Ship Shape | https://www.providermagazine.com/Issues/2015/September/Pages/Ship-Shape.aspx | Ship Shape | <p>Shirley Payne, of South Kingstown, R.I., grew up on the water. At age nine, she fell in love with boating while at summer camp learning how to canoe. It wasn’t long before she became a camp counselor and shared her love of the water with others.</p>
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<h2 class="ms-rteElement-H2">Embarking On Life</h2>
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<div>A child of the Great Depression, Payne learned to appreciate the simple joys of life—even more so as she anxiously awaited her soon-to-be husband’s return from World War II. When Ken Payne returned, the two moved back to Rhode Island—a sailing mecca—and started their family. <br></div>
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<div><br><img class="ms-rtePosition-2" src="/Issues/2015/September/PublishingImages/sailing_18934988.jpg" alt="" style="margin:5px 10px;" />Shirley Payne shared her passion with her three sons, 10 grandchildren, and numerous great-grandchildren. The sole woman in an all-male household, she relished the opportunity to lead a local Mariner Girl Scout Troop on the water and expose the young women to the joys of sailing.</div>
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<div><br>Payne entered college during World War II but left without her degree to start her family. Once her sons were grown, Payne, unwilling to sit around the house, went back to school, finished her degree, and embarked on a 25-year career as a librarian. She loved exposing younger generations to a world of knowledge—whether in the library or on the water.</div>
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<div><br>Today, at age 90, Payne is the picture of good health and retains the same passion for the water, sailing, and having fun as she always had. </div>
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<h2 class="ms-rteElement-H2">The Tide Is High (As Are The Demands)</h2>
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<div>An accomplished and compassionate senior and current resident of Brookdale Senior Living’s South Kingstown community, many of Payne’s wishes have come true. However, Wish of a Lifetime, a nonprofit organization committed to creating a cultural shift on how aging is viewed in the United States, granted her a very special wish: Payne wanted to meet and sail with the women of Team SCA, the only all-female sailing team competing in the 2014-2015 professional Volvo Ocean Race (VOR), viewed as one of the most grueling sporting events in the world. <br><br>The VOR is a nine-month, round-the-world sailing race in some of the most challenging waters. When the teams are at sea, they are racing nonstop, sleeping in shifts. Members are allowed to take only one change of clothes for the entire voyage.</div>
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<div><br>No fresh food is on board—the team eats around four freeze-dried meals per day. Each woman burns 600 to 1,500 calories a day and loses around 17 lbs. over the course of the race (they have to lift sails that can weigh over 650 lbs. <br>each!). </div>
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<div><br>As one member of the team summed up, it is like “driving a convertible through a carwash”—they’ll experience unpredictable weather and temperatures ranging from 23° to 104° Fahrenheit.</div>
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<div>In addition to meeting members of Team SCA, Payne, with several fellow residents from her Brookdale community, sailed around Newport Harbor in a companion boat while witnessing Team SCA in action, competing in the in-port Pro-Am race.<br><br></div>
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<div>The Pro-Am race does not count for the overall ranking for the greater VOR competition. Guests are allowed on the racing boats with the team, and spectator boats sail around watching the race. Payne got a chance to sail with several Team SCA sailors as well as have lunch with them. <br><br></div>
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<div>“This is a wonderful dream,” says Payne. “At 90, it’s nice to check a few things off the list.”</div>
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<h2 class="ms-rteElement-H2">Sail On Sailor</h2>
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<div>“Getting Shirley back on a sailboat exemplifies that older adults continue to dream and want to connect with the things they are passionate about and add meaning to their lives,” says Sara Terry, vice president of resident and family engagement at Brookdale. “For each of our residents, our focus is to seek out and find opportunities to enrich their lives and honor their spirit.”<br><br></div>
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<div>Wish of a Lifetime partnered with SCA, a global hygiene and forest products company that develops and produces personal care products, and Brookdale Senior Living, a leading operator of senior living communities throughout the United States and No. 1 this year on Provider’s Top 40 Largest Assisted Living Companies list, for Payne’s seafaring journey.</div>
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<h2 class="ms-rteElement-H2">Further Adventures Await</h2>
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<div>This summer, two additional senior women with a similar commitment to helping others and a passion for adventure also saw their wishes fulfilled through this partnership. <br><br></div>
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<div>SCA recently launched an initiative to recognize women around the world. Amazing Women Everywhere (<a target="_blank">www.teamsca.com/aweonmosaic</a>) is a global storytelling platform that honors and celebrates women who have had a positive impact on others, their communities, and their surroundings—just like Shirley Payne. <br><br></div>
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<p></p> | Shirley Payne shared her passion with her three sons, 10 grandchildren, and numerous great-grandchildren. The sole woman in an all-male household, she relished the opportunity to lead a local Mariner Girl Scout Troop on the water and expose the young women to the joys of sailing. | 2015-09-01T04:00:00Z | <img alt="" src="/Issues/2015/September/PublishingImages/sailing_t.jpg" style="BORDER:0px solid;" /> | Culture Change;Caregiving | Special Feature |
