With the H1N1 virus lurking in our office (so far, one confirmed case), experts agree that aside from vaccination, the best defense is thorough handwashing. Check out this video from the Washington Post that shows proper handwashing technique.

We hear these messages all the time, but truthfully, we could all probably do a better job following through. In fact, a recent Australian study found that three out of ten men and one out of ten women didn;t wash their hands after using the restroom.

On a related note, did you know yesterday (October 15) was Global Handwashing Day? www.globalhandwashingday.org

A study published in The New England Journal of Medicine questions whether dialysis is the best treatment for nursing home patients. As reported by USA Today, more than half of older nursing home residents die within a year of starting dialysis and "nearly another third experience a significant decline in their ability to perform simple tasks, such as feeding themselves."

Study authors said they hope the results will encourage health care professionals to engage in "open and honest discussions" with residents about the risks of the treatment.

For frail elderly nursing home patients, permanent kidney failure "is like metastatic cancer with rapid deterioration and short life expectancy," [says Peter Aronson, Yale University nephrologist]. "The results of this study should inform end-of-life planning for such patients and encourage consideration of alternatives to dialysis, such as palliative care" to relieve symptoms.

 Read the full article here.

Given the recent push to vaccinate, this statement is sure to become controversial. One of the points mentioned is the pre-existing H1N1 immunity that some elderly people may have.

To those of you who work in senior living facilities: What do you plan to do about vaccination?

Not only does my doctor's office not have any, but they don't even know if they'll get any at all. Off I went to the Dept. of Health to investigate.

Each provider must put in a request to the state and wait to hear if they're approved. The state is looking for risk groups as well as the ability to house the vaccine with sufficient refrigeration, and distribute it efficiently. Here in Pennsylvania, all vaccine is going to pediatricians right now, and the priority is five to nine year olds. Though my kids got it even though they're only 3 and 4. There's no word on when my baby can get one-she needs the shot and only the mist is currently available.

Every week, the state will distribute a group of doses with instructions on who is to be prioritized. But no one knows who will be next in the priority list. The person I spoke to at the health department-who was suprisingly unfrazzled-said that the only thing for people to do it watch the Web site (http://www.h1n1inpa.com/ for local folks) and call in a few weeks. She also reminded me that the flu is being a bit overblown.

What has your experience been?

I recently discovered a rather interesting awards ceremony, the IG Nobels. Hosted by the Harvard-based journal Annals of Improbable Research , the awards honor less-than-traditional research and are handed out by real Nobel laureates.

Highlights from this year include:

• The veterinary medicine prize went Catherine Douglas and Peter Rowlinson at Newcastle University's school of agriculture for discovering that cows with names give more milk.
• The peace prize went to Stephan Bolliger and colleagues at the University of Bern in Switzerland, who found that empty beer bottles are sturdier than full ones, but either can fracture the human neurocranium.
• The medicine prize-my personal favorite as a knuckle cracker, went to Donald Unger, a doctor in Thousand Oaks, Calif. He cracked the knuckles of his left hand, but never those on his right, every day for 60 years to investigate whether it caused arthritis. (He concluded that it does not.)
• The chemistry prize was awarded to Javier Morales who heated 80-proof tequila blanco in a pressure vessel to create diamonds.

Read more at http://improbable.com/ig/winners/.

The following is a guest blog from Anthony Cirillo:

Recent Harvard articles have been consistent in their insistence that a different mode of leadership will be required in all businesses going forward. Business as usual got us into the predicament we are in so we can't simply go back to it when the economy recovers. New leadership will be about facilitating, collaborating and empowering. I write a lot about person-centered care. When readers write back, they pin a lot of the stagnation in implementing person-centered care on leadership. People change because they want to change. Leadership has to create that context. Albert Einstein said "No problem can be solved from the same level of consciousness that created it." With that in mind, here are some leadership qualities I believe are necessary to overcome the present stagnation.

Leaders must be committed to:
1. Creating exceptional experiences for everyone - staff, patients, residents, caregivers and family members.
2. Fostering a collaborative leadership style focused on empowering and energizing employees and adopting and acting on ideas that flow from bottom upwards.
3. Being an innovative thought leader, continuously exploring, experimenting, learning and sharing not afraid to have a point of view and take a stand on it.
4. Evolving into a change agent for Person Centered Care by walking the talk.
5. Educating the public about aging issues by sharing stories that in turn enhance their brand and contributes to operational success.

Is this you? Who do you know who exemplifies these qualities, and what has been your experience with them? Are you in? If so let's talk!

Anthony Cirillo, FACHE, ABC is a healthcare consultant, senior advocate and blogger for Wellsphere in the area of aging and senior health. He consults with long-term care facilities and is available for management retreats and association keynotes. He is the author of "Who Moved My Dentures? His company, Fast Forward Consulting empowers organizations to change the healthcare experience and leverage it in their marketing. To read more, go to http://community.advanceweb.com/blogs/ltc_1/archive/2009/09/04/guest-blog-new-leadership-methods-needed-if-person-centered-care-to-blossom.aspx and http://community.advanceweb.com/blogs/ltc_1/archive/2009/08/05/guest-blog-putting-person-centered-care-in-perspective.aspx.

After examining life expectancy and mortality data from 1920 to 1940, University of Michigan researchers José Tapia Granados and Ana Diez Roux found a surprising boost. Over that time, they found U.S. life expectancy increased by 6.2 years during the Great Depression-from 57.1 years in 1929 to 63.3 years in 1933, according to this article posted on MSNBC.com.

In fact, the researchers found that while overall population health (as measured by life expectancy) rose during the Great Depression and other recessions between 1921 and 1938, mortality increased during periods of strong economic expansion, such as 1923, 1926, 1929 and 1936-37.

The researchers looked at mortality rates for specific age groups and as a result of six specific causes that accounted for about two-thirds of total mortality in the 1930s: cardiovascular and renal diseases, cancer, influenza and pneumonia, tuberculosis, motor vehicle traffic injuries and suicide. Mortality for all ages due to all the causes declined in periods of economic downturn, except for suicide.

The researchers acknowledge these findings seem counterintuitive, but they still say they may apply to the current recession. Still, there are significant economic and societal differences between now and the 1930s, Granados told LiveScience. While overall population health and life expectancy may improve during down times, that might not be the case for any particular person, especially someone who is unemployed or worried about getting laid off and suffering attendant stress, he noted.

The overall rise persists, though despite potential health declines in those who have lost their jobs, because the majority of the work force is still employed (or retired and receiving benefits), he explained.

Reliable information on the quality of nursing homes is hard to come by these days, according to an article in the Los Angeles Times.

Currently, a Web site called Nursing Home Compare, which was created by the Centers for Medicare and Medicaid Services in 1998, provides information on nursing homes, from characteristics of residents to staffing and quality. But the Web site has been criticized since its inception over a decade ago.

Legislation included in a health care reform bill could revamp the site, making it more accurate and comprehensive:

That legislation, the Nursing Home Transparency and Improvement Act, would require the site to provide more precise data on staffing ratios and facility ownership, and improve and accelerate the complaint process. It would also require the Department of Health and Human Services to scrutinize the site to ensure the information provided is clear to consumers.

The bill has long been awaited by advocates of nursing home reform.

To read the full article, including shortcomings and assets of the government-run Web site, click here.

The program, which is billed as the first of its kind, takes place in the Hebrew Home for the Aged, Riverdale, N.Y.  It addresses the insomnia that often occurs with Alzheimer's or dementia and old age, according to the article on ABCNews.com.

The 11-year-old program offers various activities--from salsa dancing to art class and even field trips to restaurants and movie theaters--for patients with dementia every night of the week, from 7 p.m. to 7 a.m. The program also provides van service to pick up patients and bring them to the facility.

