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Don’t Miss These Events

Wed, 08/01/2018 - 00:00
Core Online Fall Early Bird Deadline

Lessons Learned About Teamwork, Successful Change From QI Award Winner

Wed, 08/01/2018 - 00:00
If the Foundation for Post-Acute and Long-Term Care Medicine’s Quality Improvement and Health Outcomes (QIHO) Awards had a face, it might be that of Marian McNamara, RN. She and her colleagues have received this honor four times in the last 5 years, and Ms. McNamara embodies the innovation, creativity, passion, and teamwork that the award was designed to empower.

Journal Highlights From the August Issue of JAMDA

Wed, 08/01/2018 - 00:00
Falls, a common occurrence in nursing homes, can lead to injuries and result in legal liability for the facility, making prevention all the more important, yet there is often a lack of communication about medication or other factors that may lead to falls and ways to prevent them.

Caring for Older Patients with Skin Disease Has Unique Considerations

Wed, 08/01/2018 - 00:00
Authors of a “Viewpoint” article published in JAMA Dermatology have asserted that older individuals with skin disease need “unique considerations” for care, while also addressing the principles of geriatric science that permit this more appropriate care.

Who Is the Nursing Home Administrator?

Wed, 08/01/2018 - 00:00
Cynthia Tredwell, JD, administrator of a small, highly-rated nursing home in North Dakota, talks about the role of the nursing home administrator.

A Rehabilitation Paradigm for Medically Complex Care

Wed, 08/01/2018 - 00:00
Patients with medically complex conditions present difficult challenges for rehabilitation centers, but St. Mary’s d’Youville Pavilion in Maine is embracing these individuals with an innovative approach. The 12-room Specialty Care Rehabilitation Suite features specially trained staff caring for patients with medically complex conditions. It is a companion program to the organization’s Transitional Rehabilitation Center, which has a strong orthopedic focus.

Low BP Rarely Triggers Medication Adjustment in VA Nursing Homes

Wed, 08/01/2018 - 00:00
Physicians lowered or eliminated doses of hypertension medications in fewer than 20% of nursing home residents who had fallen after an episode of low blood pressure, a recent study found. The researchers linked drug deintensification in patients with especially low blood pressure to a much lower risk of future falls but a much higher risk of death.

Tributes

Wed, 08/01/2018 - 00:00
William Carlos Williams, MD, born in Rutherford, New Jersey in 1883, trained as a generalist and pediatrician before returning to his home town to practice medicine the rest of his life.

ACP Video Tool Does Little to Increase DNH Status in Advanced Dementia

Wed, 08/01/2018 - 00:00
Compared with usual care, an advance care planning (ACP) video did not change the rate of do-not-hospitalize (DNH) directives at 6 months among proxies for nursing home residents with advanced dementia, according to results of the Educational Video to Improve Nursing Home Care in End-stage Dementia (EVINCE) trial. However, the ACP video arm demonstrated an increased rate of documented directives for no tube-feeding during the follow-up period and goals-of-care discussions at 3 months.

Medication Reconciliation: A Necessary Process for Patient Safety

Wed, 08/01/2018 - 00:00
Medication reconciliation is the process of determining the most accurate list of medications the patient is taking. Sounds simple, doesn’t it? However, in more than 25 years as a nurse practitioner (NP) — the majority spent in inpatient settings (hospital, rehabilitation, skilled nursing facility) — I have found medication reconciliation is still one of the most frustrating aspects of patient care. The use of electronic health records to communicate information was supposed to improve the process and patient safety, but I have yet to see this happen consistently.

Rebalancing Arrives in Home-, Community-Based Long-Term Care

Wed, 08/01/2018 - 00:00
States are currently spending 30% to 80% of their Medicaid long-term care expenditures on home- and community-based long-term care compared with institutional long-term care, which means that the long-sought “rebalancing” of long-term services and supports (LTSS) is likely “coming to you,” health policy analyst Virginia Kotzias said at the annual meeting of AMDA – the Society for Post-Acute and Long-Term Care Medicine.

Idolatry in Care Transitions

Wed, 08/01/2018 - 00:00
In our current medical reality, movement of increasingly aged, comorbid and frail patients between sites of care is fraught with potential harm. Enhancing care transitions justifiably demands our attention. Witnessing the illnesses of my parents, I made the painful discovery of the gaps and flaws in a health care system I had spent my career believing was the best the world had to offer. More than a decade ago, I made a decision to do whatever I could to make those flaws fewer and the gaps smaller.

Transitioning to ED: A Difficult but Improvable Process

Wed, 08/01/2018 - 00:00
GRAPEVINE, TEXAS — Although transitioning patients from post-acute and long-term care to the emergency department (ED) remains a challenging scenario for those involved, opportunities exist to improve the process for health care providers and for patients’ outcomes, according to two presenters at the 2018 Annual Conference of AMDA — the Society for Post-Acute and Long-Term Care Medicine.

Promising Care Paths Emerge on the Transition Trail

Wed, 08/01/2018 - 00:00
Promising new practices and options are emerging for patients transitioning between emergency departments and skilled nursing facilities or nursing homes, such as averting ED use altogether by treating the patients in place, several speakers reported at the annual meeting of AMDA – the Society for Post-Acute and Long-Term Care Medicine.

Revisiting Comfort Care

Wed, 08/01/2018 - 00:00
Dear Dr. Jeff:

Too Few Patients With Heart Failure Get Palliative Care

Wed, 08/01/2018 - 00:00
Few patients with heart failure receive palliative care, although their condition often warrants it and evidence suggests it’s helpful, a specialist in geriatrics and palliative medicine told an audience at the 2018 annual meeting of the American Geriatrics Society.

Behavioral Health Disorder Diagnosis Decreases Access to High-Quality Facilities

Wed, 08/01/2018 - 00:00
Post-acute patients diagnosed with a behavioral health disorder are more likely to enter low-quality nursing home facilities and less likely to enter high-quality facilities than those without the diagnosis, according to study results in the American Journal of Geriatric Psychiatry.

Building Community Palliative Care

Wed, 08/01/2018 - 00:00
The Center to Advance Palliative Care, in collaboration with the National Coalition for Hospice and Palliative Care, has launched an initiative to build a comprehensive inventory of community palliative care programs across all service settings — including home, office/clinic, and long-term care. AMDA – the Society for Post-Acute and Long-Term Care Medicine is supporting this important project. The Society believes it will make it easier for patients, families, caregivers and practitioners to find local resources to meet their needs.

The Readmissions Conundrum: How (and What) Are We Doing?

Wed, 08/01/2018 - 00:00
It’s been a good 6 years since the Centers for Medicare & Medicaid Services started wielding the stick called HRRP, the Hospital Readmissions Reduction Program, designed to encourage hospitals to improve discharge planning and reduce unnecessary acute care rehospitalizations. In 2012, the 30-day readmission rate for Medicare beneficiaries was around 19%, and it was thought that many of these readmissions were potentially avoidable. The penalties started at a maximum of 1% of a hospital’s total Medicare A payments, and initially considered only the diagnoses of heart failure, acute myocardial infarction, and pneumonia.

Collaborative Quality Improvement Project Aims to Improve Pain Management in PA/LTC

Wed, 08/01/2018 - 00:00
A collaborative quality improvement (QI) project to improve pain management for nursing home residents is changing outcomes through facility-specific interventions, ranging from changes in health records and electronic documentation to more structured comfort care rounding and consistent use of pain scales.

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