| Healthy Skin | https://www.providermagazine.com/Issues/2014/Pages/0114/Healthy-Skin.aspx | Healthy Skin | <div id="__publishingReusableFragmentIdSection"><a href="/ReusableContent/4_.000">a</a></div><p>Pressure ulcers are among the most common soft tissue injuries that occur in nursing homes and hospitals. They also cause pain and increase the risk of infection. The treatment of pressure ulcers often requires the person to be in bed on a special surface for long periods daily, which may result in feelings of social isolation and depression. In 2008, the Centers for Medicare & Medicaid Services (CMS) deemed pressure ulcers a “never event,” which meant they were considered preventable. The designation prompted CMS to exclude hospital-acquired pressure ulcers from reimbursement.</p>
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<div>These events also spurred the creation of the Pennsylvania Restraint Reduction Initiative (PARRI). Under the auspices of Kendal Outreach, PARRI has been collaborating with nursing homes in Pennsylvania since August of 2008 on pressure ulcer prevention, mainly focusing on process and prevention. </div>
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<h2 class="ms-rteElement-H2">Boosting Best Practices</h2>
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<div>Having compiled a collection of best practices from nursing homes that demonstrated success with pressure ulcer prevention, PARRI created in 2010 “A Practical Guide to Pressure Ulcer Prevention,” which includes process components, data collection tools, assessment tools, and prevention techniques. </div>
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<div><br>In 2011, the concept of the Pennsylvania (PA) MAP-IT for Healthy Skin emerged after a year of planning and working with other entities in the state. MAP-IT stands for Manage, Assess, Plan, Implement, and Teach. An expert panel discussion led to identification of potential barriers as well as some key discoveries, which helped launch a successful program. There already existed an abundance of resource materials, evidence-based interventions, standards, and guidelines that were collected and made available for all MAP-IT participants and as a repository for the general public. </div>
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<h2 class="ms-rteElement-H2">Education Key To Success</h2>
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<div>The cornerstone of the program has been, and continues to be, educational opportunities for staff providing all levels of care, with a particular focus on the education of frontline and direct care staff and their roles in preventing pressure ulcers. <br></div>
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<div><br>A website (<a href="http://www.pamap-it.org/" target="_blank">www.pamap-it.org/</a>) has helped disseminate information, keep communication open, and accord additional educational opportunities for staff.</div>
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<div><br>In April 2012, the MAP-IT initiative was officially launched. From this auspicious beginning, partnerships among health care organizations were established. Hospital, long term care, personal care, and home health care organizations with established associations were assembled into a continuum of care. Two continuums of care were recruited, with each consisting of one acute-care agency, skilled nursing homes, personal care homes, and home health care agencies. </div>
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<div><br>The organizations in each continuum were identified by the discharge planners working in the acute setting, based on the post-acute referrals for care. </div>
<h2 class="ms-rteElement-H2">
Identifying Process Weaknesses
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<div>The first step in the development of each continuum was to have the participating agencies complete an organizational needs assessment to help identify gaps and/or weaknesses in the current pressure ulcer prevention and treatment process in each participating organization.</div>
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<div><br>Included was a checklist of pressure ulcer-related topics, which included screening for pressure ulcer risk, developing a pressure ulcer care plan, assessing and reassessing pressure ulcers, monitoring prevention of pressure ulcers, monitoring treatment of pressure ulcers, and assessing staff education and training </div>
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<div><br>Pennsylvania’s MAP-IT for Healthy Skin adopted the Institute for Healthcare Improvement’s model of collaboration across the health care continuum, a process that gathers a group of health care workers, along with experts in the field, to enable better learning from each other. This system employs evidenced-based practices throughout the continuum and encourages consistent use of such practices in all care settings. </div>
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<div><br>The PARRI team has provided in-services and individual consultation to participating organizations to fill gaps identified by the needs assessment. The PARRI education modules have been used by the MAP-IT organizations to educate their own staff, their clients, and family members. </div>
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<div><br>Many of the modules have activities that help revitalize staff enthusiasm for pressure ulcer prevention. </div>
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<div>Additional proficiency has continued to be gleaned through best practices that are shared among participating organization members.</div>
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<div><br>Education has been a large part of this collaboration, using both experts and practitioners to emphasize best practices. The first topic of prevention to be targeted was the appropriate response for all direct care staff and nursing staff when a change in the skin color, texture, or temperature is discovered, aptly named the Red Alert Program. </div>
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<div><br><img alt="The Skincare In-Service" class="ms-rtePosition-1" src="/Issues/2014/PublishingImages/0114/caregiving1.gif" style="margin:5px 15px;" />Prior to the Red Alert Program, staff completed a survey to help determine future educational needs. Based on these survey results, PARRI staff developed a second in-service, known as the SKINCARE Bundle, based on the SKINCARE bundle from Penn Presbyterian Hospital (see sidebar, left). </div>
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<div><br>Organizations were asked to incorporate this material into training for new staff and annual training or as needed. </div>
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<div><br>Another level of education was added by offering continuum participants the Wound, Ostomy, and Continence Nurses Society’s new program for Wound Trained Associate (WTA). The WTA program is an online class that focuses on wound physiology, prevention, treatment, and care. </div>
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<div><br>Abington Memorial Hospital (AMH) sponsored the program, which provides certified training to all levels of nursing staff, including certified nurse assistants, licensed practial nurses, and registered nurses.</div>
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<div>The 40-hour training modules have been offered periodically to all MAP-IT members.</div>
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<h2 class="ms-rteElement-H2">Dialogue, Communication Prioritized</h2>
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<div>Data collection began in July 2012, prior to the Red Alert program, and continues. Thus far, most organizations have benefited from the ongoing education, collaboration, and communication afforded by MAP-IT. A few organizations that have seen an increase in prevalence have been involved with additional training and education from the PARRI staff, with positive results. </div>
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<div><br>Another measured outcome was increased satisfaction regarding communication across the continuum. Communication was initially identified as a barrier for both continua, since it is common to attribute pressure ulcers to care settings other than staff’s own. </div>
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<div><br>Establishing relationships and allowing open, honest dialogue among continuum members has brought effective communication to the forefront, making it a priority for the first year. </div>
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<div><br>Along those lines, communication guidelines were developed by both continua to stipulate information that moves among health care settings concerning the skin of patients. The combined recommended information was published as “Guidelines for Communicating Skin Condition Across the Continuum” and is available on the MAP-IT website (<span><a href="http://www.pamap-it.org/" target="_blank">www.pamap-it.org</a><a href="http://www.pamap-it.org/" target="_blank"><span></span></a></span>). </div>
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<div><br>A consequence of the guidelines being developed was building relationships of trust, mutual respect, and cooperation among the various organization representatives. For example, in the western continuum a wound, ostomy, and continence nurse from one organization offered to become the wound expert for a small nursing home that could not financially afford its own wound nurse.</div>
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<div><br>This typifies the exchange of expertise and knowledge among members being established through this program. Mentoring on an unofficial level has also occurred among members. One member has retired but agreed to continue to attend the meetings and share her expertise and experiences with other members. </div>
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<div>Relationships and network building have become common side effects of the continua.<br><span id="__publishingReusableFragment"></span></div>
<h2 class="ms-rteElement-H2">Best Practices Identified</h2>