Ethnic Disparities On The Decline In Skilled Nursing Centers | https://www.providermagazine.com/Issues/2015/September/Pages/Ethnic-Disparities-On-The-Decline-In-Skilled-Nursing-Centers.aspx | Ethnic Disparities On The Decline In Skilled Nursing Centers | The faces of elderly Americans in recent decades have not been reflected by those seen in skilled nursing facilities (SNFs). <br><br>Among SNF residents aged 65 and over in 2012, 86 percent were white, 8.8 percent were black, 7.3 percent were Hispanic, and 3.8 percent were Asian, according to U.S. Census Bureau data. Nursing care centers had been primarily populated by white residents for the past two decades. Compared with whites, ethnic residents are typically cared for in SNFs with limited clinical and financial resources, low nursing staff, and high deficiency citation numbers.<br><br>Yet the tide may be turning. A recent <em>Health Affairs</em> article indicates that from 2006 to 2011, citations and disparities across facilities with four different concentrations of ethnic minority residents have decreased. The reason? Increased Medicaid payments tied to quality improvement measures.<br><br>“Improved payments will help all nursing homes, in particular nursing homes used by racial and ethnic minority residents because minorities are predominately Medicaid residents,” says lead author Yue Li, associate professor in the Department of Public Health Sciences at the University of Rochester Medical Center in New York. <br><br>Culture partially explains the disparity seen in SNFs. Hispanics view SNFs as a last resort, says Li, who adds that Hispanics and Asians have more familial support—adult children typically house and/or look after their elderly parents. Additionally, ethnic minorities tend to avoid institutional care, says Li.<br><br>Yet a rise has been seen in SNF admissions for Hispanics, Asians, and blacks and a drop in whites. For one, all ethnic groups have a longer life expectancy due to improved health care. Also, the SNFs have become big business, compared with 20 to 30 years ago—more SNF beds are now available in the community. Lastly, a concurrent rise in assisted living may attract higher socioeconomic elders, in particular, white elders. <br><br>During the five-year observation period in Li’s study, the average number of health care-related and immediate-jeopardy deficiencies essentially decreased for SNFs in all groups of ethnic minority concentrations. Life safety deficiencies actually increased a bit over time.<br><br>When Li’s team examined Medicaid payment policies over this time period, they found that the increased payments improved both overall SNF quality and disparities. In their paper, they caution that “these efforts may not lead to equally improved care for all subgroups of residents or in all nursing facilities… To our knowledge, national initiatives targeting racial/ethnic or site-of-care disparities in nursing homes do not exist.” | During the five-year observation period in Li’s study, the average number of health care-related and immediate-jeopardy deficiencies essentially decreased for SNFs in all groups of ethnic minority concentrations. Life safety deficiencies actually increased a bit over time. | 2015-09-01T04:00:00Z | <img alt="" src="/Issues/2015/September/PublishingImages/news_ethnic.jpg" style="BORDER:0px solid;" /> | Caregiving | Column |
Alzheimer’s Families Want More Focus On Care, Less On Cure, Reports New Study | https://www.providermagazine.com/Issues/2015/September/Pages/Alzheimer’s-Families-Want-More.aspx | Alzheimer’s Families Want More Focus On Care, Less On Cure, Reports New Study | <br>Families and friends who care for those afflicted with Alzheimer’s disease think it’s much more important to get help to caregivers rather than to spend money on a search for a cure, a new study finds. <br><br>Researchers at the University at Buffalo surveyed hundreds of relatives, friends, and lovers of those suffering from Alzheimer’s. The team found that families’ and friends’ top priority was money and other resources “to support caregiving,” followed by financial aid for long term care and “aging in place” and then research for a cure. <br><br>“Their voices have not been heard over the clamor for research dollars,” University at Buffalo Professor Davina Porock writes for the team. Last year, hundreds of millions of federal dollars were spent on “science and drug development,” but only “$10 million to care, services, and education,” Porock says. <br><br>In 2013, there were about 40 million family caregivers taking care of their loved ones. If they were paid the prevailing wage for their efforts, it would be worth some $470 billion, according to an analysis by AARP. <br><br>Porock and her colleagues quote one respondent: “I have known for a long time that there will be no cures in my lifetime. Maybe in my children’s, not sure now, not even sure if [a cure will come] in my grandchildren’s [lives]. So there has to be some more emphasis/support/help for caregivers, and some way has to be found to pay for care—in homes.”<br><br>Porock runs Buffalo’s Institute for Person-Centered Care. Her team’s research is “part of a larger project to develop a national advocacy group… providing an opportunity for people living with any type of dementia and their care partners to contribute to the national debate.”<br><br>The survey comes amid growing clamors for more emphasis on the care of Alzheimer’s, rather than the cure: <br><ul><li>Last spring, for instance, several senators introduced the Health Outcomes, Planning, and Education (HOPE) Act, which, among other things, would link families and patients to “care coordinators,” who (ideally) will be a kind of advocate for hard-pressed families and friends.</li>
<li>In July, presidential candidate Hillary Clinton called for federal programs to address what she called “a caregiving crisis.”</li>
<li>A few days later, Advancing Excellence’s Doug Pace announced that he was heading over to the Alzheimer’s Association as the newly minted director of dementia care services and support.</li>
