ADVANCE Perspective: LTC

Top 10 Tweets of the Week (05.13.13)

Elizabeth Rosto Sitko — Wed, 15 May 2013 18:02:00 GMT

We've compiled our top 10 favorite tweets from accounts we follow on Twitter. Be sure to follow ADVANCE for Long-Term Care Management by going to @ADVANCEforLTC!

1. Alzheimers Support ‏@SandyAlz - Pat Summit Meets a diagnosis of Dementia Head-On - Alzheimers Support http://t.co/Vc1GLPrI04

2. AHCA/NCAL ‏@ahcancal - National Nursing Home Week Highlights Team Care: A Long Term Care Update from AHCA/NCAL http://t.co/4NwU8NuSQi

3. Everyday Health ‏@EverydayHealth - 12 reasons you're not losing weight... http://t.co/AD5sUnCYno

4. LeadingAge ‏@LeadingAge - How #hospice providers are using smartphone technology to engage: http://t.co/uhyPLpFgvA

5. ACHCA ‏@ACHCA - Congratulations to our newest Board Members installed during Convocation! To see list of ACHCA Board of Directors: http://t.co/qER6fTQ6is

6. NICHE ‏@NICHEProgram - May is Older Americans Month: Unleash the Power of Age - Check out our Pinterest Board: http://t.co/bGkNlaT000 #OlderAmericansMonth

7. BrookdaleLiving ‏@BrookdaleLiving -It's #NationalWomensHealthWeek! Ladies-start taking control of your health now! http://t.co/OlGkdUVpGW

8. ChangingAging ‏@changingaging - Should The Eden Alternative and The Green House Project become more active and aggressive and place a new... http://t.co/U72fmQ9t3A

9. Mather LifeWays ‏@MatherLifeWays - RT @huffpost50: A 94-year-old's secrets for #aging well http://t.co/S6JnFbZVft

10. CareBuzz ‏@Carebuzz - Make Your Senior Care Business Unlike Competitors: http://t.co/7aTajJuRoF

The New World of Collaborative Healthcare – With Data Leading the Way

Linda Jones — Fri, 10 May 2013 15:43:00 GMT

"Fee for service is truly dead," concluded Jade Gong, MBA, RN, senior vice president Strategic Initiatives at Health Dimensions Group in a webinar presented for ADVANCE. We now must transition away from this payment model and look at models such as bundled payment where the risks and the savings are shared among care providers in the continuum.

Any entity providing care to Medicare and Medicaid recipients must be prepared to participate in this collaborative environment. Gong and co-presenter Brian Fuller, MBA, FACHE, senior consultant for Health Dimensions Group, see this change as a time for excitement and opportunity for those in post-care care.

When CMS announced the bundled payment initiative in August 2011, it issued a press release that read, in part, that the new bundled payment initiative will "help lower costs and improve care coordination ... this opportunity can serve as a catalyst for connecting the parts of our healthcare delivery system for improved performance and value."

Fuller, in his portion of the webinar, explained seven key steps to create a bundled payment model. They are 1) create "episodes of care" (define needs); 2) analyze the cost distribution across services; 3) identify sources of variations in costs for same conditions; 4) map pathways of care; 5) understand performance of all partners (costs, utilization, quality outcomes, practice patterns); 6) identify levels and types of risks; and 7) develop pricing.

The common element in all of this is data. You must have the ability to collect, analyze and react to data. Data "will fuel your opportunity and journey," Fuller said; "Do you have the data necessary to evaluate current care delivery patterns and identify possible areas for improvement?" This is what will be essential to stay in healthcare, especially post-acute care, today.

The webinar, "Bundled Payment: An Opportunity for Post-Care Providers to Move Up the Healthcare Delivery Chain," was recorded and will be posted to our site by May 16, 2013.

MORE WEBINARS

ADVANCE presents free webinars each month for our members. See the full catalog here.

See You in Charlotte!

Elizabeth Rosto Sitko — Thu, 02 May 2013 13:01:00 GMT

Assisted living operators hold a unique niche in the long-term care market. Offering more than independent living, but not quite skilled nursing, assisted living can be the best of both worlds for residents who need a little help with activities of daily living.