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<div>MAP-IT participants have identified some best practices of member organizations for pressure ulcer prevention and treatment. For example, PARRI staff recently interviewed an eastern continuum member, who shared his facility’s process for maintaining a pressure-ulcer-acquired incidence rate of less than 0.2 percent (see <a href="http://www.pamap-it.org/" target="_blank">www.pamap-it.org</a>). </div>
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<div><br>PARRI staff also identified a MAP-IT organization that has decreased its incidence rate by 50 percent over five months.<br><br><span><img width="372" height="434" class="ms-rtePosition-2" src="/Issues/2014/PublishingImages/0114/resources_caregiving.gif" alt="" style="margin:5px;" /></span>In the eastern continuum, members are developing information about the skin for consumers that will be posted on YouTube to educate the general public about skin care and pressure ulcer prevention. In the western continuum, members are concerned that insufficient lighting was preventing them from visualizing the earliest manifestation of pressure ulcers. A proposed pilot study will explore ideal lighting across the various settings of the continuum of care. </div>
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<div><br>Also, both continua are interested in additional education for nursing staff on the correct use of the Braden Risk Assessment for Predicting Pressure Ulcers.</div>
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<div><br>The long-term goals for PA MAP-IT include identifying new continua of care interested in pressure ulcer prevention. To serve the needs of the underserved urban population, a third continuum has been identified and initiated in Philadelphia. </div>
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<div><br>Another goal is to use the PA MAP-IT process to improve other quality measures that participants across the current continua choose. For example, PA MAP-IT for Safe Environments would encompass both fall management and restraint elimination and would be a good fit for both continua using the expertise the PARRI team can provide. </div>
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<div><br>PA MAP-IT for Palliative Care would involve quality of care and a holistic approach to care at all levels of care and would enhance serious illness and end-of-life experiences for patients and their families, as well as staff involved in the care. As PA MAP-IT moves forward, the group anticipates that the relationships will continue to grow and contribute to seamless movement of patients within the health care continuum. </div>
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<div>Education will continue to be at the forefront for participants. These processes, in turn, will improve care and efficiency in the participating systems, which will enhance the patients’ outcomes. </div>
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<div><br>The MAP-IT process can be used as a model for other continua to develop an enhanced experience for patient and staff alike. <br><br></div>
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<em>Linda Hnatow, RN, a regional director of the Pennsylvania Restraint Reduction Initiative, can be reached at lhnatow@kendaloutreach.org or (610) 742-6416. Karen Russell, RN, a regional director of the Pennsylvania Restraint Reduction Initiative, can be reached at krussell@kendaloutreach.org or (724) 864-3767.</em><br> | In 2011, the concept of the Pennsylvania (PA) MAP-IT for Healthy Skin emerged after a year of planning and working with other entities in the state. MAP-IT stands for Manage, Assess, Plan, Implement, and Teach. An expert panel discussion led to identification of potential barriers as well as some key discoveries, which helped launch a successful program | 2014-01-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/0114/caregiving_thumb.jpg" style="BORDER:0px solid;" /> | Caregiving | Column | 1 |
| Study Reveals Varying Characteristics Of Assisted Living Residents | https://www.providermagazine.com/Issues/2014/Pages/0114/Study-Reveals-Varying-Characteristics-Of-Assisted-Living-Residents.aspx | Study Reveals Varying Characteristics Of Assisted Living Residents | <p>An analysis of the 2010 National Survey of Residential Care Facilities data, completed by George Mason University (GMU) researchers, helped establish some important distinctions among the populations and care needs of residents in small and large assisted living communities nationwide. </p>
<p>“It’s important to recognize we are not drawing conclusions on the quality of care between communities of different sizes,” says Andrew Carle, executive-in-residence/director of the program in Senior Housing Administration at GMU. “The care required by an older adult with chronic conditions and those who are younger, dealing with severe mental illness or a developmental disability, or those afflicted with Alzheimer’s, is simply different. What we now know is these specialty populations are being more frequently served within the nation’s smaller communities.” <br></p>
<p>The researchers analyzed data gathered for the National Center for Health Statistics’ report. Data on almost 8,100 residents from 2,302 assisted living communities were analyzed. <br></p>
<p>The data were then compared for residents in communities categorized as small (four to 10 beds), medium (11 to 26 beds), and large/extra-large (more than 26 beds). The data in this report excluded communities exclusively for individuals with developmental disabilities or mental illness, but did not exclude assisted living communities that co-housed seniors and individuals with severe mental illness or developmental disabilities.<br></p>
<p>Following are some highlights of the study:<br></p>
<p>■ Small Community Characteristics: Small assisted living communities are nearly three times more likely to house “non-senior” residents under 65 years, with more than 21 percent of residents falling within this group, compared to slightly more than 7 percent in larger communities. Small communities housed more than twice as many residents with severe mental illness (13 percent versus 6 percent) and five times as many residents with a developmental disability (10 percent versus 2 percent). In addition, small communities were also more likely to house residents with Alzheimer’s or other forms of dementia (53 percent versus 41 percent), conditions typically associated with seniors 85 years and older. <br></p>
<p>The researchers noted that the data do not provide a clear picture of whether an individual with Alzheimer’s or dementia is in a setting designed for dementia care or co-housed with younger residents, or a combination both. <br></p>
<p>■ Larger Community Resident Characteristics: Larger assisted living communities typically had residents who were older than smaller communities. Nearly 85 percent of residents in large communities were older than 75 years, with 56 percent older than 85 years. Residents in larger communities had more chronic conditions than residents in small communities, such as congestive heart failure (36 percent versus 25 percent), hypertension (58 percent versus 50 percent), and osteoporosis (21 percent versus 14 percent). <br></p>
<p>GMU researchers want to pursue a second phase of the study that would compare specific quality-of-life indicators of an average assisted living resident to a peer-acuity senior who chooses to stay at home. <br></p>
<p>Carle added that such a study would be the first to compare at-home seniors to those in assisted living. It would also help “in separating what is thought of as a ‘typical’ assisted living resident from the specialized groups, versus viewing all assisted living communities as the same.”<br><br></p> | The researchers analyzed data gathered for the National Center for Health Statistics’ report. Data on almost 8,100 residents from 2,302 assisted living communities were analyzed.
| 2014-01-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/0114/mgmt2_thumb.jpg" style="BORDER:0px solid;" /> | Management | Column | 1 |
| Demystifying QA Record Disclosure Rules | https://www.providermagazine.com/Issues/2014/Pages/0114/Demystifying-QA-Record--Disclosure-Rules.aspx | Demystifying QA Record Disclosure Rules | <div>During annual certification surveys, nursing homes are routinely faced with surveyor requests for incident reports, audits, tracking logs, and other records analyzed by the provider’s quality assurance (QA) committee, as part of the <a target="_blank" href="/Issues/2014/Pages/0114/QA-What-You-Need-To-Know.aspx">QA</a> process.</div>
<h2 class="ms-rteElement-H2">‘Privileged’ COmmunications</h2>
<div>Historically, these documents have been considered privileged communications. <br></div>
<div><br>An ever-present concern has been that if a nursing home discloses such QA records to surveyors, the privilege will be destroyed and they may become discoverable in future litigation, or worse, form the basis for additional survey deficiencies.</div>
<div><br>In short, the ability of facility staff to engage in frank, meaningful QA discussion and analysis, and even to conduct thorough investigations, is at risk when QA records are disclosed. </div>
<div><br>Recent interpretations of F-Tag 520, Quality Assessment and Assurance (QAA), by state and federal courts, as well as the Departmental Appeals Board (the independent review for the Department of Health and Human Services), warrant revisiting this often-sticky issue. </div>
<h2 class="ms-rteElement-H2">Basic Law</h2>
<div>F-Tag 520, which contains the requirements for nursing facility QAA committees, defines not only the composition and meeting requirements of the QAA committee, but also its function. </div>
<div><br>Specifically, a QAA committee “meets at least quarterly to identify issues with respect to which quality assessment and assurance activities are necessary, and it must develop and implement appropriate plans of action to correct identified quality deficiencies.”</div>
<div><br>The QAA privilege plainly states: “The State or the Secretary [of Health and Human Services] may not require disclosure of the records of the committee except insofar as such disclosure is related to the compliance of [the quality assessment and assurance] committee with the regulatory requirements.”</div>
<div><br>That is, is the QAA committee comprised of the appropriate individuals, meeting quarterly as required, and is it identifying issues and developing plans to address problematic areas? The CMS investigative protocol for F-Tag 520 further clarifies that “the facility is not required to release the records of the QA committee to the surveyors for review, and the facility is not required to disclose records of the QA committee beyond those that demonstrate compliance with the regulation.” </div>
