Detecting and Treating Dementia Early<p><img src="/Breaking-News/PublishingImages/740%20x%20740/senior_woman_daughter_2.jpg" class="ms-rtePosition-1" alt="" style="margin&#58;5px;width&#58;256px;height&#58;179px;" />​​Dementia is staggeringly common, with an <a href="https&#58;//www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf" target="_blank">overall prevalence of 11 percent&#160;in people ag​ed 65 and over​</a>. This prevalence increases markedly with age, such that it affects over half of octogenarians and one in three will ultimately die in this condition. These statistics do not include mild cognitive impairment (MCI), mental changes that are measurable but not severe enough to affect daily function and are often but not always a precursor to dementia, or <a href="https&#58;//www.cdc.gov/aging/data/subjective-cognitive-decline-brief.html" target="_blank">subjective cognitive decline</a>, self-reported mental fogginess or memory depreciation that aren't able to be measured by a test.</p><h3>Detecting and Diagnosing Dementia</h3><p>Despite being widespread, official diagnosis lags behind the true prevalence, with only 3-4 percent​&#160;of patients having “dementia&quot; (let alone Alzheimer's disease or a specific type of dementia) written anywhere in their chart. This amounts to more than 3 million Americans lacking a diagnosis, a number which will double in the next decades if diagnosing doesn't catch up.</p><p>The early stages of dementia, particularly Alzheimer's disease, which most commonly manifests with short-term memory loss and difficulty navigating an environment, is not always obvious from a short interaction. Verbal abilities can be intact, and a patient can regale you with stories from their youth, masking the fact that when they are sent home from the doctor's office with instructions to take a medication once a day, they may not fully understand, remember, or have the capacity to follow instructions. Caring family members such as adu​​lt children living out of state may also take a long time to go from a subtle feeling or suspicion that something seems off or odd to the conclusion that there may be a real problem. This can obviously have catastrophic consequences—preventable adverse events and hospitalizations; missing the opportunity to reverse, slow, and mitigate disease; and treatment for symptoms that can improve quality of life and functional independence.</p><p>Improving detection and arriving at diagnosis before the onset of catastrophic events, more severe disease, and unmanageable symptoms begins with equipping clinicians on the front lines with validated tools to assess function rapidly, reliably, and comprehensively across <a href="https&#58;//www.ncbi.nlm.nih.gov/pmc/articles/PMC5772157/" target="_blank">cognitive domains</a>. Tools must be simple enough for the non-specialist to gain comfort with and fit reasonably within their established workflows. For example, a recent peer-reviewed study in the <a href="https&#58;//aging.jmir.org/2022/2/e36825/" target="_blank"><em>Journal of Medical Internet Research (JMIR) Aging</em></a> validates the efficacy of a computerized cognitive test. Conducted in-person or remotely, this type of assessment improves accessibility to testing while providing physicians with the tools necessary to diagnose and treat patients.</p><p>To better detect and diagnose dementia, physicians must go beyond patient interviews (i.e. do you feel like you are losing your memory?) and use formal assessment tools, looping in a specialist for complex cases when needed. If MCI is identified, the physician must further assess for functional impairment to arrive at a diagnosis of dementia and perform serial assessments for changes in cognitive status (improvement or decline) that could change diagnosis and management approach.</p><h3>Preventing Adverse Events and Hospitalizations</h3><p>People with dementia have much higher hospitalization rates than older adults without. According to a recent study, 40 percent&#160;of <a href="https&#58;//agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16636" target="_blank">hospitalizations in the dementia cohort could have been preventable</a> with proper identification, education, and outpatient care. When care teams are on the same page about a person's cognitive status, the individual can be given additional supervision or support to prevent adverse events. Consistency between caregivers is essential toward preventing trips to the hospital as well as reducing uncertainty and conflict around patient care and well-being.</p><h3>Ruling Out and Addressing Reversible Causes</h3><p>Cognitive impairment does not always spell dementia. Many cases of MCI are due to reversible causes, with the most common offenders being medication adverse events, depression, sleep apnea, infection, and thyroid disease. Long COVID is another major driver, with more than 70 percent​&#160;of sufferers calling out brain fog as a chief complaint.