| Medication Management Key To Improving Quality | https://www.providermagazine.com/Issues/2016/February/Pages/Medication-Management-Key-To-Improving-Quality.aspx | Medication Management Key To Improving Quality | <div> </div>
<div>According to the National Institutes of Health, those older than age 70 are 3.5 times more likely than younger individuals to be admitted to the hospital due to adverse drug reactions associated with psychotropic medications. </div>
<div>While that stat may be shocking, it should be no surprise that medication management plays a large role in clinical and resident-centric care.</div>
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<div>Improved medication management processes combined with senior care organizations’ electronic health record (EHR) and e-prescribing tools can better protect residents, but also help meet care quality goals and drive performance improvement initiatives.</div>
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<div>Safer and efficient medication management should be an enterprise-wide quality goal, which will require information technology tools to be accessed at any location across the senior care organization, or the medical practice or home of the prescriber, when necessary. </div>
<h2 class="ms-rteElement-H2">Collaboration Necessary</h2>
<div>Similar tools have allowed organizations to drastically reduce the number of residents’ current prescriptions, improving safety and medication adherence. Quality improvement efforts such as better medication management, however, are less likely to be successful without collaboration among organizational leaders, staff providers, and external physicians whose prescribing behaviors may need to be modified.<br><br></div>
<div>When presented with verifiable data in this regard, prescriber behavior discussions are often more productive and can result in eliminating unnecessary medications and improving outcomes.<br><br></div>
<div>Reducing potential inappropriate medications (PIMs) is not just about reducing hospitalizations, although that itself is a worthy quality improvement goal. Reducing PIMs is also a significant quality issue among residents due to the increased chances of drug-drug interactions associated with “polypharmacy” situations and the improved medication adherence associated with reducing the number of medications.<br><br></div>
<div>From a cost perspective, prescription medications constituted $271 billion of the $2.9 trillion the Centers for Medicare & Medicaid Services (CMS) spent in 2013, the agency reported. CMS attributes the 2.5 percent medication spending growth that year to new medicines and increased utilization, both of which could be impacted by reducing PIMs.<br><br></div>
<div>One study shows that almost 40 percent of older adults in the United States take five or more prescription medications per month. Up to one-quarter of these prescriptions may be PIMs. This study also found that electronic-data analysis and electronic decision support tools positively impacted physician prescribing habits and, on average, eliminated two PIMs in the senior population studied. <br></div>
<h2 class="ms-rteElement-H2">Linking Systems</h2>
<div>As senior care organizations are discovering, however, it is crucial that EHR and e-prescribing systems are linked across communities. Ineffective medication monitoring can be partly attributed to health information technology that is neither integrated nor interoperable. Linked information systems allow for rapid medication reconciliation, drug-allergy and potential drug-drug interactions, and side-effect notifications, all delivered within the physician’s workflow at the point of prescribing. <br><br></div>
<div>More advanced, integrated e-prescribing systems include simplified screens for order entry tailored to physicians’ preferences to allow for quick check-ins and streamlined entry for medication, imaging, lab, treatment, and diet orders. These tools can improve resident safety and streamline documentation for accurate, easy reporting and can significantly reduce or eliminate medication-related errors.<br><br></div>
<div>Moreover, improved safety reduces liability and regulatory compliance exposure for the senior care organization. For optimal safety, the system should be certified with Omnicare, Pharmerica, Prescribers Connection, and SoftWriters, giving the senior care organization access to accurate, real-time exchange of pharmacy information that meets National Council for Prescription Drug Programs’ standards.<br><br></div>
<div>Further certification should be sought from the Drug Enforcement Administration’s electronic prescriptions for controlled substances rule, which designates that the medication management technology has been subject to an audit process. </div>
<h2 class="ms-rteElement-H2">A Case In Point</h2>
<div>One senior care organization leveraging health information technology tools to improve medication management and reduce PIMs is a nonprofit, faith-based organization with two continuing care retirement communities in Northern Virginia. The company offers a continuum of services and health care, as well as home, palliative, and hospice care.<br><br></div>
<div>One of the company’s buildings recently completed a medication-management pilot project that integrated and consolidated its EHR and e-prescribing data across the enterprise. The pilot project was part of its program to create a more homelike environment, including easier access to the outdoors or shorter distance to basic activities, but also clinical changes to help reduce PIMs while still effectively managing residents’ conditions.<br><br></div>
<div>While residents’ preferences about their medications and side effects are a major consideration, so are analyzing clinical data and working with residents’ physicians and pharmacies to identify unnecessary prescriptions. The results have been a significant reduction of PIMs and improved communication with residents’ physicians about prescribing behaviors. <br></div>
<h2 class="ms-rteElement-H2">Quality Improvement Is Continuous </h2>
<div>Whether it is improved medication management or another quality target, with data easily accessed across an organization, clinical leaders can efficiently monitor trends and clinical documentation from any location. This access makes facility or community reviews more efficient because leadership is better informed prior to visits. More review time can be spent understanding and improving team workflows instead of determining which data are accurate.<br><br></div>