<h2 class="ms-rteElement-H2">QAA Committee Record Reporting Requirements</h2>
<div>The critical question is then, what constitutes the “records of the QAA committee” that are not required to be released or disclosed? While a broad definition has often been used, the Centers for Medicare & Medicaid Services (CMS) and the federal courts have narrowed the definition over the past several years. </div>
<div>In fact, CMS recognizes that nursing home providers collect and analyze data about their performance in various forms and from various sources that may help them to identify quality deficiencies. </div>
<div><br>The agency’s interpretive guidelines for F-Tag 520 specifically reference “facility logs and tracking forms, incident reports, and consultant reports” as part of the data collection process. </div>
<div><br>But the F-Tag 520 interpretive guidance, labeled “Identification of Quality Deficiencies,” goes on to clarify that while records of the QAA committee meetings that identify quality deficiencies “may not be reviewed by surveyor,” unless the facility chooses to provide them, “the documents the committee uses to determine quality deficiencies are subject to review by the surveyors.” </div>
<div><br>Therefore, logs, tracking forms, and incident reports may be reviewed by surveyors, at least according to CMS’ interpretation. <br></div>
<h2 class="ms-rteElement-H2">Can QA Records Form The Basis For Survey Deficiencies?</h2>
<div>As existing case law makes clear, CMS takes the position that incident reports authored contemporaneously with an accident or incident are subject to review by surveyors, and these reports are not privileged under the statute. </div>
<div><br>Incident reports, according to CMS, are simply fact-gathering documents and are separate and distinct from the QA process. </div>
<div><br>With regard to QA committee minutes, internal deliberations, analyses, and good faith attempts by the QA committee to identify and correct quality deficiencies “will not be used as a basis for sanctions.” </div>
<div>Furthermore, as found in F-Tag 520, the facility is “not required to release the records of the [quality assurance] committee to the surveyors to review, and the facility is not required to disclose the records of the QA committee beyond those that demonstrate compliance with the regulation.” </div>
<h2 class="ms-rteElement-H2">Guidelines Advise Finding Alternative Measures</h2>
<div>The interpretive guidelines at F-Tag 520 suggest that viewing QA records is appropriate “if it is the facility’s only means of showing the composition and functioning of the QA committee.” </div>
<div><br>In other words, surveyors should exhaust alternative investigative measures to assess compliance with the F-Tag before the surveyors request that the facility disclose QA records. Alternative investigative measures may include interviews with QA committee members and review of QA policies, meeting schedules, and blank or redacted QA committee forms. </div>
<div><br>Under no circumstances should copies be required to be turned over to surveyors.</div>
<h2 class="ms-rteElement-H2">What Is Allowable</h2>
<div>What seems most problematic is when surveyors demand disclosure of QA records when investigating a resident fall or another accident. Incident reports and their corresponding investigatory information can demonstrate that an appropriate investigation has occurred and may be requested by, and reviewed by, the survey team. </div>
<div><br>But a subsequent request to review additional analytical materials prepared by or at the request of the QA committee should be resisted. Where data compilations such as monthly fall logs, weight-tracking reports, or other similar analyses are compiled at the request of and distributed to the QA committee for review and analysis, the best approach is to avoid disclosure. </div>
<div><br>Based on the above Medicare requirements, surveyor requests to review QA records for the purpose of investigating a particular incident are inappropriate. </div>
<div><br>Instead of reviewing QA records to investigate resident falls and accidents, surveyors should review resident medical records and other records kept as a part of the resident’s medical record in the ordinary course of treatment. And if a facility feels compelled to allow surveyor review based on a particular situation, the reviewed documents cannot be used as a basis for sanctions. </div>
<div><br>Any attempt by CMS to do so should be challenged. <br><br><em>Jeannie Adams, director at Hancock, Daniel, Johnson & Nagle, Richmond, Va., advises long term care providers on state and federal reporting requirements and Medicare certification and survey requirements. Adams is a frequent speaker and contributor to written publications involving the long term care industry. She can be reached at (804) 967-9604 or at <a target="_blank" href="mailto:jadams@hdjn.com">jadams@hdjn.com</a>.</em></div> | During annual certification surveys, nursing homes are routinely faced with surveyor requests for incident reports, audits, tracking logs, and other records analyzed by the provider’s quality assurance (QA) committee, as part of the QA process. | 2014-01-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/0114/legal_thumb.jpg" style="BORDER:0px solid;" /> | Legal | Legal Advisor | 1 |
| Providers Grapple With Managed Care Inevitabilities | https://www.providermagazine.com/Issues/2014/Pages/0114/LTC-Execs-Managed-care-Inevitable.aspx | Providers Grapple With Managed Care Inevitabilities | <p><em>This is the first of a two-part series covering a recent </em>Provider<em> roundtable held in conjunction with the AHCA/NCAL convention in Phoenix, Ariz., in October. The purpose of the forum was to convene long term and post-acute care providers from a variety of states and markets around the country to shed light on how they are tackling the many issues that accompany the ever-growing cadre of managed care and Accountable Care Organizations around the country. The roundtable was sponsored by American HealthTech, at <a href="http://www.healthtech.net/" target="_blank">www.HealthTech.net</a>.</em><br><br><img class="ms-rtePosition-1" alt="Provider Roundtable, Phoenix, Arizona" src="/Issues/2014/PublishingImages/0114/Phoenix-Roundtable_0347.jpg" width="283" height="185" style="margin:5px 15px;" /><br>Lengths of stay, hospital readmission rates, and five-star ratings remain buzzwords for long term and post-acute care providers as managed care works its way into markets around the country, according to a recent gathering of roundtable participants. </p>
<p>Be it a managed care organization (MCO) or an Accountable Care Organization (ACO), the consensus of the gathering was that it’s not a matter of whether it’s coming but a matter of when it’s coming. And the corollary to that is: Providers must know their quality measures, and they must know them very well. <br><br>In Kansas, where Medicaid managed care is just nine months old, all beneficiaries have been assigned to one of three MCOs, reports Fred Benjamin, chief operating officer of Medicalodges in Coffeyville, Kan. In fact, his company has embraced the roll-out of managed care in the state. “It’s been interesting so far,” he says. “I’m excited about it because we have an opportunity to rebuild the health care system the way we want to rebuild it. It’s not being dictated to us by the hospitals, and it’s not being dictated to us by somebody else. We have a fairly good relationship with a couple of MCOs. We have an opportunity to partner with them, and they seem very receptive to it.” <br><br>On the West Coast, California is currently enduring the “throes of managed care,” says Jim Gomez, chief executive officer of the California Association of Health Facilities. He notes that California now has 13 MCOs within the state’s eight largest counties, representing about 25 million people. “For about the last two-and-a-half years, I’ve been preaching to my members that it’s coming,” he says. <br><br><img class="ms-rtePosition-2" alt="/archives/2014_Archives/PublishingImages/0114/roundtable_thumb.jpg" src="/Issues/2014/PublishingImages/0114/Phoenix-Roundtable_0373.jpg" width="279" height="192" style="margin:5px 10px;" />“I meet with the head of the [health maintenance organization] association on a monthly basis to make sure those relationships are connecting and we’re saying the same thing. My biggest fear is the loss of independent providers in the state. The bigger companies, I believe, can integrate vertically and horizontally, and they are going to present a different picture to MCOs than an independent owner/operator who does only skilled nursing.”<br><br>In an effort to stave off this fear, Gomez has been educating independent operators in the state “so they’re in front of the curve,” he says. “I would say this at every workshop: All administrators should know their rehospitalization rates and their lengths of stay. And any administrator who doesn’t know these data should be fired.” Regarding length of stay, Gomez believes that it will drop from an average of 28 days to 21 days as a result of managed care. He points to Kaiser Health System, the largest player in the Sacramento area, as evidence: “Their average length of stay is 12 days,” he says. “They put their own nurse practitioners and docs in the nursing homes.” <br><br>In Massachusetts, ACOs are the main focus, as opposed to MCOs, says Naomi Prendergast, chief executive officer of D’Youville Life and Wellness Community in Lowell, who has been working with the state association to create a model ACO contract for other providers in the state. <br><br>“Forty percent of all fee-for-service Medicare beneficiaries are going through an ACO,” she says, adding that they are also creating educational programs for providers in order to get ACOs and skilled nursing facilities on the same page with regard to expectations on both sides. <br><img class="ms-rtePosition-1" alt="/archives/2014_Archives/PublishingImages/0114/roundtable_thumb.jpg" src="/Issues/2014/PublishingImages/0114/Phoenix-Roundtable_9103.jpg" width="308" height="170" style="margin:15px 10px;" /><br>“One ACO is in the process of going from 500 down to 50 [skilled nursing facilities] in its network,” says Prendergast. <br><br>“The sands around us are shifting constantly. We need to be aware of who now is affiliating with whom. It’s changing almost daily.” <br></p> | This is the first of a two-part series covering a recent Provider roundtable held in conjunction with the AHCA/NCAL convention in Phoenix, Ariz. | 2014-01-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/0114/roundtable_thumb.jpg" style="BORDER:0px solid;" /> | Management;Reimbursement;Quality Improvement | Management | 1 |
