ADVANCE Perspective: LTC : General Information

Easing the holiday stress

Maureen Salera — Tue, 24 Nov 2009 20:03:00 GMT

With the holiday season officially kicking off this Thursday, people's stress levels are sure to increase. Whether it's shopping or entertaining, the holidays often bring a cup of cheer with an added dose of anxiety. Throw the current economic situation into the cookie mix, and you've got a recipe for stress.

But it doesn't have to be this way. This article from The Washington Post outlines several strategies to reduce your holiday stress levels. These tips, which were culled from physician and psychologist Claire Wheeler's "Ten Simple Solutions to Stress," are simple and straightforward.

Start by simplifying your expectations, and go from there.

Researcher Develops Healing Bandage

Maureen Salera — Fri, 20 Nov 2009 02:48:00 GMT

A Penn State researcher has developed a bandage material made from microbial cellulose that the body can absorb. He has developed a method to incorporate enzymes with the bandage that break down the cellulose in a controlled way, according to the Penn State Live news source.

In 2007, Jeffrey Catchmark, associate professor of agricultural and biological engineering in Penn State's College of Agricultural Sciences, presented a seminar on a new approach for "bioresorbable" materials. This presentation caught the attention of health care company representatives who were in attendance, and the idea took off from there.

To read the article, click here.

Can You Succeed as a Jekyll and Hyde Leader?

Liz Rosto — Fri, 06 Nov 2009 20:38:00 GMT

The following is a guest blog from Anthony Cirillo:

In his latest book Warren Bennis raises questions about the nature of leadership. He asks, "Can a leader both act and be real?" Bill George, a professor at the Harvard Business School, in his book True North, contends that a "journey to leadership" cannot be made without "framing your life story, discerning your passions, finding your leadership purpose" and aligning it with that of your organization. In short he is saying that you cannot fake leadership, acting one way in the work environment and another way when away from work.

Bennis contends that there are times when it is necessary to avoid being authentic. I disagree especially when it comes to healthcare. In this age of consumerism and transparency where you are dealing with people's lives and the emotions of caregivers and families it is paramount that you walk the walk of person-centered and patient-centered care in your personal and professional life. People will see through leaders who lead double lives. And given that most of our hospitals and long-term facilities are in small towns where "everybody knows your name" and your business, you better believe that they will be looking out to see if you lead your life with the same values you profess to lead your organization. Employees see through this as well and will not be motivated to authentic change following a Jekyll and Hyde leader.

That could get to a more systemic issue about how we hire and promote leaders in healthcare. We always look at past accomplishments and metrics that have been moved in previous jobs. But what about how they lead their lives? Should that be considered? I believe it should though I am not sure how you screen for that. Tell me how you do that.

I can tell you that to re-certify as a Fellow in the American College of Healthcare Executives, you need to show how you contribute to the community beyond work. So at least in one instance you know that when you hire a Fellow of the College you are probably hiring someone who walks the walk in all areas of his/her life. This is not a commercial for the College but rather one example where you can begin to see a person's whole life picture. Are some able to lead without being authentic to their organizations or to themselves? What do you think?

Anthony Cirillo, FACHE, ABC is a healthcare consultant, senior advocate and blogger for Wellsphere, Medpedia and others in the area of aging, person and patient-centered care and marketing. 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.

AARP Endorses House Health Care Reform Bill

Maureen Salera — Fri, 06 Nov 2009 01:54:00 GMT

At a press briefing today at AARP's Washington headquarters, AARP Chief Executive A. Barry Rand said AARP supports the House health care reform bill over other proposals because this plan does more to lower drug costs for Medicare beneficiaries, strengthen Medicare and bar insurance companies from denying people coverage because of their health or age. The bill also would lower premiums for Americans ages 50 to 64 who have to buy private insurance and would create a voluntary long-term care insurance program.

To read more, click here for the AARP Bulletin and video on the announcement.

Fighting off Germs

Maureen Salera — Fri, 30 Oct 2009 16:40:00 GMT

We all know that washing our hands is the best way to guard against the spread of germs. But there are several other measures that can also help protect us from contamination.

In this Washington Post article, health care professionals share some other tips on how they stop the spread of infection.

Six-year-old girl faces eviction from retirement community

Maureen Salera — Thu, 22 Oct 2009 16:52:00 GMT

There's a debate raging in a Florida retirement community over evicting a six-year-old girl who lives there with her grandparents.

Kimberly Broffman is the little girl at the center of it all. She lives in the retirement community with grandparents Jimmy and Judie Stottler because they are her legal guardians.

The community's homeowner's association wants Broffman out because the bylaws of the community clearly state that residents must be 55 years or older. Apparently the Stottlers were willing to leave: They've been trying to sell their home, but the housing crisis has prevented them doing so, even after they decreased the asking price by almost $100,000.

Pretty soon, a judge will have to decide whether Broffman can stay or if she must go.

Click here to see the Today's show coverage of the story.

What do you think of this debate?

Futile end-of-life care

Maureen Salera — Fri, 16 Oct 2009 17:42:00 GMT

Two new studies from The New England Journal of Medicine indicate that nursing home residents may be receiving futile care measures at the end of their lives.

In one study, doctors examined health records of 3,702 nursing-home residents across the nation who started dialysis between 1998 and 2000. While the average age was 73, many had other health problems, including diabetes, heart disease and cancer. Within the first year, 58 percent died and 29 percent declined in their ADL ability.

The second study followed 323 people with advanced dementia from nursing homes in the Boston area. Their average age was 85 and they could not recognize loved ones or walk or talk. One out of four died within six months and half died during the 18 months they were followed.

As this article points out, experts agree that these two studies point back to the need for more palliative care in nursing homes.

Proper Handwashing Technique

Liz Rosto — Fri, 16 Oct 2009 14:44:00 GMT

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

Dialysis May Do More Harm Than Good

Heather Simons — Thu, 15 Oct 2009 20:34:00 GMT

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.

Nurses Against H1N1 Vaccination

Maureen Salera — Fri, 09 Oct 2009 17:41:00 GMT

A letter to the editor in today's Philadelphia Inquirer details the reasons why two Philadelphia-area registered nurses are rejecting the swine flu vaccine after attending a conference on the subject. Read the letter to the editor 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?

Recession May Spur Longevity

Maureen Salera — Fri, 02 Oct 2009 18:36:00 GMT

Longevity actually flourishes in times of economic hardship, and that may be true for the current recession as well, according to research that appears in the Proceedings of the National Academy of Sciences.

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.

Salsa at 3 a.m.?

Maureen Salera — Thu, 24 Sep 2009 14:23:00 GMT

This morning, Good Morning America ran a segment about a program that allows patients with Alzheimer's or dementia to stay active all night long.

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.

Not Just Part of the Job

Maureen Salera — Fri, 18 Sep 2009 02:24:00 GMT

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.

Still Alice

Maureen Salera — Fri, 11 Sep 2009 02:11:00 GMT

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.

Guest Blog: "New Leadership Methods Needed if Person-Centered Care to Blossom"

Liz Rosto — Fri, 04 Sep 2009 19:34:00 GMT

The following is a guest blog by Anthony Cirillo:

The Joint Commission recently emphasized the need for more involvement from healthcare administrators, executives and trustees in preventing medical errors. It also recommended using successful methods from other industries to improve quality in healthcare. According to the Commission involved administrators, physician leaders and other figures of authority can drive improvements.

Improvements in quality across the healthcare spectrum are to be lauded. But consider this recent and unsurprising finding from a recent study by Planetree and the Picker Institute: What is most vital to patients "has little to do with the clinical, technological or scientific aspects of medicine. These are taken for granted as minimum standards of care. Far more meaningful - and memorable - are compassionate interactions, access to information, involvement of loved ones, a healing physical environment, and an approach that supports mind, body and spirit."

I have been writing a lot about person-centered care and stirring the pot so to speak. When readers write back, they pin a lot of the stagnation in implementing person-centered care on leadership.

A couple of recent Harvard articles might hold the answer to the leadership question. The article, Are You Ready to Manage in an Irrational World?, is a kind of primer for the second.

I particularly like this quote: "Instead of a management philosophy centered around the manager as the play-caller, assigning tasks and motivating people to carry them out, we are told by the neuroscientists that the new management job is one of facilitating more of a customized, do-it-yourself process centered around each newly-energized employee, one centered on questions (often leading) rather than direction."

In the command and control, checklist, regulated environment it is hard to imagine let alone convince leadership that adopting this stance will actually help you check off the checklist sooner. Yet when you help create context and then empower people to come up with their own solutions, creativity is heightened, new ways emerge and there is a passion around it because those who helped craft the solutions did so because they authentically wanted things to change.

The second article, Leadership in a (Permanent) Crisis, takes the stance that economy recovers, things won't return to normal and a different mode of leadership will be required. That leadership will embrace staff empowerment, collaboration and shared problem solving.

Fundamental shifts come from self-driven authentic change by people empowered to do so. I think we have created the illusion of some of this in the person-centered care arena through scripts, training around how to deliver red carpet service, etc. But all of these miss the more systemic issue. People change because they want to change. Leadership has to create that context.

Are long term care leaders up to this challenge? Are health care management programs looking at these new methods? And is the current crop of enlightened long term leaders prepared to mentor and teach others?

Anthony Cirillo, FACHE, ABC is a health care consultant, elder 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 long-term care organizations to change the experience and leverage it in their marketing. Their "Experience Makeover" is a four-step process that assesses the employee and resident experience, redesigns it, equips and empowers everyone to change it and makes it an indelible part of the culture. To read more, go to www.4wardfast.com and www.anthonyssong.com.