<div>In addition, demonstrating quality improvement trends to prospective residents, families, payers, or provider organization partners is easier and more accurate and timely than trying to report from disparate clinical data analytics systems. Easily integrated and interoperable information systems also make participating in emerging value-based care models, such as Accountable Care Organizations, much more feasible and cost-effective for senior care companies.<br><br></div>
<div>Not to mention, top-down-driven quality improvement initiatives, especially when they involve altering physician behaviors, are less likely to be successful without input and collaboration from frontline clinicians and other caregivers.<br><br></div>
<div>By involving all providers in goal setting, listening to their feedback, and understanding their concerns, organizations can gain better insight into how the leadership’s quality-improvement targets will impact clinician workflows and, most importantly, resident care.<br><br></div>
<div>With the internal and external providers’ collaborative participation in quality improvement goals, organizations can increase the likelihood of achieving the desired safety results and clinical outcomes. <br><br></div>
<div>These goals may include reduced PIMs and adverse drug events, which will no doubt also improve staff morale, resident care, and community-wide satisfaction. </div>
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<div><em>Aric Agmon is executive vice president and president of MatrixCare CCRC Solutions.</em></div> | Improved medication management processes combined with senior care organizations’ electronic health record (EHR) and e-prescribing tools can better protect residents, but also help meet care quality goals and drive performance improvement initiatives. | 2016-02-01T05:00:00Z | <img alt="" src="/Issues/2016/February/PublishingImages/caregiving_t.jpg" style="BORDER:0px solid;" /> | Caregiving | Column |
| Ten Steps To Staff Stability | https://www.providermagazine.com/Issues/2016/February/Pages/Ten-Steps-To-Staff-Stability-Part-Two.aspx | Ten Steps To Staff Stability | <div id="__publishingReusableFragmentIdSection"><a href="/ReusableContent/4_.000">a</a></div><div> </div>
<div>As the economy continues to improve and more job opportunities open up, it is harder to replace staff who leave. Maintaining current staff is all the more important.</div>
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<div>Staff stability is necessary to succeed in this performance business environment. Health care payers and partners are increasingly focused on outcomes. Staff who work with the same residents and co-workers everyday can prevent avoidable declines. They recognize immediately when something’s wrong and can work together to address it. </div>
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<div>It’s a common myth that staff will leave for a small difference in pay. When staff are part of a team and their contribution is valued, they aren’t inclined to look around. But if staff don’t feel their contribution matters, they will look for a workplace where it does. A few cents more is only tempting if the current workplace is stressful and unrewarding. </div>
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<div>Company leadership and that of direct supervisors are the crucial ingredients to keep current staff. They will stay, even as options open up in a good economy, when they have a good daily work experience. </div>
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<div>Just as the company can keep new employees by establishing a solid relationship from the start (<a target="_blank" href="/archives/2016_Archives/Pages/0116/10-Steps-To-Staff-Stability.aspx"><em>see Part One, Steps 1 through 5, January 2016</em></a>), so too, can it keep its longer-term staff by maintaining that relationship.</div>
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<div>Part Two of this series encourages companies to create a stable environment, maintain a level of communication staff can count on, and put systems in place so staff can work together. With staff actively engaged day-to-day, the company will be well on its way to accomplishing the rest of its organizational priorities. Without staff stability and engagement, it will be hard pressed to succeed on any front. </div>
<h2 class="ms-rteElement-H2B">STEP 6. Reduce stress and improve morale. </h2>
<div>Today’s stressed-out employees are tomorrow’s call-offs. To reduce the stress:</div>
<div>■ Check in with people. Round daily and ask if staff have what they need, what they need help with, and how the new person is working out. Say thank you. Show a genuine interest in their well-being, both on and off the job.</div>
<div><br>■ Take management stand-up to the staff. A quick daily stand-up with staff allows leaders to check in and problem-solve on the spot with the whole team present so that communication is seamless. Leaders can use the stand-up to review a watch list of residents known to be especially vulnerable to decline, and they can hear from the staff immediately about any concerns.</div>
<div><br>■ Over-communicate. In the absence of direct communication from leaders, staff will fill in with their own assumptions and even rumors. Make sure they hear from leaders—and leaders hear from them—directly and regularly. Hold staff meetings to let staff know that management is working hard to bring good people on board, and invite them to be partners in the process. Keep them informed throughout the process. </div>
<div><br>■ All Hands on Deck. At the high-labor times of day, especially mealtimes, have the management team get out on the units and provide extra support. There are many nonclinical ways to help so that certified nurse assistants (CNAs) and nurses are available to attend to the services only they can provide.</div>
<div><br>■ Focus on morale boosters that build community. Have fun. Have cookouts and family events. Celebrate any successes. Show appreciation. </div>
<h2 class="ms-rteElement-H2B">STEP 7. Create daily stability.</h2>
<div>Aim for a perfectly staffed day:</div>
<div>■ No call-outs and no sick-pay hours.</div>
