition, it did reduce the adverse impact on blood sugar commonly seen with statin use. </div>
<div> </div>
<h3 class="ms-rteElement-H3">Infection Control Takes Center Stage</h3>
<div>There are many developments that could positively impact how infections are prevented and managed in long term care and other settings. Among them is Food and Drug Administration (FDA) clearance for the first test for Staphylococcus aureus (S. aureus) infections that can diagnose and distinguish methicillin-resistant infections (MRSA) from methicillin-susceptible (MSSA) ones. </div>
<div> </div>
<div>The KeyPath MRSA/MSSA Blood Culture Test can determine whether bacteria growing in a person’s positive blood culture sample are MRSA or MSSA in approximately five hours from the time bacterial growth is seen in the sample. The test doesn’t require any special instruments—beyond blood culture equipment—to get results, so it practically can be performed in any laboratory. Ideally, this test will enable practitioners to diagnose these conditions quicker and promptly implement precautionary measures to prevent spreads or outbreaks.</div>
<div> </div>
<h3 class="ms-rteElement-H3">Other Conditions Have New Remedies</h3>
<div>Elsewhere, FDA recently approved Dificid (fidaxomicin) tablets for treating Clostridium difficile-associated diarrhea (CDAD). Two trials involving a total 564 patients with CDAD compared Dificid with the antibiotic vancomycin. The clinical response was similar between the two groups in both studies. However, more patients treated with fidaxomicin were still symptom-free after three weeks than those in the vancomycin group. </div>
<div> </div>
<div>To maintain the new drug’s effectiveness and avoid development of a drug-resistant bacteria, fidaxomicin should be used only to treat infections caused by or strongly suspected to be linked to C. difficile, according to FDA. The drug’s most common side effects are nausea, vomiting, headache, abdominal pain, and diarrhea. </div>
<div> </div>
<div>In another drug-related development, an old osteoporosis drug may be effective in killing influenza viruses, including the H5N1 bird flu virus, according to Reuters Health Information. Pamidronate boosts a class of human immune cells and causes them to attack flu virus-infected host cells. </div>
<div> </div>
<div>Antiviral drugs target flu viruses, which can be problematic as viruses often mutate and become resistant. However, this isn’t a concern with pamidronate because it targets cells and not the viruses. </div>
<div>To date the drug has been tested for this purpose only with mice specially bred with human immune systems. It is too early to tell the potential use of pamidronate in humans, no less older adults. However, if it is proven to produce positive outcomes in human subjects, the drug could be particularly useful in a pandemic when typical flu medications are in short supply.</div>
<div> </div>
<div>Indeed, preparing for pandemics and vaccine shortages have been focuses for researchers in recent years. In another study, by A. Pollack, reported in the New York Times, scientists have developed a flu vaccine made by a new, faster method to make flu vaccines. </div>
<div> </div>
<div>The new process involves growing influenza virus in animal cell cultures, rather than in chicken eggs. This could prevent problems such as the 2009 swine flu pandemic, during which large quantities of vaccines weren’t available until after the height of the flu season. The new vaccine could become available in the United States within a few years. </div>
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<h3 class="ms-rteElement-H3">Positive News For Infection Control</h3>
<div>Standard precautions haven’t changed much over the years. However, a new precautionary measure could have a positive impact on reducing infections. </div>
<div> </div>
<div>According to a recent study, antimicrobial copper surfaces in intensive care unit rooms reduced the risk of hospital-related infections. In the Department of Defense-funded study, sites replaced frequently touched areas, including bed rails, over-bed tray tables, nurse call buttons, and poles, with antimicrobial copper. One site experienced a 97 percent reduction in surface pathogens in rooms that replaced existing surfaces with copper.</div>
<div> </div>
<div>If further studies produce similar results, this could have tremendous repercussions in nursing facilities, where the spread of infections is a constant concern and traditional precautionary measures aren’t always enough. Of course, facilities will have to weigh the cost of installing copper surfaces with the potential benefits.</div>
<div> </div>
<div>Another recent study could lead to an additional change in precautionary measures. Researchers in Rhode Island studied 7,700 adult patients in a hospital setting and found that using antiseptic-laced washcloths lowered the risk for MRSA and vancomycin-resistant Enterococcus better than traditional soap and water. </div>
<h3 class="ms-rteElement-H3">Unraveling The Parkinson’s Mystery</h3>