I've been away from long-term care conference travel for a little over a year, so I am excited to meet with all of our assisted living members at next week's ALFA Annual Conference & Expo in Charlotte.

There are some interesting events on the schedule, including Southern-inspired hospitality, ALFA Hero Awards presented by First Lady Laura Bush and expert advice from business leaders both inside and outside the senior living industry. One of those experts is Jim Fitzgibbon, former president of Four Seasons Hotels. As you probably already realize, assisted living providers can learn a lot about hospitality from the resort industry.

And don't forget to visit all of the product and service providers in the exhibit hall (including ADVANCE at booth #1203!) We'll be mixing and mingling at happy hour on Tuesday evening. Looking forward to seeing you!

For more information, go to http://www.alfa.org/alfa/ALFA_Conference_and_Expo.asp

More on this:

ALFA Conference Preview

Return to ADVANCE for Long-Term Care Management Homepage

Screening for C. difficile Upon Admission

Linda Jones — Tue, 30 Apr 2013 16:46:00 GMT

Wouldn't it be great if you could stop the spread of C. difficile at the front door? Since carriers can be asymptomatic it can be challenging to initiate the correct precautions without first identifying carriers. A new study attempted to identify whether carriers could actually be identified at the door - upon admission.

Researchers from the Mayo Clinic in Rochester, Minn., identified independent predictors of C. difficile colonization to be recent hospitalization, chronic dialysis and corticosteroid use. They found one or more of the three independent risk factors were present in 48% of their study participants (320 patients), and screening only those with one or more of these factors would have identified 74% of the carriers.

Their findings are published in the May issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC). The authors were careful to note limitations of the study: only 22% of all eligible patients provided stool for C. difficile testing, and the study population was not representative of all patients admitted to the hospital.

"Our objective was to estimate the burden of asymptomatic C. difficile carriers at admission because that constitutes an important checkpoint where risk factors can be assessed and infection prevention measures instituted," said the authors. "This is the first study to demonstrate the feasibility of performing C. difficile surveillance on hospitalized patients at admission.

"While more research needs to be conducted on the transmission of C. difficile infection from colonized patients, this study may help institutions with persistently high rates of transmission develop an expanded strategy for targeted C. difficile surveillance," added APIC 2013 President Patti Grant, RN, BSN, MS, CIC.

Why LTC Needs to Change: ACOs, ACA, Data, Re-Hospitalization & More

Linda Jones — Mon, 29 Apr 2013 15:12:00 GMT

Recently I had the pleasure of attending two conferences focusing on care of elders. On April 12 I attended the last day of the 16th annual NICHE (Nurses Improving Care for Healthsystem Elders) Conference in my own backyard of Philadelphia. The perspective I gained here was different than what is presented on this website as most in the audience were from the acute-care settings rather than LTC.

The day I attended the conference, each presentation was on site innovations - what facilities are doing to improve elder care - in the areas of palliative care, transitions and resources. Cassia Chevillon, BSN, RN, CCRN, and Catherina Madani, MSN, RN, CHPN, of the University of California San Diego, presented "Incorporation and Utilization Patterns of Nursing Palliative Care Triggers in the ICU." In the presentation, Madani noted that many nurses in ICU believe they push back death, but in fact, 20% of Americans die in the ICU. She said "we lack emotional preparedness that is concurrent with increased clinical/technical knowledge." In other words, it's easier to implement some sort of care than to have a difficult conversation with a patient or family member.

A barrier to palliative care in the ICU is the physicians and surgeons. A suggestion that palliative care is needed implies they have failed in their job. Nurses in the UCSD ICU went about creating a way to bring up the need for palliative care without meeting with resistance from the docs. They created a list of 8 triggers and each nurse has them listed on the back of her name badge. If a patient has just one trigger, the standard of care is to request a palliative care consult. Having the list readily available and being able to show this as protocol to the doctors makes the issue easier to approach.

One of the interesting innovations in transitions is the LINCT program out of Northwest Community Healthcare in Arlington Heights, Ill. The goal of this program was to reduce hospital re-admissions when patients are transferred to an extended care facility. Dina Lipowich, RN, MSN, and Julie Knight, APN, RN, ACNS-BC, told about their program: Liaison in Nursing Care Transitions, which placed a geriatric clinical-nurse navigator in both the hospital and the extended care facility. The patients and families reacted positively to the familiar face during the transition, and they found a better continuum of care. The LINCT nurse also worked with the administrators on both sides and analyzed re-admissions that did occur to determine trends and solutions. In the 1.5 years the program has been in place re-admissions dropped from 19.6% to 9.4%.