<div><br>■ No registry hours.</div>
<div><br>■ No light-duty assignments.</div>
<div><br>■ No orientation hours.</div>
<div><br>■ Fully staffed to budget—every shift, every neighborhood.</div>
<div><br>■ Total hours (not ppd).</div>
<div><br>■ Overtime = less than 1 percent (or four overtime hours).</div>
<div>Pay attention to attendance. It’s an area that tends to slip out of control during times of stress and can prevent management from getting traction to stabilize. While some absences are part of the vicious cycle as staff who are over-extended call-off, as the company makes more good hires and fills vacancies, staff stress will abate. This will allow managers to re-establish good attendance, which is necessary for continuity of daily care. Here’s how to get a hold of it:</div>
<div><br>■ Tell everyone daily stability is the priority. When everyone on the schedule comes to work, everyone can do their job and help each other out. Explain that management will be keeping track and talking with anyone who is struggling with their attendance. Remind everyone of the attendance policies that are in force and the help that is available.</div>
<div><br>■ Count it. Accurately track individual absences and look for trends. Assign one staff member to record all call-offs on individual staff member attendance records. Start tracking the total number of call-offs per month (whole staff, all call-offs count).</div>
<div><br>■ Let people know management is paying attention. Show staff how they are performing by sharing their attendance record with them each quarter. One director of nursing (DON) keeps a list on the white board in her office of everyone who calls off for the month. She says staff are startled to see their names up there when they stop by her candy bowl. </div>
<div><br>■ Discuss absences at daily stand-up, and act on them immediately. When people call off, talk with them within 24 hours and let them know they were missed. Assume that everyone tells the truth and that they all want to work as scheduled. When people are held accountable in a nice way with immediate feedback, they tend to want to do better because they know the manager will notice. </div>
<div><br>■ Have people call the administrator or DON. If the company has high numbers of call-offs, require anyone calling off to speak directly with the administrator or DON. This will eliminate frivolous call-offs and give leaders direct knowledge of and communication with staff who are struggling.</div>
<div><br>■ Be proactive. If someone has a sick child or is ill themselves, check in to see if they think they will be absent for more than one shift. The staff member who is most likely to call off tomorrow called off today. So plan ahead to get a substitute instead of waiting until they call off later that night.</div>
<div><br>■ Don’t use the attendance policy enforcement to substitute for holding people to high performance levels. If some individuals are not doing their jobs, deal with their performance issues directly, not through their attendance.</div>
<h2 class="ms-rteElement-H2">SCHEDULING ISSUES</h2>
<div>Scheduling and attendance go hand in hand. Some keys to scheduling success include:</div>
<div>■ Allow staff to trade days, within guidelines, such as:</div>
<div>○ Person scheduled to work must notify supervisor and scheduler of who is taking their shift and what the traded schedule is.</div>
<div>○ No overtime without approval.<br><br></div>
<div>■ Honor requests for time off. If staff need time off, give it to them. In an environment where everyone is working well together, staff will cover for each other. Better to have a planned absence than an unscheduled one.<br><br></div>
<div>■ Increase full-time and decrease part-time. Aim for at least 75 percent of staff members to be full-time. The company should be its employees’ primary employer. Have their full focus. Full-time staff are able to follow up and maintain continuity in ways that part-time staff can’t, because they aren’t there.<br><br></div>
<div>Having lots of part-time people is a scheduling nightmare. With a high percentage of part-time staff, schedulers focus on getting people their hours. With a high percentage of full-time people, schedulers can focus on building regular schedules. With regular schedules, the same staff work with each other and build teamwork.<br><br></div>
<div>■ Organize the schedule to maximize stability. One example is the 4-on 2-off schedule. People get into a rhythm of working four days and having two days off. They can count on it. They get regular rest and can plan ahead. By contrast, the every-other-weekend-off schedule is more complicated. It means staff sometimes work long stretches without a break. Their days working and days off vary from week to week. This makes planning ahead more difficult. It’s often hard in theory for staff to give up every weekend off. But, in reality, many staff come to appreciate the regularity and the pace of a 4-on 2-off. (It can be modified so that staff have every third weekend off.)<br><br></div>
<div>■ Make a master schedule for staff. Get it out at least a month ahead. Keep it up to date and highly visible. Indicate staff’s assignment on the master schedule.<br><br></div>
<div>■ Have consistent work teams. Have staff work on the same unit. Don’t move people around. When people work regularly with each other, they develop ways of pitching in at each other’s heavier times (see Step 9 on consistent assignment). Working with the same residents and co-workers enables staff to anticipate and plan their work, instead of having to continually adapt to new, unfamiliar needs. <br><br><span id="__publishingReusableFragment"></span></div>
<h2 class="ms-rteElement-H2B">STEP 8. Charge nurse leadership.</h2>
<div>The company’s charge nurses are the most important leaders in the organization because they are the leaders where care happens. The organization’s performance depends on the quality of teamwork and critical thinking among staff closest to the residents.<br><br></div>
<div>■ Communicate in-person daily. Bring the nurses together for a quick stand-up, or round, and meet with each of them. Discuss staffing, clinical, and operational issues. They will step up their leadership as they are called upon. </div>
