Pharma

9% increase in wholesale drug prices will add $10BN to the US drug bill

alberta health service pay-outs

......................

death of the nursing home

..the numbers speak for themselves.

The number of facilities has fallen by nearly 1,000 to about 15,700 since 2000. More than 80,000 beds have been shuttered over those nine years. And the number of Medicaid-only beds—those certified for long-term care stays-- has plunged by half since 1995, to about 114,000

Stelmach returns serve...

..no comment

move to assisted living...

..our somnolent opposition finally stirs....

bed closures

..all of this predicated on the creation of space in the community. Capacity problems are rampant and persistent across the country. Until decision-makers ( and consumers) realize that an integrated system of care is the only way to address this problem we will be stuck in an outdated and inefficient hospital-first oligarchy.

"What they said is that they have determined that there are 350 people in acute-care beds between Edmonton and Calgary that should not be in acute-care beds and that as those people are moved, the beds will be closed," she said.

The province will create 800 community-care places to accommodate these patients, which will include options like home care and assisted living, Smith said.

Steve Jobs

..this has to be good for organ donation...

placement woes in Montreal

..a systematic lack of attention to this health service area now blossoms with average LOS of residents in hospital waiting placement of 133 days! If we only ever see real change through crisis, long live this crisis!

neglect causing death

....you can't make this stuff up. Of course the line of accountability doesn't stop here but it is handy to have someone to embody the problem.

dabigatran

...is this warfarin's swansong?

the face of future care

..has it come to this? It may have some utility during transfers but the intensive elements of 'intimate' or 'personal ' care will require a robot with more finesse!

3%

...Alberta Continuing Care Association responds to 'cuts' announcement. Fewer desserts apparently. This is the only sector funded on a case mix basis and has always had to justify its costs. The medicine that comes through the doors of most centres is no different from the medicine that left the hospital a short ambulance ride away. Why it continues to be considered a separate and external service to 'health' is a mystery. Fewer desserts, I think this will mean more than fewer desserts.

on the receiving end

.. certainly would give anyone naïve to chronic care a unique perspective, another novel way might be to actually practice there ;-)

Alzheimer's not a health condition

...well, now it's official! This is a good example of how this age-related condition has been institutionally subjugated by decision makers. Disgusting.

Stephen Duckett

..in this interview he talks mostly of his planned move to activity based funding for hospitals and his pragmatic approach to healthcare.

small town health care 2009

...changes in 'health' are looming for municipalities but information is scarce and uneven...

fractures and death

....large observational study, three fold risk....

falls and the elderly

...Steve Tyler's fall, intrinsic or extrinsic factors?

anemia and old age

...hazard ratio for death 1.41 ( 95% CI 1.13-1.76) with anemia from the outset adjusted for comorbidity at 5 years ( CMAJ)

post mortem payments

..if nursing home care is mostly a site based chronic health care model , how could this proposal be described as fair ?

not your average nursing home resident

...Stanley Colson from a nursing home near the Kennedy space centre..

Leas Cross

.....harsh criticism in today's report. How will this watershed case change care?

THE COMMISSION OF INVESTIGATION
(LEAS CROSS NURSING HOME)

Georgetown research

....US slow to develop community services for chronic care. Isn't community development how Obama cut his teeth?

Long‐Term Care in Health Care Reform:
Policy Options to Improve Both

Halifax doctors

.. excellent work from colleague Dr Barry Clarke in Halifax....

Humanity in medicine

.....an elegant essay written from the first hand in the first hand. The current state of affairs is a moral impoverishment of the practice of medicine.....

do you know where your neighbour is?

mmm......this says what about us?

falls & walking aids

...significant rates of falls and injuries in this CDC study , need to redesign walkers..

US kicks UK ass

memory and mood cagefight.........

H1N1 in LTC

....heads up

Dr Stephen Duckett

....Picard may be overstating things here but he is correct in his assertions regarding the new CEO's mandate to manage costs.

Mr Biggs

an interesting new admission perhaps, not sure what his reputation does for the reputation of LTC....

Cholinesterase inhibitors

..69% relative risk of bradycardia, 49% and 18% RR for pacemaker and hip fracture. A review of Ontario data does little to encourage use in this class.

sleepovers

...this is one way, typical I suppose of a 'me-first' culture. Another would be to work as a care aide and see it from both sides across a variety of care recipients.