</p><p>It is for this reason that the <a href="https&#58;//www.ncbi.nlm.nih.gov/pmc/articles/PMC5772157/" target="_blank">American Academy of Neurology</a> cites ruling out and addressing reversible causes as a primary reason for performing cognitive assessment. Clinicians should perform a medical evaluation of common reversible causes.</p><h3>Addressing Risk Factors to Slow Progression</h3><p>The landmark FINGER study and subsequent <a href="https&#58;//pubmed.ncbi.nlm.nih.gov/32627328/" target="_blank">World-Wide FINGERS network</a> found that 40 percent&#160;of dementia is preventable by addressing certain modifiable risk factors. These include&#58;<br></p><ol><li>high blood pressure,</li><li>smoking,</li><li>diabetes,</li><li>obesity,</li><li>physical inactivity,</li><li>poor diet,</li><li>high alcohol consumption,</li><li>low cognitive engagement,</li><li>depression,</li><li>traumatic brain injury,</li><li>hearing loss,</li><li>social isolation, and</li><li>air pollution.</li></ol><p></p><p>The physician is charged with the task of working with the patient and caregivers to put together a comprehensive cognitive care plan that addresses these modifiable factors in a holistic manner. By giving them the knowledge, resources, and motivation to see the patient through the long journey of cognitive change, they can slow dementia's progression and give the patient a better prognosis.</p><p>There are now few pharmaceutical options to treat dementia, with cholinesterase inhibitors showing efficacy in dementia's early stages. There are multiple medications at different stages of the drug development pipeline, and all of them depend on patients being identified as early as possible to have the best chance of success.</p><p>Behavioral and psychiatric symptoms are common in dementia, and an early and specific diagnosis enables clinicians to treat these with the best approaches available.</p><p><em>Yael Katz, Ph.D.,​​ is co-founder and CEO of BrainCheck. Katz&#160;received her Ph.D. in neuroscience from Northwestern University and conducted her postdoctoral work at Princeton University.​</em><br><br></p>2022-06-23T04:00:00Z<img alt="" src="/Topics/Guest-Columns/PublishingImages/2022/YaelKatz.jpg" style="BORDER&#58;0px solid;" />Dementia;ClinicalYael Katz, Ph.D.The early stages of dementia, particularly Alzheimer’s disease, which most commonly manifests with short-term memory loss and difficulty navigating an environment, is not always obvious from a short interaction
Supporting Caregivers’ Emotional Needs to Avoid Burnout<p>​Imagine walking into a health care facility and finding there were no housekeepers, nurses, physical and occupational therapists, recreation, dietary, social workers and nutritionists onsite? Imagine if residents were left to fend for themselves in the absence of these valuable and often forgotten heroes? Despite the setbacks of the past few years, health care heroes continue to not only make themselves available to our most vulnerable population, but also strive to go above and beyond. They continue to provide optimum care even when they themselves, or their loved ones, may need this same care.&#160;</p><p>Think about the fallen heroes that died on the frontline caring for our most vulnerable population during the pandemic. Think about those that continue to put on their game faces every day to go out and give the best of themselves to the elderly, veterans, children, and anyone in need at our health care institutions. Yet who provides the caregivers with what they need to continue giving? <br></p><p>We hear about the efforts to locate staff to cover various shifts, but we seldom hear about locating services to cover the physical and emotional needs of current caregivers. Some have physically recovered from COVID, but never had the opportunity to explore resources for psychological support. Some have experienced the loss of their loved ones and didn’t have the opportunity for a traditional burial and therefore lack closure.</p><h3>When Caregivers Need Support</h3><p>Recognizing when to reach out for support is important and is often missed by caregivers as they are often the beacons of support for others. According to the National Alliance on Mental Health (NAMI), one needs to check in with themselves frequently and reach out for support if experiencing symptoms of depressed emotions and/or burnout. These symptoms include irritability or anger, anxiety, depression, loneliness, sleep deprivation, new or worsened substance abuse, fatigue, and finding it difficult to empathize with others. <br></p><p>Jeff Grzybowski, Director of Rehabilitation at Boro Park Center, a 505-bed skilled nursing facility in Brooklyn, New York, took the initiative to recognize four to five therapy staff employees during his weekly team meetings. He uses the designation “hero” when recognizing these individuals for their outstanding work. <br></p><p>“I felt that I needed to come up with ways to at least lessen, or hopefully remove, that feeling of burnout and to inject that second wind, if you will,” said Grzybowski. “As a result, several people on my team became motivated to pay it forward and made efforts to help those around them as well.”