<div>Have expectations of their leadership. Make sure they are engaged leaders and are responsible for the teamwork among their staff. Expect charge nurses to huddle with their staff and show them how if they need help. <br><br></div>
<div>■ Evaluate the nurses. Individually assess each of them. Look at their clinical skills, their interpersonal skills, their dependability, and their leadership. Identify strengths, opportunities for growth, and action management can take to support that growth.</div>
<div>○ Act to improve their leadership. Leadership skills are rarely taught in nursing school. For many new nurses, this is their first time to step into a leadership role. Many long-time nurses who have for years been able to be crusty “my way or the highway” nurses, now need to be required to pay attention to their impact on team cohesion and performance. Address this with them directly. Identify specific practices and skills, and make a plan to support their development. </div>
<div>○ Provide regular support to struggling nurses. Consider the charge nurses the “canary in the coal-mine”—their stress is an early warning sign of a distressed workgroup and the poor outcomes that naturally follow. Use quick check-in meetings and regular rounding to touch base, identify needs, and provide support. Provide daily support to new nurses over their first three to six months, guiding them to step into their leadership roles and manage their time and their team.</div>
<h2 class="ms-rteElement-H2B">STEP 9. Create systems that support teamwork and high performance.</h2>
<div>Processes that have a high return include Consistent Assignment, Shift Huddles, and Inclusion of Consistently Assigned CNAs in Care Planning.<br><br></div>
<div>By caring for the same people every day that they work, they have in-depth and timely knowledge and insight to share with the rest of the care team. They are able to do the little things that make a resident’s day, catch early warning signs immediately and help resolve issues, and be part of the discussion about the goals of care.<br><br></div>
<div>Not only do these practices improve outcomes for residents, they also improve staff satisfaction and retention. People tend to stay in jobs where they are needed and where what they do makes a difference. </div>
<h2 class="ms-rteElement-H2">Consistent Assignment</h2>
<div>■ Why. When staff work with the same residents and the same staff they become a cohesive unit. A team. Co-workers cover for each other during breaks, they help each other out when two people are needed, and they work out their schedules if one needs time off.</div>
<div>○ Residents benefit by having people who know them provide them with intimate care. This way of working provides a high level of connection and affiliation for both the staff and residents. Staff who are consistently assigned become very tuned in to the residents they care for and are able to note subtle changes that may indicate an acute change in condition. Consistently assigned staff are very valuable team members. They have critical information that can make a real difference for a resident. <br><br></div>
<div>■ How. Start by grouping staff so that they work in the same area every day. Make assignments based on staff’s interests and abilities. Some staff work better with people with dementia and others with short-term rehab.</div>
<div>○ Be fair. Make sure there is an even distribution of the workload. Have staff discuss what is needed to take care of each resident and together determine fair assignments. Revisit as census, acuity, and staffing change.</div>
<div>○ Make the schedule assignment-centered. Instead of having the schedule be built by giving staff their hours, structure the schedule around the resident assignments. Have primary CNAs and consistent back-ups for each resident assignment. </div>
<div>○ Don’t move them. Even if unscheduled absences occur, don’t pull staff. Pulling staff to cover for absent staff disrupts two groups of residents instead of one. Use All Hands on Deck instead.<br></div>
<div>○ Listen to what staff tell you about residents. They have timely, accurate information about residents that is crucial to the facility’s ability to deliver good care. When management values their contribution, they become even more committed to doing a good job. When it doesn’t, managers may be putting them in the position of having to go against what they know, such as when they are told to go ahead and get the person up or give them a bath, when they know that’s not best for the person at that time.<br><br></div>
<div>Not being listened to makes some staff not want to be consistently assigned but instead be able to maintain emotional distance as they carry out the mandatory tasks.</div>
<h2 class="ms-rteElement-H2">Huddles</h2>
<div>■ Why. Quick daily start-of-shift huddles with CNAs and nursing staff help get everyone on the same page at the start of a shift. Mid-shift huddles help everyone stay on the same page, updating everyone on current information. These huddles give the consistently assigned CNA a place to share information, and a way to game plan with the other staff ways of working together when needed.<br><br></div>
<div>■ How. These huddles are five to 10 minutes long and review residents by exception. Talk about anyone on a watch list, any new residents, anything unusual or of concern, and any appointments or new developments.</div>
<div>Nurses fill in any medical factors, contributing to what CNAs are sharing, or requiring extra attentiveness. Problem-solve on the spot. Huddles require good facilitation to keep on time and on target and draw out everyone’s contribution. </div>
<h2 class="ms-rteElement-H2">Involving CNAs In Care Planning</h2>
<div>■ Why. Including CNAs in care planning makes the care planning process come alive. The information they bring to the table is so real and relevant that it changes the quality of the meeting. Residents and family members feel the comfort of having them in the room, and the caregiver is an integral part of the process. Using this valuable information and having this structured way of capturing the information formalizes the connection and affiliation the company is nurturing. <br><br></div>
<div>■ How: First make sure the care plan meeting is functioning well, that everyone is on time, prepared, and uses the time for real problem solving. Prepare CNAs by explaining how the meeting works. Consider a role-play of a meeting. Communicate the care plan meeting schedule to CNAs each week, post it in the break room, and note it on their assignment sheet. Have them work with hall partners to cover while they are in the meeting.</div>