Ontario readies itself for growth

....1 billion over 4 years, is it enough?

The protective power of contract bridge

.....'the evidence suggests that people who spend long stretches of their days, three hours and more, engrossed in some mental activities like cards may be at reduced risk of developing dementia. Researchers are trying to tease apart cause from effect: Are they active because they are sharp, or sharp because they are active?'

vitamin D and fracture prevention

......this meta-analysis is a further look at vitamin D and fracture prevention. NNT = 93 over 12 months for non vertebral fracture prevention. The addition of calcium did not improve results.

Bisphosphonates: Controversies and Clarifications

....an argument in favour of a 5 year course ( from the FLEX study at least)

MDRGN bacteria more prevalent than MRSA in long-term care facilities, new report suggests

....mover over MRSA

personal care aides

.......According to a HHS survey more than 50% of care aides ( certified nursing assistants) were injured on the job last year. The backbone of the industry receive a median wage of $10 an hour. 16% have no health insurance and 33% receive 'other' financial assistance such as food stamps or rent subsidies.

Patient-centeredness

......Dr Don Berwick , the 'extremist' , saying it like it is.

possible link between atrial fibrillation and alzheimer's

.......the plot thickens

zoledronic acid improves mortality in hip fractures with lower comorbidity scores

28% mortality reduction in the treatment group

Dr Jeffrey Turnbull

Incoming CMA president. Well, at least he is talking about long term care. Adding more LTC beds will not solve this problem. Integration of services plus innovative housing and care models would be a start.

Bisphosphonates and atrial fibrillation

a review of the mostly observational data with mixed results. A flag.

Guided Care

.......an elegant sounding idea. This could be something our Home Care coordinators take on with an increased case management role. Unfortunately, again , no hard outcomes according to a JAMA study of 15 similar programmes. My guess would be that the closer the working relationship with the attending physician the greater the savings on unnecessary visits, tests etc. On a positive note the Guided Care trial found "Results showed that patients rated the quality of their health care higher, physicians reported increased satisfaction, and caregivers registered lower stress levels on a measurement called the C.S.I. — the Caregiver Strain Index".

Cost of LTC in New Brunswick

from $70 to $83 a day. Although this only affects those with an income >$56,000 where is the equity in a system that covers your hospital costs but not your chronic care costs? Is functional loss from dementia a less legitimate need than any other medical condition?

Nursing home fee hike hits hard for some N.B. families

geriatricians to leave Cape Breton

a sad commentary






Geriatric specialists plan exit from Cape Breton

freedom, senior style........

Seniors would choose cancer over loss of driver's licence Believe it, I've seen it.

prions.......

'Harmless' prion protein linked to Alzheimer's disease this looks promising , at least for mice.

infection control in Canadian LTC.

...this is not very encouraging.......Infection control at nursing homes found lacking: study

medical and nursing staff in NS long term care falls short

........N.S. nursing home inspections find staff shortages, patient risks

mounting evidence of harm

.......becoming harder to justify use.............

The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial

pressure ulcers in 2004

....according to CDC, 11% of LTC residents had a pressure ulcer, most commonly stage 2......

Nursing home pressure ulcer rates topped 11% in 2004, new report finds



Pressure Ulcers Among Nursing Home Residents: United States, 2004

the rising use of sensors; a New York Times slideshow

.............technology for the elderly

the words we use

.......changing the language people use won't change attitudes, will it?


'Elderly' no longer acceptable word for older people

help for the 'annoyingly cheerful'

...........Depressant Drug

use it or lose it......

well, according to a study ( to be published) in JAGS , mental exercise , an hour a day , five days a week for eight weeks, can double processing speed. 240 volunteers all 65+

Mayo Clinic Research Shows That Improving Brain Processing Speed Helps Memory

PACE ( programs of all inclusive care for the elderly)

this one in North Carolina


PACE helps ease demands on adult caregivers

bombs

surely made up?

Doctor with ties to nursing home controversy a victim in car bombing

New capacity in Saskatchewan

economic stimulus, perhaps?