</p><p>Grzybowski’s efforts showed gratitude and awareness of staff efforts and this led to further acts of support. Staff were bringing in donuts, checking in with other therapists, and reaching out to other department employees and their supervisors to ask, “How are you doing?” and offering words of encouragement. <br></p><p>Jocelyn Nackley, Director of Rehabilitation at Onondaga Center, an 80-bed skilled nursing facility in Syracuse, New York, also praises her staff members during her internal weekly team meetings and publicly when she works alongside her team on the unit. </p><p>“Rehabilitation directors are treating this growing and common situation throughout nursing facilities,” said Nackley. “My team particularly enjoys it when I bring in their favorite foods from local lunch and coffee chains. It brightens their day and helps them go the extra mile. They love their patients but we’re no use for them if we cannot get past that burned out feeling.”</p><h3>Going Further</h3><p>Bringing in food and expressing gratitude is a start in the right direction, but it’s certainly not the entire answer. It shows that leadership is paying attention. It is a focus on helping ourselves so that we can better treat the residents and their loved ones.</p><p>Several free services are available to assist caregivers including <a href="https&#58;//www.covidmentalhealthsupport.org/" target="_blank">COVID Mental Health Support</a> from the Pandemic Crisis Services Response Coalition. The <a href="https&#58;//emotionalppe.org/" target="_blank">Emotional PPE Project</a> is another support service that connects heath care professionals with licensed mental health professionals who can help. This service is free and does not require insurance. NAMI can also be contacted directly to access confidential professional support. In addition to these, there are other numerous support services available for health care professionals with both local and nationwide access.</p><h3>Self-Care Suggestions</h3><p>In addition to professional support, leadership should encourage caregivers to use self-care as another strategy to combat burnout. Ideas for self-care include&#58;<br></p><ul><li>Humor can be used to cope. Seek out the things that make you laugh. Laughter is the best medicine.</li><li>Recognize you are vital and are critically important in the fight against the pandemic. You are doing the best you can with what’s available.</li><li>Sleep is important and one of the best ways to rejuvenate. Try to get at least 7 hours of sleep daily.</li><li>Eat to provide fuel to your body. Ensure you eat as balance of a diet as possible. Adequate hydration is essential as well.</li><li>Meditate to relax, reduce anxiety, and manage stress. There are online classes and apps available.</li><li>Exercise is hugely beneficial. Walking increases circulation and endurance and can be a great way to escape from the everyday. Simple muscle stretching and coordinated breathing techniques add to the benefits of exercise. You don’t have to join a gym to get going as many activities are available free of charge. </li><li>Reach out to family, friends, and coworkers for support. Don’t go at it alone—talk to others for support. Many facilities also offer more formal support programs that can be helpful. </li><li>Stay positive. Healing improves when the mind is relaxed and in a positive state. Try to see the positive in others and yourself. Provide positive reinforcements to others every chance you get. </li><li>Connect with your spirituality. Ask yourself how you are feeling each day. Ensure you listen to the voice within and act in ways to support it. Calming environments and music may aid this journey. Learn to appreciate what you have and be thankful to yourself and others that helped along the way</li><li>Take a trip. Travel to a place you want to explore. This can be anywhere from the new restaurant down the street to another state or even international travel. This helps you to focus and reflect as you explore other worlds outside your own.</li><li>Love yourself and others. Find ways to remember the good you’ve done and show compassion to others.</li></ul><p>The pandemic stressed health care providers to their limits. Now it is time for leaders to provide additional support to these caregivers in order to avoid burnout. <br><br><em>Dexter Vickerie, RN-BC, MSN, RAC-CT, is Corporate Director of Quality/Clinical Compliance and Risk Management at Centers Health Care.</em></p>2022-06-01T04:00:00Z<img alt="" src="/Topics/Guest-Columns/PublishingImages/2022/DexterVickerie.jpg" style="BORDER&#58;0px solid;" />CaregivingDexter Vickerie, RN-BChealth care heroes continue to not only make themselves available to our most vulnerable population, but also strive to go above and beyond.
