Nursing Homes Sometimes Wrongly Blamed in Medication Misuse

A recent article in the Chicago Tribune examines the roles physicians play in nursing home care, particularly when it comes to medication management. When physicians or psychiatrists prescribe a drug for a patient, facilities must administer it as long as the order is consistent with state and federal nursing home regulations. If inspectors determine a violation occurred, they cite the nursing facility, not the doctor.

"There's no downside for the physicians" who order inappropriate psychotropics, said Robert Hedges, a former regulator with the Illinois Department of Public Health who now co-owns five nursing facilities.

The Tribune found that inspectors documented many cases in which doctors prescribed powerful antipsychotic drugs without adequate justification or in doses that were too high.

It points to a larger issue that people do not often think of before and after a loved one is admitted to a facility - your physician choice. In most cases, your primary care doctor probably does not make house calls or visit long term care facilities. For residents unable to leave the facility for physician appointments that poses a dilemma as often they and their families must choose from a list provided by the nursing home. As the article points out that can often have dire consequences.

So if a loved one needs to enter a long-term care facility, add this issue to your list of things to investigate. How will your loved one access physician care? Who are these physicians? Do you have a choice? Can you find one on your own? Be sure to do your homework on the quality of physicians the facility offers. There are online tools to assess physician quality.

Boomers Less Healthy Than Their Parents

This study comes as absolutely no surprise to me because as a nation we do not take care of ourselves. We are a fast food nation that is getting fatter. More proof that boomers are less healthy than their parents-researchers at UCLA have found that seniors aged 60-69 exhibited 40%-70% increases in several types of disabilities over time, while groups aged 70-79 and 80+ showed no increases in disabilities. In some cases, the older age groups had fewer disabilities than previous generations. This research forecasts the fate of boomers about to turn 60.

There is a perfect storm brewing. Health reform will give access to 50 million more people and those under-insured will start using the system again. Then add to that millions of baby boomers and prepare for a really poor healthcare delivery system.

Reform is not reform at all. It is increased access IF you can get in! Bottom line - self-responsibility. Yes there are some things genetically predisposed for all of us but if we do not start taking care of ourselves prepare not only to be sick but also to find it hard to be treated.

One more thing - it's OK. Wait until Friday to start!

Scripps Howard Analyzes Five Star Rating System

Scripps Howard conducted an analysis of the Centers for Medicare and Medicaid Services’ Nursing Home Compare after Five Star introduction. Some nuggets:

For-profit corporations, which account for about two-thirds of all nursing homes, generally get lower scores than those run by nonprofits groups.

Homes with more nursing staff per patient, which also tend to be run by nonprofit groups, generally do better in the ratings.

Homes with more than 100 beds tend to get lower scores in all categories, including health of residents and levels of nursing care.

Ratings are lowest in Southern states, particularly for nursing care and registered-nurse staffing, and highest for homes in the Northeast.

Slightly more than 20 percent of nursing homes nationwide have been regularly given the lowest ratings, and 12 percent to 13 percent have received the top rating.

More at Scripps here.

Internet Use Reduces Depression in Elderly

Spending time online reduces depression by 20 percent for senior citizens, the Phoenix Center reports. In addition they report that reducing the incidence of depression by widespread Internet use among older Americans could trim the nation’s health care bill.

“Maintaining relationships with friends and family at a time in life when mobility becomes
increasingly limited is challenging for the elderly,” says Phoenix Center Visiting Scholar and study co-author Dr. Sherry G. Ford. The policy paper examines survey responses of 7,000 retired Americans 55 years or older. The data was provided by the Health and Retirement Study of the University of Michigan.

The implications of the findings are significant because depression affects millions Americans
age 55 or older and costs the United States about $100 million annually in direct medical costs,
suicide and mortality, and workplace costs. The Pew Internet & American Life Project estimates
that only about 42 percent of Americans aged 65 or more use the Internet, far below the adoption rate of other age groups.

“Efforts to expand broadband use in the U.S. must eventually tackle the problem of low
adoption in the elderly population,” says study coauthor Dr. George S. Ford. “The positive mental health consequences of Internet demonstrate, in part, the value of demand stimulus programs aimed at older Americans.”

View the study here.

Depression Common in Older Cancer Patients

Depression is common in older cancer patients and could be treated in primary care according to a study in the Journal of General Internal Medicine on cancer survivorship care. 55 percent of the patients who receive collaborative treatment, compared with 34 percent receiving the usual care, showed a 50 percent or greater reduction in depression symptoms.

They also suffered less fatigue, had a better quality of life, less functional impairment and fewer thoughts of death.

