Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog] ‘Inherently dangerous’ drugs routinely prescribed to seniors: Report

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April 29, 2014 Posted by | Consumer Health, Consumer Safety, health care | , , , , | Leave a comment

Explore how changing nursing home culture affects care

From the 28 January 2014 article at Covering Health

 

Any journalist who covers nursing homes should check out this month’s special supplement in The Gerontologist, the Gerontological Society of America’s journal. It focuses on the two-decade long effort to change nursing home culture and many of the articles and studies raise important questions about whether enough progress has been shown.

English: Nursing Home in Goldthorn Hill. This ...

English: Nursing Home in Goldthorn Hill. This area of Wolverhampton has a cluster of nursing homes. (Photo credit: Wikipedia)

For example, this study finds that nursing homes that are considered culture change adopters show a nearly 15 percent decrease in health-related survey deficiency citations relative to comparable nonadopting homes. This study looks at what is meant by nursing home culture change – the nature and scope of interventions, measurement, adherence and outcomes.  Harvard health policy expert David Grabowski and colleagues take a closer look at some of the key innovators in nursing home care and what it might mean for health policy – particularly in light of the Affordable Care Act’s directive to provide more home and community-based care. Other articles look at the THRIVE study, mouth care, workplace practices, Medicaid reimbursement, and more policy implications.

Any of these studies — or several taken together — can serve as a jumping off point for local coverage. Are there nursing homes in your community that are doing things differently? Have any instituted policies or processes that show improvements in care coordination, outcomes, quality, or other key measures? Are there homes that are resisting change? Why? Which one(s) best exemplify person-centered care? How do these changes affect the workforce?

Nursing Home Compare from CMS provides the data behind complaints, violations, quality, and cost, among other metrics. This article in The Philadelphia Inquirer is a great example of interweaving research with personal narrative. Another approach might be to look at trends in the city, state, or region. How are nursing homes marketing themselves to consumers? To referral sources? Have their business models changed?

Experts on all sides have been talking about culture change for more than a decade. And in 2008, a Commonwealth Fund report explored culture change in nursing homes. Has the time finally come, for real?

 

Read the entire article here

 

Unfortunately, the articles referred to are subscription based only.
For information on how to get them for free or low cost, click here.

 

Articles referred to above

 

  • Transforming Nursing Home Culture: Evidence for Practice and Policy

     

  • What Does the Evidence Really Say About Culture Change in Nursing Homes?
  • A “Recipe” for Culture Change? Findings From the THRIVE Survey of Culture Change Adopters
  • High-Performance Workplace Practices in Nursing Homes: An Economic Perspective
  • Medicaid Capital Reimbursement Policy and Environmental Artifacts of Nursing Home Culture Change
  • Building a State Coalition for Nursing Home Excellence
  • Implications for Policy: The Nursing Home as Least Restrictive Setting

     

 

 

 

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March 14, 2014 Posted by | health care | , , , , | Leave a comment

[Hospital Newsletter Article] The New Nursing Home

Screen Shot 2013-11-06 at 5.46.49 AM

 

Believe I’ve reblogged on this concept within the past two years…
Yes, this model is a bit pricy, but can we afford not to move in this direction?

Excerpts from the Fall 2003 article at Proto – Dispatches from the Frontiers of Medicine (Massachusetts General Hospital)

At the vanguard of innovation in the nursing home industry, the three-year-old Leonard Florence Center for Living exemplifies a new model of long-term care known as the Green House, and nothing about it seems institutional. Each of the five upper floors constitutes two separate “households” with private rooms for 10 residents. The normally dominant nurse’s station has been eliminated and instead there are common areas in each household—a living room furnished with comfortable sofas and chairs around a fireplace, an open kitchen and a communal dining table where residents often eat together. Cooking, housekeeping and even laundry are handled by two certified nursing aides known as shahbazim—derived from Persian, it means “nurturing of elders”—who also care for residents. Traditional nursing homes, in contrast, have clear demarcations separating housekeepers, kitchen workers, nurses and aides, who follow rigid schedules for serving meals or dispensing medications.

At Leonard Florence, Mehlhop can sleep, bathe, eat and roam around whenever she wants. The environment is calm and cheery, with none of the physical restraints found in most nursing homes or the alarms that sound if residents get up from a wheelchair, for example. (Instead, patients wear ankle bracelets that help the staff keep tabs on them and will disable the elevator if a patient tries to leave.)

Leonard Florence is far from the only nursing facility striving to create a homelike atmosphere and improve residents’ quality of life. Building a new Green House or undertaking a major physical renovation can be part of the strategy, but other nursing homes are primarily working to transform how they’re run, embracing a movement known simply as “culture change” that entails shifting away from the emphasis on efficiency and economies of scale that characterizes most nursing homes. Culture change typically requires an operational reorganization to give staff members more autonomy and to let residents have a say in even the smallest details of their lives. “It’s about not looking at residents as a task, but rather as who they are as individuals,”

Yet building a new, small nursing home that can handle only a relative handful of residents is an expensive proposition. “If it weren’t for the price tag, everyone would be doing it,” says Barry Berman, chief executive officer of the Chelsea Jewish Foundation, which owns the Leonard Florence Center. The home cost $36 million to build, with some two-thirds of the money coming from private donations and government programs. Most traditional nursing homes cost less than half that much, but the Leonard Florence Center is over twice the size of a traditional nursing home and was the first Green House to be built in an urban area. Its multistory construction is also a departure from the usual single-level, ranch-style homes that are typical of Green House centers. The payoff, however, has been the residents’ lower hospitalization and readmission rates. The center has also received high scores for resident and family satisfaction, which Berman describes as “off the charts.” The foundation is now undertaking a $13 million renovation of a 30-year-old, 120-bed skilled nursing facility across town from Leonard Florence. “We’re bringing in as many elements of the Green House as we can and doing our best to retrofit a traditional nursing home,” says Adam Berman, chief operating officer of the nonprofit.

The Green House model is receiving increased academic scrutiny, and early studies have shown positive trends in quality of life for residents, greater family satisfaction, and a lower incidence of rehospitalization, bedsores, depression and other health problems. According to the Green House Project, 83% of Green Houses received a rating of four out of five stars or better on the Centers for Medicare & Medicaid Services’ five-star quality rating system, compared to 42% of nursing homes nationally. But the data are early. “The jury’s still out on whether Green Houses or other small homes achieve equal or better clinical outcomes than traditional models, and whether they’re financially sustainable—factors that may ultimately matter a lot more than the humanistic components in terms of their future growth…

Studies of the model’s effectiveness have found a higher quality of care, reduced staff turnover and lower rates of infections for residents….

As  encouraging as such stories may be, however, there are questions about how far relatively small-scale efforts can go to reform a giant industry. In a 2010 study by Susan Miller, a professor of health services, practice and policy at Brown University School of Public Health, leadership issues, higher costs and regulatory problems were cited by long-term-care leaders as the most common barriers to implementing culture change. Yet many experts believe those obstacles can be overcome. For example, a campaign called Advancing Excellence in America’s Nursing Homes provides an array of do-it-yourself resources and networks of advisors to help improve clinical outcomes. More than 9,000 nursing homes have participated since the campaign’s launch in 2006. Meanwhile, federal regulators have adjusted some rules to encourage and reward culture change—for example, rather than checking that a nursing home has regular meal schedules, making sure that residents are well fed. And proponents point to studies showing that nursing homes committed to culture change may benefit financially. A study by Pioneer Network, for example, found that from 2004 to 2008, facilities undergoing culture change achieved higher occupancy rates and increased revenue.

Related Resource

November 6, 2013 Posted by | Consumer Health, Consumer Safety, health care | , , , , | Leave a comment

November is Long-Term Care Awareness Month

English: Nursing and Residential Care Home, Wi...

English: Nursing and Residential Care Home, Withington This is Clyde Court, on Lapwing Lane. (Photo credit: Wikipedia)

 

From a recent USA.gov email

 

When planning ahead in these uncertain financial times, it’s important to think about long-term care for yourself and your loved ones. Long-term care (LTC) is a range of services and supports you may need to meet your health or personal needs over a long period of time. These services might include emergency response systems, senior centers, assisted living, nursing homes, transportation services, and many more.