5 Ways to Get Creative with Your Employee Referral Program<p></p><p><img src="/Topics/Guest-Columns/PublishingImages/2022/MadelineCecil.jpg" alt="Madeline Cecil" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />When it comes to the 2022 hiring market, cutting through the noise of job boards and reaching qualified applicants directly is a momentous task. The simplest way to do this is to tap into your employees' already existing networks of former colleagues, neighbors, and friends in the form of an employee referral program.</p><p>There is a myriad of reasons why companies are leaning heavily on employee referrals to keep fully staffed, including that referred applicants are hired at four times the rate of&#160;non-referral candidates. In addition, these programs allow candidates to move forward with the hiring process quickly, with an average hire being made eight days after starting the hiring process compared to 11 days with a non-referral. Employee referral programs produce the types of hiring results that businesses are looking for; in fact, out of Hireology's customers alone, referral programs drive one in eight hires.</p><p>Not all employee referral programs are created equal, however. Even if your company already has one in place, there's always room for improvement. To keep your employee referral program from going stale, here is a list of five ways to get creative with your employee referral program.</p><p><strong>1. Create multi-tiered ambassador programs.</strong><br>Tap into your employees' competitive side with a tiered ambassador program. With this type of program, you design multiple tiers that offer higher rewards and more payout the more referrals someone submits. For example, someone who refers one candidate might be entered into tier one, which pays out $500 per hire. But someone who refers three candidates might be entered into tier two, earning them $750 per hire and additional company swag.</p><p>This encourages your employees to refer as many qualified applicant leads as possible. Multiple levels in this arrangement motivate employees to actively recruit from their networks in order to move up in the tiers and then receive higher rewards—all while you receive applications that are already vetted.</p><p><strong>2. Utilize social media for referrals.</strong><br>Your employees are already spending time on social media, and most of them are connected to hundreds of other individuals on these profiles. Take advantage of this network by encouraging your team to share open roles on their social media profiles.</p><p>You could offer to enter folks into a lottery to win gift cards, cash prizes, or additional paid time off for every role they share on social media. Or, with modern employee referral platforms, you can even provide employees with a personal link that allows you to track exactly which post referral candidates come from, making it even easier for you to reward your employees for sharing roles and driving applicants.<br><strong>&#160;</strong><br><strong>3. Focus on values in your recruitment</strong><strong> </strong><strong>programs.</strong><br>Another way to get creative with your employee referral program is to build one designed to hire individuals who align with your company's values—widening your network of potential referral applicants.</p><p>With this type of program, you might broaden your employment parameters to candidates who meet certain values rather than your preferred list of skills and experiences. Many jobs can be learned, but values are hard to reshape; sometimes, encouraging your employees to refer folks who embody certain values over skills can help you find candidates who are a better fit in the long term. These types of programs can also be used to diversify your existing workforce.</p><p><strong>4. Renew messaging with seasonal pushes.</strong><br>With every season that passes, the world—and workforce—continues to change. Chances are your company is always in need of additions to your staff. People are always needed in some capacity. Some businesses experience temporary hires and labor shortages, but the perfect time to get ahead of being short staffed is before it affects your customers. That's why pushing an employee referral program seasonally with a simple rebranding can make all the difference in the hiring process and help keep your business running smoothly.