ADVANTAGE – Long Term and Post Acute Care

Nursing Home of the Future: Mamaroneck’s Sarah Neuman Pioneering Resident-CenteredCare
By Stefani Kim, Nanuet Patch

Although few would plan for the years after retirement to be spent in a nursing home, unforeseen illness and declining mobility could render dreams of traveling the country by RV or perfecting agolf swing unlikely. According to a 2004 report compiled by the Centers for Disease Control(CDC), 27 percent of Americans over the age of 65—1.3 million—were residing in nursing homes.  What’s more, the Census Bureau predicts that the population of people 65 and over willmore than double to 86.7 million in 2050 from 36.3 million in 2004, a number that reveals the potential rise in health issues as a result of an aging population whose life span has become increasingly higher than in previous years.  But with many elderly people stubbornly resisting the transition to a nursing home—stereotypes of loneliness, isolation and stifled independence abounding—is there any alternative other than home health care for people requiring day to day care? Based on the teachings of Dr. Bill Thomas, a geriatrician whose Eden Alternative philosophy teaches that “aging should be a continued state of development and growth, rather than a period of decline,” the Sarah Neuman nursing home in Mamaroneck plans to build a freestanding set of buildings modeled after Thomas’ Green House project, which will address what Thomas says are the basic problems affecting nursing home residents: loneliness, boredom and helplessness.  In a poignant quote from a National Public Radio (NPR) interview in 2005, Thomas said, “I believe that in the nursing home every year, thousands and thousands of people die of a broken heart. They die not so much because their organs fail, but because their grip on life has failed.”  Please continue reading at:

Former CMS administrator scolds long-term care providers — but he has it all wrong!
By Steve Moran, Senior Housing Forum

McKnight’s Long-Term Care published an article titled “Former top Medicare official scalds long-term care leaders”  on September 26. According to this article, Tom Scully, the former chief of the Medicare & Medicaid Services Administration, brutally chastised the long-term care industry for exploiting a change in the Medicare reimbursement rules that allowed providers to extract an extra $5 billion from the system in less than a year.His proposition was that the long-term care providers should have known that it would not last and would damage their lobbying efforts for the foreseeable future. He has it wrong on so many counts. Last year, I pointed out:
The system, as designed by the government, is adversarial in nature, meaning that the government works to pay out as little possible and the providers work to get paid as much as possible while not breaking the rules, which is exactly what they did.The government is that stupid! If they had thought out the rule change it would have been easy to  figure out how the providers would react. This was an easily predictable outcome.You could even make a case that if the providers had not taken advantage of the rule change, they would have been violating their responsibility to their investors.The providers did nothing that was illegal or even against the rules. It is hard to even figure out how to apply morality to this particular situation. At the end of the day, even with the “take backs”, the long-term care providers who were the most aggressive in taking advantage of the system ended up financially better off than if they had not. At least some of those providers who”did the right thing” ended being penalized for not taking advantage of the system.The blame for this colossal waste of tax money, my money and your money, lies squarely at the feet of the CMS.

Simple Products That Can Make Mobility Easier
by Lynda Shrager, The Organized Caregiver

After 33 years of practicing in the field of occupational therapy, it still never ceases to amaze me how a simple piece of adaptive equipment can so highly impact how a person completes a task.Whether they have joint limitations, decreased strength, loss of the use of one extremity, poor balance, or difficulty mobilizing, a simple modification can often turn an impossible task into an achievable one. One of my principles of health organizing is to gather all of the equipment you need ahead of time before undertaking a task:The Organized Caregiver’s Top Ten Choices for Products That Will Make Life Easier and Safer:
1. Elastic shoe laces: Lace in shoes, pull to desired tension, tie a bow and then never have to tie your shoes again! It turns tie shoes into slip-ons.
2. Button hook/Zipper pull: The button hook is inserted through the button hole, hooks the buttonand easily pulls it back through. The zipper pull easily grabs hard to grasp zippers. This is a greattool for people with decreased fine coordination or arthritis.
3. Rocker knife: Simultaneously stabilizes and cuts food. The knife has a sharp, curved blade thateasily cuts when rocked back and forth over food. For one handed use, decreased coordination orweakness.
4. Spike board: A cutting board with several long nails protruding up to stab meats, vegetablesand fruits for cutting or peeling. Look for suction cup legs and a raised corner against which apiece of bread can be placed for buttering. This is a good product for people with weakness, onehanded use, a lack of coordination or low vision.
5. Bed rail: Available in many types and sizes, this small rail provides support to help people safely get in and out of bed. Many have a base that fits between the mattress and box spring with no assembly required!
6. Sock aide: An incredible gadget that helps you put on socks without bending over. An inexpensive tool that is helpful for those with limited mobility or recovering from hip replacement surgery.
7. Raised toilet seat with handles: If you have decreased mobility in the hips, knees or back your toilet can seem very low. This product raises it about four inches and has armrests for added safety and support.
8. Reacher: Helps you pick up things more than an arm’s length away for people with limited reach or strength. Various types have different “jaws” depending on what type of objects you need to grab.
9. Bathtub transfer bench: Two legs sit outside of the tub and two are in. The person sits down and slides in without needing to step over the wall of the tub.
10. Grab bars: I saved the best for last. Place them in the shower, on the way into the tub, by the toilet, or near the door jam on the way out of the house. Be sure they are installed properly and have a textured surface making them easier to grasp. This simple bar will increase safety and make transfers easier.
You may purchase most of these items in your neighborhood home medical supply store. Many drugstores or big box stores also carry them. For more information, pictures of the products and where to purchase, go online to “Home Health Care Equipment and Supplies” or Google the name of the item.