| Match Making | https://www.providermagazine.com/Issues/2014/Pages/0114/Match-Making.aspx | Match Making | <div> </div>
<div>When a resident is in a skilled nursing facility for Medicare-based rehabilitative services (physical therapy, occupational therapy, and/or speech therapy), who is responsible for the plan of care? Is it the nursing or therapy department? </div>
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<div>According to the “Semiannual Report to Congress” submitted by the Office of Inspector General (OIG), 37 percent of Medicare stays in 2009 did not have the appropriate care plan in place to meet the needs of the resident. </div>
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<div>In addition, the study found that services either did not match the care plan or the facility provided too much care, resulting in harm to the resident. OIG reported an estimated $5.1 billion in overpayments for the reporting period. Getting the care plan right is essential to avoiding OIG scrutiny and payment loss.</div>
<h2 class="ms-rteElement-H2">Department Coordination Improves Care</h2>
<div>When care coordination does not occur, not only does the chart lack proof of necessary care, but residents suffer. In an OIG podcast, Judy Kellis, an OIG team leader, described a situation found during an audit where a resident received intensive therapy five times a week for five weeks, even though he had terminal lung cancer and did not want the therapy. </div>
<div><br>In another situation, a resident received hours of therapy even though she had a dislocated hip. Treatment plans that are detrimental to the resident can be avoided when therapy and nursing staff work together holistically to assist the resident in achieving his or her rehabilitative goals, to provide pain control, and to support disease management. </div>
<div><br>As part of the required Resident Assessment Instrument (RAI) process, it is critical to link the Minimum Data Set (MDS) process to the care plan in a way that accurately reflects the needs of the resident. The purpose of the RAI process is to conduct an interdisciplinary review of the resident’s care needs that is holistic in scope. </div>
<div><br>In order to do this effectively, therapists and nursing staff must closely align their work in caring for the Medicare resident. Dialogue between therapy and nursing staff should clearly identify the resident’s baseline status, as well as his or her progress toward goals. Wasteful spending to the tune of $1.5 billion was blamed on the use of incorrect Resource Utilization Groups (RUGs) in establishing payment, the result of inaccurate MDS coding. </div>
<div><br>The OIG-identified culprit was inaccurate charting for therapy services and activities of daily living (ADLs), which OIG auditors reported was the result of upcoding. </div>
<div><br>Therefore, it is critical that nursing and therapy department staff coordinate appropriate Medicare services so that care is cohesively and accurately captured by the medical record, care plan, MDS, and billing claim. </div>
<h2 class="ms-rteElement-H2">Pay Attention To The RAI Process</h2>
<div>Tying the RAI process to care that is delivered in the therapy department can greatly enhance the coordination of care that needs to occur. The critical thinking involved in the RAI process helps facility staff determine appropriate interventions, address critical elements of the resident’s preferences and needs, and avoid providing too much care. </div>
<div><br>The nurse involved in completing the ADL Functional/Rehabilitation Potential Care Area Assessment should work closely with the treating therapist to enhance the integrity of the critical thinking process. This will enhance the likelihood of a comprehensive care plan that results in appropriate treatment provided by all staff involved in caring for the resident. </div>
<div><br>In addition to the RAI process, teamwork is essential when therapy starts and ends, when residents refuse treatment, and in between these times. Another way to put it: Teamwork and coordination should occur during the entire Medicare stay. </div>
<div><br>At the start of therapy, teamwork is essential to communicate the baseline and the goals. Nursing involvement in the resident’s ADLs contributes to supporting the need for therapy services by reflecting the resident’s deficits as well as showing the progress a resident is making as a result of the therapy services. </div>
<div>For example, nursing can show how a resident’s mobility has gone from non-weight-bearing, to weight-bearing with two assists, to weight-bearing with one assist, to guided maneuvering. This type of coordination of service paints a powerful picture of the benefit the resident is receiving from therapy services.</div>
<h2 class="ms-rteElement-H2">Don’t Forget To Review Residents’ Needs</h2>
<div>When a resident refuses therapy, the best practice is for nursing and therapy staff to work together to assess the reason for the refusal and coordinate mitigating interventions. This coordination includes assessment of, and interventions for, pain, sleep needs, scheduling of daily activities, potential illness, mood status, and so on. </div>
<div><br>If the end of therapy always spells the end of the Medicare stay, then coordination of care may be lacking. Some residents require skilled nursing services after therapy ends. </div>
<div><br>A thorough review of the resident’s needs is necessary to ensure that residents aren’t precipitously dropped from Medicare when continued coverage is reasonable and necessary. On rare occasions, residents may need observation and assessment, teaching and training, management and evaluation of the care plan, or direct skilled nursing care.</div>
<div><br>For a resident on Medicare for rehabilitative services, an appropriate care plan is the responsibility of both the nursing and therapy departments and should include involvement by other interdisciplinary team members. Appropriate, well-documented care is essential to protecting the facility from adverse OIG audits. To achieve this, it is critical to dialogue openly about how well the nursing and therapy departments coordinate care services. </div>
<div><br>There should be no territorial overtones or departmental silos that prevent honest dialogue and thorough teamwork. Managers should take time to evaluate the communication and coordination that occurs between the nursing and therapy departments. </div>
<div><br>This action can make the difference between accurately providing each resident with the appropriate level of care and coming under scrutiny from OIG auditors. </div>
<div> </div>
<div><em>Judi Kulus, NHA, RN, MAT, C-NE, RAC-MT, is vice president of curriculum development for the American Association of Nurse Assessment Coordination. She can be reached at (800) 768-1880.<br><img src="/Issues/2014/PublishingImages/0114/AANAC.jpg" alt="" style="margin:5px;" /><br><br></em></div> | According to the “Semiannual Report to Congress” submitted by the Office of Inspector General (OIG), 37 percent of Medicare stays in 2009 did not have the appropriate care plan in place to meet the needs of the resident. | 2014-01-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/0114/mgmt_thumb.jpg" style="BORDER:0px solid;" /> | Management | Column | 1 |
| Parkinson’s Disease: A Brain Tune-Up | https://www.providermagazine.com/Issues/2014/Pages/0114/Parkinsons-Disease-A-Brain-Tune-Up.aspx | Parkinson’s Disease: A Brain Tune-Up |
<div>Parkinson’s disease (PD) has dragged me through hellfire; it has wrecked my body and tested my soul. This ordeal has taught me much about life in general, and about matters both great and trivial. Following are some highlights of my life with PD, and of what this mean teacher taught me about modern medicine, its marvels and pitfalls. </div>
<h2 class="ms-rteElement-H2">A New Tack</h2>
<div>It happened 10 days before Christmas 2009. I was somewhere over the rainbow, in deep slumber—when I felt a hand pressing my shoulder and heard a voice, “Dr. Tellis-Nayak! I want you to be awake!” <br></div>
<div><br>Reality dawned ray by ray—I couldn’t budge; I was belted down, my skull was in a vise inside a steel trap bolted down to the metal bed. Around me stood six men and women, all oozing smarts. I saw, on my left, a compact figure wearing a white gown and a triumphant smile. “How do you feel?” Dr. V asked. Suddenly, reality crashed in, and everything came into focus.</div>
<div><br>I was at the hospital getting a brain tune-up from Dr. V. I was under “conscious sedation” and told to stay awake, but trusting my brain in Dr. V’s hands, I had slid into a midday siesta on my personal “Fantasy Island.”</div>
<div><br>PD had sneaked up on me; my left-hand tremors started in 1995. PD turned my world upside down, and it directed its unmitigated fury toward my professional life; it took aim at areas where I felt particularly proud and would hurt the most.</div>
<div><br>Worse, PD made me watch in slow motion my descent into a personal hell. The professor, the researcher, and the public speaker in me suffered exquisite mortification. My strut gone, now I shuffled my way to the podium; I stood there unstable and ungainly, my left hand shaking against my will, my voice barely louder than a squeak, my speech reduced to a mumble, my words slurring; I could not read my scrawl on the blackboard. </div>
<div><br>My medical regimen had blunted PD’s attack but did not halt its advance. My intellectual and spiritual defenses did not match its resolve to drag me toward the black hole of helplessness, meaninglessness, self-pity, and despair.</div>
<div><br>On the verge of surrender, I reached out to Dr. V for a brain tune-up. He recommended DBS (Deep Brain Stimulation). I signed on immediately.</div>
<h2 class="ms-rteElement-H2">Resetting Brain Circuits</h2>
