ADVANTAGE: Long Term & Post Acute Care

Study finds 21% of Newly Admitted Nursing Home Residents Sustain a Fall During Stay
by Capra Dalton, President, Pedagogy, Inc.

One in five short-stay nursing home patients sustains a fall after their admission. The study, published in the Journal of the American Geriatrics Society, also found that certified nursingassistant (CNA) staff was associated with a decreased risk of falls. Pedagogy has released a fall prevention course “Managing Falls in the Nursing Home: Who,Why and What Next?” There is more to fall prevention than the management of the environment. In this online continuing education course the student will learn a comprehensive program of interventions that can be taken to manage falls within the nursing home. View the course curriculum here: While you are there, stop by our home page and test yourfall prevention knowledge with our Quick Quiz:
Medicare Reimbursements for SNFs: “It was the best of times, it was the worst oftimes . . .”

Last week brought good reimbursement news for SNFs after what seemed like years of Medicare bummers: The federal government raises Medicare payments by 1.8 percent in fiscal year 2013. Even AHCA praised CMS for the news:  “After years of reimbursement volatility, today’s update to Medicare payments is welcome news to skilled nursing providers. AHCA appreciates CMS’ balanced approach to this year’s Medicare payment system after recognizing the many rounds of government reductions the profession has already endured. Stable Medicare funding will help ensure America’s seniors continue to have access to high quality, post-acute care.” Rejoice! The tides have turned! After the dreaded Oct. 1, 2011, cuts of 11.1% (sorta), and declining state revenues and reimbursement uncertainty, SNFs finally get some good news. Right? And then the buzz kill. This analysis from Avalere Health says brace for $65 billion in cumulative Medicare cuts over the next 10 years. There are two main reasons: New rules that reduce the amount Medicare reimburses for bad debt (such as unpaid deductibles and copays), and the “sequestration” cuts (fixed cuts that were part of the congressional budget compromise),which include a 2 percent Medicare reduction.  But wait again, hope returns! The White House has 30 days to submit it’s plan for the sequestration cuts to Congress, which opens some hope for a plan that might minimize the effectof cuts on skilled nursing facilities. The lesson from this churning cycle of hope and despair? SNFs must keep focusing on the basics, despite the highs and lows of Medicare reimbursements. Focus on building quality census. Increase your Medicare census (no matter what, higher Medicare census still means more revenue). Maximize margins to invest in your mission of quality patient care and life experience. Medicare cuts don’t mean the sky is falling. Far from it, in fact; many providers are thriving. Instead of being paralyzed with panic over the things they can’t control (moving reimbursement targets),  SNFs must continue to take charge of the things that they do control (working faster and smarter to build and maintain quality census).

Accreditation Improves Care in Nursing Homes
by Zachary Zlotoff with Senior Home Blog

According to a new study, nursing homes that have gone through the process of accreditation report a stronger safety culture than non-accredited facilities. The study was published in the May 2012 issue of the “Joint Commission Journal on Quality and Patient Safety,” which is published monthly by Joint Commission Resources. Findings Are Significant : The study has found that Joint Commission accreditation at more than 4,000 facilities across the United States has a positive influence on administrative level functions such as hiring, staff training and teamwork, openness in communication, and reserving punishment on smaller mistakes. These positive influences lead to a stronger culture of safety and care. Few studies have looked at the impact of Joint Commission accreditation in senior living facilities, so the findings that accreditation leads to positive changes that affects the care of residents is significant. Laura M. Wagner, Ph.D., R.N., and assistant professor at the New York University College of Nursingat the Hartford Institute for Geriatric Nursing, was the lead author of the study. She notes that the managers who were surveyed such as nursing home administrators and nursing directors can wield a great amount of influence over an organization’s culture, and the research is “both timely and of great importance.” Benefits Outweigh the Costs:  Even though accreditation can be a costly process for many facilities, studies such as Wagner’s show that the benefits are much better for those facilities in the long run. With staff profiting from better training, team work, and communication, the resulting culture of safety is reflected in better care given to residents. According to Wagner, “[i]t has been suggested that the process of sustaining the level of standards compliance required for accreditation can create asafety-oriented culture within a facility, and our results appear to support this contention.” “Although there are costs associated with accreditation, these findings suggest that the benefits ofvoluntary accreditation may ultimately outweigh the extra costs,” she adds. An earlier one of Wagner’s studies also demonstrated the benefits of Joint Commission accreditation for long term care facilities and their residents. Appearing in the March 5 issue of the journal “The Gerontologist” in an article titled “Impact of Voluntary Accreditation on Deficiency Citations in U.S. Nursing Homes,” showed that Joint Commission accredited facilities had fewer deficiency citations than nonaccredited facilities. Additionally, Wagner and her co-authors have a forthcoming study to be published in the journal “Policy, Politics & Nursing Practice.” This latest study will show that long term care facilities with Joint Commission accreditation have better resident outcomes that continue to improve over time. Perhaps with this and continued evidence of the positive influences of accreditation on senior living facilities, more will take part in the accreditation process.