Lawsuit Filed Over Negligence In DVT Prevention and Treatment
Tampa, FL (Law Firm Newswire) October 10, 2012 –

A lawsuit has been filed against an Illinois nursing home over negligence in the prevention and treatment of deep vein thrombosis (DVT). Carol Harrison, 63, was admitted to Maple Ridge Care Centre for rehabilitation and ventilator care following complications from surgery. As with many patients in long-term care, Harrison was at risk for blood clots. According to the lawsuit, medical staff failed to detect the fact that Harrison had developed DVT. Her leg had to be amputated, which allegedly hastened her death. DVT is a potentially fatal condition that staff at hospitals and nursing homes must be alert to, as anyone with limited mobility may be at risk due to compromised blood circulation. DVT happens when a blood clot is created in the veins of the legs or pelvis. If the clot breaks free and travels through the bloodstream, it becomes an embolism. Common symptoms of DVT include discoloration and swelling of the limb, usually the leg. Patients at risk may be prescribed blood thinners like Warfarin, but pneumatic compression therapy is another alternative. “Some doctors prescribe blood thinners like Warfarin to reduce the chance of blood clots, but these drugs are expensive, and have potentially dangerous side effects, which can be as serious as the clots themselves,” said Greg Grambor, owner of VascularPRN, a distributor of DVT prevention devices. “Pneumatic compression therapy is a far less expensive alternative, which is every bit as effective as the drugs, with absolutely no dangerous side effects.”Maple Ridge Care Centre is a nursing home in Lincoln, Illinois specializing in wound care,pulmonary diseases and physical therapy. The facility provides respiratory care through a partnership with the Springfield Clinic and Southern Illinois University Pulmonology. The nursing home lawsuit was filed in Macon County Circuit Court by Harrison’s husband. To learn more about a Sequential Compression Device, SCD boots, visit or call 800-886-4331.

There has been significant discussion regarding hospital readmissions and the impact tocompensation. CMS has just begun a study looking at readmissions from nursing homes.
by Candyce Henry

A 79 year old woman had advanced heart failure, chronic lung disease and diabetes. She recently had signed a D.N.R., “do not resuscitate” order and there was nothing more that could be done to care for her at the hospital. The cardiologist called her doctor and they agreed that they would respect her wishes to be kept out of the hospital. Within a few hours after being placed in long term care, the staff noticed her very low oxygen levels and contacted another doctor who was not familiar with the woman’s medical history who gave the order to send her back to the hospital.The situation highlights problems with long-term care that frequently frustrate caregivers and that are receiving fresh attention from medical providers and Medicare. The nursing home staff had no knowledge of the woman’s D.N.R. and the patient was unable to provide information. This might not have happened if the woman’s D.N.R. order had traveled with her when she was discharged from the hospital. It is a common problem that results in the default option being to send the individual back to the hospital. When the patient goes to the hospital, she will be seen by a physician who doesn’t know her, usually for only a few minutes. Because the medical history is not readily available for nursing home patients, the doctor will order a number of tests which will likely show abnormalities because of the patient’s age and medical conditions. Then ext step is to readmit the woman to the hospital for more evaluation and observation. The patient will become afraid and disoriented because of the unknown situation, little sleep, and noise. She then will receive aggressive medications and be confined to her bed.
Few caregivers realize this is a likely chain of events. Rarely do nursing home doctors or nursessit down and explain the risks of hospitalizing a frail older person who is profoundly physicallyand mentally compromised. This is the set of problems that a new pilot program of the Centersfor Medicare and Medicaid Services (CMS) hopes to address in Alabama, Indiana, Missouri,Nebraska, Nevada, New York and Pennsylvania later this year. Seven organizations arepartnering with 145 Nursing Facilities to reduce avoidable hospitalizations. CMS will fundorganizations that provide enhanced on site services to support nursing facility residents. Nearlytwo-thirds of nursing facility residents are enrolled in Medicaid, and most are also enrolled inMedicare. These Medicare-Medicaid enrollees are among the most fragile and chronically illindividuals served by the programs. Research found that approximately 45 percent ofhospitalizations among Medicare-Medicaid enrollees receiving skilled nursing facility servicescould have been avoided. Total costs for these potentially avoidable hospitalizations forMedicare-Medicaid enrollees for 2011 were estimated to be between $7 and 8 billion. Allselected organizations will have on-site staff to partner with the existing nursing facility staff toprovide preventive services as well as improve assessments and management of medicalconditions. Participants will also work toward more seamless beneficiary transitions of care, andleverage use of emerging technologies, among many other activities. Each model will be subjectto a rigorous external evaluation.  The Initiative will be run collaboratively by the CMSMedicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation,both created by the Affordable Care Act to improve health care quality and reduce costs in theMedicare and Medicaid programs.