<div>DBS is based on the evidence that each human action (motor, memory, or cognition) is modulated by a specific brain circuit located in a specific brain area. DBS works as a radio works. You turn one dial to locate the station and another to turn the volume up or down. Similarly, you locate the brain area whose circuit is linked to a specific human activity. You implant a pace setter to stabilize, accelerate, or slow that circuit and so to regulate the activity associated with it. </div>
<div><br>Two professors at Grenoble, France, introduced DBS to the world in 1987 as an effective treatment for PD. It is now used to treat other movement disorders and neurological and psychiatric conditions. About 100,000 DBS implants have been done worldwide.</div>
<div><br>I was at the hospital the night before my early morning date with DBS. Dr. V planned the event to unfold in two steps. First, they wrapped a metal trap around my skull, calling it a “halo.” </div>
<div><br>The halo bolted down my head immovably as the medical cognoscenti mapped my brain; the coordinates set and traced the optimal route to my subthalamic region. They numbed my scalp, cut a five-inch gash, and, with a press-drill a bit fancier than my TrueValue version, they bore a hole the size of a quarter into my skull. </div>
<div><br>Human brains have no pain feelers. So, under “conscious sedation,” I was supposed to stay awake and enjoy the sight and sounds of my own demolition. I chose to snore away in dreamland. </div>
<h2 class="ms-rteElement-H2">High Drama</h2>
<div>The next part was high drama. The docs held an electrode (metal rod) at the hole in my head (front-right and due north from the eye), angled it about 45 degrees, and drove it through the center of the brain toward a pea-sized target in the subthalamus basement of the brain.</div>
<div><br>The mindless invader decimated my brain cells in its path and sent them into oblivion, each emitting a digital dying wail. I mourned the IQ points I lost in Operation DBS.</div>
<div><br>With the rod lodged close to its destination, Dr. V pulled me back from my dreamy escape. His smiley-like smile told me the train had arrived, and now he needed my help to pick the right platform where it should be stationed. </div>
<div><br>For the next 15 minutes he twisted and turned my left hand in every direction, while Dr. O, his partner in this invasion, jabbed, stabbed, and poked around my brain till they found the optimal spot to park the hot rod. </div>
<div><br>To spare me the gruesome sight of the last scene, the medicine men tripped my main fuse and blanked me out. They cut open a pouch below my right collar bone, nested in it a thick credit-card-sized battery with a trailing cable, which they buried under the skin along a path from my chest, winding up behind the ear and joining it to the electrode under the skull. </div>
<div><br>My traumatized brain protested, swelled, and delayed the turning on of the switch buried in my chest. They gave me a remote control that turns the stimulator in my brain on or off. </div>
<div><br>I take care to keep out of reach of my grandkids, lest they should get ideas and use it as a joystick. </div>
<h2 class="ms-rteElement-H2">Belles and Cherubs</h2>
<div>The gurney brought me to the recovery room looking like Lazarus swaddled in bandages staggering out of the sepulcher.</div>
<div><br>I was relieved that I survived the eight-hour storming of my defenseless brain, and was buoyed by the company of Mary, my long-suffering personal nurse and bride of over four decades. </div>
<div><br>Back in my room a bevy of belles—bright-faced, freshly minted young nurses—greeted the return of their most compliant patient who since last evening had let them poke needles into me; draw blood from me; and thrust thermometers, meds, and other foreign objects into my orifices. </div>
<div><br>I felt blessed among these women. </div>
<div><br>My son had dropped in the night before and had fortified my soul for the ordeal. This evening, he came with his consort and their two bouncy cherubs in tow. The next two hours were pure chaos—laughter, son, and horse play as the cherubs revived Grandpa Lazarus.</div>
<div><br>Jocelyn, RN, had recorded my runaway blood pressure a little before the kids came. She dropped by to track it again, as they were about to depart. Her jaw dropped to the floor: My blood pressue had plummeted down to normal!</div>
<div><br>Do kids have a role to play in brain surgery? Why do hospital visiting rules for kids vary so widely? Some hospitals encourage families to visit, when some others cannot seem to bear the sight of them. I wondered which of these policies and practices were rooted in firm evidence and which in common sense? </div>
<div> </div>
<div>Next month: Anomalies of Bionic Medicine<br><br><em>Vivian Tellis-Nayak, PhD, is senior research advisor at National Research Corp., Lincoln, Neb. He has been a university professor, whose scholarly work has been published in national and international professional journals. He has conducted research in the United States and abroad, and his major findings have reached a wider public through his writings in trade magazines. Tellis-Nyak can be contacted at <a target="_blank" href="mailto:vtellisn@gmail.com">vtellisn@gmail.com</a>. </em><br></div>
| Parkinson’s disease (PD) has dragged me through hellfire; it has wrecked my body and tested my soul. This ordeal has taught me much about life in general, and about matters both great and trivial. | 2014-01-01T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/senior_hands.jpg" style="BORDER:0px solid;" /> | Quality;Caregiving | Column | 1 |
| Rep. Renacci: A Centrist With LTC Experience | https://www.providermagazine.com/Issues/2014/Pages/0114/Rep-Renacci-A-Centrist-With-LTC-Experience.aspx | Rep. Renacci: A Centrist With LTC Experience | <p>U.S. Rep. Jim Renacci won his first election by a wide margin. A former long term care executive and a Republican, he ran in 2010, when public anger over Obamacare was at its fiercest. <br></p>
<p>But, despite that background, Renacci is no fire eater. He has spent his time in Congress talking openly about the need for a “safety net”—words that otherwise would act like a dog whistle to some of his colleagues.<br></p>
<p><img width="152" height="407" class="ms-rtePosition-1" alt="Jim Renacci" src="/Issues/2014/PublishingImages/0114/Renacci.jpg" style="margin:5px 10px;" /><br>As Renacci tells it, he simply sees government problems as a business manager ought to do. <br></p>
<p>“We need to look at the drivers of the debt,” he told an Ohio television station during last fall’s government shutdowns. “Entitlement programs are drivers of the debt. Now that doesn’t mean we should eliminate entitlement programs. Quite frankly, we need to make sure they’re around for our children and our grandchildren. If we do nothing, which is one of the problems, we’ve let this government just allow some of these programs to continue without change, and if we don’t change them, they’re not going to be around in the future.”<br></p>
<p>It’s that kind of centrist, business-minded approach that has made him a welcome, and constructive, partner for long term care advocates. <br></p>
<p>“As a former skilled nursing care owner and operator, Rep. Renacci is able to bring a unique perspective to Congress,” says Mark Parkinson, president and chief executive officer of the American Health Care Association. “He knows how important it is to protect access to skilled nursing care.”<br></p>
<p>Renacci, an accountant by training, formed LTC Management Services in 1985. It brought him into long term care centers across Ohio. <br></p>
<p>He’s proud of his background and familiarity with the profession, and he says that advocates have to do more to make his colleagues familiar with their businesses. “They should be inviting their congressperson into their facilities,” he told Provider in a recent interview in his office on Capitol Hill. “If you’re going to ever be able to show somebody what you’re doing, you need to be able to bring them in and show them how you do it and why you need certain things. I think there are many members of Congress here who’ve never been in a nursing home. And yet it’s a big expenditure. I think officials, legislators, need to get into these facilities, understand how they operate.”<br></p>
<p>Renacci won plaudits from long term care advocates recently when he introduced what he calls the CARES Act, which would eliminate requirements that Medicare patients spend three days in a hospital before their skilled nursing care can be reimbursed. <br></p>
<p>“Clearly for those that qualify and need to be in a nursing home … they should have the ability to go straight to the nursing home,” he says. “This comes down to what care is needed.”<br></p>
<p>For Renacci, this isn’t ideology; it’s just good business. “My career has been based on making sure that the elderly have the opportunity to get the proper care that they need,” he says.<br></p>
<p>This makes it all the more important for providers to bring their congressional representatives into their centers.<br></p>
<p>“There just has to be a connection,” Renacci says. “It’s one of the things we should make sure the system is there, that it’s working … and ultimately we need to make sure that we’re paying for what we’re requiring nursing homes to do.” <br></p> | Renacci won plaudits from long term care advocates recently when he introduced what he calls the CARES Act, which would eliminate requirements that Medicare patients spend three days in a hospital before their skilled nursing care can be reimbursed. | 2014-01-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/headshots/Renacci-thumb.jpg" style="BORDER:0px solid;" /> | Management;Quality | Column | 1 |
| In The Spotlight: Rising Stars In Long Term And Post-Acute Care | https://www.providermagazine.com/Issues/2014/Pages/0114/Rising-Stars-In-Long-Term-And-Post-Acute-Care.aspx | In The Spotlight: Rising Stars In Long Term And Post-Acute Care | <div>Effective and caring leaders come in all shapes and sizes. And this year’s class of 20 To Watch demonstrates now more than ever that passionate leaders lead from every position. </div>
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<div>The best leaders lead in the moment they are in and from the place they are in that moment, with vision, authenticity, transparency, and a steadfastness; all of these are key when their calling and work is the health, wellness, and safety of another person.</div>
<div> </div>
<div>One of the effective leadership attributes shared by all of the outstanding professionals chronicled on these pages is a sense of calling, and each of this year’s 20 To Watch is driven to be the part of the solution that ensures quality care for people in need and thoughtful support and empowerment to the families of the people receiving care.</div>
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<div>Among this year’s honorees, you will also read of leaders—among them nurses, physicians, administrators, and chief executive officers—who are not only helping residents and patients to be their best, healthiest, and most engaged selves, but who are dedicated to doing it for their colleagues, 360 degrees in their organizations.</div>
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<div>By honoring these leaders, we are planting a flag dedicated to what could and must be in meeting the health and care needs of an aging America; the best of our best don’t aim for the lowest bar, they reach and stretch over the highest one.</div>
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<div>Their stories are uplifting and inspirational, and that’s important because in this age, and with the challenges and opportunities we and the people in long term and post-acute care face, we live in a time when we need as many great leaders as we can get. I encourage you to read, discuss, and share these brief profiles of <em>Provider’s</em> 2014 Class of 20 To Watch with colleagues, friends, families, and people inside and outside the industry. </div>
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<div>And if you are a passionate leader yourself, I ask you to join me in asking the following questions:</div>
<ul><li>What vision do I do I have for a better tomorrow?</li>
<li>Who can, and must, I ask to join me, lead me, or follow me in this vision?</li>
<li>What action can I take today to make this vision for a better tomorrow a reality? <em> </em> </li></ul>
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<div style="text-align:right;">–Joseph DeMattos Jr.</div>
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<div><em>Joseph DeMattos Jr. is president and chief executive officer of the Health Facilities Association of Maryland, an adjunct professor at the University of Maryland Baltimore County’s Management of Aging Services master’s program, and a leadership consultant.</em> <br></div>
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<h2 class="ms-rteElement-H2B"><img class="ms-rtePosition-1" alt="Michelle Gifford" src="/Issues/2014/PublishingImages/0114/MichelleGifford.jpg" width="123" height="179" style="margin:5px 15px;" />Michelle Gifford, RN</h2>
<div><strong>Director of Nursing</strong></div>
<div><strong>Atlantic Nursing and Rehab Center</strong></div>
<div><strong>Atlantic, Iowa</strong></div>
<div> </div>
<div>Being a caregiver is in Michelle Gifford’s roots. Both her mother and grandmother were nurses, and Gifford herself was a certified nurse assistant (CNA) for 12 years, working in both hospitals and long term care, before becoming a nurse. She was motivated to get a nursing degree after tiring of “wanting to do more but not having credentials and education to do it,” she says.</div>
<div><br>Today she is “a teacher, a mentor, and a leader,” says Kim Jimerson, RN, Atlantic’s administrator. “She seldom hesitates to offer to help out at our buildings or help another director of nursing [DON] figure something out. She does this because she loves to teach and share and work with others.”</div>
<div> <br>Gifford, who worked as a charge nurse before becoming a DON, has adopted a motto that illustrates her leadership style: “You never want to tell someone to do something that you wouldn’t want to do yourself,” she says with conviction.</div>
<div> </div>
<div>Among Gifford’s accomplishments, says Jimerson, are her efforts to reduce turnover among staff at Atlantic, as well as working with local hospitals to reduce rehospitalizations. </div>
<div> <br>Says Jimerson: “Michelle has worked very hard to reduce staff turnover within our building. With the support of our corporation she has been able to offer such things as anniversary bonus programs. Michelle works directly with our employees in the nursing department, trying to make sure that our employees are able to earn their bonus check. She listens to what her employees need, and she advocates for that.”</div>
<div> </div>
<div>The result of Gifford’s work has paid off. Jimerson reports that Atlantic’s turnover within the building has plummeted from “more than 120 percent … to less than 50 percent at last review; we are working on a 34 percent turnover rate currently year-to-date.”</div>
<div><img class="ms-rtePosition-2" src="/Issues/2014/PublishingImages/0114/Top20-1.jpg" width="182" height="635" alt="" style="margin:10px 15px;width:217px;height:857px;" /><br>Gifford’s mentoring of staff has earned her additional accolades, while many of her staff have gone on to obtain their registere nurse or licensed practical nurse degrees and returned to Atlantic to work. </div>
<div><br>“Michelle meets with her staff to discuss such things as hours and what will work for them. She assists them with the ability to juggle their schedules and find replacements, as necessary,” Jimerson says.</div>
<div><br>“When an employee looks to leave our employment, Michelle will try to find out the real reason for their leaving, and then she will try to find a way to work within their limitations so that the residents have stable staff in our building.”</div>
<div><br>Gifford’s efforts to reduce unnecessary hospitalizations have brought her additional praise, as well. She utilizes a program known as LTC Trend Tracker—an American Health Care Association (AHCA) software tool that enables users to access reports to track, organize, identify, benchmark, examine, and compare the profession’s data online—to augment her efforts and learn about how other providers are doing.</div>
<div><br>Jimerson notes that Gifford also takes advantage of multiple educational opportunities available to her. She takes classes through the Iowa Health Care Association and recently became certified as a Resident Assessment Coordinator and as a Nurse Executive, “to get that extra little bit of education,” Gifford says.</div>
<div><br>“I always say that I’m lucky for working with my peers, I always say it’s not me it’s them,” Gifford says. “I love talking to elders and learning their stories.”</div>
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<h2 class="ms-rteElement-H2B"><img class="ms-rtePosition-1" alt="Andrea Rathbone" src="/Issues/2014/PublishingImages/0114/AndreaRathbone.jpg" style="margin:5px 15px;width:123px;height:143px;" />Andrea Rathbone</h2>
<div><strong>Administrator </strong></div>
<div><strong>D’Youville Senior Care</strong></div>
<div><div><strong>Lowell, Mass.</strong></div>
<div> </div>
<div>As administrator of a 208-bed skilled nursing facility, Rathbone’s first priority is helping both residents and staff to achieve their full potential, says Ann Marie Antolini, vice president of administration for the Massachusetts Senior Care Association (MSCA).</div>
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<div>“Each employee and resident is supported in their endeavors with respect, dignity, and compassion. Whether encouraging an employee to apply for a scholarship to support their educational goals or interacting with a resident in the facility’s Learning Center as they expand their knowledge, Andrea provides an unrivaled level of enthusiasm, passion, and energy in her support of employees and residents,” says Antolini.</div>
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<div>Rathbone’s take on her recognition as one of this year’s 20 To Watch is much humbler, indeed. She admits that she doesn’t understand why she was chosen for the honor, but those familiar with her work have nothing but praise for her accomplishments. From being instrumental in the development of a Dedicated Education Unit at D’Youville to her prominent roles in achieving AHCA’s Bronze and Silver Quality Awards, as well as being responsible for the construction, development, and implementation of an orthopedic recovery unit within a skilled nursing center, Rathbone’s modest response speaks volumes about her dedication and compassion.</div>
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<div>For the past two years, under Rathbone’s leadership, D’Youville Senior Care has participated in MSCA’s Statewide Initiative to Safely Reduce the Off-Label Use of Antipsychotic Medications. </div>
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<div>What’s more, according to Antolini, “staff have successfully adopted and implemented a unique, person-centered approach that helps staff understand and respond to the individual needs of each resident in order to develop and refine strategies that will improve the resident’s quality of life and job satisfaction for staff.” </div>
<div> </div>
<div>As a result these efforts, D’Youville achieved a 15 percent reduction in atypical antipsychotic drug use for long-stay residents over the past two years, Antolini reports.</div>
<div> </div>
<div>Of her center’s accomplishments, Rathbone notes that “at the end of the day we’re here for one reason and that’s [to be here] for residents and staff, and I try to make that part of my day,” every day, she says.</div>
<div> </div>
<div>What motivates Rathbone is knowing that every day she can make a small difference in someone’s life. “I think in life it’s all about the small differences we make. And in life all those small differences build, and you realize you’ve done a good thing for a family member or a resident,” she says.</div>
<div> </div>
<div>Rathbone’s experience with long term care reaches back to her elementary school days. Her mother was a scheduler for a large nursing home. Rathbone would go to the home after school and wait in the lobby until her mother was finished with her day. Once in high school, Rathbone worked at the home answering phones in the evenings. “It was all that I knew,” she says. “I went to college knowing that I would major in health care administration, although I wasn’t sure about long term care. But midway through college, I knew I wanted to be in long term care, and I shifted my work and studies to elders.”</div>