<div>Have CNAs focus their contribution on three key areas: </div>
<div>○ Activities of daily living—any change in the person’s ability to participate in care?</div>
<div>○ Mood and cognition—does the resident seem content? Agitated? More or less confused?</div>
<div><div>○ Dining—change in appetite? Change in the amount of assistance needed for dining?<br><br></div>
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<div style="text-align:center;"><img width="597" height="390" src="/archives/2016_Archives/PublishingImages/HR.jpg" alt="" style="margin:5px;" /></div>
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<h2 class="ms-rteElement-H2B">STEP 10. Quality improvement (QI) closest to the resident: Grow and develop staff.</h2>
<div>This includes daily problem-solving about residents as concerns come up, QI rounding for clinical areas of focus such as antipsychotics or pressure ulcers, incident-specific reviews such as post-fall, and Quality Insurance and Performance Improvement pilots for performance improvement projects.<br><br></div>
<div>In all these situations, as the consistently assigned CNAs bring forward concerns, be sure to seize teachable moments.</div>
<div>Follow up and close the loop, so that they know what is being done and how it is going and can share how it is going from their end. <br><br></div>
<div>Staff appreciate opportunities to grow in their abilities and knowledge about what is happening with residents. Being involved at this level is very meaningful to staff as they are able to make a contribution to residents’ well-being at a critical juncture. It reinforces how much they are valued and bolsters their own commitment to the organization.</div>
<h2 class="ms-rteElement-H2">Where Everyone Wins</h2>
<div>Nursing care centers are facing a defining moment. Performance at the point of service matters more than ever before. Success depends on the company’s ability to maintain staff stability and to engage staff. And that’s just what staff are looking for—a positive work environment where they matter. It’s a win-win. </div>
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<div><em>Cathie Brady and Barbara Frank are co-founders of B&F Consulting. Brady can be reached at cbrady01@snet.net or (860) 334-9379, and Frank can be contacted at bfrank1020@aol.com or (617) 721-5385. David Farrell, LNHA, MSW, is vice president, subacute services, at Telecare Corp. in Alameda, Calif. He can be reached at dfarrell@telecarecorp.com or (510) 725-7409.</em></div> | Staff stability is necessary to succeed in this performance business environment. Health care payers and partners are increasingly focused on outcomes. Staff who work with the same residents and co-workers everyday can prevent avoidable declines. They recognize immediately when something’s wrong and can work together to address it. | 2016-02-01T05:00:00Z | <img alt="" src="/Issues/2016/February/PublishingImages/HR_t.jpg" style="BORDER:0px solid;" /> | Workforce;Management | Column |
| OT: The Misunderstood Therapy | https://www.providermagazine.com/Issues/2016/February/Pages/OT-The-Misunderstood-Therapy.aspx | OT: The Misunderstood Therapy | <div><br>For some, long term care (LTC) is synonymous with the last chapters of older adults’ lives. But today’s nursing care center can become a new community where roles and routines are transformed and redefined: how older adults will live, where they live, whom they interact with, and the quality of care provided daily.<br><br></div>
<div>The quality of care is dictated by the competency and range of skilled and ancillary services provided within the nursing care center, and that includes the occupational therapist (OT), who should play an important role on the interdisciplinary team. OTs offer unique perspectives focused on the older adult’s functional level of performance of daily roles and routines in the skilled nursing setting. </div>
<h2 class="ms-rteElement-H2">Clarifying The Discipline</h2>
<div>OTs are often asked what their profession truly does. To clarify, OT does not assist older adults with securing employment, as health care providers, families, and residents have inquired. Physical therapy and speech therapy are afforded professional titles that are self-explanatory and widely understood. However, the majority of health care providers do not wholly understand the scope of OT practice.<br><br></div>
<div>OT is typically associated with providing skilled services in the areas of assistance with daily living and wheelchair seating and positioning. While this is true, OT expertise is specialized, comprehensive, and diverse, offering a much wider range of skilled services provided to LTC residents. </div>
<h2 class="ms-rteElement-H2">An Underutilized Resource</h2>
<div>OT plays a vital role in the provision of skilled health care services. The therapist is instrumental in determining the health care needs of LTC residents and providing services that ultimately enhance their quality of life and health.</div>
<div>While OT is common in skilled nursing centers, literature suggests medical staff don’t understand OTs’ roles and scope of practice in LTC. This is unfortunate given the OT’s potential to help enable individuals to achieve and maintain an independent, functional, and meaningful life. <br><br></div>
<div>While OT is offered as a resident service alongside physical and speech therapy, research suggests OT is the most misunderstood and under-appreciated of all three disciplines. This malignment of the profession is important to note, because practicing in an interdisciplinary setting with limited or inaccurate information presents significant barriers to the best possible care for the LTC resident. Knowledge deficits include the understanding of splinting, physical agent modalities (PAMs), and evidence-based practice. </div>
<h2 class="ms-rteElement-H2">What OTs Actually Do </h2>
<div>Using specialized skills in assessment and treatment, OTs provide care to long term residents to prevent injury or impairment, restore functional activity, and enhance participation in daily life. Splinting—temporary immobilization of a limb—is a crucial component of a comprehensive long-term rehabilitation program. Its early, effective, and consistent use is recommended for successful prevention and management of upper extremity deformities.</div>