<div><img width="150" height="150" class="ms-rteImage-3 ms-rtePosition-1" src="/Issues/2011/PublishingImages/0911/coverstory_thumb.jpg" alt="" style="margin:15px 10px;" /><br>While there have been no recent innovations in Parkinson’s disease (PD), several studies have delved into PD’s causes and how to keep patients with the illness safer and more comfortable. For example, one recent study showed a connection between the use of two pesticides (rotenone and paraqual) and PD, as reported in Environ Health Perspective.</div>
<div> </div>
<div>According to the study results, people who used either pesticide developed PD about 2.5 times more often than those who didn’t use the chemicals. Still another new study reported in Health Day suggested that methamphetamine abuse increases the risk for PD by up to 76 percent.</div>
<div> </div>
<div>Another recent study reported in Health Day has suggested a change that needs to be made to better protect PD patients. According to the results, antipsychotic drugs are still being prescribed for many PD patients, despite a six-year-old warning that the drugs can worsen symptoms. In fact, between 2002 and 2008, the rate of antipsychotic prescriptions for PD remained consistent in spite of the warning issues in 2005. </div>
<div> </div>
<div>While there was a shift toward better-tolerated antipsychotics, researchers stress that these medications aren’t necessarily safer or more effective. </div>
<div> </div>
<div>“We still need to learn more about the origins of PD. Until we have more insights on this, treatment isn’t likely to change much. In the meantime, we are focusing on keeping patients with the disease as safe and comfortable as possible,” says Day. Another focus is identifying patients who are experiencing drug-related Parkinsonism from antipsychotics and other medications, he says.</div>
<div> </div>
<div>With antipsychotic use receiving growing national attention, this will be an area of focus for facilities and prescribers alike—for PD patients and others taking these drugs. Karlawish says, </div>
<div>“We need to use antipsychotics carefully. We also need to develop and implement better ways to treat these problems. We are seeing greater attention to implementing systems to monitor medication usage and scrutinize med records.” Increasingly, prescribers will need documentation to support the use of various medications, and payers will be scrutinizing records for cost inefficiencies and medications deemed unnecessary, observers say. </div>
<h3 class="ms-rteElement-H3">Pressure Ulcers: Ways To Promote Healing</h3>
<div>Preventing and treating pressure ulcers is always a top priority in long term care facilities, and some new research and developments may make this easier. For example, European researchers have determined that negative-pressure wound therapy may not promote healing in chronic persistent and complex wounds any better than conventional wound care.</div>
<div> </div>
<div>Negative-pressure wound therapy, which involves covering the wound with an airtight film and placing an electric pump over the wound to drain exudates, can be costly and time-consuming. So with the current emphasis on cost cutting, it is important to understand what treatments are most cost effective. </div>
<div> </div>
<div>At the same time, researchers at Loyola University Health System have determined that it might be possible to promote wound healing by suppressing neutrophils and natural killer T (NKT) cells. </div>
<div>While these cells kill bacteria and other germs that can cause wound infections, they also can be harmful—producing enzymes that digest surrounding tissue, cause scar tissue to develop, and hinder healing. </div>
<div> </div>
<div>Scientists from the United States, Israel, and Japan have developed an inexpensive nanometer-sized drug that can treat foot ulcers and other chronic wounds. Several growth factor proteins have been shown to speed wound healing, but purifying these proteins is expensive, and they don’t last long on the injured site. </div>
<div> </div>
<div>Now, scientists have used genetic engineering to produce a “robotic” growth factor protein. Because these respond to temperature, dozens of these proteins can fold together into a nanoparticle more than 200 times smaller than a human hair. This simplifies protein purification, making it inexpensive to produce and enabling the protein to remain at the wound site longer.</div>
<div> </div>
<div>In general, wound care really hasn’t changed much in many years, says Carolyn Brown, BS, Med, LTC-RN, a clinical consultant for Advanced Tissue, a Medicare Part B billing service company located in Little Rock, Ark. </div>
<div> </div>
<div>“As far as treatments go, we are seeing more and more collagen products.” These provide a moist wound-healing environment with the benefits of collagen. However, Brown suggests that facilities focus more on “good basic skin care.” </div>
<div> </div>
<div>“Good incontinence care, good nutrition, and other basics of skin care continue to be the key to pressure ulcer prevention. I’ve seen people taken care of at home by family members, and their skin is healthy—despite the fact that they’re 95 and homebound. The difference is care,” she says.</div>