<li>And, in early August, the American Health Care Association/National Center for Assisted Living formally endorsed legislation for the so-called RAISE Family Caregivers Act, which would create an advisory board to study (and to recommend solutions to) the problems of America’s army of unpaid caregivers.<br></li></ul>
| In 2013, there were about 40 million family caregivers taking care of their loved ones. If they were paid the prevailing wage for their efforts, it would be worth some $470 billion, according to an analysis by AARP. | 2015-09-01T04:00:00Z | <img alt="" src="/Issues/2015/September/PublishingImages/news_alzheimers_t.jpg" style="BORDER:0px solid;" /> | Caregiving;Clinical | Focus on Caregiving |
Learn New Best Practices And The Latest Regs | https://www.providermagazine.com/Issues/2015/September/Pages/Learn-New-Best-Practices-.aspx | Learn New Best Practices And The Latest Regs | <div id="__publishingReusableFragmentIdSection"><a href="/ReusableContent/4_.000">a</a><a href="/ReusableContent/4_.000">a</a></div><div>The 66th Annual Convention & Expo of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) is coming Oct. 4–7 to San Antonio, Texas.</div>
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<div>Here are some samples of the more than 70 CEU-credited symposia beginning on Monday, Oct. 4, and going on for three days.</div>
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<h3 class="ms-rteElement-H3 ms-rteForeColor-3">Strategies For Individualizing Care Of The Person With Dementia </h3>
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<div>A cornerstone of good care and positive quality of life for a person with dementia is knowing that person—their likes and dislikes, preferences and routines, history and background, what frustrates them and what soothes them, what a “good day” means for them, and so much more. Gathering that information on an ongoing basis is critical to developing and implementing the best possible care plans for each individual. <br><br></div>
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<div>This session will explore strategies and will incorporate lessons learned from providers that have been hard at work improving their ability to serve these individuals through Mass Senior Care’s OASIS training program. <br><br></div>
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<div><span class="ms-rteForeColor-8">Session Leader: </span><em>Susan Wehry, MD, commissioner, Vermont Agency of Human Services, Department of Aging, Disabilities and Independent Living, Burlington, Vt.</em></div>
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<h3 class="ms-rteElement-H3"><span class="ms-rteForeColor-3">Comprehensive Care For Persons With Dementia: Survey Readiness Around Person-Centered Care</span> </h3>
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<div>As a key element of the National Partnership to Improve Dementia Care, the Centers for Medicare & Medicaid Services (CMS) has worked with a number of states to pilot approaches to better capture and assess the quality of care for persons with dementia in nursing care centers.<br><br></div>
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<div>Current regulatory guidance at F309 and F329 addresses the comprehensive experience of the person with dementia, the facility’s understanding and knowledge of that person’s needs, and the successful implementation of approaches to meet those needs, avoiding the use of antipsychotic drugs as a response to behavioral communication. This session will review CMS’ report on the pilot survey experience and will include an overview of comprehensive care practices for the person with dementia.<br><br></div>
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<div><span class="ms-rteForeColor-8">S</span><span><span class="ms-rteForeColor-8">ession Leader:</span> <em></em></span><em>Alice Bonner, PhD, RN, associate professor, Northeastern University, Westborough, Mass.</em><span><em></em></span><em></em></div>
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<h3 class="ms-rteElement-H3"><span class="ms-rteForeColor-3">SNF PPS FY 2016 Final Rule And Outlook For Future Rules</span> </h3>
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<div>The fiscal year 2016 Notice of Proposed Rulemaking (NPRM) marked the first time the skilled nursing profession has experienced quality requirements in its prospective payment system (PPS). <br><br></div>
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<div>Because of the Protecting Access to Medicare Act, the Improving Medicare Post-Acute Care Transformation Act (IMPACT Act), and the Affordable Care Act, future NPRMs will contain additional quality requirements in addition to existing PPS payment methodology longstanding practices. At the same time, CMS continues to explore possible payment methodology changes. <br><br></div>
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<div><span class="ms-rteForeColor-8">Session Leaders: </span><em>Mike Cheek, vice president, Medicaid and long term care policy, AHCA/NCAL, Washington, D.C.; Barry Lazarus, vice president, chief compliance officer, HCR ManorCare, Toledo, Ohio; Mary Ousley, RN, president, Ousley and Associates, Richmond, Ky.</em></div>
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<h3 class="ms-rteElement-H3 ms-rteForeColor-3">Happy Staff = Better Quality </h3>
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<div>This session will cover a wide variety of techniques to empower leaders at all levels to improve and maintain community culture and improve retention and recruitment strategies. <br></div>
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<div>Participants will be empowered to evaluate their current programs, identify desired changes, implement those changes, and develop communitywide buy-in. The leader will bring examples from a variety of care settings. By the close of the session, participants will have a list of take-aways that they can implement right away with their leadership teams. <br><br></div>
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<div><span class="ms-rteForeColor-8">Session Leader:</span><em><span class="ms-rteForeColor-8"> </span>Robert Simandl, Simandl Law Group, Waukesha, Wis.