Saskatchewan government promises to build 13 new long-term care facilities

what one star looks like

Misery: Inside a 1-star nursing home

Irish and old in New York

.....old social networks dissolve in the mists of time. Are they 'far from home', does 50-60 years of making a home for themselves not count for something?


Growing old far from home

what will it take to politicize this issue?

Care reform is 'too difficult' for Tories

MedSeek

...transfer of information , I don't know why it has taken so long..........

Discharge process lauded by long-term care facility

a good education , good for cognitive function but not so good against rate of decline

well, scientists may well have long debated whether aging and memory loss tend to have a lesser affect on highly educated people but in practice you're hooped regardless of your level of education once the disease gets a foothold. Sadly

Education may not slow memory loss: study

find 5 star nursing homes

....yes, they do exist! an interesting service courtesy of CMS

Nursing Home Compare

eyesight

is not as poor as you think in LTC. This study was able to measure VA in 80% of patients (of whom 80% had dementia). In that group 80% had normal or only mild visual impairment.........


Assessment of Visual Function in Institutionalized Elderly Patients

is the NHS ageist?

......it has been said that a test of a civilization is how it treats its sick and its elderly. In the west we prefer to forget or defer, perhaps future generations will discover the beauty of our elders?

Half of doctors say NHS is ageist

wow

$1.4BN


off-label

'alternate level of care'

is the jargon of management which continues to be dressed up as something manageable...30% of this hospital beds at any one time occupied by patients waiting placement. Is this not a system that has failed? Everyone needs to take notice of what's happening, we need to build communities of care that care to keep our elderly at home or in their own community. How hard is that?

Home in the hospital
With a long-term care bed crisis that's among the worst in the country, more and more seniors are forced to wait it out in the hospital

How to avoid LTC......

low-tech networks Seniors relying on web of care

hi-tech sensors High-tech sensors help seniors live independently

vitamin D

another reason to consider the celebratory vitamin.......

'Sunshine vitamin' link to cognitive problems in older people

severe weight loss

surely some mistake here......87lb in 19 days. Possibly the best and cheapest marker in advanced AD. Measuring it is one thing , acting on it is clearly another.

Nursing home patient lost 87 pounds in 19 days

assisted living knock on

Sunrise halts 54 projects nationwide, an ominous development as we move towards expanded AL capacity........


Economy squeezes assisted living
Two of the nation's biggest senior-care providers face staggering debt payments.

what makes people unhappy ?

....isn't it obvious ( and ridiculously simple)?

the largest number of complaints to her office or seven local long-term care ombudsmen focused on issues like lack of choices in daily activities, visiting restrictions placed on family members or friends, residents not being allowed to leave the facility, or lack of choice of medical care or treatment options.

Complaints to state about long-term care increase 39 percent

transitions

respect, kindness, caring, how hard is it?

The Bumpy Ride From Hospital to Home

a useful lexicon

.......for families requiring chronic care

Terms and Definitions
Expressions Frequently Heard in
Health Care Settings

survival to LTC ( Irish style)

median length of stay 30 months ( cf Calgary median 20 months )


Survival of Patients Discharged to Long Term Care

sudden death and antipsychotics

further safety evidence in the NEJM this week regarding atypical antipsychotics.Rate of sudden death was twice that of the control group equivalent to 3 deaths for every 1,000 patients taking the drugs for a year.....Jerry Avorn in the editorial recomending caution with use in children and the elderly.


Risk Found in Newer Antipsychotic Drugs

gizmos for geezers

my only anxiety is that technology could further marginalize the older patient by replacing human contact and touch, if , on the other hand, it supports independence then that's a different story.......

Gadgets for Growing Old at Home

nursing home death

I'm sorry Mr Wagamese, we get the system we deserve. Why is this issue only relevant to you now as you consider old age? It's this sort of pious rambling that holds us all back from progress in this area, don't you know we all share some responsibility for this poor woman's death?



Nursing home death made worse by lack of accountability

dementia

The problem is that long term care is mostly about dementia and dementia , especially end stage dementia, is perceived to be a social problem. It's a disease that is progressive and fatal. It is a medical problem no less deserving than any other. Until decision-makers understand this it will continue to be passed from pillar to post.


A future for long term care

case management

another plus for Intermountain Healthcare and case management.

Geriatric study finds team-based care saves lives, money