quality improvement

CMS and several industry groups kicked off a participation drive today as part of "Advancing Excellence in America's nursing homes" The eight areas to choose from are
The eight areas are: reducing high-risk pressure ulcers; reducing use of physical restraints; improving pain management for short- and long-term residents; setting specific targets for quality improvement; assessing resident and family satisfaction; increasing staff retention; and making staff assignments more consistent.

Group kicks off initiative to improve long-term care

Abuse and neglect

A sad litany of events in this review article. Has nothing changed? Many issues can be traced back to staffing levels but surely its more than a supply issue?

Residents in nursing homes are some of the most vulnerable and helpless citizens in the US, with nearly 1.7 million elderly and disabled persons residing in about 17,000 facilities. And as difficult as it is to believe in this day and age, there is indisputable evidence to show that many nursing home residents are being neglected and abused on a daily basis

Nursing Home Fraud Neglect & Abuse Much Too Common

faux resident

A student in gerontological studies programme at Miami university spends 12 weeks as a resident in a nursing home. She described the experience as 'indescribable, wonderful'

MU student spent 12 weeks living in a nursing home

Telephone medicine in LTC

From this months JAMDA.This article discusses the fact that nurses and physicians appreciate different aspects of telephone medicine in LTC. From two focus groups the researchers made the following QI recomendations

1) better nursing assessment and provision of patient information
2) minimization of nonurgent calls after hours
3) more decisive physician action (or explanation of inaction)
4) better physician familiarity with facility policies/logistics
5) better communication/paging system.

Considering how many care decisions are made over the phone this study should be broadly distributed and read!

Inter-disciplinary Focus Groups on Telephone Medicine: A Quality Improvement Initiative

Hospital food ( again)

No surprises here. I was intrigued by 23% of patients being too far from their food, I moved a couple of patients closer to the table on my last rounds.....

58 percent of older hospital patients have problems eating, 31 percent leave most of their meal

AMDA responds to Consumers Report

The American Medical Directors Association suggests that the prescence of a strong medical director on site has been associated with the following

- Reduced use of physical restraints by 50%;
- Reduced dehydration by 50%;
- Reduced rate of use of indwelling catheters by 29%;
- Increased treatment of depression by 12%;
- Increased residents with advance directives by 64%;
- Increased use of hearing aids for persons with hearing difficulty by 30%; and
- Reduced use of hospital services by 25%.

AMDA Responds to Consumer Reports Article on Nursing Homes

Long term acute care

? same as subacute care
Read more about this rehab unit in Northern California

Medical makeover: Rehab hospital switches focus to long-term acute patients

Al Wilke's blog

Read Dr Wilke's blog entry on nursing homes.......

Nursing Homes, Part of the "Shell Game"

delayed placement

Another study that demonstrates delay to placement ( three months) and improved quality of life in patients taking cholinesterase inhibitors.

Drug May Delay Nursing Home Placement for Dementia Patients

BNP

This could be a useful test in LTC in the setting of dyspnea and raised respiratory rate. The authors of this review article conclude that there is strong evidence that a low BNP level will exclude CHF in patients presenting to Emergency.


Natriuretic peptides in the diagnosis and management of heart failure

nimby in St John's

Don't you love it?

Posh St. John's neighbourhood nixes home for seniors

New Canadian Lipid Guidelines

Unfortunately not full text online yet that I can see. Published in the Canadian Journal of Cardiology September 2006, Volume 22, Number 11: 913-927. Not much about the elderly or LTC but they have expanded the Framingham table by 5 years up to 79, small steps...

Canadian Cardiovascular Society position statement – Recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease

quake zone

More needs to be done for older patients living in the earthquake zone of Kashmir ( 2005)it was announced at a 3 day conference in Muzaffarabad ( capital city of the state of Azad Kashmir) by a representative of HelpAge International.


‘Geriatric, palliative care received less attention in quake hit zone’

Campus of care

Fraser Health to control 90 LTC beds

Care home gets nod

minimum staffing levels

The Ontario government is promising to release a new Long Term Care Act in the fall to the legislature. According to SEIU Local 1.on there will be no reference to minimum staffing levels. A report will be released on Friday

Ontario Nursing Home Residents Deserve a Guaranteed Amount of Care Hours

Staying in bed

Is it bad for patients to stay in bed in LTC? Who gets to decide? Baycrest and U of T are collaborating in a research project to find out.