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<div>Rathbone is emphatic about serving elders and remembering that they come first. “Something I say to staff every day is you have to remember we’re not the ones going through the transition, it’s the residents who are going through transitions. They may have just lost a spouse or just moved in or just recovered from surgery; they have a whole lot of transition, and we can’t forget that,” she says.<br><br></div>
<div><img class="ms-rtePosition-1" alt="Wendell Anderson" src="/Issues/2014/PublishingImages/0114/WendellAnderson.jpg" width="160" height="161" style="margin:5px 10px;" /></div>
<h2 class="ms-rteElement-H2B">Wendell Anderson </h2>
<div><strong>Certified Nurse Assistant</strong></div>
<div><strong>Maravilla Care Center</strong></div>
<div><div><strong>Phoenix, Ariz.</strong></div>
<div> </div>
<div>Having worked in long term care as a CNA for nearly three decades, Wendell Anderson is highly regarded at Maravilla Care Center, where he has worked for the past 11 years. Anderson’s supervisor, Virginia Krueggel, extols his virtues without hesitation: “He is amazing with the residents—and we deal with some of the most difficult people in the psychiatric population—and he can walk into a room and bring this calmness and deescalate a potential situation,” she says. “He’s awesome, great, amazing—the way he’s grown and taken opportunities that he’s run with, and he’s amplified it to the nth degree.”</div>
<div> </div>
<div>Anderson was inspired to become a CNA after seeing how well his grandfather, who suffered from cancer, was cared for in a Veteran’s home. Working as a caregiver was his way of giving back, he says.</div>
<div> </div>
<div>“I love taking care of the neighbors [his term for elders]; I love being there to help with my neighbors’ quality of life and being a part of their family. Every morning I get up and look forward to being with my family,” he says. </div>
<div> </div>
<div>His love for elders is reflected in Krueggel’s testimony: “Residents feel safe and secure with Anderson, and he works well with almost everybody—a huge asset to our team here,” she says, adding that Anderson has “grown beyond leaps and bounds for the past 11 years that I’ve been working with him.”</div>
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<div>Krueggel notes that Anderson started on the floor and showed great leadership skills. So much so that he moved up to a lead CNA position and “has been my right and sometimes my left hand,” she says. </div>
<div> </div>
<div>Anderson’s leadership skills have been on display in his work with the National Association of Health Care Assistants (NAHCA). Having served on NAHCA’s National Steering Commission for three years and currently holding the position of vice chair, Anderson helps plan and execute activities within the association, such as the annual CNA conference, and is active in the group’s advocacy efforts in Washington, D.C. </div>
<div> </div>
<div>“He has spearheaded NAHCA programs and activities at Maravilla Care Center that bring recognition, education, and leadership to his fellow team members, resulting in enhanced teamwork, reduced turnover, and enhanced morale—all of which ultimately positively impact the neighbors being served,” says Kathleen Collins Pagel, executive director of the Arizona Health Care Association in her nomination letter.</div>
<div>He even played the superhero “NAHCA Man,” complete with costume, in a YouTube video encouraging positivity and teamwork. </div>
<div> </div>
<div>“With Wendell’s leadership, Maravilla Care Center’s NAHCA Leadership Team received the NAHCA Leadership Team of the Year Award in 2011, a national honor,” Collins Pagel wrote. Anderson’s efforts at Miravilla and with NAHCA also earned him the 2013 NAHCA Member of the Year award.</div>
<div> </div>
<div>“Wendell Anderson is a shining example of a leader from the frontline with compassion, capability, and unlimited potential. He is an outstanding and articulate advocate, with a proven track record on Capitol Hill. But it is Wendell’s passion and fierce devotion to those he cares for, along with his belief in the power of CNAs, that make him a ‘person to watch.’ He truly represents the very best of our profession in every way. It is an honor to be his colleague.”<br></div>
<h2 class="ms-rteElement-H2B"><img class="ms-rtePosition-1" alt="Bernadette Ledesma" src="/Issues/2014/PublishingImages/0114/BernieLedesma.jpg" style="margin:5px 10px;width:123px;height:153px;" />Bernadette Ledesma, MPH</h2>
<div><strong>Administrator</strong></div>
<div><strong>Pearl City Nursing Home</strong></div>
<div><div><strong>Pearl City, Hawaii</strong></div>
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<div>Bernadette Ledesma is a hands-on administrator, involved in the day-to-day activities of Pearl City Nursing Home, policy development and education, and communication with residents and their families.</div>
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<div>Ledesma is often seen making rounds through the building and stopping to encourage residents to participate in their plans of care, talking to families to resolve issues, and observing staff to ensure that the facility is meeting the needs of residents.</div>
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<div>Through her professional work and service, Ledesma exemplifies what it means to be a champion for the aging. She does so as a provider of care, a leader in improving policy, and an active community member who helps others achieve their goals. She is acknowledged throughout the health care and broader community as a leader.<img class="ms-rtePosition-2" src="/Issues/2014/PublishingImages/0114/Top20-2.jpg" width="173" height="635" alt="" style="margin:10px 15px;width:228px;height:905px;" /></div>
<div> <br>Ledesma provides excellent care for older persons, advocates for improving Hawaii’s capacity to care for residents across settings, and shares her experience and expertise throughout the community. Ledesma is always generous with her time and knowledge, and she is patient and calming even during times of duress. As one Healthcare Association of Hawaii staff member who has worked with her for years shares, “[She] has a wonderful personality; is always supportive, creative, and fun to work with; and gets along with everyone she meets.” </div>
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<div>Ledesma has been a tireless champion for long term care in Hawaii for over 30 years, and she has done so with grace, humor, and a generosity of spirit that is contagious.</div>
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<div>Her supporters note that Ledesma has contributed to the welfare of the elderly throughout her 30+ years in geriatric health care in Hawaii. She is very involved in statewide and nationwide initiatives related to long term care, including legislation, regulations, and guidelines that affect the long term care community in general and nursing homes in particular.</div>
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<div>Ledesma incorporates her wealth of knowledge, providing direction for the operation of Pearl City Nursing Home, and openly shares her knowledge with other nursing home administrators and people interested in geriatric health care. She effectively educates national and local elected officials on policy and regulatory issues and continually mentors new members and colleagues. She makes connections along the continuum of care, across the health care delivery system and community health.</div>
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<div>Colleagues say that Ledesma exemplifies the spirit of aloha. Here are three recent examples:</div>
<ul><li>At Pearl City Nursing Home, Ledesma is an advocate for Culture Change and the Namaste philosophy of looking beyond the surface into the true nature of every resident. The culture change movement in long term care strives to change the way frail people interact with their surroundings. Namaste programs also are focused on individualized engagement and the embrace of each resident’s needs and preferences.</li>
<li>Under Ledesma’s leadership, Pearl City Nursing Home joined a nationwide CMA Partnership to Improve Dementia Care in Nursing Homes, which included training staff and emphasizing nonmedical interventions for behavioral health issues faced by long term care residents.<br></li></ul>
<div>Keith Ridley, chief of the Hawaii Department of Health’s Office of Health Care Assurance and head of the Dementia Care Improvement task force, called the results “remarkable.” Already a leader in the nation for utilization, Hawaii has reduced its rate of antipsychotic medication for dementia residents from 19 percent last year to 11 percent this year.</div>
<ul><li>To address the ongoing challenge of transitions of care, Ledesma has spearheaded communication between transferring facilities in her region to promote sharing a list of federally-required and facility-specific documents.</li></ul>
<h2 class="ms-rteElement-H2B"><img class="ms-rtePosition-1" alt="Alicia Seaver" src="/Issues/2014/PublishingImages/0114/AliciaSeaver.jpg" style="margin:5px 10px;width:123px;height:174px;" />Alicia Seaver</h2>
<div><strong>Executive Director</strong></div>
<div><strong>Bridges by EPOCH at Hingham</strong></div>
<div><div><strong>Hingham, Mass.</strong></div>
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<div>On the job at Bridges by EPOCH at Hingham for two years, Executive Director Alicia Seaver says she sought the assisted living facility out, knowing that it was moving into the area of memory enhancement, which is a field she has been heavily involved in for 25 years. </div>
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<div>As a CNA in a nursing home, Seaver met her first person with memory impairments at 18 and “fell in love,” she says. “It’s something that I have a passion for.</div>
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<div>“When I get into my car in the morning, I know where I’m going. And when I get into my car every night, I know that I’ve made a difference.” </div>
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<div>Seaver is arguably the foremost expert in memory care in all of new England. Co-workers say her dedication and passion are beyond anything they have seen, that she sets the bar high for herself and encourages other staff to do the same. </div>
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<div>Seaver is a memory-impairment specialist certified by the National Institute on Aging. In addition to running the memory care program at Bridges by EPOCH at Hingham, Seaver regularly leads educational presentations about memory impairment for caregivers, nurses, social workers, and family members.</div>
