"Congress, apparently still with time left over after all those hearings dissing the drug industry, is beginning to turn up the heat on nursing homes," reports the Wall Street Journal. Read the grisly details here.

Seniors with at least a high school education spend more of their older years without cognitive loss, including the effects of Alzheimer's, Parkinson's and dementia, but die sooner after the loss becomes apparent, reveals a new study appearing in the June 2008 issue of the Journal of Aging and Health.

Read a summary of the report at http://www.seniorjournal.com/NEWS/Alzheimers/2008/8-05-12-SenCitWithMost.htm.

A study conducted by the Wake Forest University School of Medicine found that many commonly administered drugs can hasten decline in the elderly. Elderly people who took drugs for incontinence, allergy or high blood pressure walked more slowly and were less able to take care of themselves than others not taking the drugs, researchers found.

The findings, presented at the American Geriatrics Society Meeting in Washington, add to a growing body of research that suggests that anticholinergic medications can hasten functional and cognitive declines in elderly people. 

Head researcher Dr. Kaycee Sink explained that many useful drugs from many different classes of medications have anticholinergic properties. The researchers found that the more anticholinergic drugs people had in their systems, the worse their physical function. They also pointed out that in many cases, newer drugs are available that do not have these effects.

This is just one example of what makes medication management often difficult. Treating one symptom, can sometimes lead to several other detrimental side effects. Make sure your records keep track of these, so medications can be adjusted accordingly.

The Washington Post puts an interesting spin on an article about the decision to move into a retirement community. Instead of telling the story from the oft-used angle of those who work in the retirement living industry, the article is written by a 79-year-old woman who recently made the move from her home into retirement living. She explores the way her and her husband came to terms with their idea of "aging in place." She concludes that this decision was best made on their own terms, when they were ready. She talks about timing being everything.

In an accompanying article, the writer's daughter shares her thoughts on coming to terms with her parents' move to a retirement community. While she originally felt some guilt, she says it was assuaged by witnessing her mother making many new friends and starting a new phase of life.

Is this general feeling shared by most people who move into retirement living? In your experiences of dealing with residents, what do you find? Are most ready? If they're not ready, are they glad once they've made the move? What role do adult children play in the process?

These two unique perspectives can give you some idea of just exactly what's going through the minds of your potential residents.

Happy Earth Day 2008! As people all over the world are paying more attention to environmental issues, there are many things individuals can do close to home--even in long-term care facilities.

In our March-April issue, contributor Mike LePostollec wrote about incorporating elements of sustainable design into long-term care. Some of the most common sustainable features include:

• improved insulation
• solar hot water heating systems
• daylighting (using natural light to illuminate building spaces, rather than relying solely on electric lighting during the day)
• geothermal heating, which distributes natural heat from the earth throughout a building
• green roofs, which reduce solar gain on buildings and lower cooling costs
• heat recovery systems, which provide a counter-flow temperature exchange between inbound and outbound air. Warm air leaving the building heats the inbound air, and vice versa.

For more ideas on how we can conserve resources, read the New York Times' Green Issue.

A recent article in the Washington Post explores how certain games and other activities can help family members form more meaningful connections with loved ones who have dementia.

Researchers conducted a study on 33 families, and found that satisfaction was higher after playing one of the new board games with a relative with dementia than after a visit that involved no game-playing.

The article also indicates that memory books and scrapbooks can be helpful for those who live in nursing homes and similar settings, providing a method for staff and volunteers to get to know residents.

Look for more on this in the future: The National Institute on Aging supported the study and the researchers have submitted it for publication in a peer-reviewed journal.

Last year, we ran a salary survey for a variety of long-term care professionals. Some of the results are highlighted below. Do these figures hold true for you? How has the economic downturn affected your salary?

Average Salary by Job Title

Administrator: $82,869

Asst. Administrator: $62,476

CEO: $115, 510

CFO: $108,333

COO: $156,500

Director of Operations: $105,400

Executive Director: $92,064

Owner: $118,000

President: $127,250

Vice President: $102,875

I recently heard a comment that when the Clintons tried to reform health care, it had an unforseen negative impact on nursing. Hospitals, my source noted, were laying off nurses because they did not think they were going to have enough money to pay them because of the cuts. Many nurses left the profession and others decided against nursing careers.

How do you think the presidential candidates stated plans will affect the industry? Which candidate's plan, of any, do you support?

"We didn't know better," Koren said. "We didn't understand what it did to people both physically and psychologically."

What is your facility's policy? Is anyone still using restraints in this day and age?

Mark your calendars - National Nursing Home Week will be celebrated beginning Mother’s Day, May 11, and continuing through May 17, 2008. This year's theme is "Love is Ageless."

National Nursing Home Week, established by AHCA in 1967, is an annual event that recognizes residents and caregivers. AHCA has produced a National Nursing Home Week kit consisting of an event planning guide, promotional products for this observance and suggested activities.

What better opportunity to celebrate your community! For more information go to www.NNHW.org.

A recent study suggests that antibiotics are overused in people dying of dementia and should be prescribed more carefully because of the increasing prevalence of drug-resistant superbugs, according to an article from the Associated Press.

In the study, published in the Feb. 25 issue of the Archives of Internal Medicine, researchers followed more than 200 people with advanced dementia from Boston-area nursing homes for 18 months or until their deaths. Almost half died during that time. All the patients failed to recognize loved ones, had stopped speaking, were unable to walk or feed themselves and were incontinent.

By reviewing medical records, researchers found that 42 percent of these patients received antibiotics—many intravenously—within two weeks of their deaths. The closer they were to death, the more likely they were to receive antibiotics.

Antibiotic overuse contributes to the rise of superbugs, so experts have been recommending physicians become more hesitant to prescribe antibiotics in many types of patients.

Antibiotic overuse in dementia patients also calls to mind the Alzheimer’s Association’s Phase 3 End-of-life care recommendations, which are part of the association’s Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes. These recommendations suggest that residents and family members carefully consider the use of antibiotics in care planning for end-stage dementia patients.

We covered this—and other end-of-life issues—extensively in the "Making the Case for Comfort Care" cover story from the May/June 2007 issue of ADVANCE for Long-Term Care Management.

The New York Times is paying attention to the fight against pressure ulcers and reports:

"New research is suggesting that the battle against bedsores requires a team approach, enlisting everyone from nurses and nursing assistants to laundry workers, nutritionists, maintenance workers and even in-house beauticians. In a study of a collaborative program involving 52 nursing homes around the country, The Journal of the American Geriatrics Society reported last August that team efforts had reduced the number of severe pressure ulcers acquired in-house by 69 percent."

 

Read the article online.

About half of the country has yet to vote in their party's primary election, but already the presumed winners have emerged. John McCain will be the Republican presidential candidate, while Barack Obama is poised to represent the Democrats.

Our country is facing so many important issues, but is anyone talking about the long-term care of our nation's aging population? The topic is largely absent from political debate.

Check out the candidates' Web sites, and health care is of course a top priority, but largely as it relates to uninsured workers and children, prescription costs and electronic health records.  

Barack Obama's health care plan

John McCain's health care plan

The industry associations are doing their part to lobby for long-term care, but the more voices heard, the better. Contact the candidates, and your local legislators, and tell them why what you do is so important.

A week ago, the Bush administration published the names of 131 nursing homes with poor inspection records and said some were already showing signs of improvement, according to the Associated Press.

The list, released by the Centers for Medicare and Medicaid Services, represents troubled facilities cited as a "special focus facility," a term used to identify those that merit more oversight. For these homes, states conduct inspections at six-month intervals rather than annually.

CMS will update its list of troubled nursing homes on a quarterly basis, with its next release scheduled for April.

The list released last week shows 52 nursing homes as not showing improvement after they were cited as a higher-risk nursing home, while another 52 did show some improvement. Twenty-seven nursing homes were added to the list in the last six months.

Out of the 54 nursing homes initially disclosed as poor performers last November, 21 have shown improvement, CMS said, adding that publicity about the problems might have played a factor.

While most nursing homes have some deficiencies, with the average being six to seven deficiencies per survey, the special focus facilities typically have about twice that number, and continue to have problems over a long period of time. However, the states determine which nursing homes should get the designation, and inspection standards vary among the states.

The offenses typically involve unnecessary use of medication for elderly residents, or inadequate safeguards to protect residents such as those with Alzheimer's from day-to-day hazards in the nursing home, the Associated Press reports.

What do you think of the publication of this list? We'd love to hear your thoughts.

President Bush's proposed budget doesn't look good for health care providers. Over the next five years, his recommendations would cut Medicare spending by $66 billion and Medicaid spending by about $25 billion, reports the Associated Press. Even with the attempt to slow entitlement spending, the budget for the Department of Health and Human Services will rise about 8.7 percent next year. The CDC is also facing cuts up to $50 million, and states may get less grant money to prepare for bioterrorism. There is hope: the president called for smaller reductions last year, and they were soundly rejected.