The collaborative care program, known as Improving Mood-Promoting Access to Collaborative Treatment, included medication and other care coordinated by a depression care manager under the supervision of the primary-care provider and a psychiatrist. Said one researcher "It can literally double the likelihood that the patient's depression will improve over time."

Causes You Adopt Can Come Back to Help You!

If I told an orthopedist he/she should adopt the cause of fall prevention, they might twitch, raise an eyebrow and say I am crazy. Likewise the nursing home administrator who can count many a hip and knee replacement patient as their resident might look at me funny. But the cause you adopt are no laughing matter. In fact cause adoption done strategically will gather you great word of mouth in the short term and patients and residents in the long term.

Walk Faster to Prevent Cardiovascular Disease

This is almost too logical! Researchers at the Université Pierre et Marie Curie in Paris measured the walking speed of more than 3,200 seniors aged 65 to 85 and followed their health status over the next five years.

Seniors who walked slower were 44% more likely to die during the study and three times as likely to develop cardiovascular disease than the quicker walking seniors.

Walking speed has long been an indicator of risk of future frailty and other adverse health conditions among seniors, researchers note. This new study shows for the first time a clear link between slower walking and cardiovascular disease. The report appears in the Nov 10 online edition of BMJ.

So pick up the speed if you can.

Another Indication that Healthcare Reform is Not Reform at All

Here is an LA Times article worth reading that goes into what will NOT change under reform and that is the ability for insurers to deny care. Yes they may be mandated to cover you but that may not stop them from denying you.

Congress would give patients little new power to challenge life-and-death decisions. Congress, in promoting cost containment and price competition, may actually add to the pressure on insurers to deny requests for treatment. Reform will make it more difficult for insurers to control their costs. According to the Times that "leaves insurers with the other big cost-containment tool: turning down requests to cover treatments."

Americans Lacking in Long-Term Care Knowledge

Overall, Americans did not do well on a survey of their long-term care knowledge, according to results gathered by the MetLife Mature Market Institute. Most know what long-term care is and how much it costs, but their scores fall short regarding how many people will need it and how they will pay for it.

The MetLife Long-Term Care IQ Survey, taken by 1,021 individuals aged 40 to 70 in 2009, compared results with a similar 2004 study. The respondents' overall score was 52%, unchanged since 2004; and only 21% scored 70% or higher. The study reveals that most are not taking appropriate steps to protect themselves from potentially catastrophic expenses. Read the article at Long Term Living News.

Can Leaders Succeed without Being Authentic?

What is authentic leadership? Can leaders succeed wearing masks at some point and unveiling them at others. You may have viewed my video blog on the subject. Here is a guest blog just published in Advance in Long Term Care Management.

How Useful is Patient Satisfaction Data?

Exactly how useful is patient satisfaction data, anyway?

Read our guest blog on Hospital Impact.

California Nursing Homes Mandated to Post Five Star

The controversial Five Star nursing home rating system got more controversial as Governor Schwarzenegger signed legislation requiring California nursing homes to post their rating effective January 1, 2011.

The Five-Star Quality Rating System, which was launched in December 2008, uses data from nursing home surveys, staffing rates, and 10 quality measures to calculate star ratings, ranging from one to five.

The new legislation requires nursing homes to post their overall star rating information in at least the following locations:

• An area accessible and visible to the public
• An area used for employee breaks
• An area used by residents for communal functions and activities

The information must include the following:

• The full name of the facility, in a clear and easy to read font of at least 28 point.
• The full address of the facility, in a clear and easy to read font of at least 20 point.
• The facility’s most recent overall rating determined by CMS’ Five-Star Quality Rating System.

Many providers, associations, and other professionals in the long-term care industry are not thrilled that this legislation has passed.

The legislation also requires nursing homes to provide consumers with a detailed explanation of their rating as well as how to access this information on the Nursing Home Compare Web site. Failure to comply with the provisions of this legislation will result in a class B violation, the fines from which will be deposited into the State Health Facilities Citation Penalties Account.

2011 is a while away so who knows what will happen with this rating system by then. There is clearly two divisive camps around this issue. I am personally for more transparency. Until some one comes up with a better system then the public should be privy to what is available now and make their own conclusions. Not sure why the industry is up in arms as recent studies have shown that nursing home quality has been improving. Perhaps the quality has been improving, the quality of care that is. In terms of quality of life well that is a different story.

New Service Helps Bridge the Communication Gap between Care Providers and Families

One of the reasons experiences break down in healthcare is lack of communication. And that lack of communication leads to misinformation, lack of trust and other issues. A new service helps bridge the communication gap between care providers and the families and caregivers of those receiving care.