Read more about the NICHE conference in our coverage online.

Two days later I was in already-humid Orlando for the 47^th Annual Convocation of the American College of Health Care Administrators (ACHCA). Most of the sessions I attended at this conference focused on the need for long-term care facilities to prepare for the changes in healthcare. Ron Present, CALA, CHNA, principal at the St. Louis accounting firm Brown Smith Wallace, advised LTC needs to find a better way to calculate costs; looking just at PPD is no longer enough. LTC facilities have to figure out what their costs are so they can be competitive when it comes to being part of an ACO, or just getting referrals from health systems. He also emphasized if you are not currently collecting data, you need to start - and figure out a way to transfer that data easily to other systems.

Hospitals are getting out of the LTC business, he said, but need to partner to offer the service. Out of this need comes bundled payments. (Learn more about bundled payment plans at free ADVANCE webinar on May 9.)

You'll be hearing more about the topics presented at ACHCA in the coming months as many of the presenters will be contributing to this website. Look for articles on Identifying Future Leaders, Effective Communication with People with Dementia, Using Therapy Services to Avoid Hospitalization and a several articles on labor management issues.

Complications Boost Hospital Profits, According to New Study

Elizabeth Rosto Sitko — Fri, 19 Apr 2013 13:42:00 GMT

At a time when long-term care providers are doing their best to prevent hospital admissions and re-admissions, a new study from Harvard Medical School came up with some disturbing results. The study, which was just published in JAMA, reveals that hospitals can make more money when surgery results in complications, thus adding to the patient's medical bill and perhaps disincentiving hospitals to reduce medical errors.

According to the study, if a patient with private insurance had complications after surgery, hospitals made $39,017 more profit than if all had gone well. That's compared to an additional profit of $1,749 for a Medicare patient with complications after surgery.

The researchers looked at 34,000 surgeries at 12 hospitals in the Texas Health Resources system in 2010. About 5 percent of people experienced complications. That included surgical site infection, sepsis, pulmonary embolism, stroke, heart attack, pneumonia and other infections. The study was part of a larger effort to improve quality in the system.

It's obvious that the more care provided, the more reimbursement received. But I'd like to think that any ethical medical provider would not try to pad the bill. The study authors say their hope is to try to reduce financial incentives for providing more care, including bundled payments for Medicare that pay the same amount for a procedure, with or without complications.

Top 10 Tweets of the Week (04.01.13)

Elizabeth Rosto Sitko — Fri, 05 Apr 2013 16:37:00 GMT

We've compiled our top 10 favorite tweets from accounts we follow on Twitter. Be sure to follow ADVANCE for Long-Term Care Management by going to @ADVANCEforLTC!

Senior Living News ‏@ALFA_Online - ALFA's Members in the News is out! http://t.co/BAUXrflmOQ Top stories today via @GenesisCareers @WALAMembership @BMAmanagement

NYTimes Health ‏@nytimeshealth - The New Old Age Blog: Caregiving From Another Continent http://t.co/q8aanzTONd

ACHCA ‏@ACHCA - Congratulations to Our 2013 Award Winners! https://t.co/erNeU0OMHw

LeadingAge ‏@LeadingAge Tell #Congress to restore funding to #aging services programs. http://t.co/w6HLw32Wpf

AHCA/NCAL ‏@ahcancal - LTC Trend Tracker - your facility's best resource for hospital readmission data: http://t.co/WNquivsfn4 #QualityInitiative #SNF

Alzheimer's Assoc. ‏@alzassociation Stress and Alzheimer's disease: What's the connection? http://t.co/La6w9qwxs6 #ENDALZ

Sunrise Senior Lvg ‏@SunriseSrLiving - An informative video that provides valuable caregiver tips: http://t.co/u3qmz6eTow

Unidine ‏@Unidine - A downloadable fresh food audit form. How fresh is your #LTC dining program? http://t.co/iXUvTbHq9I