<div><br>Researchers have found that LTC splinting: 1.) reduced treatment time; 2.) eliminated the need for multiple medical providers; 3.) promoted faster recovery resulting in decreased medical costs; and 4.) resulted in functional outcomes ensuring a faster return to productive lifestyles. <br><br></div>
<div>PAMs represent interventions that address a broad range of prevalent conditions, including pain, edema, neuromuscular dysfunction, stroke recovery, contracture, arthritis, urinary incontinence, slow-healing wounds, carpal tunnel syndrome, peripheral neuropathy, chronic obstructive pulmonary disease, and fall prevention, according to R. Richards in a 2011 article on PAMs in therapy in Advance magazine. These interventions optimize treatment outcomes and improve quality of life without use of surgery or medications. PAMs do not replace therapists, but do represent valuable clinical tools that can enhance outcomes for a range of conditions. </div>
<h2 class="ms-rteElement-H2">Evidence-Based Practice</h2>
<div>OT fall prevention programs are multifaceted interventions that increase residents’ self-confidence during daily functional routines, lower the frequency of falls during functional mobility, reduce rates of injury and re-injury, improve perceptions of environmental safety within LTC units, and enhance residents’ sense of self-efficacy and well-being.<br><br></div>
<div>Similarly, OT bed and wheelchair positioning programs significantly decrease risk of wound occurrence and amount of healing time, increase adherence to positioning protocols for high-risk residents, and improve quality of life due to decreased pain.</div>
<h2 class="ms-rteElement-H2">The Time Has Come</h2>
<div>Medical and other interprofessional disciplines are positioned as critical liaisons to OT services. Medical staff initiate requests for OT through the referral process that connects residents to therapy services. Overlooking residents who are appropriate for OT and inaccurately identifying needs minimizes residents’ opportunities to enhance quality of life and mastery within their environment. </div>
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<div>OT practitioners play a vital role in providing client-centered, short-term, and long-term rehabilitation services to individuals in skilled nursing centers that enhance the client’s participation in meaningful roles and occupations of daily living. They also provide consultative services to facility staff and residents to improve quality of life and client satisfaction. The time has come to recognize their services. </div>
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<div><em><img width="79" height="109" class="ms-rtePosition-1" alt="Richard Dressell III" src="/Issues/2016/February/PublishingImages/mgmt_RichardDressel.jpg" style="margin:5px 10px;" /></em></div>
<em><div> </div></em><div><em>Richard J. Dressel III, OTD, OTR/L, is an occupational therapist at Westminster Village at Dover with Select Rehab. He can be reached at Richard.dressel3@gmail.com and (302) 980-8333.</em></div>
| OT is typically associated with providing skilled services in the areas of assistance with daily living and wheelchair seating and positioning. While this is true, OT expertise is specialized, comprehensive, and diverse, offering a much wider range of skilled services provided to LTC residents.
| 2016-02-01T05:00:00Z | <img alt="" src="/Issues/2016/February/PublishingImages/mgmt_t.jpg" style="BORDER:0px solid;" /> | Management | Column |
| February Trends | https://www.providermagazine.com/Issues/2016/February/Pages/February-Trends.aspx | February Trends | <h2 class="ms-rteElement-H2B">Lift Up Your Glass: Moderate Drinking Tied To Fewer Deaths In Early-Stage Alzheimer’s
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<div>An aperitif every now and then may reduce risk of death in patients with early-stage dementia or Alzheimer’s disease, reports a recent study in BMJ Open.<br><br></div>
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<div><img width="171" height="164" src="/Issues/2016/February/PublishingImages/trends_glass-icon.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;" />Whether alcohol truly is a vice or a virtue in terms of preserving health has long been debated by researchers. Moderate drinking has been associated with a lower risk of developing and dying from heart disease and stroke. But alcohol is known to damage brain cells, and given that dementia is a neurodegenerative disorder, drinking might be harmful in those with the condition.<br><br></div>
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<div>Danish researchers decided to weigh in on the half empty/half full debate by following for three years 321 people with early-stage dementia or Alzheimer’s disease. The group asked the patients’ caregivers to track how much they drank and compared these results with mortality data.<br><br></div>
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<div>Tipplers—those who drink two to three units of alcohol every day—saw the most benefit. These drinkers had a 77 percent lowered risk of death compared with those who sipped one or fewer units. No difference in death rates occurred among abstainers or those who quaffed more than three units every day.<br><br></div>
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<div>The study authors offer several explanations for the findings. For instance, moderate drinkers may have a richer social network, which has been linked to improved quality, and possibly length, of life. “We cannot solely, on the basis of this study, either encourage or advise against moderate alcohol consumption in patients with Alzheimer’s disease,” the authors write, suggesting that further studies are needed.</div>
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<h2 class="ms-rteElement-H2B ms-rteThemeForeColor-8-5">Gear Change: Aging Impacts Brain’s 24-Hour Clock </h2>
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<div>Brain research confirms the adage: “Times change and we with time.” As we age, our body’s internal clocks that regulate brain and body processes, called circadian rhythms, speed up and slow down, such that most of our clocks stay longer in the “morning” phase and less in the “night” phase. <br></div>