</p><p>For example, during the holiday season, you could encourage employees to participate in this type of program by using messages like “Want to earn some extra cash for the holidays? Refer your friends to win $1,000,&quot; or “Use your vacation time to relax after earning $1,000 by referring a friend.&quot; With simple tweaks to the messaging, you use to incorporate the changing seasons, you can reuse the same reward program perpetually.</p><p><strong>5. Target specific locations.</strong><br>Say, for instance, that your branch in North Carolina is fully staffed, but the one in Kansas is in desperate need of employees. Instead of launching a company-wide referral campaign, you can tailor your employee referral messaging to receive only applicants from locations where you truly need them. By channeling your resources toward locations that need it most, you optimize your spending power and maximize ROI all in one go.</p><p>Employee referral programs work, so long as you put the effort into motivating your team to participate. Try one of the above strategies to breathe new life into your program today.</p><p><em>Madeline Cecil</em><em> is a content writer for Hireology.</em></p>2022-05-10T04:00:00Z<img alt="" src="/Topics/Guest-Columns/PublishingImages/2022/MadelineCecil.jpg" style="BORDER&#58;0px solid;" />Workforce;RecruitmentMadeline CecilEmployee referral programs produce the types of hiring results that businesses are looking for; in fact, out of Hireology's customers alone, referral programs drive one in eight hires.
Cultivating Continuous Improvement in Senior Care and in Leadership<p>​<em><img src="/Topics/Guest-Columns/PublishingImages/2022/JeraldCosey.jpg" alt="Jerald Cosey" class="ms-rtePosition-2" style="margin&#58;5px 15px;width&#58;175px;height&#58;175px;" />Jerald Cosey is the Operational Leadership Development Director for American Senior Communities (ASC), the largest senior living and senior healthcare company in Indiana.</em></p><p><em>&#160;</em><em>His goal is to help develop leaders for the organization in three ways&#58;</em><br></p><ol><li><em>Oversee the administrator-in-training cohort program that accepts both internal and external candidates.</em></li><li><em>Coach 10 emerging operational leaders from a non-reporting position.</em></li><li><em>Teach behavioral science for leaders, workforce behavior, and maximizing stakeholder communication and engagement.</em><br></li></ol><em>He also serves as an industry advocate outside of Indiana as a speaker, thought leader, and senior advocate. Cosey is passionate about communicating </em><a href="http&#58;//jeraldcosey.com/2020/05/senior-healthcare-workers-are-the-forgotten-frontline/" target="_blank"><em>the lessons learned</em></a><em> by leaders and frontline senior health care workers throughout the pandemic.</em><p></p><p><strong><em>Provider</em></strong><strong> magazine&#58; How did you become interested in the health care industry, and specifically senior care?</strong></p><p><strong></strong><strong>Jerald Cosey&#58;</strong> I started as a volunteer while I was a pharmaceutical sales manager. I was part of that industry for 18 years. I started a <a href="http&#58;//jeraldcosey.com/2019/03/senior-isolation-grace-church/" target="_blank">senior ministry focused on minimizing isolation</a>, named Graceful Moments, when I was downsized for the first time. The mission of Graceful Moments is to minimize isolation and listen, love, and learn from our revered elders.</p><p><strong><em>PM</em></strong><strong>&#58; You previously served as Executive Director at Greenwood Meadows, with the organization winning a 2019 American Health Care Association's Silver Quality Award. What helped you the most on the journey to improve quality at Greenwood Meadows?</strong></p><p><strong></strong><strong>JC&#58;</strong> My father often said nothing worthwhile in life is ever easy. During the process of applying for the award, I learned five lessons.<br></p><ol><li><em>The value of continuous improvement.</em> In such a highly regulated industry, it's easy to get overly concerned about documentation, root cause interventions, and the possibility of missing something important. The consequences can be unforgiving. It's imperative to always evaluate and audit systems used to maximize the care for others. A common trend throughout the application process requires providing details of how your facility captures, evaluates, and improves performance/outcomes. For every level of leadership and operational processes within an organization, continuous improvement and development is necessary and expected.</li><li><em>Just start.</em> In the beginning, I found the award application process intimidating. As operational and clinical leaders, our days are packed, leaving little time for non-mandatory tasks. I acknowledged that this application process would require time and effort. The action and effort slowly defeated the intimidation and sparked enthusiasm for capabilities of our facility.