Survey Supports Key Role of Attending Physicians in Quality Care<p>A recent article in JAMDA details a job analysis of attending physicians in long term/post-acute care that documents the unique and specific role they play in this setting.</p><p>“The pandemic highlighted the importance of engaged physicians to care for our residents, provide comfort measures, and prevent avoidable hospitalizations. This analysis bears out the importance of this involvement,” says Laura Morton, MD, CMD, one of the article’s authors. </p><p>The survey of attending physicians addressed a list of tasks, experience, and medical knowledge needed in their role in long term care. These items, developed and refined by a task force of subject matter experts, were written as statements that described distinct, identifiable, and specific practice-related activities. In all the survey consisted of 260 items.</p><p>The results showed that attending physicians supported statements related to ethical and culturally sensitive conduct, including applying principles of shared decision making, to achieve a patient- and resident-centered approach to care.</p><p>They also ranked highly knowledge relating to maintaining good facility coverage. Top medical care delivery statements related to recognizing, assessing, and treating patients and residents in a timely and nondisruptive manner, and ensuring continuous medical coverage. </p><p>Top-rated medical knowledge tasks centered on utilizing individualized information about comorbidities and risk factors to evaluate symptoms, as well as developing and following plans for additional and regular evaluation and re-evaluation. This includes deprescribing medications whenever possible. In support of these tasks, knowledge of differential diagnosis, deprescribing, pain management, multiple morbidity, and the use of decision-making tools were all highly rated.</p><p>“We hope that facility leaders will use this information to start a dialogue with attending physicians,” says Morton. “Talk about how you can work together to ensure the best possible care for residents.” Some physicians are more experienced than others, she notes, but there are numerous training and educational opportunities for all of them. “It is important to give physicians the tools and resources to succeed in this environment,” she says.</p><p>As new attendings come into facilities with little experience in this setting, it is important to ensure they understand the many unique aspects of long term/post-acute care, Morton says. “This requires training and education, and it will be useful to connect them with experienced practitioners who understand the specific regulatory environment, clinical evidence, and best practices for this space.”</p><p>More than ever, she says, “We understand the need for collaboration with all team members. These relationships will help us moving forward and prepare for future outbreaks. Our attendings are a key part of this.”</p><p>The job analysis was conducted for the American Board of Post-Acute and Long-Term Care Medicine. It is available online <a href="https&#58;//paltc.org/node/9298">here.</a><br></p>2021-07-15T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0120_News4.jpg" style="BORDER&#58;0px solid;" />CaregivingJoanne KaldyAs new attendings come into facilities, it is important to ensure they understand the unique aspects of long term/post-acute care.
Collaborative Effort Best on Pain Management in Nursing Homes<p>A new report in <em>JAMDA </em>said chronic pain is an enduring issue in nursing homes, but despite its high prevalence, there is no definitive approach to managing this condition in older adults. </p><p>The study suggests that it is important for administrative nursing home leadership, the medical director, and the interdisciplinary team to work together to promote chronic pain management through a multipronged approach, with an emphasis on person-centered care.<br></p><p>In “Chronic Pain Management in Nursing Homes&#58; Navigating the Challenges to Improve Person-Centered Care,” the authors stress that nonpharmacological means are under-used in nursing home settings but are the preferred first step to manage mild pain. </p><p>Nonopioid pharmacological agents should be added as a second step to manage moderate to severe pain. Opioids, commonly prescribed as a first step to manage chronic pain in this care setting, “should be used as a last resort,” according to the report’s authors. </p><p>“We want to emphasize that it is not necessarily inappropriate to prescribe opioids in older adults with chronic pain,” researchers said. Fears and myths about opioids, they added, sometimes have led to an “unnecessarily abrupt cessation of opioid prescriptions for older adults who need them for management of chronic pain.”</p><p>Challenges to the successful implementation of comprehensive chronic pain management at the nursing home may include ambiguous directions on specific therapeutic interventions, insufficient guidance on treatment duration, and limited availability of treatment options, the report said. </p><p>“Clinicians should carefully evaluate the need for continuation of chronic pain medications during their routine visits in nursing homes,” the authors said. </p><p>The facility administrative and clinical leadership, they noted, can promote appropriate opioid prescribing and deprescribing when indicated through an opioid stewardship program. Proper management of expectations of residents and their support systems is essential when such a multifactorial approach toward chronic pain management is taken.​</p>2021-07-01T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/medications_1.jpg" style="BORDER&#58;0px solid;" />CaregivingPatrick ConnoleOpioids should be used as “a last resort," according to a new report.