<div> </div>
<div>“We’re focusing on disease states that put people at high risk for skin breakdown and making sure that—whenever possible—patients aren’t on drugs that can affect their nutritional status,” says Day. “We are stressing prevention and ways to protect skin and prevent breakdown in the first place.”</div>
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<h3 class="ms-rteElement-H3">Alzheimer’s Work</h3>
<div>Not surprisingly, the diagnosis and treatment of Alzheimer’s disease (AD) and dementia continue to evolve. As Karlawish says, “The field of Alzheimer’s increasingly is recognizing and understanding the biology of the disease with the practical goal of diagnosing the disease at the earliest onset or even before significant symptoms present, and then use these same insights to target interventions and treatments.” </div>
<div> </div>
<div>An expanding focus on diagnostics, says Karlawish, has led to a “relaxation of interest on developments of symptomatic treatment. This is a change from 10 to 15 years ago when the focus was on medications.” In long term care, decisions about medications often involve how long to continue treatment. </div>
<div> </div>
<div>As Karlawish says, “If patients are on medications designed to slow the disease’s progress, we need to decide if they should stay on these as Alzheimer’s advances.”</div>
<div> </div>
<div>Clearly, AD is a common diagnosis in long term care. However, according to one study, the diagnosis of AD may not always be accurate. Researchers found that only about one-half of over 200 subjects diagnosed with AD were determined on autopsy to have brain conditions associated with the disease. Instead, they had other brain abnormalities, including generalized brain atrophy, according to a study reported in HealthWorks Collective.</div>
<div> </div>
<div>While the authors admitted that larger studies are necessary to confirm their findings, this could lead to new ways to diagnose the disease and to ensure that patients aren’t being treated inappropriately or unnecessarily. </div>
<h3 class="ms-rteElement-H3">Isolating Risk Factors</h3>
<div>Other recent studies have suggested factors that determine one’s risk for AD. For example, a Swedish study published in Neurology has determined that extra weight during middle age (defined as having a body mass index of 25 to 30) could lead to a greater dementia risk in later life.</div>
<div> </div>
<div>Another, conducted in Germany and involving 3,200 German seniors age 75 years or older, indicated that elderly adults whose alcohol intake is approximately two drinks daily have a significantly lower risk of developing AD and dementia than nondrinkers. In fact, they estimated that the risk for dementia is 30 percent lower and the risk for AD reduced by 40 percent. </div>
<div> </div>
<div>Another study also has suggested a link between lifestyle and AD. University of Alabama researchers determined that an epigenetic eating regimen—a diet that includes soybeans, cauliflower, broccoli, cabbage, green tea, fava beans, kale, and grapes—may suppress gene aberrations that ultimately can cause diseases such as AD. </div>
<div> </div>
<div>Confirming that AD may run in families, a recent study also published in Neurology indicated that a person’s risk for developing AD is higher if one’s mother—rather than one’s father—had the disorder. </div>
<h3 class="ms-rteElement-H3">New Treatment Options</h3>
<div>Other recent studies may help lead to identifying—and treating—AD earlier than ever before. One study indicated that the liver, as opposed to the brain, actually may be the source of the amyloid that leads to brain plaques associated with AD. If confirmed, these data could change how clinicians approach diagnosis and treatment. </div>
<div> </div>
<div>Elsewhere, scientists have taken a potential step forward in AD treatment by discovering how to turn human embryonic stem cells and a type of human skin cell into the kind of brain cells lost to AD, reported in Stem Cells 2011. The new study suggested that perhaps scientists someday may be able to produce a supply of these cells in a laboratory setting and test different drugs on them to see which ones keep the cells alive. This, in turn, could aid in the development of drugs to combat AD. </div>
<div>Looking further into the future, this technology eventually might be used to transplant healthy cells back into AD patients’ brains to treat the disease.</div>
<div> </div>
<div>Of course, drugs are still a part of AD treatment; and Karlawish notes that there are several drugs in later phases of clinical trials that “we will hear results of in the next 24 months. All have a common approach—addressing the accumulation of amyloid plaque in the brain.” He says, “We’ll know when the results come out if this approach is successful.” </div>
<h3 class="ms-rteElement-H3">Geriatric Research Lags</h3>