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<h3 class="ms-rteElement-H3 ms-rteForeColor-3">Rehospitalizations: Solutions Through Root-Cause Analysis </h3>
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<div>It’s not surprising that many long- and short-stay residents are frequently hospitalized for varied reasons such as deconditioning, illnesses, or other complications. However, many of these hospitalizations are potentially avoidable and costly. Health care reform promises continued scrutiny on this issue, challenging providers to develop stronger clinical and operational systems. Most recently, the IMPACT Act is calling for quality monitoring and reporting of rehospitalizations. This session will lead attendees to analyze patterns of rehospitalizations through a process of root-cause analysis and management of risk factors. Additional strategies to prevent avoidable hospital readmissions, including utilizing the evidenced-based INTERACT process, will be explored.<br><br></div>
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<div><span class="ms-rteForeColor-8">Session Leader:</span> <em>Lisa Hohlbein, RN, RAC-MT, CDP, CADDCT, curriculum development specialist, AANAC, Anna, Ohio</em>
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<h3 class="ms-rteElement-H3 ms-rteForeColor-3">The New Face Of Privacy: Facebook, Other Social Media Sites, And Increased Enforcement</h3>
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<div>The use of social media and other electronic communication is increasing exponentially, with growing numbers of social media outlets; platforms; and applications, including blogs, social networking sites, video sites, and online chat rooms and forums. Social media can benefit health care in a variety of ways, including fostering professional connections, promoting timely communication with patients and family members, and educating and informing consumers and health care professionals. Without a sense of caution, however, these understandable needs and potential benefits may result in disclosure of too much information and violations of patient privacy and confidentiality. See <a title="Members log in" target="_blank" href="http://www.ahcancal.org/News/publication/Provider/LegalOctober2010.pdf">www.ahcancal.org/News/publication/Provider/LegalOctober2010.pdf</a> as a starting point for this presentation.<br><br></div>
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<div><span class="ms-rteForeColor-8">Session Leader:</span> <em>Nancy Bonifant, JD, associate, Reed Smith, Washington, D.C.</em></div>
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<h3 class="ms-rteElement-H3 ms-rteForeColor-3">Ideal Candidates Exist! Strategies To Hire And Retain Staff </h3>
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<div>The ability to hire and retain employees in long term/post-acute care is challenged by caregiver shortages, high turnover, and an aging population with more sophisticated care needs. This “staffing reality” can turn into a vicious cycle as providers rely on current staff to fill additional shifts, causing burnout, dissatisfaction, and, ultimately, more turnover. This session will detail how a consistent staffing and hiring strategy is the keystone for building staff stability. Participants will discover how to proactively identify hiring needs, recruit high-quality candidates, and attract best-fit employees. In addition, they will discover how a consistent, balanced approach to staffing improves staff satisfaction, resident and family relationships, and quality of care.<br><br></div>
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<div><span class="ms-rteForeColor-8">Session Leaders:</span> <em>Irene Fleshner, RN, MHSA, FACHE, senior vice president, strategic nursing initiatives, Genesis HealthCare Corp., Sarasota, Fla.; Mark Woodka, chief executive officer (CEO), OnShift, Cleveland, Ohio</em></div>
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<h3 class="ms-rteElement-H3 ms-rteForeColor-3"><span>Understanding The Brain </span><span>And Behavior In Persons With Dementia
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<div>While the person with dementia is far more complex than a diagnosis, understanding how various disease processes typically affect individuals and their abilities to understand and engage with the world around them can offer important insights into how best to interact and provide care. In this session, participants will review the impact of different types of dementia and their progression on the brain and on function and behavior, including unique aspects of caring for persons with younger onset dementias. In addition, participants will explore strategies, tips, and tools to share with their teams to help them better respond to behavior in ways that minimize fear, anxiety, and defensive responses.<br><br></div>
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<div><span class="ms-rteForeColor-8">Session Leader: </span><em>Susan Wehry, MD, commissioner, Vermont Agency of Human Services, Department of Aging, Disabilities and Independent Living, Burlington, Vt.</em></div>
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<h3 class="ms-rteElement-H3 ms-rteForeColor-3">Achieving Truly Managed Care: How Enrollment And Payment Trends Are Changing Medicare Managed Care </h3>
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<div><div>Even as enrollment in Medicare Advantage (MA) plans continues to grow, reform has fundamentally changed managed care by linking quality to payment. Payment cliffs are looming for many MA plans, and financial pressures will affect the rates and contracts offered to post-acute care (PAC) providers. MA plans bring an array of other challenges to providers, including prompt payment issues, truncated length of stay, payment recovery as part of post-utilization review, network narrowing, and payments at less than Medicare fee-for-service levels. </div>
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As PAC providers seek to advance partnerships and networks with MA plans, post-acute providers will <span>need targeted business strategies to ensure successful partnerships. <br><br></span>
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</span><div><span class="ms-rteForeColor-8">Session Leaders: </span>Eric Hammelman, vice president, Avalere Health, Washington, D.C.; Tammy Trasti, Golden Living; Jill West, Petersen Health Care</div>
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<h3 class="ms-rteElement-H3 ms-rteForeColor-3">Strengthening Resident Choice And Culture Of Safety Using Frontline Staff Engagement</h3>
