July 27, 2005

Legislative Update July 27, 2005

Senate Bill 1525 recently passed and established a number of protocols that must be followed in regard to the safe handling of residents. The bill requires that the quality assurance committee of a nursing home must adopt strategies to control the risk to patients and nurses associated with lifting, moving, or otherwise repositioning the residents. At a minimum, the process must include:
  1. Analysis of the risk of injury to both patients and nurses posed by the environment in which a patient must be handled or moved;
  2. Education of nurses in the identification, assessment and control of risk of injury associated with handling;
  3. Evaluation of alternative ways to reduce risks associated with handling;
  4. Restrictions, if possible, of manual patient handling unless it is an emergency;
  5. Collaboration with and reporting annually to the nurse staffing committee;
  6. Procedures for nurses to refuse to perform a handling that the nurse in good faith believes would pose a risk the the nurse or patient;
  7. Submission of an annual report to the quality assurance committee on activities related to assessment and strategies to control the risks associated with lifting and movement; and
  8. Consideration in any future building projects for incorporating handling equipment or increased physical space.

This act will become effective on January 1, 2006.

Diabetes Causes Concern in LTC Facilities

A recent article in Yahoo News emphasized how critical diabetes care has become to ensuring a high quality of care in nursing homes and assisted living facilities. Diabetes is the fifth deadliest disease in America, and it afflicts a disproportionate amount of older Americans. Half of all diabetes cases involve individuals over the age of 55, and over a quarter of the residents in LTC facilities suffer from the disease. The American Diabetes Association (ADA) estimates that nearly 1 in 5 people over 60 has diabetes. Due to its prevalence in nursing homes and other similar facilities, approximately 10% of healthcare costs are associated with the disease.

With the technology changing and the nature of the disease, it is important that a facility regularly monitor their diabetes management program. The ADA suggests that facilities use the following steps to evaluate their diabetes management programs:

-- Assess the current diabetes situation
-- Screen high-risk patients who have not been diagnosed with diabetes
-- Order appropriate lab tests to determine the resident's condition
-- Assess the patient's hyperglycemia and identify the cause
-- Confirm diabetes diagnosis
-- Evaluate the nature and severity of diabetic complications
-- Obtain input from staff who have worked with the resident
-- Summarize the patient's condition
-- Develop an individualized care plan and define treatment goals
-- Address causes and complications with the resident and caregivers
-- Use oral hypoglycemia agents or insulin as necessary
-- Implement the care plan
-- Re-evaluate the patient at regularly scheduled intervals
-- Routinely monitor the patient's blood glucose levels

It is also important for healthcare facilities to stay abreast of any developments in the field. Continuing education programs and open communication will both help to increase awareness and improve treatment of diabetes.

For more information please click here.

July 19, 2005

The Compassion of Hospice: Dame Cecily Saunders

I wrote yesterday of the passing of Dame Cecily, the founder of modern hospice. Today, I find a beautiful article by Wesley J. Smith about the purpose of hospice as envisioned by Dame Cecily. Click here to read the article.

July 18, 2005

Founder of Hospice, Dame Cicely Saunders, Dies

Dame Cicely Saunders has died in the hospice she founded.

Dame Cicely Saunders, who died yesterday aged 87, was regarded as the mother of the modern hospice movement; at St Christopher's Hospice, Sydenham, south London, founded in 1967, she charted new approaches in techniques for treatment of the terminally ill, based on her Christian belief that no human life, no matter how wretched, should be denied dignity and love.


Cicely Saunders first had the idea of creating a modern hospice in 1948, when she was working as a lady almoner (medical social worker) at St Thomas's Hospital in London. There she met David Tasma, a young Polish waiter who, having escaped from the Warsaw ghetto, was dying of cancer, in great pain, on a ward she was visiting.

Though he had little English, they spent their time together talking about death and the care of the dying: "He needed to make his peace with the God of his fathers, and the time to sort out who he was," she recalled. "We discussed the idea of somewhere that could have helped him to do this better than a busy hospital ward."

Cicely Saunders fell deeply in love and, when he died, he left her all he had - £500 - and told her: "I'll be a window in your home." "It was as though God was tapping me on the shoulder and telling me 'You've got to get on with it'," she recalled.

Carrying Tasma's memory with her, Cicely Saunders became a physician and went on to found St Christopher's Hospice, where she hoped to "help the dying to live until they die and their families to live on". She had no new drugs, but showed how, by using them earlier in anticipation of, rather than in response to, the onset of pain, terminally ill patients could be kept comfortable until the end.

What a great lady. We owe her a debt of gratititude. (HT Wesley J. Smith)

State Governors Gather to Discuss Medicare

According to the Associated Press, a number of governors gathered on Sunday to discuss a number of national concerns, chief among them the budget concerns over rising Medicare expenses. Some governors believe that the President's new policy changes will unfairly require the states to pick up a large portion of the new prescription drug benefit.

A significant portion of the discussions focused on a small part of the new policy dealing with individuals old enough to qualify for Medicare and poor enough to qualify for Medicaid. The states want the federal government to absorb the expenses for this group of individuals, which are significantly larger than the rest of the Medicaid population.