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<div>She presents about the different types of dementia, coping tips for caregivers, understanding dementia from multiple perspectives, and more. She offers these presentations in part because of a personal passion to educate, support, and help people who are affected by memory loss. By regularly sharing her knowledge of and experience with memory impairment and caregiving, Seaver continuously supports her residents and staff, as well as members of the larger community. </div>
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<div>For example, Seaver leads a monthly support group for her residents with early-stage memory impairment. These residents have a working memory and can articulate how frustrating it is to deal with their memory loss on a daily basis. The support group offers a safe environment where residents can articulate their frustration and receive support and encouragement from their peers. Ever sensitive to the needs and emotions of her residents, Seaver encourages them to drive the group. Sometimes, that means they ask her to discuss common types of dementia; other times, it’s a simple check in. Seaver has said that the most important thing is that people have a venue to talk openly about their feelings, because talking leads to healing.</div>
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<div>Seaver and her staff hold resident council meetings every month, encouraging residents to offer any suggestions or ideas they have. These meetings have helped residents thrive, inspiring them to participate in a number of volunteer projects, including car wash fundraisers and bake sales for the Alzheimer’s Walk and a carnival to benefit the Hope for Caroline foundation. </div>
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<div>An ardent believer in the power of support groups, Seaver also hosts a group for spouses of individuals with memory impairment. What’s really special about this program is that she invites and welcomes spouses to bring their loved ones with memory impairments along. While caregivers attend the support group, their spouses participate in activities taking place in the community. This has allowed many family caregivers to receive the support and encouragement they need from people who have walked in their shoes—often, spousal caregivers are hesitant to attend such support groups, not wanting to leave their loved one home alone. Seaver has eliminated this worry. <br></div>
<h2 class="ms-rteElement-H2B"><img class="ms-rtePosition-1" alt="Melanie Lite Matthews" src="/Issues/2014/PublishingImages/0114/MelanieLiteMatthews.jpg" style="margin:5px 10px;width:123px;height:154px;" />Melanie Lite Matthews</h2>
<div><strong>Vice President of Operations</strong></div>
<div><strong>Prestige Care</strong></div>
<div><strong>Vancouver, Wash.</strong><br><br>Quality care is in the spotlight in the long term care community, and Melanie Lite Matthews is doing her part to promote, implement, and practice quality throughout her organization and in Washington state’s long term care community.<br><br>Taking the lead by motivating her colleagues to apply for and achieve Bronze and Silver Awards through the AHCA/National Center for Assisted Living National Quality Awards Program; participating on the Quality Improvement Committee for the Washington Health Care Association (WHCA); and promoting quality care through projects, initiatives, and efforts of the association through her board position are just a few of the ways that Matthews is helping Washington move the dial on quality. <br><br>Matthews is a rising star in long term care. Large organizations have sought to employ her because of her energy, drive, understanding of long term care, and her sincere passion to improve outcomes for residents. <br>Currently the WHCA Board vice chair, Matthews believes in working together with legislative, regulatory, and other state entities to achieve common goals.<br><br>Matthew’s enthusiasm for a focus on quality is contagious, and her efforts are having an impact. She has helped put quality at the center of WHCA’s legislative priorities and worked with the Department of Social and Health Services and other policy-making entities in Washington in an effort to connect providers with oversight agents to achieve quality outcomes together. <br><br>Matthews works tirelessly with the Washington state Quality Improvement Organization on the Collaborative Project, designed to help providers learn from one another. She spends time with the Medical Directors Association in an effort to work on the goal to safely reduce unnecessary readmissions to the hospital. <br><br>It is under Matthews’ supervision, training, and example that many of the communities she oversees have earned national recognition for AHCA/NCAL Quality Initiative goals achievement. Her efforts and those of her communities made had a direct impact on the reduction of the off-label use of antipsychotic medications, the reduction in staff turnover, the improvements in resident satisfaction levels, and the safe reduction of unnecessary readmissions to the hospital. <br><br>Matthews is continuously looking for ways to improve. She spends time with administrators, DONs, caregivers, residents, legislators, and others who can help to improve the quality of care for seniors in Washington. She motivates her own organization to have legislators in for facility tours and she encourages other organizations to do the same.<br><br>While busy in her public role, Matthews does not diminish the time she spends or the attention she gives to making quality the center of her everyday operations. <br><br><strong>Sponsored by:</strong><br><img class="ms-rtePosition-1" alt="Tena logo" src="/Issues/2014/PublishingImages/0114/Tena.jpg" style="margin:20px 10px;" /><br>SCA is a leading global hygiene and forest products company that develops and produces personal care products, tissue and forest products. With sales in 100 countries, SCA has 37,000 employees and had revenue in 2012 of $13 billion. With nine manufacturing facilities across North America, the company’s Americas headquarters is in Philadelphia, Pennsylvania.<br><br>In North America SCA produces the Tork line of napkin, towel, tissue and wiper products used in commercial settings such as office buildings, restaurants, schools and health care facilities and the TENA® line of incontinence care products used by consumers at home and in health care facilities. TENA and Tork the global leading brands in their categories.<br><br>More information at <a href="http://www.sca.com/us" target="_blank">www.sca.com/us</a>.<br></div></div></div></div></div> | The best leaders lead in the moment they are in and from the place they are in that moment, with vision, authenticity, transparency, and a steadfastness; all of these are key when their calling and work is the health, wellness, and safety of another person. | 2014-01-01T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/dr_staff.jpg" style="BORDER:0px solid;" /> | 20 to Watch;Caregiving;Management;Quality | Cover Story | 1 |
| Survey: Docs Slow To Adopt Mobile Devices For Drug Care | https://www.providermagazine.com/Issues/2014/Pages/0114/Survey-Docs-Slow-To-Adopt-Mobile-Devices-For-Drug-Care.aspx | Survey: Docs Slow To Adopt Mobile Devices For Drug Care | <p>Nursing home doctors appear reluctant to use mobile gadgets for help in prescribing drugs, researchers at the University of Pittsburgh are saying. <br></p>
<p>Researchers surveyed hundreds of long term care doctors at an annual convention and asked them about whether, and how often, they used iPhones or other mobile devices for help in writing prescriptions for residents. “Fewer than half (42 percent) of the respondents indicated that they owned and used a mobile device for assisting with prescribing” in the nursing home. <br></p>
<p>Experts argue that smartphones and other hi-tech gadgets can help doctors in their rounds, particularly in looking up drug interactions and potential bad reactions to medicine. Those adverse drug events (ADEs) are associated with some 93,000 nursing home deaths and another $4 billion in excess health care costs per year. <br></p>
<p>“Mobile devices, such as personal digital assistants (PDAs), hand-held computers, table PCs, and smartphones, represent a potentially attractive alternative solution to prevent or mitigate ADEs without requiring extensive investment in software and hardware infrastructure,” lead researcher Steven Handler, MD, wrote for the team. <br></p>
<p>The research findings were reported in the December issue of the Journal of the American Medical Directors Association. <br></p>
<p>Earlier surveys had found that up to 86 percent of doctors in other clinical settings used mobile devices for help in their rounds. But long term care doctors appeared to be behind their colleagues, Handler and his colleagues found. <br></p>
<p>In fact, the more veteran the long term care doctors were, the less likely they were to seek cellular help, the researchers found. <br></p>
<p>“Specifically, those with 15 or fewer years of clinical experience were 67 percent more likely to be mobile device users, compared with those with more than 15 years of clinical experience,” Handler wrote. <br></p>
<p>And the more time doctors spent in the nursing homes, the less likely they were to use mobile devices. Doctors who reported spending less than half of their time in long term care centers were 64 percent more likely to use the gadgets, compared with those who spent more than half of their time in the centers, Handler said. <br></p>
<p>For those doctors who are using the devices, though, they appear to be helpful: The doctors reported that they looked up one to two medicines per day, with 43 percent saying they looked up about six different medicines per day, Handler said. <br></p>
<p>The three most common mobile brands were Palm (31 percent), iPhone (30 percent) and Blackberry (25 percent), Handler wrote. <br><br></p> | Researchers surveyed hundreds of long term care doctors at an annual convention and asked them about whether, and how often, they used iPhones or other mobile devices for help in writing prescriptions for residents. | 2014-01-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/0114/caregiving2_thumb.jpg" style="BORDER:0px solid;" /> | Caregiving | Column | 1 |