Because Medicare and Medicaid cover the program, it can help alleviate the financial burden that families can incur from providing nightly nursing supervision to patients.

While the program is widely supported by the state of New York, people all around the world are taking notice. In fact, representatives from senior centers in Ireland, Canada and Great Britain have sought recommendations from the Hebrew Home, and are hoping to replicate the nightly program.

Providing quality health care to people in remote and rural areas is a challenge. Fortunately for some seniors, a new study shows that cognitive testing by telephone is generally as effective as in-person testing.  

The study, which will appear in the International Journal of Geriatric Psychiatry, is the first to evaluate the effectiveness of telephone assessment in an elderly group using established neuropsychological tests. Fifty-four healthy women with an average age of 79 were divided into two groups and subjected to a series of standard neuropsychological tests that are typically used in clinical trials of Alzheimer's Disease. Both groups received in-person assessment of cognition as well as assessment by telephone.

The results suggest that telephone assessment may be a useful, cost-effective and time efficient alternative to in-person assessment of cognition in the elderly.

With new technologies that allow for free live video chatting (like Skype), telemedicine equipment might not even be required, and those in underserved areas will have more opportunities for care.

A press release from ALFA today announces that the Senate Finance Committee accepted an amendment by Senator Bill Nelson to Senator Max Baucus' health care reform legislation that would eliminate prescription drug co-payments under the Medicare Part D Prescription Drug Program for all dual eligible residents in assisted living waiver programs. This legislation could benefit up to 650,000 low-income seniors nationwide, 75,000 of whom reside in assisted living communities.

ALFA will continue to work very closely with Senator Nelson's office to eliminate co-payments for all dual-eligible residents in assisted living and other home and community-based settings. We thank Senator Nelson for his leadership on this issue and will continue to work with him and other members of Congress on this and other critical issues on behalf of America's seniors.

Click here to read the full release. Then leave us a comment and let us know what you think.

Most people figure that work-related injuries are just part of the job for nurses. With all that lifting, turning, repositioning and transferring that nurses do, injuries abound. In fact, a report on the American Nurses Association Web site indicates that an estimated 12 percent of nurses leave the profession every year because of back injuries and more than 52 percent experience chronic back pain.

But it doesn't have to be this way. As I've learned from researching this topic for an upcoming Safety column, no-lift policies--which can help prevent these injuries--are increasingly becoming a mandated policy at many types of health care facilities.

To learn more about safer patient handling, look for an article in the Safety column in an upcoming issue of ADVANCE.

Two things many seniors can be hesitant about-exercise and technology-are coming together in Taizo, the Japanese fitness robot. Taizo weighs about 14 pounds and stands two feet tall. It can do about 30 moves, mostly while sitting down. It will sell for about $8,000. See the fit little guy here.

I'm not sure seniors would be best served by an $8,000 robot. It seems like a human would be far better served to ensure a safe exercising environment. So you see any benefits to a robotic exercise instructor? Maybe for community-dwelling seniors who lack access to formal exercise programs?

My book club recently started reading Still Alice, a novel by Lisa Genova. The book chronicles a 50-year-old woman's experience with early-onset Alzheimer's disease.

In doing some research on the book, I came across the author's Web site, and found the Still Alice blog. It's here that Genova shares some of what she's learned about Alzheimer's and other general musings. The information could potentially be useful for anyone caring for patients with Alzheimer's.

"We can make health care safer. Not just a little safer, a lot safer," The Joint Commission President Mark R. Chassin, MD, MPP, MPH, said in a press conference today announcing the launch of a new center to improve patient safety.

The Joint Commission Center for Transforming Healthcare is working with the nation's leading hospitals and health systems to use new methods to find the causes of and develop solutions for deadly breakdowns in patient care.

Read the full report here, or go to the Center's Web site: www.centerfortransforminghealthcare.org

The Center's first initiative is hand washing, which Chassin says is the simplest, most cost effective way to prevent health care-associated infections that kill nearly 100,000 Americans annually.