ADVANTAGE: Long Term & Post Acute Care

News from the U.K.

Nurse ‘threatened to nail dementia patient’s hand to the floor’

From The Telegraph, London

A nurse told a vulnerable patient suffering from dementia she would “f—ing nail your hand tothe floor” if she touched her buzzer again, a misconduct hearing heard. Sally Miller pushed,grabbed and swore at patients in her care, telling one vulnerable resident “I’m sick of you”adding: “if you keep coming and complaining, I will sort you out.” She also confided in acolleague she wanted to put a pillow over one elderly patient’s head, adding: “That’s the way theymake me feel sometimes.” The nurse, who began working at the Rosendale Nursing Home inAmsdell, Lytham St Annes, Lancashire, which cares for patients with Dementia, in 2007, faces amisconduct hearing at the Nursing and Midwifery Council (NMC). Ms Miller did not attend thecentral London hearing today, stating that she is “not well” and her career as a nurse is alreadyover. She faces being struck off from the profession if it is found her fitness to practice isimpaired. Kristian Garsed, representing the NMC, told the hearing: “She has herself decided hernursing career is over and has decided not to actively participate in the proceedings.”  Thehearing was told concerns were first raised about the nurses’ abusive behaviour towards elderlyresidents in April 2010, two and half years after she began working at the home. Staff claimedMs Miller was “verbally abusive, threatening and aggressive” behaviour towards residents andcolleagues. Nurse Mohammed Shahid told his managers how Ms Miller forced a patient, knownas ‘Resident A’ to drink tap water instead of orange juice, before telling her “If you fucking touchthis buzzer again, I am going to fucking nail your hand to the floor.” He also told how on anotheroccasion, she pushed ‘Resident B’, saying: “I am sick of you and I don’t want to hear yourmoaning, and if you keep coming and complaining, I will sort you out.” In a letter to the NMC,she also admitted abusing ‘Resident B’, adding: “I am truly very sorry for my outburst. I wasinappropriate towards this resident by shouting at her.” Jayne Bamber, another colleague,revealed how she later grabbed ‘Resident C’, pushed her into a chair and shouted at her: “Don’tyou leave this room now and sit in this fucking chair,” the hearing was told. Nurse SuzanneWhatmough became so concerned about a telephone conversation she had with Ms Miller, inwhich she talked about putting a pillow over a female patient’s head, she gave a statement to hermanagers. During the conversation, Ms Whatmough said “you can’t say things like that,” towhich the nurse replied: “No, I’m serious,” adding “that’s how they make me feel sometimes” inreference to the patient’s family. Ms Miller later admitted the comment, saying she was “unableto cope with her duties” at the time and had “no one to turn to for help.” Mr Garsed told thehearing: “Those members of staff raised specific allegations. An investigation was carried outfollowing information received. The case was referred to the NMC. “The allegations were put tothe registrant and she was suspended pending disciplinary. “But immediately upon beinginformed of her suspension the registrant provided her written notice of resignation.” The hearingcontinues.

For the Elderly, Emergency Rooms of Their Own
By Anemona Hartocollis

Phyllis Spielberger, a retired hat seller at Bendel’s, picked at a plastic dish of beets and corn asher husband, Jason, sat at the foot of her hospital bed, telling her to eat. Although she had beenrushed to Manhattan’s busy Mount Sinai Hospital by ambulance when her leg gave out, theatmosphere she encountered upon her arrival was eerily calm. There were no beeping machinesor blinking lights or scurrying medical residents. A volunteer circulated among the patients like aflight attendant, making soothing conversation and offering reading glasses, Sudoku puzzles andhearing aids. Above them, an artificial sun shined through a skylight imprinted with aphotographic rendering of a robin’s-egg-blue sky, puffy clouds and leafy trees.  Ms. Spielberger,who is in her 80s, was even getting into the spirit of the place, despite her unnerving condition.“It’s beautiful,” she said. “Everything here is wonderful.”  Yet this was an emergency room, onespecifically designed for the elderly, part of a growing trend of hospitals’ trying to cater to themedical needs and sensibilities of aging baby boomers and their parents.Please continue reading at:

