ADVANTAGE – Long Term and Post Acute Care

Case Study – “Suit: Facility let woman ‘waste away”

by Steve Moran

Suit: Facility let woman ‘waste away’ is the title of a front page article in the Sacramento Bee, my local paper. Here is a brief summary of the lawsuit: Joan Boice was suffering from Alzheimer’s and was no longer able to live at home. In September 2008 she was moved into Emeritus at Emerald Hills, in Auburn (a community in the foothills outside of Sacramento) Three months later the community discovered pressure ulcers had formed on both of her feet, her right hip and her right elbow. Emerald Hills staff immediately began the process of having her transferred to a skilled nursing facility. She died 3 months after being moved the memory care building to a skilled nursing building. Here are the charges being made by the family: Emeritus is only commitment is to growing their empire and making money. They had inadequate staffing and staff training They should never have admitted her to the community as frail as she was It is unclear if they are suggesting they should have never let the wounds develop or if the primary error was not promptly noticing and addressing them. Here are the questions/issues (some legal, some operational) Should she have been admitted in the first place? Did she have pressure sores when she was admitted? When were the pressure sores first discovered? (There is conflicting evidence) Should the community have discovered the pressure sores sooner? Is this a case of being too aggressive about getting one more head in a bed? At what point should care givers have noticed newly formed pressure sores? Is this just a case of greedy lawyers taking advantage of a terrible situation or do they have a righteous cause? Who’s fault was this . . . if anyone’s? Does the family have any responsibility in all of this? Given that she may very well have died in the same time frame, should the company have any financial obligation here?

US News and World Reports 2013 Best Nursing Homes Report

by Steve Moran

California has better nursing homes than any other state in the US . . . it has to be a joke right? The vaunted magazine US News & World Report has just released their 2013 list of best nursing homes. I was astonished to see that California led the way in having the most and highest percentage of highly rated skilled nursing facilities. California did not lead by just a little bit. It “has twice as many highly rated homes as any other state, or in a region”. I found myself saying “Huh?” I live in California and in my many years in the senior housing industry I have been in maybe 2 or 3 thousand senior housing communities across with country and in more than half of all the licensed skilled nursing buildings in the State of California. I don’t think anyone who is objective about skilled nursing in this country, would ever try to make a credible argument that overall, California has the best nursing homes in the country. Within the skilled nursing community it is well known that the 5 star system is very flawed and in fact provides consumers very little in the way of useful information. A quick google search will provide a variety of articles that question the 5 star rating system. Here is my take after reading the article and browsing the list: US News & World Report has done a shabby job of reporting. In fact, they didn’t do any serious reporting or they would have been more cautious about equating a 5 star rating with the highest quality care. It confirms that the 5 star system continues to be flawed. This is not to say it has no value, but I would argue that at best, it’s value is primarily as a early detection tool to identify and rule out terrible nursing homes. The one reliable conclusion you can draw from the list is that the highly rated skilled buildings are experts at getting a high rating 5 star rating. There are some really great skilled nursing buildings in California and other states that don’t have a 5 star rating. In fact often these buildings take on patients with complex problems and get terrific results, but because those patients are complex it hurts their star rating.

How do you place your MDS Coordinator on the organizational chart?

Do they report to the DON or to the NHA? Analyzing trends related to enhanced realized gains/maximization. We agree that the MDS Coordinator role is “intrinsically integrative,” with potential to impact quality of care. However, the potential of the MDS Coordinator to influence important care processes such as assessment, decision-making and care planning may be moderated by the quality of their relationship patterns across the organization. Maximizing that potential by attention to relationships patterns among staff can help to unlock that capacity of the MDS Coordinator to positively influence care processes and improve quality of care. Its not Just the DON or NHA Good connections exists when there is latitude to interact and freedom to share information with others who can best use that information. Some connections occur naturally when staff members interact to do work. The number, variety, and quality of these connections influence the extent to which staff learns and the extent to which the organization is capable of change. New information flow refers to the exchange of information within or across levels of the organization. New information of good quality provides knowledge that the staff can use to adjust their work behavior. This information may be general, such as the mission of an organization, or specific, such as communication from a Certified Nursing Assistant (CNA) to a floor nurse that a resident appears more confused than is usual. This new information flow promotes mutual exchange of information for the purpose of understanding and making sense of a situation, allowing staff to adjust their behavior to meet emerging demands

Family Communications Important Aspect of Long-Term Care Facility Norovirus Prevention Measures

From Groupcast

Norovirus prevention measures implemented at senior living and skilled nursing centers demand improved family and visitor communications. Restricted access and containment measures are often at odds with family members’ desire to visit their loved ones. Immediate and ongoing communications with family members at the outset and during the quarantine are key to success. The norovirus, a fast-moving gastrointestinal virus, spreads quickly in settings where the community members are in close proximity and share eating facilities. Nursing homes, cruise ships, hotels, and schools are all locations where such a virus can rapidly spread from member to member. Unlike the vast majority of schools in the US, which now have implemented school-wide notification systems, many senior living and skilled nursing centers lack the ability to immediately reach key family members. For nursing facilities, the CDC recommends fast action to prevent norovirus outbreaks, including restricting visitation, separating residents during mealtimes, restricted activities, and quarantining known cases. Each of these measures can be of major concern to a family member, especially those who are accustomed to unfettered access to their mom, dad, or other senior family member. The key to addressing the concerns of family members is by increasing the level and frequency of communication, preferably by way of direct messaging, beginning with the instant the heightened measures are implemented. With a system such as GroupCast, which is already in use at numerous senior living centers, a facility administrator could effortlessly record a personal message to family members and broadcast it instantly to their home and cell phone numbers. As the conditions persist or expire, periodic norovirus communications should also be sent advising family members of facility conditions, how to get more information on the loved one’s status, expectations as to the duration of the restrictions,etc. According to the CDC, nearly 60% of norovirus cases occur at long-term care facilities: “Healthcare facilities, including nursing homes and hospitals, are the most commonly reported settings for norovirus outbreaks in the United States and other industrialized countries (see Norovirus in Healthcare Settings). Nearly two-thirds of all norovirus outbreaks reported in the United States occur in long-term care facilities.”

Outbreaks can sometimes last months according to the CDC: “Outbreaks in these settings can be quite long, sometimes lasting months. Illness can be more severe, occasionally even fatal, in hospitalized or nursing home patients compared with otherwise healthy people.” Prolonged modification of visitation and care programs can place extreme stress on caring family members. Heightened levels of mass communication with the family members is the key to successful disease management. Otherwise, the facility will be fighting two battles – the norovirus and irate family members demanding to know what is happening with their loved ones. Proactive communication will reduce stress on both sides and will serve to reduce inquiries to care staff from family members seeking information on the restrictions and when they will be lifted. Systems like GroupCast are the answer. Low-cost, easy-to-use, and highly effective, a mass notification system such as GroupCast can cover all forms of notification including phone broadcast, email broadcast and text messages. These are the very reasons why they have been so heavily embraced by schools, and why they should be equally embraced by long-term care facilities.