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<div><br><img src="/Issues/2016/February/PublishingImages/trends_daynight.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;" />“Studies have reported that older adults tend to perform complex cognitive tasks better in the morning and get worse through the day,” said psychiatrist Colleen McClung, MD, at Pitt School of Medicine and lead author of a recent article in the Proceedings of the National Academy of Sciences. “We also know that the circadian rhythm changes with aging, leading to awakening earlier in the morning, fewer hours of sleep, and less robust body temperature rhythms.”</div>
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<div><br>Gene activity of these daily patterns has rarely been studied in the brain until now. McClung and her group examined post-autopsy brain samples of 146 people with no history of mental health or neurological problems, categorizing the brains on whether they came from a person younger than 40 or older than 60, and analyzing the prefrontal cortices for the gene expression of thousands of genes. </div>
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<div><br>The team identified 235 core genes that make up the molecular clock in this part of the brain. They also found a set of genes that gained rhymicity in older individuals. </div>
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<div><div><br>This information could ultimately be useful in the development of treatments for cognitive and sleep problems that can occur with aging, as well as a possible treatment for “sundowning,” a condition in which older individuals with dementia become agitated, confused, and anxious in the evening.<br><br></div>
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<h2 class="ms-rteElement-H2B ms-rteThemeForeColor-7-0">One-Two Punch: More Veterans With Advanced Cancer Using Hospice Care And Chemotherapy </h2>
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<div>A one-two punch is being increasingly employed by veterans with advanced cancer to fight this veritable foe: receipt of hospice care concurrently with chemotherapy or radiation therapy.</div>
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<div><br><img src="/Issues/2016/February/PublishingImages/trends_1-2.jpg" class="ms-rtePosition-1" alt="" style="margin:5px 15px;" />Unlike Medicare, the Veterans Health Administration (VA) health care system does not require veterans with cancer to make the “terrible choice” between receipt of hospice services or disease-modifying chemotherapy/radiation therapy. </div>
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<div><br>Researchers led by Vincent Mor of the Providence VA Health Administration Medical Center in Rhode Island recently combed through VA and Medicare administrative data to see the numbers of hospice and cancer treatments received among veteran decedents with cancer from 2006 to 2012.</div>
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<div><br>The proportion of veterans receiving chemotherapy or radiation therapy remained stable at approximately 45 percent, whereas the numbers of veterans who received hospice increased from 55 percent to 68 percent, they wrote in Cancer. Concurrent care, defined as days in the last six months of life during which veterans simultaneously received hospice services and chemotherapy or radiation therapy, rose during this time from 16.2 percent to 24.5 percent. </div>
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<div><br>This dual strategy appeared to extend the patients’ lives. Of those in hospice and on chemo, the median time between treatment termination and death ranged from 35 to 40 days, compared with those who only had hospice (21 days). </div>
| February 2016 Trends | 2016-02-01T05:00:00Z | <img alt="" src="/Issues/2016/PublishingImages/trends_l.jpg" style="BORDER:0px solid;" /> | Management;Caregiving | Column |
| What key health care issue should the presidential candidates focus on? | https://www.providermagazine.com/Issues/2016/February/Pages/What-key-health-care-issue-should-the-presidential-candidates-focus-on.aspx | What key health care issue should the presidential candidates focus on? | <div>In our new “Ask The Reader” feature, each month <em>Provider</em> will pose a question related to a key issue in the long term and post-acute care field. Selected answers will appear in the next issue of the magazine, while additional </div>
<div>responses will be posted online.</div>
<h3 class="ms-rteElement-H3B ms-rteFontSize-3">What key health care issue should the presidential candidates focus on?</h3>
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<div><img width="101" height="142" src="/Issues/2016/February/PublishingImages/Tom%20Color2.jpg" alt="Tom Coble" class="ms-rtePosition-1" style="margin:5px 15px;" />“The key health care issue of the 2016 presidential campaign is the “Silver Tsunami,” yet we hear no candidate talking about it. The cost is not just financial—the issue also affects our workforce and delivery system. The effects are being already being felt at both the state and federal level. The candidate we elect as president is dramatically going to come face-to-face with this issue at the end of their first term (2020), whether they want to talk about it or not.” </div>
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<div><strong>Tom Coble, </strong>President/chief executive officer (CEO), Elmbrook Management Co.</div>
<div>Chair, American Health Care Association (AHCA) Board of Governors<br><br></div>
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<div><img width="101" height="135" src="/Issues/2016/February/PublishingImages/KrisMastrangelo.jpg" class="ms-rtePosition-1" alt="Kris Mastrangelo" style="margin:5px 15px;" />“Health care reform incentivizes lower cost and higher quality across all continuums of care. Three areas that come to mind include:</div>
<div>1. Ensuring cost reduction without clinical compromise;</div>
<div>2. Retaining access to Medicare benefits for the senior population; and</div>
<div>3. Supporting health care providers through the transition via education, access to information, as well as proper funding. </div>