Celebrating National Skilled Nursing Care Week 2021<p><img src="/Topics/Special-Features/PublishingImages/2021/0721/0721_NSNCW-LaurelHills.jpg" class="ms-rtePosition-1" alt="" style="margin&#58;5px;" />National Skilled Nursing Care Week® (NSNCW) began on Mother’s Day, Sunday, May 9, and was celebrated through the following Saturday. </p><p>Founded in 1967 by the American Health Care Association (AHCA), the observance highlights the important role of nursing homes in caring for America’s seniors and individuals with disabilities. This year’s celebratory week is <a href="/Topics/Special-Features/Pages/Words-From-Our-Sponsor.aspx" target="_blank" title="Words from Our Sponsor">sponsored by Essity</a>.<br></p><p>“We are grateful to Essity for their generous support of National Skilled Nursing Care Week, which was an important celebration recognizing the compassionate care provided by nursing homes and their staff during this unprecedented time,” says AHCA/National Center for Assisted Living President and Chief Executive Officer Mark Parkinson.<br></p><p>COVID-19 made this past year unimaginable for skilled nursing care centers, many of which were hit hard by the pandemic. Throughout it all, however, staff members across the country cared for residents around the clock as challenges such as social distancing rules prevented residents from in-person visits with loved ones.<br></p><p>Recognizing the amazing work of certified nurse assistants, nurses, food service workers, and other nursing home staff is at the root of NSNCW. The theme, Together Through the Seasons, honored the collaboration and commitment of skilled nursing care facilities and their staff in providing compassionate care to their residents every day during this challenging year. <br></p><p>While not all nursing homes were able to celebrate the week, many developed creative and inspiring ways to celebrate their staff and residents during NSNCW. Social media posts, photos, and videos depict a multitude of wonderful activities and events corresponding to the Together Through the Seasons theme.</p><h2><span class="ms-rteForeColor-10">Outdoors Together</span></h2><p>For many skilled care centers, being together outside was the safest and simplest way to maintain social distance while still hosting activities and special events. Themed parties, cook-outs and barbeques, drive-by parades, classic car shows, Olympic games, balloon launches, dance celebrations with young and old, concerts, sing-alongs, and award ceremonies were just a few of the ways staff and residents celebrated.<br></p><p>Other events focused on seasonal celebrations like spring planting, with staff and residents working side-by-side to plant flowers and vegetables in both planters and dedicated gardens. Visits from furry friends were also extremely popular. Four-legged friends that made their way into many nursing homes and into the hearts of staff and residents included therapy dogs, horses and ponies, bunnies, pigs, and even baby goats.</p><h2><span class="ms-rteForeColor-10">Celebrating Together</span></h2><p>Across the country, residents and staff were delighted finally to be able to gather together safely for the first time in over a year. At the Florence Hand Home in LaGrange, Ga., residents were thrilled to be together again to share laughs and s’mores at a festive outdoor garden party. <br></p><p><img src="/Topics/Special-Features/PublishingImages/2021/0721/0721_NSNCW-Painting.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;" />Other fun and imaginative celebrations included large group memory and Bingo games, themed costume parties, movie nights, Native American ceremonial dancing and music, and luaus.<br></p><p>Many other activities focused on past decades, featuring movies and musical gatherings from a particular time period, such as the hippie years of the 1960s.<br></p><p>Treats and special meals were also part of the celebrations, with ice cream trucks and s’more parties at the top of the list. </p><h2><span class="ms-rteForeColor-10">Creating Together</span></h2><p>From art to apple butter, residents were invited to engage in joint creative projects. Building on the Together for the Seasons theme, residents at Lee Health and Rehab in Penning Gap, Va., spent one day painting and constructing a “4 Seasons Art Project” and the next day planting tomatoes, bell peppers, and watermelons in a special garden.<br></p><p>Creative projects were not limited to painting and drawing but also included yarn crafts like God’s Eyes, button art, popsicle-stick architecture, and colorful felted flowers planted in decorative flower pots.<br></p><p>Other creative events included staff theatrical productions and costume parties. In many nursing homes, residents honored their staff and caregivers in both heartfelt and humorous ways. Staff received hand-made cards, signs, and video-taped messages and were treated to special lunches.<br></p><p>At Azria Health Woodhaven in Ellinwood, Kan., caregivers received certificates of heroism as well as lottery tickets with a note attached that said, “We hit the jackpot with staff like you!”</p><h2><span class="ms-rteForeColor-10">Connecting Together</span></h2><p>From coast to coast, elected officials made special proclamations in honor of NSNCW. In the words of Gov. Ralph Northam, “the Commonwealth of Virginia is thankful to the dedicated workers… [and] for the heroic contributions they make every day to the well-being of the residents and families they serve.”<br></p><p><img src="/Topics/Special-Features/PublishingImages/2021/0721/0721_NSNCW-photo-contest.jpg" class="ms-rtePosition-1" alt="" style="margin&#58;5px;" />Some proclamations were more local and targeted. In Darke County, Ohio, “Proclamation Day” was designated on May 10, encouraging county residents to place calls to friends and family in local care facilities with messages of love and support. The week also served as a special time to recognize staff in Darke County.<br></p><p>In a quote for the <em>Sydney</em> (Ohio) <em>Daily News</em>, Senior Administrator Kristy Earick of Versailles Rehab said, “Our entire team went to extraordinary lengths protecting our residents’ health, not to mention that of our staff themselves and their families as the pandemic intensified. We cherish the work they do every day; however, during these special weeks of honor, we especially focus on their compassionate care.”<br></p><p>The week was recognized in many unique and creative ways, but across the country, the primary focus was to honor and recognize the compassion and dedication of skilled care staff, especially during these hard times, and to celebrate the lives of residents in their care.<br></p><p>To view all the ways that NSNCW was recognized this year, please visit #NSNCW, Facebook.com/#NSNCW, and NSNCW.org. ■<br><br><em><a href="mailto&#58;lhohenemser@ahca.org" target="_blank" title="Email Lisa!">Lisa Hohenemser,</a> MPH, is marketing manager for the American Health Care Association. </em><br>​</p>2021-07-01T04:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2021/0721/0721_NSNCW.jpg" style="BORDER&#58;0px solid;" />CaregivingLisa HohenemserFounded in 1967 by AHCA, NSNCW highlights the important role of nursing homes in caring for America’s seniors and individuals with disabilities.
Florida Nurse Answers the Call After Miami Beach Building Collapse<p><img class="ms-rtePosition-1" alt="Carla Spalding" src="/Breaking-News/PublishingImages/CarlaSpalding.jpg" style="margin&#58;5px;width&#58;348px;height&#58;211px;" />When the news broke that a condominium in Surfside, Fla., in the Miami Beach area had suddenly and tragically collapsed, it took Carla Spalding, a registered nurse with long term care provider Infinity Health Care Management, only minutes to be on the move.</p><p>“It was early in the morning, and I was watching the TV, and the breaking news bulletin came across the screen,” she says. “I saw what happened in Surfside, which is only 10 to 15 minutes away from where I live, and I immediately got dressed and went there. I could not just do nothing.”</p><p>When she arrived, Spalding did not get immediate access to the area, but eventually parked and walked to draw closer to the partially collapsed building site to see if she could render assistance, which is something Spalding is well accustomed to doing from her years in the U.S. Navy and now as a nurse.</p><p>“I told the person in charge from the police department that I am a nurse, and he directed me to where the EMTs were. There were no nurses there on the day of the event, so I was the only nurse present, and there was also one doctor,” she says.</p><p>People around the building were frantic, given the sudden building collapse, asking anyone and everyone what was happening. Spalding says the anxiety and grief were palpable.</p><p>Some had just broken down completely. People wanted to know what had happened to their loved ones,” she says.</p><p>To her, Spalding says, the only way to relate to what it looked and felt like around the collapse site was September 11 and what the rubble looked like there when she saw that tragedy unfold on TV so many years ago.</p><p>“It was the only thing to compare it with … there was rubble and smoke coming up from it.”<br>Since there was no way to access the site itself, her main nursing duties played into her specialty, which is psychological care.</p><p>“The biggest thing I saw there was fear, the fear of the unknown regarding the loved ones. I helped one woman who had her only child in the building. I worked to help calm them down. My work in the Navy and Infinity helped prepare me for this event. It is about calming people down but also about listening to what they have to say,” Spalding says.</p><p>Her efforts at Surfside have lasted more than just the one day, as she had the permission and support of her work, namely from Michael Blisko, chief executive officer of Infinity Health Care Management, to do what she needed to do in her effort to aid people suffering from the tragedy.</p><p>“I had to do whatever was needed to help,” Spalding says.&#160; “I think it is just part of who we are as people working in the medical field as medical nurses. It is a calling I believe. I just personally don’t want to see people hurt,” she says, her voice breaking at the thought of what has happened in Surfside.</p><p>And, of course, being a comfort in challenging times is what being a long term care nurse is all about on a daily basis, through the pandemic and before that through hurricanes in Florida, Spalding says.</p><p>“Our last big hurricane, I stayed in the nursing home for five days straight to help care for our residents. What people don’t always get about what we do is that we often are many residents’ family, they don’t have anyone to take care of them. We are their loved ones, and they rely on us for anything and everything.”</p><p>And, for this week at least and maybe longer, Spalding is a life saver for residents of Surfside, who will be in search of loved ones as well.</p>2021-06-30T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/Spalding_collapse.jpg" style="BORDER&#58;0px solid;" />CaregivingPatrick ConnoleBeing a comfort in challenging times is what being a long term care nurse is all about.