<div>While much has changed regarding how common conditions are treated in long term care, one thing hasn’t changed. Clinical trials still fail to involve older patients to any significant degree. One in five studies still excludes many patients simply because of their age; about half of the remaining trials employed criteria that were likely to eliminate older adults from involvement. This is according to a study analyzing over 100 studies published in <em>The Journal of the American Medical Association, The New England Journal of Medicine, Lancet, Circulation, The British Medical Journal,</em> and others, according to a report in the <em>New York Times.</em> While the average age of participants in the trials included in the study was 61, many excluded nursing facility residents and patients with physical disabilities or existing medical conditions. </div>
<div> </div>
<div>“We just don’t have the data on how medications affect geriatrics as much as we should. We are still dealing with trial and error,” says Day. “We really need more studies specific to this population.” </div>
<div>Considering that the geriatric population is growing exponentially, says Day, this is a key issue that calls for national attention. </div>
<div> </div>
<div>He says, “More and better studies addressing this population are likely to influence how we manage conditions such as PD, AD, pressure ulcers, and others in the years to come.” </div>
<div> </div>
<div><em>Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.</em></div> | 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. | 2011-09-01T04:00:00Z | <img alt="" src="/Issues/2011/PublishingImages/0911/coverstory_thumb.jpg" style="BORDER:0px solid;" /> | Clinical;Caregiving | Column | 9 |
| Meaningful HIT Aids Frontline Caregivers | https://www.providermagazine.com/Issues/2011/Pages/0911/Meaningful-HIT-Aids-Frontline-Caregivers.aspx | Meaningful HIT Aids Frontline Caregivers | <div id="__publishingReusableFragmentIdSection"><a href="/ReusableContent/4_.000">a</a></div><div>Health information technology (HIT), while an increasing priority for long term care providers, often triggers questions about whether the potential is more promise than reality. HIT is expected to help make daily work more smooth and efficient for clinicians while supporting improvements in delivery of care and associated resident outcomes. In practice, however, there are often unexpected challenges. </div>
<div> </div>
<div>Learning how to use technology takes time and considerable effort, and, once mastered, the technology may disappoint frontline caregivers who struggle with integrating the new HIT into daily practice. </div>
<div> </div>
<div>Described in this article is an approach for implementing HIT by showing frontline staff how to leverage it to support clinical decision making. This approach makes a clear connection between HIT use and quality improvement (QI) and focuses on care process improvements to impact outcomes. </div>
<div><h3 class="ms-rteElement-H3">An Approach That Works</h3>
<div>Known as Quality Improvement Integrated into Information Technology (QI-IT™), it is an approach based on principles of QI, information analytics, clinical workflow reengineering, and more than 10 years of experience working with more than 100 skilled nursing facilities to implement quality improvement strategies as part of HIT implementation. </div>
<div> </div>
<div>The purpose of this article is to describe the QI-IT approach and better explain why and how quality improvement considerations should be explicitly integrated into the process of implementing HIT in skilled nursing facilities to help narrow the gap between clinician expectations and reality. </div>
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<div>For organizations that may be struggling to gain user acceptance of newly installed HIT, disappointed with the results, or struggling with establishing an explicit link between HIT and improved clinical processes and outcomes, this article may offer helpful insights.</div>
<div> </div>
<div>At the core of the QI-IT approach is the idea that when specific quality improvement goals, clinical processes, and outcome improvements are integrated into facility strategies and plans for using information technology, then there is a clear QI-IT link and expectation that HIT will support the hands-on caregiver team using clinical best practices on a routine basis. </div>
<div> </div>
<div>By employing specific QI objectives, the HIT implementation discussions take on an added dimension, and frontline staff are encouraged to think about HIT’s purpose beyond automating paper processes. </div>
<div> </div>
<div>For example, implementing HIT to promote earlier identification of residents at risk for pressure ulcers, falls, or hospital transfers is a tangible goal, versus implementing to improve resident clinical care in general. Confirming the specific care processes and outcomes to improve sets a framework that frontline staff understand and helps identify particular aspects of processes that will impact resident care. </div>
<div> </div>