<div>“If we want to get more specific, we should discuss value-based purchasing and the historical successes, failures, and adaptations that have occurred in other settings.” </div>
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<div><strong>Kris Mastrangelo,</strong> CEO, Harmony Healthcare International</div>
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<div><img src="/Issues/2016/February/PublishingImages/RobinHiller.jpg" alt="Robin Hillier" class="ms-rtePosition-1" style="margin:5px 15px;width:101px;height:152px;" />“I am interested in hearing the presidential candidates focus on how to balance the desire to make health care efficient and reduce health care costs with ensuring that patients continue to receive high-quality services and have access to the providers they prefer, which is a very delicate dance. It seems currently the focus is solely on cost reduction, with quality and choice being sacrificed. </div>
<div>“As it relates to long term care, I would love to see the candidates discuss the need for more research related to Alzheimer’s disease, acknowledging the aging of the nursing profession, and recognizing the future reduction in the workforce available to provide care coupled with the explosion in population needing services.”</div>
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<div><strong>Robin Hillier,</strong> CPA, LNHA, STNA, RAC-MT, Owner, Lake Pointe Rehabilitation and Nursing Center Independent owner representative, AHCA Board of Governors</div>
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<div> <img width="124" height="157" src="/Issues/2016/February/PublishingImages/DayneDuVall.jpg" class="ms-rtePosition-1" alt="" style="margin:5px 15px;" />“Alzheimer’s disease and related disorders are the costliest medical conditions we face as a nation. When you factor in all out-of-pocket dollars (estimated at $226 billion in 2015) and the unpaid care that family and friends provide (estimated at $218 billion in 2014), this half-trillion-dollar total per year is staggering. These numbers are expected to skyrocket in the next few years, unless an effective treatment is discovered.”<br><br><strong>Dayne DuVall,</strong> LMT, CAEd, CRTS<br>Chief operating officer, National Certification Board for Alzheimer Care<br><br><br><br><br></div>
<div>Our question for March is, “What keeps you up at night regarding your job?” <br>Email your response to Joanne Erickson at <a href="mailto:jerickson@providermagazine.com">jerickson@providermagazine.com</a>, by Feb. 25.</div>
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| | 2016-02-01T05:00:00Z | <img alt="" src="/Issues/2016/PublishingImages/PersOpins.jpg" style="BORDER:0px solid;" /> | Caregiving | Column |
| The Quality Forum | https://www.providermagazine.com/Issues/2016/February/Pages/The-Quality-Forum.aspx | The Quality Forum | <br><div>The concept of narrowing the network of skilled nursing facilities (SNFs) to which a hospital will refer has gained momentum in some market areas. More often, it involves Medicare discharges for SNF care, related in large part to the increasing penalties in the Hospital Readmission Reduction Program (HRRP).</div><br>However, payers such as Medicare Advantage programs or even Medicaid managed care may use the concept of a network based on both quality and discounted costs. So let’s face it, as we move to more integrated models of care, whether for payment such as bundling, or value-based purchasing to reduce readmissions, “networks” of different types will be tried in different markets. <br><br>First, remember that, ideally, most hospitals and payers would like as large a post-acute network as possible of good quality providers. Provider location will remain critical in choosing both post-acute and long term care, both for the patient visitation by family and proximity to other health care services. <br>Thus, if hospitals can have a larger network of providers with whom they have successful partnerships, they would prefer that. <br><br>Except in the case of specific contracted plans, beneficiaries and families have a choice of providers, and often have multiple sources of input. As they become more sophisticated in choosing post-acute and long term care residences, they will be more discerning.<br><br>The profession is only in the early stages of developing models to track and compare quality metrics in post-acute settings, such as readmission rates for specific diagnoses. Even though readmissions are the focus of some of the networks and models of care, this single metric is just one aspect of what you do.<br>I’ve studied readmission data from SNFs and potentially avoidable causes for many years, and their underlying importance is that lower rates of preventable hospital or Emergency Department visits means you are managing risks of infection, and unstable medical and surgical conditions, effectively.<br><br>So my advice is that you focus on measuring quality comprehensively and objectively, striving to continuously improve it, and report to health care partners about your quality and the systems you have in place to assure and improve it.<br><br>Also, recognize that the client is the resident and their family and that other providers, be they hospitals or physicians, often have difficulty evaluating the options based on different patients’ needs. You have to help them with information, but not by over-emphasizing a small set of metrics.<br><br>The Five-Star rating system on Nursing Home Compare, with all its limitations, has advantages over focusing exclusively on readmission rates and is the one external review of quality that all organizations receive. <br><br>So, as we have known for a long time, a commitment to continuously improving quality and complying with the evolving regulations remain critical. Furthermore, as residents and families have more choices in where they will receive care, customer experience is increasingly critical to monitor and improve on an ongoing basis.<br><br><em>Andy Kramer, MD, is a long term care researcher and professor of medicine who was instrumental in the design and development of the Quality Indicator Survey.</em> | The concept of narrowing the network of skilled nursing facilities (SNFs) to which a hospital will refer has gained momentum in some market areas. | 2016-02-01T05:00:00Z | <img alt="" src="/Articles/PublishingImages/headshots/AndyKramer.jpg" style="BORDER:0px solid;" /> | Quality | The Quality Forum |