Study takes a look at patients in continuing care

Measurement of care

Dr Chappell in Victoria is leading a group of investigators using new easy to use measures for care of older people with dementia in LTC

An ongoing study seeks ways to improve dementia care in British Columbia

Home Care in Hamilton

Deficits and waiting lists in Hamilton.
9% increase in people receiving home care this year and a 18% increase in clients post acute care
20 out of 42 CCACs are projecting deficits
Hamilton CCAC has 11,000 clients a month and will soon merge with five neighbouring CCACs

Home-care service cuts would be 'disaster' for seniors

Driving cessation

A Canadian study on driving cessation in the context of dementia/cognitive impairment led by Dr Hermann out of Sunnybrook looks at 3 years of data in todays CMAJ. Agitation, apathy and hallucinations were all predictors of driving cessation. However no easy solution is suggested to assist the family and family physician in counselling regarding cessation of driving in early dementia.

Predictors of driving cessation in mild-to-moderate dementia

pre-MCI : what next?

What do I tell patients now? A study out of Dartmouth

Seniors who feel their 'mind is going' could very well be right

hospital food ( in Glasgow anyway)

Confused, sick, starving … old

Ageism in the health service

A study and editorial in today's BMJ regarding the undertreatment of strokes and TIAs on the basis of age and in light of clear benefit. As Professor John Young (Academic Unit of Elderly Care and Rehabilitation, St Luke’s Hospital, Bradford, UK) states in his editorial

Whenever a clinical stone is turned over, ageism is revealed, he says. For example, in cancer services, coronary care units, prevention of vascular disease, and in mental health services. To this list, we must now add the management of transient ischaemic attacks and minor strokes.

AGEISM ENDEMIC IN HEALTH SERVICES

Green House Project

Hear Dr William Thomas ( founder of the Eden Alternative) talk about his latest project , the Green House project. Smaller more resident orientated housing for LTC. In this brief sound clip he talks about reducing the use of wheelchairs in one centre from 70% to 30%. Smaller housing means better privacy and dignity.

A Different Kind of Nursing Home

ADRs

From this weeks JAMA. A one hour educational intervention resulted in a ten fold increase in reporting of adverse drug reactions in 1,400 physicians in Portugal. A significant difference in the intervention group was sustained at one year.

An Educational Intervention to Improve Physician Reporting of Adverse Drug Reactions

Smart beds

This story from Singapore where a smart bed has been developed that will trigger staff to attend to residents who are in imminent danger of falling from bed

No more falling off beds

Geriatrician shortage

September JAGS article from Canadian geriatrician Dr Laura Diachun describes the current and projected shortage in her area ( 200 geriatricians for the entire country , approximately a third of the current requirements at 1.25 physicians per 10,000 65+)


Boomers face critical shortage of geriatricians when they reach old age: study

Cholinesterase inhibitors

The debate in the UK continues in this BMJ commentary from Friday. Too little evidence of efficacy too many resources spent in specialty memory clinics, not enough care throughout the disease.


Role of cholinesterase inhibitors in dementia care needs rethinking

Risk factor for LTC?

This recent study in the Journal of Gerontology:Medical Sciences gives persistent difficulty with bathing requiring assistance a 77% increased risk of nursing home admission.

Bathing a marker for nursing home

Nursing homes in China

Some 140 million Chinese people are aged 60 or older ( this is the same proportion of seniors as in the whole of Europe). In this article in the Shanghai Daily a senior kindergarten is proposed which offers 'non-secluded' care in Shijiazhuang, capital city of north China's Hebei Province.


"Senior kindergartens" provide care elderly close to home

Incompetence in Cambridge

More of the same.......


MP calls for probe into nursing home

AARP paper

This was published in 2002 by AARP and provides an excellent summary of how chronic care is evolving in the US away from nursing homes into the community.

Before the Boom:Trends in Long-Term Supportive Services for Older Americans with Disabilities