<div>There are three guiding principles of the QI-IT approach. While these principles might be intuitive, the extent to which they are considered simultaneously with HIT implementation plans should be objectively assessed in order to maximize the potential of HIT and gain user acceptance. </div>
<div>The principles are: Focus on QI objectives, improved processes, and outcomes first; leverage capabilities of HIT to support specific QI objectives; and be strategic when integrating HIT into workflow.</div>
<div> </div>
<div>An important factor embedded in all three principles is involvement of multiple disciplines and frontline staff throughout, whereby the entire care team focuses on QI goals, processes, and information needs and how HIT supports them. </div>
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<div><h3 class="ms-rteElement-H3">Applying QI-IT</h3>
<div>Two scenarios illustrate the impact of QI-IT. In the first scenario, a facility automates its admission assessment form as part of a plan to automate all nurse assessments. To this end, the facility team creates a replica of the existing admission assessment forms in the new computer system. Minor revisions are made to the online admission assessment, but it appears very similar to the paper forms. </div>
<div> </div>
<div>The team is pleased with the new electronic admission assessment and is optimistic that nurses will adapt readily to completing the form online because the form will be familiar to nurses, requires no change to workflow, and does not entail new learning. </div>
<div> </div>
<div>The electronic system provides updates to the automated assessments, and the facility is pleased to have the ability to see progress of the assessments, which aids in the management of outstanding work or overdue or incomplete documentation. </div>
<div> </div>
<div>The nurses find the online admission assessment form easy to use, medical records staff monitor status and follow up with nurses who have not completed admission assessments, and work has been streamlined. </div>
<div> </div>
<div>However, the team is not able to say that HIT is helping to identify resident needs or risks in a more timely manner, nor are they able to say that they are better coordinating care with physicians and other disciplines. </div>
<div> <img width="451" height="253" class="ms-rteImage-3 ms-rtePosition-1" src="/Issues/2011/PublishingImages/0911/tech_chart1.gif" alt="" style="margin:10px 15px;height:263px;" /><br>In another scenario, QI-IT is used. The facility automates its admission assessment process with the goal of using HIT as a tool to promote earlier identification of high-risk factors for new admissions, ensure appropriate care plan interventions are in place, and improve communication to the entire care team.</div>
<div> </div>
<div>Applying QI-IT principles prior to implementing HIT prompts the multidisciplinary team to review the admission assessment form, including the information that is recorded, the processes used to complete them, and how other disciplines use the assessment information. </div>
<div> </div>
<div>Opportunities for process improvement are explored throughout the review. One commonly identified improvement is the management of risk factors for new admissions. Specifically, the team would like to ensure resident risks are identified upon admission and communicated among disciplines in a more timely manner. </div>
<div> </div>
<div>In addition, they want appropriate risk assessments completed in a timely and consistent manner and appropriate care plan interventions to be in place for each risk identified during the admission assessment process. </div>
<div> </div>
<div>The team discussion also expands to consider the HIT dynamic and analytic capabilities. </div>
<div> </div>
<div>For example, the discussion centers on how HIT can prompt the ongoing review of high-risk factors on a consistent basis. In this process, the high-risk factors assessed on admission are confirmed, and the team ensures that the risk elements are included when designing the admission assessment. Input from multiple disciplines and users of admission assessment data help identify information gaps, and workflow issues are uncovered. </div>
<div> </div>
<div>The HIT implementation discussion broadens to a review of care process and information needs and how HIT supports frontline caregiver practices. Disciplines involved in the management of each risk are invited to participate. Discussion with the HIT vendor includes a review of the facility’s requirements for admission assessment data entry as well as how information will be used.</div></div>
<div><h3 class="ms-rteElement-H3">A Different Perspective</h3>
<div>Too often, facilities start HIT implementation by automating existing paper and paper processes. What is often overlooked is that current processes are not set up to use HIT optimally. As illustrated in the scenarios above, rather than simply automating existing forms or reports, the QI-IT approach encourages facility teams to think about implementing HIT from a different perspective—one that looks at how HIT is supporting improvements in the care delivery process.</div>
<div> </div>