Most long-term care assists people with activities of daily living like dressing, bathing and using the bathroom. Other common long-term care services include helping with housework, cooking, shopping, or even managing money. Long-term care can be provided at home, in the community, in assisted living or in nursing homes. And it’s not just for seniors—if you have a significant health challenge, you may need long-term care at any age.

While there are a variety of ways to pay for long-term care, it is important to think ahead about how you will fund the care you may need. Generally, Medicare doesn’t pay for long-term care, but only for a medically necessary skilled nursing facility or home health care. Long-term care insurance may be an option to help you and your family prepare ahead of time for the potential need for long-term care. There are a variety of plans available that vary in cost depending on what services you want covered and the age you begin coverage. Before you choose a plan you should take into account where and what kind of care you might need.

Be sure to take some time this month to check out your options and plan ahead, so you can rest assured that you and your family get the care you need. And if you’re a caregiver now for a family member with health challenges, find more resources and support from USA.gov.

 

Related resources

 

 

 

November 8, 2012 Posted by | health care | , , , , , , | Leave a comment

Another reason to get your Z’s- prevent a nursing home admission

 

English: Banks o'Dee Nursing Home Modern Care ...

English: Banks o’Dee Nursing Home Modern Care Home for the elderly in Abbotswell Road, Aberdeen. (Photo credit: Wikipedia)

 

From the 19th July 2012 article at ScienceNewsDaily

 

Tired? Scientists have discovered another possible benefit of a night of restful and uninterrupted sleep. According to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health fragmented or interrupted sleep could predict future placement in a nursing home or assisted living facility. The study is featured in the July 2012 issue of the Journal of the American Geriatrics Society and outlines the association between objectively measured sleep and subsequent institutionalization among older women.

“Sleep disturbances are common in older people,” said Adam Spira, PhD, lead author of the study and an assistant professor with the Bloomberg School’s Department of Mental Health. “Our results show that in community-dwelling older women, more fragmented sleep is associated with a greater risk of being placed in a nursing home or in a personal care home. We found that, compared to women with the least fragmented sleep, those who spent the most time awake after first falling asleep had about 3 times the odds of placement in a nursing home. Individuals with the lowest sleep efficiency — those who spent the smallest proportion of their time in bed actually sleeping — also had about 3 times the odds of nursing home placement.” The authors found similar patterns of associations between disturbed sleep and placement in personal care homes, such as assisted-living facilities. Sleep duration per se did not predict placement in either of these settings…

 

 

July 20, 2012 Posted by | Consumer Health | , , , | Leave a comment

Residential Care Facilities: A Key Sector in the Spectrum of Long-term Care Providers in the United States

Figure 1 is a stacked bar chart showing percent distributions of residential care facilities and their residents by facility size for 2010.

 

From the US National Center for Health Statistics Data Brief (Number 78, December 2011)

Key findings

Data from the 2010 National Survey of Residential Care Facilities

  • In 2010, residential care facilities (RCFs) totaled 31,100, with 971,900 beds nationwide.
  • About one-half of RCFs were small facilities with 4–10 beds. The remainder comprised medium facilities with 11–25 beds (16%), large facilities with 26–100 beds (28%), and extra large facilities with more than 100 beds (7%).
  • One-tenth of all RCF residents lived in small RCFs and about that percentage (9%) lived in medium facilities, while the majority resided in large (52%) or extra large (29%) RCFs.
  • About 4 in 10 RCFs had one or more residents who had some or all of their long-term care services paid by Medicaid.
  • Larger RCFs were more likely than small RCFs to be chain-affiliated and to provide occupational therapy, physical therapy, social services counseling, and case management.

Residential care facilities (RCFs)—such as assisted living facilities and personal care homes—provide housing and supportive services to persons who cannot live independently but generally do not require the skilled level of care provided by nursing homes. RCFs are not federally regulated, and state approaches to RCF regulation vary widely (1). The ability to provide a comprehensive picture of the long-term care (LTC) industry has been hampered by the lack of data on RCFs (2,3). Previous estimates of the size of the RCF sector varied depending on how RCFs were defined (4,5). Using data from the first nationally representative survey of RCFs …

Read the entire press release

December 20, 2011 Posted by | health care | , , , | Leave a comment

   

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