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JAMDA
March 1, 2016

It was identified that nursing staff were inundating physicians with fax updates which caused frustration on the physician's part and time lost for the nurses in terms of preparing the faxes, monitoring for response, processing orders, and following up with physicians. Often times there was no “big picture” being presented to the MD, only small pieces of information at frequent intervals.

JAMDA
March 1, 2016

Nursing homes (NH) provide care to a unique subset of population that is medically, functionally, and cognitively impaired. There is evidence that the majority of residents are physically inactive. It is important to work with residents to achieve ADLs rather than provide care for, as residents in NH will experience functional decline, deconditioning, and disability if all care is provided for them. In order to alter this process, a strong mobility and restorative program is needed. Restorative care is already established in many nursing homes in the nation; however it is under-utilized...

JAMDA
March 1, 2016

Palliative sedation is defined by the AAPHM as “the intentional lowering of awareness towards, and including, unconsciousness for patients with severe and refractory symptoms”; this is generally performed after other methods to control these symptoms have failed. Refractory symptoms vary but generally include uncontrolled pain, dyspnea, or agitation.

JAMDA
March 1, 2016

Rates of healthcare- associated MDROs are increasing worldwide with US hospitals accounting for approximately 1.7 million infections and > 98,000 deaths each year. Healthcare- associated infections (HAI's) are also a major cause of hospitalization in long-term care with 1-3 million serious infections and 380,000 deaths every year. In acute care settings, rates of HH compliance > 70% have been associated with lower incidence rates of HAIs such as methicillin-resistant staphylococcus aureus (MRSA).

JAMDA
March 1, 2016

The Goodman Group defines resident wellbeing as encompassing mind, body, and spirit. Spirituality, defined as the affective approach that seeks to give meaning to life, has been found to be associated with physical and mental health and an important resource for those coping with stress. Yet a comprehensive assessment of spirituality and a related plan of care was nonexistent for the residents of the AL facilities.

JAMDA
March 1, 2016

Behavioral and psychological symptoms of dementia (BPSD) are common in patients with dementia who are admitted to assisted living facilities. These symptoms place a large burden on the staff and care providers of such patients to ameliorate such elusive affects, especially since there are no FDA approved drugs to treat BPSD. Recently, personalized music therapy (PMT) has been touted as a safe, inexpensive, and non-pharmaceutical intervention for dementia.

JAMDA
March 1, 2016

The most common infection in the nursing facility (NF) setting is suspected urinary tract infection. Up to 50% of NF residents have asymptomatic bacteriuria (ASB). Treatment of ASB is unnecessary and increases the risk of adverse drug events, C. Difficile infection and antimicrobial resistance. Inappropriate ordering of urine cultures is a prime factor leading to overtreatment.

JAMDA
March 1, 2016

Readmission following discharge is a concern for hospitals, payers, and veterans. Programs targeting single diseases for readmission reduction may miss opportunities to address the complex relationships between multiple domains of care.

JAMDA
March 1, 2016

In 2013, 10% of Medicare total program outlays went to spending on post-acute care, a large portion of which can be attributed to Skilled Nursing Facilities (SNFs). These expenditures are partially due to high length-of-stays (LoS), an issue many are afraid to combat due to the threat of re-hospitalization. Recurrent hospitalizations represent a substantial and often preventable human and financial burden in the United States and have become a major focus point for the Centers for Medicare and Medicaid Services.

JAMDA
March 1, 2016

A care transition represents a vulnerable time for older adults, especially those experiencing cognitive or functional impairment, low health care literacy, multiple chronic conditions, or lack of caregiver support. Integrated and home-based geriatric care management has been shown to improve quality of care and reduce acute care utilization among high-risk members.