Alzheimers Support @SandyAlz - Alzheimer's Patient has No memory of Nursing Home Visitors? Keep a Calendar or Guestbook - -- Alzheimers Support http://t.co/vKNI3T8L0B

AHRQ ‏@AHRQNews - #AHRQ supports the National Quality Strategy to improve #publichealth http://t.co/KMq6KYf3zu #NPHW

Return to ADVANCE for Long-Term Care Management Homepage

Denied CPR Incident Spurs Reminder to Have Clear Policies

Linda Jones — Fri, 29 Mar 2013 12:46:00 GMT

As an administrator or leader in senior living, you have likely read everything you can about the incident in the California facility where a resident died because CPR was not performed immediately. I assume most of you reviewed your own policies and maybe even contacted your legal department to be sure you and your employees are protected, and that you are able to provide the appropriate and desired care for your residents.

But just in case this news item didn't hit home, I'm sharing some insight from liability and insurance expert, Eugene Solomon, founder of Asset Guard Endorsement, a company that provides personal renter's insurance for seniors. He reminds us that senior living companies have to think beyond their own employees to contracted workers in the facility.

For example, companion service professionals routinely visit residents in assisted living communities and provide non-medical personal care. Both the resident and the community benefit from the service but what happens if there is an emergency? Where does the accountability begin and end for everyone involved?

"The positive impact companion service professionals have on seniors is extraordinary and very much needed," said Solomon. "But communities need to establish ground rules and policies, conduct a thorough review of the company and have a conversation about emergency processes upfront."

Solomon offers the following advice for senior living communities:

Conduct and establish a rigorous vetting process.
Require all outside vendors to provide a certificate of insurance before they visit with a resident. No exceptions.
Ensure vendors are licensed, insured and bonded. Ask for documentation.
Communicate and demonstrate emergency situation policies. Be clear.

"Overlooking any of these elements could result in unwelcome litigation for the community or worse, unintended harm to residents," said Solomon. "The good news is companies can safeguard themselves and be proactive."

New Reports on Alzheimer's & Dementia

Elizabeth Rosto Sitko — Fri, 22 Mar 2013 15:55:00 GMT

Two new reports were released this week that show the devastating effects of Alzheimer's and dementia.

The Alzheimer's Association reports that one in three seniors dies with, not of, dementia. The report points out that dying with Alzheimer's is not the same as dying from it. But it can speed someone's decline by interfering with their care for heart disease, cancer or other serious illnesses.

According to the report, 5.2 million Americans have Alzheimer's or some other form of dementia, and those numbers will jump to 13.8 million by 2050, Tuesday's report predicts.

Nearly 85,000 people died from Alzheimer's in 2011, the Centers for Disease Control and Prevention estimated in a separate report. Those are people who had Alzheimer's listed as an underlying cause on a death certificate, making Alzheimer's the sixth leading cause of death.

Data from the U.S. Centers for Disease Control and Prevention showed the risk of death from the degenerative brain disease rose 39 percent between 2000 and 2010 even as mortality rates for other conditions such as cancer, heart disease and stroke fell significantly.

Sad news about a disease there is currently no cure for.

Infection Control in Long-Term Care: Single-Resident Equipment for Vitals

Linda Jones — Mon, 18 Mar 2013 16:43:00 GMT

The following post is by Tina Beskie, VP Business Development & Marketing with Nurse Rosie Products.

Preventing the spread of MRSA, CRE and other hospital-acquired infections (HAIs) is quickly becoming a top priority in skilled nursing and long-term care facilities. Caregivers need to be ever vigilant to ensure hands are washed, gloves are worn, personal protective equipment procedures are followed, and a litany of other precautions are taken to protect patients, their families and themselves. In addition to the human cost, nosocomial infections in the U.S. add approximately $40,000 in medical costs per patient due to longer hospital stays, readmission and further treatment.

Residents living with diabetes have weakened immune systems that make them more susceptible to MRSA and other antibiotic-resistant infections. Those in skilled nursing and long-term care facilities are especially vulnerable, as this population is prone to developing skin wounds that easily spread bacteria. In fact, 85% of MRSA outbreaks occur in healthcare facilities.