Sen. Corker: Long-Term Care is “Heading for a National Crisis”

By Howard Gleckman

Senator Bob Corker (R-Tenn) warned today that long-term care financing is “a major trainwreck” and “heading for a national crisis.” Corker, the senior Republican on the Senate AgingCommittee, said he was very worried about the viability of private long-term care insurance andadded , “there is no doubt there is a public sector role” in the future of financing long-term caresupports and services.  At a time when the issue has fallen victim to partisan demagoguery(Exhibit A: the CLASS Act)  Corker’s remarks, at a Senate Aging Committee hearing onlong-term care,  suggested an opening to build a consensus on future financing and deliveryreforms. Interestingly, Corker was speaking on the same day a House committee proposedcompletely eliminating the federal  Social Service block grant program which, among otherthings, funds Meals on Wheels and other critical programs for the frail elderly living at home.Corker was not the only participant in today’s hearing who was worried about private long-termcare insurance.  John O’Brien, Director of Healthcare and Insurance at the federal Office ofPersonnel Management, proudly told the panel that enrollment in the federal LTC insuranceprogram rose 20 percent this year, to about 270,000 employees. But he also expressed concernthat only one carrier bid for the federal contract in 2011 and that so many insurers have left thebusiness.Please continue reading at:

What Does the Future Hold for Nursing Homes?
By Anthony Cirillo, FACHE, ABC

The Affordable Care Act has freed up $3 billion in grant money available to states looking tokeep elderly and disabled individuals out of long-term care facilities. New Hampshire will be thefirst state to receive a grant. “No one should have to live in an institution or nursing home if theycan live in their homes and communities with the right mix of affordable supports,” said CindyMann, director of the CMS Center for Medicaid and CHIP Services. No matter how much theindustry fights, it is inevitable that people want to age-in-place. My argument has been that therewill always be people that need the acute level of care offered by skilled nursing facilities. Andwhile I still believe that as a society we do not take self-responsibility, where chronic disease isrampant and obesity becoming the epidemic du jour, it is also true that technology and supportservices are increasing at such a rapid state that perhaps people with acute needs can age in place.
Of course there is still a lot of confusion in the industry and coordination of services is far fromideal. So perhaps the industry has some time to figure out their next move. Some already have bymoving into the rehabilitation business. And while hip and knee surgeries are predicted to growphenomenally, not every person will need skilled rehabilitation care and more of this will moveto outpatient setting. Then with the number of nursing homes almost triple that of hospitals, notevery skilled provider will be a fit for a hospital. In the era of accountable care, culture fit, patientexperience and clinical quality will be the indicators that hospitals will use to pick their skillednursing partners.
I see three scenarios.
First, there will be more mergers and acquisitions as well as facility closings.
A select few will excel in the rehabilitation arena.
And a visionary microscopic few will understand that they need to extend their brand bydeveloping service and product offerings that cover more of the continuum of care.
Still, many will do nothing and one of these scenarios will occur naturally. I see it on the hospitalside of my business. While many hospitals are becoming leaner and improving quality, few arepreparing for an inevitable shift to wellness, bundled payments and the reality the empty hospitalbeds, long talked about, will indeed be the norm.
Where do you fit?

Recognize depression-in-the-elderly, you may save a life
By Richard Lewis, Vice President Operations at AFFECTS LLC, STAR Preventive WellnessDivision

Depression-in-the-elderly is a common occurrence and is not always recognized. Whendepression-in-the-elderly is not  recognized, the condition is not treated. This can be seriousbecause depression is a major cause of morbidity and mortality for the elderly. It can result inimpaired physical, mental, and social functioning. And depression too often leads to suicide.People aged 65 and older account for 16% of the suicides annually. Some people think thatdepression is a part of getting older. Nothing could be further from the truth. Depression is not anatural part of aging. It is not normal to feel depressed all the time as you get older.
Risk factors for depression-in-the-elderly include:
Prior episode of major depressionFamily history of depressive disordersCurrent alcohol/substance abuseMedical co-morbidity (presence of one or more additional disease processes)Functional disability (especially new functional loss)Loss of spouse or partnerOlder family caregiver, especially if caring for persons with dementiaSocial isolation/absence of social supportCognitive distortions, stressful life events (especially loss), chronic stress, low self-esteem andexpectations, and no faith.
The characteristics of major depression are the persistent low mood, discouragement,worthlessness, sleep and appetite disturbances, or thoughts of suicide. How can you recognizedepression in yourself, a friend, or family member? Please continue reading at:

Quality of Life: Help Residents Who Require Enteral Nutrition Meet These Needs
If a resident feels self-conscious, you can do this, suggests activity expert. Nurse attorney BarbaraMiltenberger predicts surveyors will be taking a closer look at socialization for the person withtube feedings. “Due to culture change, there’s more emphasis on quality of life,” she points out.Initially released survey guidance for tube feedings (F322), which CMS had at press timetemporarily withdrawn, says that “to assure that the resident being fed by a feeding tubemaintains the highest degree of quality of life possible, it is important to minimize possible socialisolation or negative psychosocial impact to the degree possible (e.g., continuing to engage inappropriate activities, socializing in the dining room).  Overcome this potential obstacle: If aresident receiving continuous tube feedings feels self-conscious of being attached to a feedingpump while out of their room, you can ask for a routine order for ‘feeding interruption time. Thiscan be done with a PRN order for a specified time frame, i.e., PRN disconnect feed for no morethan one hour and 30 minutes to attend out of room activities. At Northern Oaks Living andRehabilitation Center, “we encourage all residents to get out of their rooms and to attendactivities of their choice,” says Barbara Lohman, MSW, social services director for the facility inAbilene, Texas. “If a resident who is tube fed wants to attend an activity, the activity directormakes sure that they get to that activity,” she tells Eli. “Some of our residents like to pass thetime ‘people watching’ in our lobby.” “The activity director and social services director makeroom visits to those who do not like to get out of their rooms much. Room activities mightinclude one-on-one conversational visits, reading a book to the resident, pet therapy visits, orreading their mail to them,” Lohman adds. Underwood also notes that “just because someonereceives food from a tube doesn’t mean that they should be isolated or excluded fromfood-related activities. Please continue reading at:

RN named the top job of 2012 by U.S. News
By Scrubs • March 7, 2012

At the end of last month, U.S. News & World Report released its annual “Best Jobs” list for2012, and the news is good for nurses. Very good. Registered Nurse comes in at the number onespot on the list this year, and the magazine points out a number of factors for this top position.Among them is the fact that the occupation has grown even in the tough economy, and theBureau of Labor Statistics reports that Registered Nurse will be one of the fastest growingoccupations in the country between now and 2020, adding over 700,000 jobs to the already 2.7million strong RN workforce. Other perks include the strong median annual salary ($64,690) andthe opportunities for specialization within the career. Now, the real question is: Is it true? Isnursing, with all the long shifts, heavy lifting and the daily risk of being squirted with bodilyfluids, really such a great job? Only nurses would know the answer. So, we asked Facebook fansfor their opinions. This is what you said:
“I love the variety of positions and different shifts. I love travel nursing the best of all!”–DavidIrthum“You may not get the position you want, but you will find a job! I love being an RN!”–LucindaPerniciaro“We deserve it–now more than ever!”–Bonita Pink“I’ll be an RN in a few months, getting capped & pinned on May 24th!” —Mandie Lurz“I love being an RN!!”–Debbie Streske ”I love being an RN too and never had trouble finding a job.” —Maggie Ornberg“Hello? C’mon young people—be a nurse!” —Cynthia Caudle“I love being an LPN and proud to have all the RNs around me as either mentors or even theirteacher!” —Sherri L Brotzman-Meyer Morse“Darn, I wish I hadn’t retired 10 years ago! 35 years was a long time to nurse, but I wouldn’thave missed it for the world!” –Carol Bock TumidiskiCongratulations, nurses! We here at Scrubs believe that nurses are the best ever—no matter theseason!