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<div>Participants will strengthen their understanding and utilization of effective staff involvement tools and techniques in the development of a sustainable resident culture of safety and resident choice. After establishing an acceptable definition of a “resident culture of safety,” leaders will—using examples of falls prevention—explore a variety of problem solving, communications, and collaboration techniques. The intention of this presentation is to help managers empower front-line staff to actively participate in the development and sustaining of a resident culture of safety and ensure resident choice.<br><br></div>
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<div><span class="ms-rteForeColor-8">Session Leader: </span><em>Raymond Miller, MSOSH, director, risk and safety solutions, Direct Supply, Milwaukee</em></div>
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</span><h3 class="ms-rteElement-H3 ms-rteForeColor-3">Emerging Infectious Diseases: A Different Kind Of Disaster Preparedness</h3>
As the world becomes increasingly interconnected, the threat of a dangerous infectious disease arriving in the local community grows ever more likely. Some of these diseases, like avian influenza, have the potential to become a pandemic that could have a huge impact on the nation’s health care system and society in general. Others, like Ebola, can have a significant psychological impact on the American public and raise major questions about the readiness of the public health sector to deal with this kind of emergency. Although not first receivers, long term care facilities are not immune to this threat, and they need to take reasonable steps to be prepared for the next infectious event. This session will give attendees the information they need to develop realistic plans for dealing with an emerging infectious disease in their community and/or their facilities. <br><div><br></div>
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<div><span class="ms-rteForeColor-8">Session Leaders: </span><em>Jocelyn Montgomery, RN, director of clinical affairs, California Association of Health Facilities, Sacramento, Calif.; Phillip Smith, MD, professor, Section of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb.; Karen Goldsmith, JD, shareholder, Goldsmith and Grout PA, Winter Park, Fla.</em></div>
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<h3 class="ms-rteElement-H3 ms-rteForeColor-3">Separating The Facts From The Fiction On Antipsychotic Medications </h3>
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<div>This session will address the evidence base and dispel common misperceptions surrounding the use of antipsychotic medications in persons with dementia as a means to address neuropsychiatric symptoms. In addition, participants will review the implications of polypharmacy and the potential interactions of these drugs with other common medications used in the older adult nursing care center population. The consultant pharmacist is a critical partner who can help integrate the evidence and best practices around use of these medications. This partnership in care can help improve the function and well-being of residents. <br><br></div>
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<div><span class="ms-rteForeColor-8">Session Leader:</span> <em>Nicole Brandt, PharmD, MBA, CGP, BCPP, FASCP, professor, geriatric pharmacotherapy, Pharmacy Practice and Science UMB School of Pharmacy, director, clinical and educational programs, Peter Lamy Center Drug Therapy and Aging, Baltimore
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<h3 class="ms-rteElement-H3 ms-rteForeColor-3"><span id="__publishingReusableFragment"></span>The Evolution Of The ACO Model: What Do These New Changes Mean For SNF Providers? </h3>
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<div>CMS’ ACO (accountable care organization) models are going strong and show no signs of slowing down. With the release of new ACO rules earlier this year, the recent expansion of the Pioneer ACO program, and the announcement of the Next Generation ACO demonstration, the ACO landscape is on course to look very different in years to come than it does today. Attend this session to learn about the recent changes to the ACO program and what challenges and opportunities face the skilled nursing facility (SNF) community. The leader will walk through the new ACO proposed rule, the Next Generation ACO model, and recent developments with the Pioneer program. He will also discuss implications and steps SNF providers should be taking to engage in these models.<br><br></div>
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<div><span class="ms-rteForeColor-8">Session Leader: </span><em>James Michel, director, Medicare research and reimbursement, AHCA/NCAL, Washington, D.C.</em></div>
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<h3 class="ms-rteElement-H3 ms-rteForeColor-3">Plaintiffs’ Attorney Tricks: How Providers Can Respond Effectively </h3>
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<div>AHCA/NCAL and its members have been frustrated by the deceptive advertising and litigation-solicitation campaigns being waged by plaintiffs’ attorney firms on nursing and assisted living centers. Further, plaintiffs’ attorney actions and subsequent litigation are forcing some providers to spend significant amounts of monies to defend themselves against these false claims, which are undermining the profession’s hard work over the past many years to build and improve quality of care for patients.<br></div>
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<p class="ms-rteElement-P"><span><span class="ms-rteForeColor-8">Session Leader:</span> </span><span><span><em>Jason Bring, JD, partner, Arnall Golden Gregory, Atlanta</em></span></span></p>
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<h3 class="ms-rteElement-H3 ms-rteForeColor-3">The New Five-Star: Actions You Can Take To Improve Your Ratings </h3>
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<div>CMS has changed how the quality measure component ratings are calculated, which impacts overall ratings. New measures are being added to Five-Star (antipsychotics, rehospitalization, discharge to community, and staffing turnover). CMS also plans to audit staffing payroll data and Minimum Data Set data. This session will review these changes and explain where individual facility data can be found and what actions providers can take to improve their ratings under this new system. <br><br></div>
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<div><span class="ms-rteForeColor-8">Session Leader:</span> <em>David Gifford, MD, MPH, senior vice president, quality and regulatory affairs, AHCA/NCAL, Washington, D.C.</em></div>
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<h3 class="ms-rteElement-H3 ms-rteForeColor-3">Let’s Get Social </h3>