The CDC recommends facilities pay particular attention to cross-contamination points -- the surfaces touched by an infected person which become the main vectors for the spread of MRSA, C. diff, and VRE. Studies have shown that a surprisingly high percentage of presumed-clean blood pressure cuffs that are shared among patients house these organisms. As a result, the CDC has issued guidelines including recommending the use of single blood pressure cuffs.

We often overlook disinfecting procedures on our vital signs monitoring equipment because we are using disposable thermometer probe covers. Shared cuffs can become an infection risk and a time-consuming disinfection procedure nightmare. Studies show that when each resident has their own blood pressure cuff, the risk of HAIs drops significantly.

The main obstacles in introducing these cuffs to the long-term care industry have historically been availability, cost and concerns about durability. However, as with anything that is in demand, vendors will evolve a product to fit the needs of their customers. Personal cuffs are now available in a variety of sizes, price points have become quite economical, and they are now durable enough to deliver a lifecycle of more than 200 readings so they can be used throughout a resident's stay without the risk of passing infection to another patient.

Facemasks for All to Prevent the Spread of Infection

Linda Jones — Fri, 15 Mar 2013 16:45:00 GMT

Who was that masked man?!

Maybe just someone hoping not to get sick.

Within the healthcare system, employees, and sometimes visitors, wear facemasks if they will encounter someone who is highly contagious with a serious airborne illness. This is a proven way to avoid the spread of infection to healthcare employees.

But there are a lot of contagious people outside of the healthcare system. Should the general public take the same precautions?

In a January 2013 article in The Journal of Infectious Diseases, "Exposure to Influenza Virus Aerosols During Routine Patient Care," the authors reported, "influenza viruses may spread as far as six feet from a person coughing or sneezing." Think about that next time you're in the grocery store and hear "achoo." But as a society are we ready to ask people with the sniffles to wear a facemask for infection source control? Or do facemasks become part of our daily attire as primary protection?

If the latter, imagine the fashion industry getting a hold of that. Whether plain or with bling, they are sure to be a hot-ticket number, according to the two U.S.-based medical mask manufacturers.

According to Matt Conlon, VP of Research and Policy at Cantel Medical (one of the two companies), "... face masks are recommended for use by the general public during pandemic events, yet the government has no supply preparedness plan to fulfill the demand that may come as a result of that recommendation."

Mike Bowen, executive VP of surgical mask manufacturer Prestige Ameritech, commented, "We saw it firsthand during the H1N1 pandemic. U.S. manufacturers were at full capacity within two weeks. Hospitals that normally depend on foreign sources were calling for masks, and we couldn't help them. Government officials have acknowledged very clearly that they couldn't create or support a policy for the use of face masks by the general public because there just isn't enough domestic manufacturing capacity even for healthcare needs."

The manufacturers admit they can make more masks - if they know somebody will buy them - which means they need to convince the public that wearing a facemask is the way to go to prevent the spread of illness.

"We need a bigger effort to include research and clear policy that can help the general public; cough and sneeze etiquette promoting the use of elbow containment, tissues, and handwashing simply isn't enough," claims Conlon.

Research, yes. And what manufacturer wouldn't want scientific evidence as part of its business plan? But if we're having a hard time getting healthcare workers to wash their hands and get vaccinated, what is the likelihood of making face masks the next great fashion statement?

Lean In in Long-Term Care

Elizabeth Rosto Sitko — Thu, 14 Mar 2013 13:37:00 GMT

With the majority of professionals working in long-term care being female (according to our 2012 survey, 67% of you are women), work-life balance is no doubt a big issue.

Facebook COO Sheryl Sandberg's new book, Lean In, has gotten a lot of publicity in the past few days, both good and bad. While Sandberg may come from a different place than many of us, this basic fundamental rings true: women must support one another.

One of her pieces of advice is to start what she calls a "Lean In Circle." This is a peer group of eight to 10 women who meet monthly, offering one another encouragement and development ideas. Her Lean In website offers downloadable circle kits that show you how to form and run one. There’s also a growing community online, where women can share experieinces on the Lean In website.

What is your experience as a female in a leadership role, and what's your take on the Lean In movement?

Return to ADVANCE for Long-Term Care Management homepage

Happy Long-Term Care Administrator's Week

Linda Jones — Fri, 08 Mar 2013 17:13:00 GMT

To all of the administrators out there, it's time to reflect and celebrate all you do to bring quality care to elders. You wear many hats - and gloves and gowns and shoes - to keep your communities running efficiently and safely. This is your week to be recognized and appreciated.