According to some governors, a number of states are contemplating a lawsuit against the government, while others are hoping for a settlement. Governor Rick Perry of Texas has already vetoed the $444 million that was budgeted to be sent to the federal government during the next two years, and has urged fellow governors to discuss changing the federal policy. Vermont's governor has acted similarly, setting aside the $43 million his state would owe until a decision is made on who pays for these services.

The governors say they have the support of all 50 governors in seeking to implement experimental programs with the aims of slowing the growing cost of Medicaid and developing more effective ways to deliver health care. One idea proposed would allow states to collect a copayment from recipients, and some programs would offer incentives (such as quitting smoking or losing weight) that would reduce or eliminate that copayment. The governors believe that they need to come up with a bipartisan plan that is possible before we can hope that Congress could reach such a consensus.

July 14, 2005

Unintended Consequences

Back last November, I wrote about rumblings in Florida to require criminal background checks on prospective resident. In Illinois, they've apparently passed such a law and are now about to suffer the consequences:

Emergency rules implementing the recently signed legislation require all 100,000 current nursing home residents to undergo a criminal background check and be checked against sex offender databases maintained by the Illinois State Police and the Illinois Department of Corrections. The same requirements apply to new admissions.


A spokeswoman for a statewide nursing home association said the new rules are going to turn a delicate family decision into a gut-wrenching experience.
"It's difficult enough to decide to put an elderly relative in a nursing home," said Pat Comstock of the Illinois Health Care Association. "But then to have your elderly grandmother or grandfather subjected to a criminal background check is even more difficult."

And then there is this:

Although the State Police and DOC databases can be easily checked from any computer equipped with Internet access, requests for criminal background checks submitted electronically to the State Police can take up to three days and cost $10. If submitted manually on paper, they can take up to a few weeks and cost $16, according to State Police spokesman Rick Hector.

More than 50 percent of new admissions to nursing homes come directly from hospitals, Comstock said. (emphasis added)

Do you think those hospitals will keep the patients for the days (or weeks) it will take to do this check?

A Discovery in the Fight Against Alzheimers & Dementia

The Washington Post is reporting that a new study may have identified a protein linked to memory loss:

Some recovery of memory may be possible in the early stages of Alzheimer's disease, suggests a provocative new study in mice that could help researchers open a two-pronged attack against the mind-robbing illness.
The research shows a mutant protein named tau is poisoning brain cells, and that blocking its production may allow some of those sick neurons to recover. It worked in demented mice who, to the scientists' surprise, fairly rapidly regained memory.
The work is years away from being useful in people. There are no drugs yet to block tau, and most of the recent search for Alzheimer's treatments has focused instead on another protein, called beta-amyloid.


It's important research because it bolsters the notion of targeting those sick neurons in hopes of one day reversing at least some of dementia's damage, said William Thies, scientific director of the Alzheimer's Association. Today's Alzheimer's drugs only treat symptoms.
"If you can actually rescue some of these sick cells, that really brings the possibility of return of some function, which would be of tremendous value," he said.

Read the whole thing.

July 12, 2005

CMS Updates

Proposed Rate Increase
The Center for Medicare & Medicaid Services (CMS) announced on Friday a 2.5% increase in Medicare payment rates for 2006. Mark McClellan, the administrator for CMS, believes that this increase will help to home health care agencies to provide the best care possible for beneficiaries. The increase is expected to increase payments by $330 million for 2006.

CMS is also proposing an adopted Core Based Statistical Area market definition that would adjust payments based on geographical area. These changes, if adopted, would bring an additional .7 percent increase in fees to rural homes. The net changes would have a 3.5% average increase for rural homes and a 2.3% increase to homes in urban areas.

CMS to Award Demonstration Projects to Improve Care for Patients with High Medical Costs
CMS awarded demonstration projects to six organizations to operate for a term of three years with the goal of increasing care to beneficiaries with complex medical problems. The focus will be on preventive care, and an effort will be made to improve on the continuity of medical services.

The Care Management for High Cost Beneficiaries (CMHCB) demonstration will test the ability of direct-care provider models to coordinate care for high-cost/high-risk beneficiaries by providing such beneficiaries with clinical support beyond traditional settings to manage their conditions and enjoy a better quality of life.

Two organizations will be working in Texas, Care Level Management (CLM) and Texas Senior Trails (TST). CLM will be working in select Texas counties as well as Florida and California while TST will be operating in 48 Texas counties in the panhandle.

The administrator of CMS believes that these changes will help reduce the fragmentation of care and lead to increases in overall quality of care that patients receive. The awardees of these demonstration projects will receive a monthly fee from Medicare to cover administrative and management expenses, but they will assume some financial risk for the increased quality of care.
Awardees will employ a variety of models including:
- support programs for healthcare coordination,
- physician and nurse home visits,
- use of in-home monitoring devices,
- provider office electronic medical records,
- self-care and caregiver support,
- education and outreach,
- tracking and reminders of individuals' preventive care needs,
- 24-hour nurse telephone lines,
- behavioral health care management, and
- transportation services.

In addition, awardees will have the flexibility to stratify targeted beneficiaries according to risk and need and to customize interventions to the meet individuals' personal needs.