<div>Spend time up front to review current practices, drill into the details of information and communication flow, and identify where and how best practices can be integrated into frontline daily work. </div>
<div> </div>
<div>Linking HIT to specific QI goals makes where and how HIT is used very concrete. It becomes a tool for improved information access and synthesis, clinical decision making, and care coordination. </div>
<div> </div>
<div>Computers alone simply automate data processing without fundamentally impacting the way information is used or the quality of care. By embedding quality improvement principles into the implementation of HIT, data can be harnessed for greater purposes, including the improvement of daily workflow routines, the effective monitoring and evaluation of resident progress, and clinical decision support tools that support delivery of care based on clinical best practices. </div>
<div> </div></div>
<div><em>Sandy Hudak, MS, RN, and Siobhan Sharkey, MBA, are principals at Health Management Strategies, a health care consulting group focused on quality improvement and HIT implementation. Michal Engleman, PhD, a consultant working with HMS, is a professor in the Department of Sociology at the University of Chicago.</em></div> | Health information technology (HIT), while an increasing priority for long term care providers, often triggers questions about whether the potential is more promise than reality. HIT is expected to help make daily work more smooth and efficient for clinicians while supporting improvements in delivery of care and associated resident outcomes. In practice, however, there are often unexpected challenges. | 2011-09-01T04:00:00Z | <img alt="" src="/Issues/2011/PublishingImages/nurses_comp_thumb.jpg" style="BORDER:0px solid;" /> | Quality;Technology | Column | 9 |
| Med Pass Makeover | https://www.providermagazine.com/Issues/2011/Pages/0911/Med-Pass-Makeover.aspx | Med Pass Makeover | <div id="__publishingReusableFragmentIdSection"><a href="/ReusableContent/4_.000">a</a></div><p>An award-winning twice-daily (BID) medication pass program pioneered by The Pines, an Easton, Md.-based skilled nursing facility that is part of a Genesis HealthCare companywide medication administration initiative, has changed the lives of residents and staff alike by reevaluating the medication administration process and reducing the frequency of medications administered to residents. As a result, residents have experienced improved sleep, socialization, and overall quality of life. The program has also resulted in increased job satisfaction for caregivers. </p>
<h3 class="ms-rteElement-H3">Implementing The Program</h3>
<p>Any medication pass system has a tremendous impact on a resident’s sleeping and waking hours, meals, and general psychological well-being. “Residents in long term care are often subjected to polypharmacy that places them at risk for adverse drug reactions, medication errors, increased costs, and decreased quality of life,” says Michael Crowley, MD, medical director of The Pines. </p>
<div>The process began with a thorough evaluation in 2010 of medication administration in the long term care units at The Pines. Based on the annual survey of residents in April 2010, the facility’s Quality Improvement Committee met to discuss the results, which indicated resident dissatisfaction with the sheer volume of medications as well as the amount of time they were spending waiting each day to receive their pills. </div>
<div> <img width="453" height="291" class="ms-rteImage-4 ms-rtePosition-1" src="/Issues/2011/PublishingImages/0911/Rx-Graph.png" alt="" style="margin:15px;height:313px;" /><br>“It was not uncommon for residents to be approached up to nine times per day in a 24-hour period. It was an institutional approach, everything centered around pill times,” says Crowley. </div>
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<div>Residents had to sit in their rooms for hours on end awaiting the arrival of the pill cart and often missed recreational activities or time spent with friends. </div>
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<div>An interdisciplinary team was formed, which included the administrator, director of nursing, medical director, nurse practitioner, pharmacist, staff nurse, and the medication aide.</div>
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<div>The goal for the project was to individualize each resident’s drug regime, eliminate unnecessary and nontherapeutic drugs, and establish two medication delivery times of 8:00 a.m. and 8:00 p.m. daily. </div>
<div>Delivery times were deliberately moved away from peak recreation and dining times. With the cooperation of the pharmaceutical team, each resident received a new schedule of medications that most effectively managed his or her care, while also streamlining their medication administration throughout the day.</div>
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<div>In some cases, residents were prescribed longer-acting medications in order to eliminate med passes. Most residents were able to easily transition to a twice-daily administration and were overwhelmingly pleased with the resulting schedule. </div>