</li><li><em>It's not about winning.</em> With every advancement through the process, the pride for the facility, the care, and outcomes seem to bubble up daily. Early in the application process, we realized it was never about winning. The goal is to recognize the performance excellence of your facility; moreover, the performance excellence required to complete the application. When it's all said and done, we had already won by completing an application worthy of review.</li><li><em>You are part of a professional community.</em> The senior healthcare industry is loaded with resources and support. I will never forget being stumped by a question and calling a fellow administrator. She allowed me to vent, listened, and translated the question, helping me to understand. This industry is loaded with state health care associations and operational/clinical leaders, all of whom are committed to advancing quality healthcare and performance excellence.</li><li><em>The industry is honorable.</em> Professionally caring for people is a great responsibility and penetrates beyond business, careers, and professions. Honor comes from putting others' needs before your own. Moreover, caring for people who are held in high regard within a family can come with unreasonably high expectations. With that, continue doing your level best each day and performance excellence will follow.</li></ol><strong><em>PM</em></strong><strong>&#58; What trends do you see on the horizon for the senior health care sector?</strong><p></p><p><strong></strong><strong>JC&#58;</strong> Category or position excellence doesn't automatically translate to leadership excellence. I believe the number one trend or need in our industry is being intentional with the development of leaders. Senior healthcare is a very emotionally demanding industry, and the last thing we need to do is lose outstanding talent from a lack of investment in their leadership.</p><p>I see leadership evolving to maximize communication and effectiveness between stakeholders. For example, many leaders tend to lead as they like to be led. Understanding your key stakeholder drivers for work satisfaction is critical for it allows the leader additional tools to maximize communication, effectiveness, and job satisfaction.</p><p>At American Senior Communities, we have committed to using the Predictive Index as the source of gathering this insight and leveraging tools to maximize understanding. For me, I like independence and flexibility. It doesn't mean I can't accept direction or formalities. However, I want my key stakeholders to know I receive job satisfaction when I can meet these needs in the workplace.</p><p><strong><em>PM</em></strong><strong>&#58; How do you describe your leadership style? How do you build and refine those leadership skills?</strong></p><p><strong></strong><strong>JC&#58;</strong> My teachable point of view on leadership&#58; A leader separates themselves in the ability to embrace the philosophy of team—a team that is built upon respect for people, continuous improvement, and a high regard for results. All of which allow a leader to empower.</p><p>I always have a developmental plan. Every leader should have a developmental plan throughout every organization. I also have mentors and follow their guidance to grow my leadership skills.</p><p><strong><em>PM</em></strong><strong>&#58; What advice do you give to someone just beginning a career in health care?</strong></p><p><strong></strong><strong>JC&#58;</strong> Make time to document why you want to lead in this space. Senior healthcare is a very emotional and intimate career choice. You must know your why and embrace it to the core. It will prove to be your foundation on the day when your career choice comes into question.</p><p>You can't do everything by yourself so take the time to establish your vision and allow leaders to contribute to the development of the vision. I was never an expert in a specific department. I hired the best, built next-up talent, and leveraged departmental excellence.</p><p><em>Hear more from Jerald Cosey in a keynote session at the 2022 AHCA/NCAL Quality Summit, May 16-18 in Kissimmee, FL. For more in​formation and to register, </em><a href="https&#58;//www.ahcancal.org/Education-Events/Quality-Summit/Pages/default.aspx" target="_blank"><em>click here</em></a><em>.</em></p>2022-05-04T04:00:00Z<img alt="" src="/Topics/Guest-Columns/PublishingImages/2022/JeraldCosey.jpg" style="BORDER&#58;0px solid;" />Caregiving;QualityJerald CoseyI like independence and flexibility. It doesn't mean I can't accept direction or formalities. However, I want my key stakeholders to know I receive job satisfaction when I can meet these needs in the workplace.