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<div>Within the past decade, social media (Facebook, blogs, Twitter, Instagram, Facetime) has become an activity of daily living for the residents and employees of SNFs. Furthermore, social media is now an integral arm of SNF marketing and admissions. What does this mean? By bridging communication gaps between residents and their family and friends, social media expands the walls of the residents beyond the SNF and helps to develop an increased sense of competency and personal happiness. This presentation will provide insight from both an occupational therapist and administrator on how social media can amplify quality of life among residents and also promote SNFs to potential clients via online content. <br><br></div>
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<div><span class="ms-rteForeColor-8">Session Leaders:</span> <em>Kris Mastrangelo, OTR/L, LNHA, MBA, president and CEO, and Elisa Bovee, MS OTR/L, vice president, operations, Harmony Healthcare International, Topsfield, Mass.</em></div>
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<div>The presenters will draw upon their experience from all angles of the bundling payment design and provide either a specific case study of a post-acute provider or a panel of post-acute providers engaged in a bundled payment pilot. These providers will each provide unique perspectives on innovative partnerships with upstream and downstream providers, evolving culture and operations for success, and diversity across market types. Concrete tools will be provided to evaluate their readiness and opportunity for participation in a bundled payment structure, as well as the future policy implications and environment for broader reform that includes bundled payments. <br><br></div>
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<div><span class="ms-rteForeColor-8">Session Leaders: </span><em>Brian Fuller, MBA, FACHE, director, Avalere Health, Washington, D.C.; George Burkley, chief strategy officer, Signature Health Care, Louisville, Ky.; John Paul Taylor, chief operating officer, Stonegate Senior Living, Lewisville, Texas; Nanci Wilson, vice president, research and development, Plum Healthcare Group, San Marcos, Calif. </em><br></div>
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<div>SNFs are under immense scrutiny with regard to the levels of therapy provided and the documentation in support of that therapy. Contractor audits, extrapolation, whistleblower cases, and Department of Justice (DOJ) investigations all have unfortunately become more prevalent and are not letting up. This session will bring the perspective of an attorney and a therapy consultant/compliance officer who have both worked on DOJ cases. The main focus of the session will be on proactive strategies that providers can implement both in anticipation of a review and in response to an active review.<br><br></div>
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<div><span class="ms-rteForeColor-8">Session Leaders:</span> <em>Aric Martin, JD, managing partner, Rolf Goffman Martin Lang, Cleveland, Ohio; Alissa Vertes, CCC/SLP, CHC, vice president of corporate compliance, HealthPRO Rehabilitation, Cockeysville, Md. </em></div>
| Here are some samples of the more than 70 CEU-credited symposia beginning on Monday, Oct. 4, and going on for three days. | 2015-09-01T04:00:00Z | <img alt="" src="/Issues/2015/September/PublishingImages/convention_t.jpg" style="BORDER:0px solid;" /> | Caregiving | Column |
Three Trends Favor New Candidates | https://www.providermagazine.com/Issues/2015/September/Pages/Three-Trends-Favor-New-Candidates.aspx | Three Trends Favor New Candidates | <div id="__publishingReusableFragmentIdSection"><a href="/ReusableContent/4_.000">a</a></div><p class="ms-rteElement-P">While the skies aren’t exactly raining money, funding options for post-acute and long term care facilities of all sizes are greater and more varied than ever. Three trends in particular can open doors, especially for those who may not have been considered viable loan candidates in the past. These trends create new opportunities and expand existing ones for facilities of all sizes.</p>
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Evaluating Engagment</h2>
<div>Increasingly, some lenders are looking beyond
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<p class="ms-rteElement-P"><br>“From a broad basis and a qualitative standpoint, this is important,” says Imran Javaid, managing director, Capital One Bank. “If your residents and the workforce are happy, you are usually driving a strong bottom line.”</p>
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<p class="ms-rteElement-P">To assess workforce stability, Javaid and his team start with a site visit. “When we walk into a building, we want to see if everyone is smiling, happy, and greeting people as they enter. This may seem like a small, simple thing, but it’s important. This kind of atmosphere makes family members feel confident about the facility and the care their loved ones are receiving,” he says. “Ultimately, we want to see that everyone in the workforce, from the laundry to the executive offices, is interested and engaged in what is going on around them.”</p>
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<p class="ms-rteElement-P">Sometimes the little things tell a big story. For instance, Javaid says, “We went to one facility that posted pictures of residents and descriptions of their food preferences for the kitchen staff. This was a nice personal touch. It was a smaller facility, and I was impressed with their ingenuity and attention to detail.”</p>
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In addition to site visits, Javaid looks at data such as turnover ratios, overtime hours, and use of agency staffing. Low turnover rates, he suggests, not only demonstrate that the organization has happy, satisfied staff. It also means that they spend less money on new staff training and can focus on inservices and ongoing education opportunities for existing staff, thereby maximizing their knowledge and their ability to do their jobs well.
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<p class="ms-rteElement-P">“We also look at quality-of-care data,” says Javaid. “We have an RN [registered nurse] who looks at survey results over time—how they’ve changed and improved. She engages with facility staff to understand what is going on when they have citations. We think this is an important measure of quality of care.” Capital One also looks at data such as 30-day hospital readmission rates.</p>
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<p class="ms-rteElement-P"><span>“<span></span></span>Of course, Javaid and his team watch for red flags that they cannot overlook. For example, “If I see a room alarm going off and no one answers, that is a serious concern, especially if I point it out and staff shrug it off or make excuses,” he says. Additionally, he says that loan approval is unlikely if what he observes doesn’t match what the center is telling him.