Connect for Healthcare helps providers communicate with family members via email and text messaging. It is a great customer experience differentiator and a great comfort to families. Not only is it a way to improve communication and experience but you then have a documented communication trail. It has proven to actually reduce family phone calls and the time spent handling those calls for families. And of course increased communication usually means less litigation. That is something we all can agree is a good thing.

Providers can communicate with one or many family members around issues that they specifically choose. The software enables providers to quickly fill out electronic forms tracking patients' eating, sleeping, temperament and other indicators and send updates to families.

Says co-founder Neil Moore, "Most lawsuits in long-term care are triggered by the failure of the providers to communicate with the family." Before launching Connect for Healthcare in February, Moore spent 17 years developing information technology systems to improve patient safety in medical facilities. Moore said he was inspired to create Connect for Healthcare after witnessing numerous encounters in which family members would call for patient updates, only to be given little or no information.

With an increasingly mobile society and more people living farther away from parents, grandparents and extended family, this might be something that providers should check out and families should ask about.

Aggressive Osteoporosis Treatment Can Reduce Hip Fractures by 37%

According to a study conducted by Kaiser Permanente, proactive measures can reduce hip fracture rates by an average of 37.2 percent -- and as much as 50 percent -- among those at risk. In the study published November 3 in The Journal of Bone & Joint Surgery, more than 625,000 male and female patients over the age of 50 in Southern California who had specific risk factors for osteoporosis and/or hip fractures were studied. The implementation of a number of initiatives in the Kaiser Permanente Southern California Healthy Bones Program reduced the hip fracture rates.

These included increasing the use of bone density test (DXA scans) and anti-osteoporosis medications; adding osteoporosis education and home health programs; and standardizing the practice guidelines for osteoporosis management.

"One-half of all women and one-third of all men will sustain a fragility fracture in their lifetime. The mortality rate due to osteoporosis-related fractures is greater than the rates for breast cancer and cervical cancer combined," said study lead author Richard M. Dell, MD, an orthopedic surgeon at the Kaiser Permanente Bellflower Medical Center. "It is possible to achieve at least a 25 percent reduction in the hip fracture rate in the United States if a more active role is taken by all orthopedic surgeons in osteoporosis disease management."

Osteoporosis has reached epidemic proportions with the rapidly aging population. Of the 10 million Americans who have osteoporosis, 80 percent are women. More than 300,000 hip fractures are reported annually in the United States. Twenty-four percent end up in a nursing home, 50 percent never reach their functional capacity, and 25 percent of patients with a hip fracture die in the first year after the incident.

So for osteoporosis sufferers, be an educated consumer and tell your doctor about this study and ask what he/she will be doing to aggressively manage your osteoporosis. The study can be found here.

Last Call for Alcohol Seniors

There has been a lot of made of studies that suggest two drinks a day can stave off functional decline in old age. New research suggests that it's lifestyle, not liquor, that really helps.

Researchers at the University of Ferrara, Italy, followed more than 3,000 seniors aged 70-79 to determine the relationship between alcohol intake and health outcomes. They discovered that, while initial results appeared to support the two-drink-a-day standard, lifestyle issues ultimately played a more important role. When lifestyle characteristics—physical activity, body weight, education, income, etc were factored in–the relationship between moderate alcohol intake and reduced risk of functional decline diminished significantly.

There is still a strong correlation between moderate alcohol consumption and reduced risk of cardiovascular disease but when it comes to physical performance, the real determination is lifestyle. So people we still need to get up off our butts and exercise, still need to watch what we eat and then we can celebrate with those two drinks at the end of the day.

The report appears in the Oct 14 edition of the Journal of the American Geriatrics Society.

Can you be a Jekyll and Hyde Leader?

Warren Bennis 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.

I agree with George. View why.

The more systemic issue is 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? And how do you measure that?

Tell me what you think.

Are some able to lead without being authentic to their organizations or to themselves?

Tai Chi Helps Alleviate Pain Depression in seniors with Osteoarthritis

Researchers at Tufts University Medical Center and Tufts School of Medicine conducted a controlled trial of individuals with symptomatic osteoarthritis. Patients were randomly assigned to 60 minutes of Tai Chi or wellness education and stretching twice weekly for 12 weeks.

Compared with the control group, patients assigned to Tai Chi exhibited significantly greater improvement in pain reduction, physical function, and vision. Researchers concluded that Tai Chi reduces pain and improves physical function, depression, and health-related quality of life for those with knee osteoarthritis.