<h3 class="ms-rteElement-H3"> Improved Quality Of Life</h3>
<div>The resulting success of the med pass program has brought about great changes for the residents of The Pines. Enhanced dining services and more time for social activities have left residents feeling as though life no longer revolves around medication. </div>
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<div>Alfred Wilson, a resident of The Pines for many years, has experienced a significant improvement in his daily routine. “I love that I can participate in whatever is happening that day, without having to worry about missing the medication cart. I know it will be coming at certain times, before and after most of my meals and events during the day,” he says. </div>
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<div>Medication is no longer administered during activities for most patients, and mealtimes occur long before and after the designated times, freeing residents and nursing staff to focus on the events of the day. </div>
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<div>On the secured dementia unit, the medication aide was transitioned to a direct care position. These additional hours enabled all staff to be responsible for the unit’s activities, and licensed nurses have more time to identify and assess residents and plan for the appropriate treatment. Finally, the medication carts have been put away to create a more residential atmosphere in each nursing unit. </div>
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<h3 class="ms-rteElement-H3">Staff Satisfaction</h3>
<div>Improved staff satisfaction and performance have been unexpected byproducts of the med pass program. Interviews with staff members reveal an increase in job satisfaction due to the increase in direct care activities.</div>
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<div>Staff felt “chained to the medication cart” and felt the existing medication system was an inefficient use of anyone’s time. </div>
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<div>The annual employee opinion survey reflected a significant increase in overall employee satisfaction, with the number of employees reporting excellent/good overall job satisfaction up by 12 percent from the prior year. </div>
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<div>The culture change toward more resident-centered care has allowed staff at The Pines to do what they do best: interact with residents. </div>
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<div>While there has been no significant change in medication costs, the hours normally spent “pushing the pill bus” have been reallocated toward direct resident care.</div>
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<div>The med pass program has been life changing for staff and residents of The Pines. </div>
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<div>“[It] exceeded expectations, and we were able to convert 90 percent of our long-term residents to the twice-daily medication pass. As a result, the number of prescriptions per residents dropped by 10 percent on average, the amount of time dispensing medications dropped by almost 50 percent, and resident satisfaction increased by 8 percent,” Crowley says.</div>
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<div>This program is replicable and sustainable in other nursing centers, as no additional staff were added to achieve these outcomes nor were there additional expenditures. </div>
<h3 class="ms-rteElement-H3"><div>Award-Winning Approach</div></h3>
<div>The Pines’ innovative approach gained the recognition of AMDA—Dedicated to Long Term Care Medicine, which awarded The Pines its 2011 Evercare Award, one of only three centers in the entire country to win the award this year. </div>
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<p>For tips on how to iniative a BID med pass program in your facility, click <a href="/Issues/2011/Pages/0911/Tips-For-Starting-A-Twice-Daily-Med-Pass-Program.aspx">HERE</a>.</p>
<p><em>Stacey Radcliffe, senior administrator of The Pines, a 185-bed Genesis HealthCare skilled nursing facility in Easton, Md., can be reached at </em><a href="mailto:Stacey.radcliffe@genesishcc.com"><em>Stacey.radcliffe@genesishcc.com</em></a><em>. Marylee Grosso, RPh, a senior director of operations for Genesis, responsible for corporate medication therapy management initiatives, can be reached at </em><a href="mailto:Marylee.grosso@genesishcc.com"><em>Marylee.grosso@genesishcc.com</em></a><em>.</em></p> | An award-winning twice-daily (BID) medication pass program pioneered by The Pines, an Easton, Md.-based skilled nursing facility, has changed the lives of residents and staff alike by reevaluating the medication administration process and reducing the frequency of medications administered to residents. | 2011-09-01T04:00:00Z | <img alt="" height="150" src="/Issues/2011/PublishingImages/Miscellaneous%20Images/Clip%20Art%20pill%20packs.jpg" width="150" style="BORDER:0px solid;" /> | Caregiving | Column | 9 |