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<p class="ms-rteElement-P">In preparation to interact with lenders such as Capital One, Javaid suggests, “Treat our visit like a survey without the stress, and prepare accordingly. If you’re providing quality, person-centered care and have a strong team, it doesn’t have to be nerve-wracking.”</p>
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<h2 class="ms-rteElement-H2">Cash Flow Over Collateral</h2>
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<p class="ms-rteElement-P">Have little collateral but still bringing in the dollars? There are lenders available. Rebecca Fatica, vice president and senior care lending specialist at Yadkin Small Business Lending in Pittsburgh, says, “This can be a great tool for many businesses that don’t have fixed assets to borrow against.” </p>
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<p class="ms-rteElement-P">This type of loan is a good option for organizations such as adult day care centers that don’t have property or real estate holdings but bring in more money than they put out. It also is useful for partner buyouts or instances where a facility owner has sold off real estate but still owns the operating company, she says.</p>
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<p class="ms-rteElement-P">Applicants for this kind of loan should be prepared to submit business and personal tax returns and financial statements. Depending on the loan’s purpose, candidates may need to submit a variety of other documents and materials.</p>
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<p class="ms-rteElement-P">For example, says Fatica, a letter of intent is required for a business acquisition loan. For refinancing, applicants will need to submit any existing loan documents. Projections will be necessary for startup or expansion loans.</p>
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<p class="ms-rteElement-P">These loans are very much connected to the individual, that is, the owner/operator. Therefore, the lender will be scrutinizing the person’s character; this includes a thorough background check. Further, says Fatica, “The owner needs to be actively involved in business, and not absent or passive.” These lenders also will be looking at the accuracy and level of detail in financial data. Fatica says, “Sometimes people will say that the business is doing one thing, but tax returns or financial statements say something else. This is a problem. You need to make sure financial data are accurately representative of what is happening with your business.”</p>
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<p class="ms-rteElement-P">If applicants get turned down for a loan, Fatica urges them not to get discouraged. Instead, she suggests that they do some “financial spring cleaning.” She advises, “Take inventory of your business and personal financial situation. An up-to-date business plan will help you determine if you are on track and, if not, what you need to improve or change.” Business financial statements are “like snapshots,” telling a story in numbers, she says.</p>
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<h2 class="ms-rteElement-H2">Match Lender To Lendee</h2>
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<p class="ms-rteElement-P">One key to a successful loan application, says Fatica, is “finding a lender with the right appetite for the type of loan you are seeking.”</p>
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<p class="ms-rteElement-P">She uses an analogy: “Some people don’t like seafood, and there is nothing you can do or say to get them to like or eat it. The same is true of loans.” If a lender makes decisions solely or mainly on equity or collateral and the operator is seeking a loan based on cash flow, for example, that lender isn’t going to be interested in the application. “Not every lender will handle every type of loan. It’s up to you to understand what lenders are seeking and find one that has the appetite for your type of loan,” Fatica says. Remember that a loan is a two-way street, she says. </p>
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<p class="ms-rteElement-P">“While lenders are evaluating you, you need to interview them as well and make sure your needs, vision, and ideals are in tune with theirs.” She recommends, “Do your homework. Find out who the credible and experienced lenders are, how they will communicate with you, and how knowledgeable they are about their product and your business or industry.”</p>
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<p class="ms-rteElement-P">Late in 2013, the Securities and Exchange Commission published rules to change its Regulation A exemption, enabling companies to raise up to $50 million in public offerings. Simply put, it increases small businesses’ access to capital, thereby enabling them to seek and utilize the necessary investment capital to grow. This is especially significant for start-ups and large expansion or acquisition projects.</p>
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<p class="ms-rteElement-P">“What this really means to small chains or mom and pop facilities is that they can now access the same capital as Wall Street investors without the cost,” says Clinton Lovell, president of Houston-based Rainmaker Underwriting. “They can tap into a larger audience—beyond ‘angel’ investors or family and friends—and get the capital they need. They can go into market with direct mail pieces or email blasts to reach potential investors.”</p>
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<p class="ms-rteElement-P">As a result of this change, Lovell says, “We will see more mom and pops entering the field and small chains growing faster. It also will create a downward pressure on investment bankers who will have to be more competitive.”</p>
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<p class="ms-rteElement-P">How to start? Go through the usual due diligence, says Lovell, including a feasibility study, negotiating architecture and construction contracts, acquiring a property management, securing civil engineering studies, and completing a detailed marketing plan.</p>
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<p class="ms-rteElement-P">“You want to have everything necessary to show that the deal is ready to go tomorrow. Cost estimates and projections must be close to reality. If it’s an attractive deal, it will attract good offers,” he says.</p>
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<p class="ms-rteElement-P">This could be a huge game changer for facilities, Lovell says. “It has the potential to lock down costs and ensure more certain outcomes so that projects are attractive to early-stage investors.” </p>