Nursing homes urged to improve with incentives
from USA Today

For years, states have struggled to raise the quality of care in nursing homes by using a regulatory stick — citations, fines and other sanctions — when serious problems are discovered. Last month, Ohio adopted a distinctly different, carrot-like approach by using financial incentives that encourage better services for frail seniors. It’s the latest effort to address longstanding concerns such as too few nurses, too many patients who develop painful bed sores and high staff turnover. Under Ohio’s new approach, almost 10% of the Medicaid payments to nursing homes will depend on factors including residents’ satisfaction, rates of medical complications and the number of nurses on staff. Medicaid, a federal-state health program for low-income people, is the largest funder of nursing home services in the nation. Seven other states have programs of this sort, but Ohio’s will be the largest. Meanwhile, Medicare, the federal health plan for seniors, plans to roll out a similar program for nursing homes nationally in the next several years, after government officials evaluate results of a three-year demonstration project in Arizona, New York and Wisconsin that ended July 1. Medicare pays for short nursing home stays for some patients who need skilled care after a hospitalization. Whether the strategy will improve nursing homecare is far from certain. “A number of states have attempted, this but most programs have been short-lived and haven’t really made much of a difference,” said David Grabowski, a professor of health policy at Harvard Medical School and lead investigator for the Medicare demonstration project. That may reflect design shortcomings rather than the failure of the underlying concept, several experts suggest. “There is a lot of room to improve the way programs are structured and to maximize their impact,” said Dr. Rachel Werner, an associate professor of medicine at the University of Pennsylvania and author of an unpublished study on states’ nursing home “pay-for-performance” efforts.  States such as Colorado, Georgia, Kansas, Nevada, Oklahoma, Utah and Vermont award a small bonus (from 60 cents to $6.16 per patient per day) if facilities achieve various standards. But industry representatives say those incentives are insufficient, says Nicholas Castle, who has surveyed nursing home administrators and is a professor of health policy at the University of Pittsburgh. Meeting the standards: Under the new Ohio program, a payment of up to $16.44 a day for each Medicaid patient depends on the facility meeting five of 20 quality standards. Ohio’s approach provides a “much more powerful incentive,” said Michael Cheek, vice president of long-term care policy at the American Health Care Association, an industry trade group. The goal of the initiative, as well as a broader health care overhaul launched last year by Republican Gov. John Kasich, is to create a “coordinated, comprehensive, patient-centered health care system in Ohio” that “reimburses forquality” and lowers the sharply rising trajectory of health care costs, explained Bonnie Kantor-Burman, director of the Ohio Department of Aging. “We’re dealing with a very challenging environment,” but Ohio’s 970 nursing homes generally support the state’s new quality initiative, in part because most will qualify for new, quality-based incentive payments without much trouble, said Peter Van Runkle, executive director of the Ohio Health Care Association.The threshold for receiving those payments has been the most controversial element of the state’s plan. “It just doesn’t seem that (nursing homes) will have to stretch themselves enough, and I’ll be advocating for raising the threshold in the future,” said Beverley Laubert, Ohio’s long-term care ombudsman. Initially, she had advocated that homes meet 15 of 20 standards, a goal that many would have found difficult to achieve. State officials say it was important to start with a program that the industry would accept and that would not penalize large numbers of nursing homes. “Our plan is to up the ante” over time, said Kantor-Burman. Differing views: Ultimately, Ohio’s program will depend on institutions such as Welcome Nursing Home in Oberlin, a 102-bed facility operated by the same family since 1945. Jill Herron, the administrator, said her facility will meet 18 out of 20 standards, but she questions how well those requirements reflect quality care. Take the standard specifying that at least 50% of Medicaid-certified beds be in private rooms. The Welcome home has only six rooms of this type. “Private rooms may be essential for market choice — people may want them and like them — but I don’t think they’re essential for quality care,” Herron said. Irene DuRell, an 82-year-old former nurse, has lived at the Welcome home for the past year with a 90-something roommate she calls “wonderful.” Asked what she likes best about Welcome, DuRell said, “They’ve been real good about helping out when I needed it. And they listen to me.”

Nothing to do with Long Term Care but you’ll all enjoy reading this………
Chocolate Each Day May Keep Strokes Away
By Cole Petrochko, Associate Staff Writer, MedPage Today

Published: August 29, 2012Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Bostonand Dorothy Caputo, MA, BSN, RN, Nurse Planner

Men who ate a moderate amount of chocolate every week had a reduced risk of stroke, Swedish researchers found. In a prospective, longitudinal study, those who consumed a median 62.9 g of chocolate a week were at a significantly lower relative stroke risk than those who ate a median of zero grams weekly (RR 0.83, 95% CI 0.7 to 0.99), according to Susanna Larsson, PhD, of the Karolinska Institutet in Stockholm, and colleagues. The researchers also found significant and similar results in a meta-analysis of studies in men and women, with those in the highest quartile of weekly chocolate consumption being significantly less likely to experience a stroke compared with those in the lowest quartile (RR 0.81, 95% CI0.73 to 0.90), Larsson’s group wrote in the Sept. 18 issue of Neurology. “Flavonoids in chocolate may be protective against cardiovascular disease through antioxidant, antiplatelet, and anti-inflammatory effects,” the authors explained. “Flavonoids in chocolate may also decrease blood concentrations of low density lipoprotein (LDL) cholesterol and reduce LDL oxidation as well as improve endothelial function,” the group wrote. Please continue reading at[email protected]&mu_id=5386199

Medicare To Penalize 2,211 Hospitals For Excess Readmissions

By Jordan Rau KHN Staff Writer
More than 2,000 hospitals — including some nationally recognized ones — will be penalized by the government starting in October because many of their patients are readmitted soon after discharge, new records show. Together, these hospitals will forfeit about $280 million in Medicare funds over the next year as the government begins a wide-ranging push to start paying health care providers based on the quality of care they provide. With nearly one in five Medicare patients returning to the hospital within a month of discharge, the government considers readmissions a prime symptom of an overly expensive and uncoordinated health system. Hospitals have had little financial incentive to ensure patients get the care they need once they leave, and in fact they benefit financially when patients don’t recover and return for more treatment.
Nearly 2 million Medicare beneficiaries are readmitted within 30 days of release each year, costing Medicare $17.5 billion in additional hospital bills. The national average readmission rate has remained steady at slightly above 19 percent for several years, even as many hospitals have worked harder to lower theirs. Please continue reading at: