scholarly journals Distress Behavior Conversations: Supporting Whole Person Whole Team Responses in VA Community Living Centers

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 854-854
Author(s):  
Julia Loup ◽  
Kate Smith ◽  
Susan Wehry ◽  
Sharon Sloup ◽  
Jennie Keleher ◽  
...  
Keyword(s):  
Personal Information ◽  
Unmet Need ◽  
Medical Model ◽  
Action Planning ◽  
Collaborative Problem Solving ◽  
Community Living ◽  
Team Approach ◽  
Term Care ◽  
Whole Person ◽  
Community Living Centers

Abstract Resident distress behavior, a prevalent challenge in long-term care, contributes to resident morbidity, staff burden, and turnover. We describe an education model developed in the Veterans Administration (VA) Community Living Centers (CLC) through a CONCERT (VA CLCs’ Ongoing Center for Enhancing Resources & Training) quality improvement series. The Distress Behavior Conversation (DBC) uses a team meeting structure and process. Informed by unmet need and relational coordination theories, it guides the whole team, inclusive of interdisciplinary team members and front-line staff with resident contact, through a collaborative problem-solving action-planning discussion. DBC uses facilitated round-robins to identify potential resident behavior causes and individualized solutions. DBC supports the team in maintaining whole person and whole team mindsets, thus challenging the narrower medical model of discipline-specific clinical mindsets and staff level hierarchies. Over two years we have co-created and refined DBC through trainings and team debriefings with over 80 CLCs. Care teams reported “aha” moments during DBCs their thinking shifted (“we are now looking at the REAL why”; “we went from asking, how did he fall? to, why did he fall?; “tended to try to treat falls in a standardized way, [but] when you focus on a specific person you get to focus on HIS needs”; “personal information about the Veteran is the 5th vital sign!”). Teams additionally reported reduced strain and improved collaborative thinking (“I feel better about what I’m doing...more motivated to keep going!; “Now I see it is a team approach – don’t have to do it by myself.”).

scholarly journals Barriers to a Timely Discharge From Short-Term Care in VA Community Living Centers

2019 ◽  
Vol 32 (2) ◽  
pp. 141-156
Author(s):  
Denise A. Tyler ◽  
Renée R. Shield ◽  
Jill Harrison ◽  
Whitney L. Mills ◽  
Kristen E. Morgan ◽  
...  
Keyword(s):  
Community Living ◽  
Short Term ◽  
Term Care ◽  
Community Living Centers

scholarly journals 2012. Trends in Microbiological Culture Collection Across Veterans Affairs Medical Centers and Community Living Centers, 2010 to 2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S675-S675
Author(s):  
Haley Appaneal ◽  
Aisling Caffrey ◽  
Stephanie Hughes ◽  
Vrishali Lopes ◽  
Robin L Jump ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Culture Collection ◽  
Veterans Affairs ◽  
Community Living ◽  
Term Care ◽  
Medical Centers ◽  
Community Living Centers ◽  
Veterans Affairs Medical Centers ◽  
Tract Infections ◽  
Over Time

Abstract Background Microbiological cultures are critical in the diagnosis of infection, identification of pathogenic organisms, and tailoring antibiotic use. However, unnecessary collection of cultures, particularly from the urine, may lead to overuse of antibiotics. There have been no national studies to evaluate trends in the collection of cultures in acute and long-term care settings. Here we describe changes in the collection of cultures nationally across Veterans Affairs medical centers (VAMCs) and Community Living Centers (CLCs). Methods All positive and negative cultures collected from 2010 to 2017 among Veterans admitted to VAMCs or CLCs were included. Cultures were categorized by specimen source (urine, blood, skin and soft tissue, or lung). Joinpoint software was used for regression analyses of trends over time and to estimate annual average percent changes with 95% confidence intervals (CI). Results A total of 5,089,640 cultures from 158 VAMCS and 342,850 cultures from 146 CLCs were identified. The number of cultures collected for all culture types in VAMCs and CLCs decreased significantly. The number of cultures collected per admission decreased significantly by 5.5% annually among VAMCs (95% CI −7.0 to −4.0%) and by 8.4% annually among CLCs (95% CI −10.1 to −6.6%). The proportion of positive cultures decreased 1.6% annually among VAMCs (95% CI −2.3 to −0.9%) and remained stable among CLCs (-0.4% annually, 95% CI, −1.1 to 0.4%). The most common culture source among VAMCs was blood (36.2%), followed by urine (31.8%), and among CLCs was urine (56.9%), followed by blood (16.0%). Urine cultures decreased by 4.5% annually among VAMCs (95% CI −5.4 to −3.6%) and 7.0% annually among CLCs (95% CI −7.6 to −6.4%). Conclusion Our study demonstrates a significant reduction in the number of cultures collected over time. Positive cultures decreased significantly in VAMCs, possibly indicating fewer culture-positive infections.In both VAMCs and CLCs, decreases in cultures taken may represent an important reduction in the collection of unnecessary cultures nationally driven by increased awareness about over-testing and over-treatment of presumed infection, particularly urinary tract infections. Disclosures All authors: No reported disclosures.

scholarly journals Change in VA Community Living Centers 2004–2011: Shifting Long-Term Care to the Community

2018 ◽  
Vol 30 (2) ◽  
pp. 93-108 ◽  
Author(s):  
Kali S. Thomas ◽  
Danielle Cote ◽  
Rajesh Makineni ◽  
Orna Intrator ◽  
Bruce Kinosian ◽  
...  
Keyword(s):  
Long Term Care ◽  
Community Living ◽  
Term Care ◽  
Community Living Centers

Pharmacology Issues Related to Dementia Syndrome of Depression in Elderly Residents of Long-Term Care Settings

2015 ◽  
Vol 25 (2) ◽  
pp. 61-69
Author(s):  
Angel L. Ball ◽  
Adina S. Gray
Keyword(s):  
Depressive Symptoms ◽  
The Elderly ◽  
Environmental Communication ◽  
Pharmacological Intervention ◽  
Team Approach ◽  
Discussion Paper ◽  
Term Care ◽  
Anticholinergic Medications ◽  
Inappropriate Treatment ◽  
Dementia Syndrome

Pharmacological intervention for depressive symptoms in institutionalized elderly is higher than the population average. Among the patients on such medications are those with a puzzling mix of symptoms, diagnosed as “dementia syndrome of depression,” formerly termed “pseudodementia”. Cognitive-communicative changes, potentially due to medications, complicate the diagnosis even further. This discussion paper reviews the history of the terminology of “pseudodementia,” and examines the pharmacology given as treatment for depressive symptoms in the elderly population that can affect cognition and communication. Clinicians can reduce the risk of misdiagnosis or inappropriate treatment by having an awareness of potential side effects, including decreased attention, memory, and reasoning capacities, particularly due to some anticholinergic medications. A team approach to care should include a cohesive effort directed at caution against over-medication, informed management of polypharmacology, enhancement of environmental/communication supports and quality of life, and recognizing the typical nature of some depressive signs in elderly institutionalized individuals.

Implementing a cornerstone of culture change: Consistent staff assignment in VHA community living centers.

2017 ◽  
Vol 14 (3) ◽  
pp. 327-336 ◽  
Author(s):  
Sonne Lemke ◽  
Penny L. Brennan ◽  
Sonya SooHoo ◽  
Kathleen K. Schutte
Keyword(s):  
Culture Change ◽  
Community Living ◽  
Staff Assignment ◽  
Community Living Centers

scholarly journals Using a multidisciplinary approach to reveal decision-making capacity within acute care for an individual with aphasia

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110270
Author(s):  
Ruth Maxwell ◽  
Michelle O’Brien ◽  
Deirdre O’Donnell ◽  
Lauren Christophers ◽  
Thilo Kroll
Keyword(s):  
Decision Making ◽  
Multidisciplinary Team ◽  
Team Approach ◽  
Term Care ◽  
Multidisciplinary Team Approach ◽  
Decision Making Capacity ◽  
Health And Social Care ◽  
Functional Assessments ◽  
Health Nursing ◽  
Communication Approach

Formal assessments of cognition that rely on language may conceal the non-linguistic cognitive function of people with aphasia. This may have detrimental consequences for how people with aphasia are supported to reveal communicative and decision-making competence. This case report demonstrates a multidisciplinary team approach to supporting the health and social care decision-making of people with aphasia. The case is a 67-year-old woman with Wernicke’s type aphasia. As the issue of long-term care arose, the speech and language therapist used a supported communication approach with the patient who expressed her wish to go home. A multidisciplinary team functional assessment of capacity was undertaken which involved functional assessments and observations of everyday tasks by allied health, nursing, catering and medical staff. In this way, the patient’s decision-making capacity was revealed and she was discharged home. A collaborative multidisciplinary team approach using supported communication and functional capacity assessments may be essential for scaffolding the decision-making capacity of people with aphasia.

Regional OutlookContinental Europe

2021 ◽  
pp. 475-478
Author(s):  
Ellen M. Immergut
Keyword(s):  
The Netherlands ◽  
Private Insurance ◽  
Unmet Need ◽  
Health Financing ◽  
Term Care ◽  
Administrative Practices ◽  
Health Politics ◽  
Health Related ◽  
Key Issues

The Continental Europe regional outlook presents a comparative assessment of the historical development of the healthcare system, health politics, and selected health-related indicators for Austria, Belgium, France, Germany, Luxembourg, the Netherlands, and Switzerland. In terms of health financing, these countries rely on the compulsory contributory insurance and corporatist administrative practices characteristic of Bismarckian health systems, to which the Netherlands and Switzerland have added mandated private insurance. Health outcomes are very positive, with high life expectancy, low infant mortality, and comparatively low levels of health inequality. Unmet need is the lowest in Europe, and satisfaction is among the highest. Since at least 2002, healthcare has tended to be a highly salient issue for Germany and the Netherlands, but not so for Belgium and Luxembourg, the two countries with the highest levels of public satisfaction with the health system. The key issues in Continental Europe have been cost containment, patient rights, and the introduction of long-term care, as well as some discussion of the role of private insurance and the efficiency of corporatist institutions.

scholarly journals Geriatrics Evaluation and Management in the Veterans Administration—An Historical Perspective

Geriatrics ◽  
2018 ◽  
Vol 3 (4) ◽  
pp. 84
Author(s):  
James Powers ◽  
Kathryn Eubank
Keyword(s):  
Assessment Tools ◽  
Successful Implementation ◽  
Department Of Veterans Affairs ◽  
Term Care ◽  
Care Community ◽  
Community Living Centers ◽  
High Risk Populations ◽  
Geriatric Evaluation ◽  
Interdisciplinary Assessment ◽  
Outpatient Settings

Comprehensive geriatric assessment, defined as an interdisciplinary assessment and development of an overall plan of treatment and follow-up, has become a fundamental part of clinical geriatric care. Since the 1970s, the US Department of Veterans Affairs (VA) has encouraged the development of geriatric evaluation and management programs. Evolution of geriatric evaluation and management has occurred over time and many VA medical centers have transferred inpatient geriatric evaluation programs to long-term care Community Living Centers, home, and outpatient settings. Availability of geriatric resources and trained personnel across the continuum of care as well as administrative collaboration between care components are critical to the successful implementation of geriatric services. Facilities may need to prioritize their resources and utilize the most effective and relevant elements of geriatric evaluation and management according to patient population needs, available space, resources, and institutional priorities. New risk assessment tools derived from the VA’s experience in geriatric evaluation may be useful for targeting services for other high-risk populations.

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