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<p class="ms-rteElement-P">At the same time, he says, “You can get the money you need with favorable rates and still control the lion’s share of the project’s economics.”</p>
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<em>View article as a <a target="_blank" title="2015 Finance Supplement" href="/archives/2015_Archives/Documents/0915_Fianance.pdf"><img class="ms-asset-icon ms-rtePosition-4" src="/archives/2015_Archives/_layouts/images/pdficon_small.gif" alt="0915_Fianance.pdf" />PDF.</a></em></p> | Increasingly, some lenders are looking beyond finances to proof of an organization’s health, as measured by workforce stability. | 2015-09-01T04:00:00Z | <img alt="" src="/Issues/2015/September/PublishingImages/finance_t.jpg" style="BORDER:0px solid;" /> | Finance | Column |
Using EHR Technology To Improve Dementia Care | https://www.providermagazine.com/Issues/2015/September/Pages/Using-EHR-Technology-To-Improve-Dementia-Care-.aspx | Using EHR Technology To Improve Dementia Care | <div> </div>
<div>In 2013, the Alzheimer’s Association estimated that 5.2 million Americans were diagnosed with the disease. This number is expected to grow to 7.1 million by 2025 and 13.8 million by 2050. </div>
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<div>It’s not news that the growing demands to meet regulatory and compliance mandates have providers torn between resident care and time spent meeting documentation needs. A logical approach to technology that crosses disciplines and meets regulatory needs is key to addressing the increased demands for effective dementia care. Here’s where electronic health records (EHRs) can come into play. </div>
<h2 class="ms-rteElement-H2">EHR Solutions Support Dementia Care</h2>
<div>EHRs can support dementia care in three important ways:</div>
<div>■ Facilitate and guide the delivery of standardized care protocols to leverage current best practices in dementia care and allow organizations to evaluate and improve the efficacy of their current dementia programs;<br><br></div>
<div>■ Ensure resident data are captured in a consistent manner so that they can be analyzed for trends in population and individual resident health to facilitate proactive interventions that can improve the quality of life for residents with dementia; and<br><br></div>
<div>■ Allow for individualized, person-centered care plans and documentation to give the interdisciplinary team a holistic view of the resident to support more effective care coordination, ultimately resulting in better outcomes for the resident.</div>
<h2 class="ms-rteElement-H2">Leverage Current Best Practices </h2>
<div>Dementia research is driving new approaches to care and changes in best practices. Given the rapid pace of change, it is challenging for clinicians and caregivers to keep current with the latest information. Clinical Decision Support (CDS) embedded in the EHR gives providers access to evidence-based care plans reflecting current best practices that can then be individualized to the needs of the resident. <br><br></div>
<div>Care plans based on standardized protocols also allow organizations to evaluate the effectiveness of their approaches to dementia care and the programs they have implemented. Absent consistent care planning and delivery, it is difficult to determine and demonstrate to the market that the organization’s approach results in better outcomes for residents with dementia.</div>
<h2 class="ms-rteElement-H2">Data Capture, Outcomes Analysis</h2>
<div>While notes regarding observations and events are helpful, information regarding a resident’s condition must be captured in a consistent, quantitative manner so that it can be analyzed for trends to drive proactive interventions and changes in the care plan to improve outcomes.<br><br></div>
<div>The EHR solution should include a Point-of-Care module that allows users to add options that trigger targeted data capture from caregivers at the bedside through touch-screen, device-friendly technology. This solution adds value to real-time behavior monitoring, which lends itself to future analysis.<br><br></div>
<div>The EHR solution should also provide a tool to allow for the analysis of data in real time. The value of analyzing Minimum Data Set (MDS) data is diminished, as those data are typically 90 days old. While it can be helpful to look back in time, the goal should be to improve the quality of life for residents today.<br><br></div>
<div>The analytics tool should also be able to aggregate data from third-party systems so that factors such as staffing can be analyzed in conjunction with resident data to determine the impact of other factors on resident outcomes.</div>
<h2 class="ms-rteElement-H2">Person-Centered Care Plans</h2>
<div>The EHR should be both customizable and evidence-based. As stated earlier, this allows the interdisciplinary team to document and easily access the holistic view of the resident, which is imperative to providing person-centered care and improving outcomes. <br><br></div>
<div>The EHR should allow providers to build a comprehensive plan of care that individualizes attention, interventions, and outcomes for residents. Clinicians and caregivers should be able to:<br><br></div>
<div>■ Build individualized and interdisciplinary care plans, with customizable goals and approaches, at a corporate or facility level for controlled access to standardized documentation;<br><br></div>
<div>■ Build custom tasks and interventions in Point of Care to ensure person-centered care and treatment;<br><br></div>
<div>■ Promote documentation of exceptions to care to further define and customize care, allowing review of changes in status and condition; and<br><br></div>
<div>■ Provide quality Point of Care reporting: </div>
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<div>documentation.<br><br></div>
<div>An EHR that can address the unique requirements of dementia care and incorporates access to current, evidence-based protocols for dementia care can enable providers to meet the increasing demands of caring for more residents with dementia. More importantly, it can help providers improve the quality of life and deliver better outcomes for residents with dementia. <br><br><em>Megan Lenthe, RN, BSN, is the senior clinical product manager at <a target="_blank" href="http://www.matrixcare.com/">MatrixCare</a>. She can be reached at <a href="mailto:Meagan.Lenthe@MatrixCare.com">Meagan.Lenthe@MatrixCare.com</a> or (952) 995-9904.</em><br></div> | In 2013, the Alzheimer’s Association estimated that 5.2 million Americans were diagnosed with the disease. This number is expected to grow to 7.1 million by 2025 and 13.8 million by 2050. | 2015-09-01T04:00:00Z | <img alt="" src="/Issues/2015/September/PublishingImages/tech_t.jpg" style="BORDER:0px solid;" /> | Technology | Column |