Hopefully your staff knows of this week and shower you with gifs. But it's also a great opportunity to market yourself and your community to your neighbors, potential customers and business partners.

People looking for long-term care housing want a place they can trust, and that starts with the people who run it. Let the public know you are a caring, responsible, well-educated professional who can assure a safe, healthy environment. You can do this by writing to your local newspaper/website, sending out press releases, and calling your local news channel to offer your expertise for related stories.

This week is also the perfect time to identify and begin mentoring others in your organization who could someday take a leadership role. Let them know the challenges and rewards of being a long-term care administrator.

Do more than treat yourself to a nice lunch this year. Sing your own praises to others and become a trusted resource for them.

Guest Blog: Reducing Elderly Loneliness

Elizabeth Rosto Sitko — Fri, 01 Mar 2013 16:43:00 GMT

Editor's note: The following is a guest blog by Wendy Drastal, RN, vice president, HomeCare Inc., a home care provider in the Merrimack Valley, Northeastern Massachusetts and Southern New Hampshire.

The cold and snowy winter months can be challenging for many people. A trip outside, even for a brief errand, can be both difficult and dangerous.

The winter can be especially treacherous for the elderly, who are at risk for broken bones from falls on ice, breathing problems caused by cold air, hypothermia and frost bite. Many hold less body heat due to a slower metabolism and reduced physical activity, so they feel the cold more severely. And, as people age, the ability to feel changes in temperature decreases, making it important for elders to monitor the house temperature and to dress in layers.

For the elderly, the winter months can also be long and lonely for the elderly who find themselves homebound with fewer social activities and outside contact.

So what can you do to help an elderly family member, friend or neighbor reduce the isolation and loneliness of winter?

Make it a New Year's resolution to visit once a week for a meal, cup of coffee or just to socialize for an hour or two.
Encourage other family members to visit, call or e-mail on a regular basis.
Contact your local senior center or community center to check for opportunities for group meals, social programs and outings, or even friendly visitor programs.
Buy, fill and hang a bird feeder in a backyard or attach it directly on a window. Birding activity can be very entertaining and a great topic for conversation.
Check the local library for a mobile book-loaning program, or offer to pick up and drop off books and magazines.
Send a letter. An old-fashioned letter in today's age of electronic communication can mean a lot to the elderly and bring a sense of anticipation while awaiting a mail delivery. Enclose a couple of pictures for added enjoyment.
Plan an occasional outing for lunch, a trip to the barber or hairdresser, or for some shopping.

Finally watch for signs of depression. The elderly are at increased risk for depression due to life changes, medication and illness.

For more articles on activities for the elderly see:

Boosting Outcomes with Animals

Keeping Busy

Return to ADVANCE for Long-Term Care Management

Need a Good Night's Sleep? Try Exercising

Linda Jones — Fri, 01 Mar 2013 16:18:00 GMT

Self-described exercisers claim to get "a good night's sleep" more often than self-described non-exercisers, according to the National Sleep Foundation's 2013 Sleep in America® poll. Both groups report the same amount of sleep on weeknights (just under seven hours).

Of those who exercise (at any level: vigorous, moderate or light), more than half report getting a good night's sleep every night or almost every night. Only 39% of the non-exercises make the same claim.

This raises the question, do people sleep well because they exercise, or exercise because they are well rested? "While cause and effect can be tricky, I don't think having good sleep necessarily compels us to exercise," said Max Hirshkowitz, PhD, poll task force chair. "I think it is much more likely that exercising improves sleep."

As a "self-described exerciser," I can support these findings. I believe I sleep well most nights. On some nights it's definitely because I got my butt kicked at the gym. That said, if there is a night where I don't sleep well, I pay for it at the gym. So, one definitely impacts the other.

You certainly know that both are good for you: sleeping well and exercising. The challenge for your residents may be access and interest. Does your community provide the right type of exercise opportunities to interest your residents and keep them engaged? Like anyone else who exercises or goes to a gym, you need to switch up the offerings regularly to keep the engagement high. And, of course, offer options for all levels of ability.

Learn more about exercise in senior living: