scholarly journals REDUCING AVOIDABLE FACILITY TRANSFERS: THE RAFT MODEL

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S769-S770
Author(s):  
Daniel Stadler
Keyword(s):  
Medical Center ◽  
Skilled Nursing Facility ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing ◽  
Life Sustaining Treatment ◽  
Acute Care Facilities ◽  
Dartmouth Hitchcock Medical

Abstract Reducing Avoidable Facility Transfers (RAFT) is a Dartmouth-developed program that identifies and honors “what matters most” to patients residing in skilled nursing facilities in a value-based, sustainable way. RAFT aims to reduce avoidable facility transfers of older adults from long-term care and post-acute care facilities to emergency departments (ED). Key components of RAFT presently include (1) systematically eliciting goals of care for all skilled nursing facility residents, (2) translating these goals into orders using the Physician Orders for Life-Sustaining Treatment form, (3) documenting patient wishes about hospitalization, and (4) ensuring that these wishes inform decision-making during acute crises. Data from a pilot program, begun in 2016 with three rural skilled nursing facilities in collaboration with the Dartmouth-Hitchcock Medical Center geriatric practice, showed a 35% reduction in monthly ED transfers, a 30.5% reduction in monthly hospitalizations, and a 50.7% reduction in monthly ED and hospitalization-related charges.

Care Management and the Transition of Older Adults From a Skilled Nursing Facility Back Into the Community

2011 ◽  
Vol 12 (2) ◽  
pp. 54-59 ◽  
Author(s):  
Adam G. Golden ◽  
Shanique Martin ◽  
Melanie da Silva ◽  
Bernard A. Roos
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Nursing Care ◽  
Care Management ◽  
Skilled Nursing Facility ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Management Interventions

After hospitalization, many older adults require skilled nursing care. Although some patients receive services at home, others are admitted to a skilled nursing facility. In the current fragmented health care system, hospitals are financially incentivized to discharge frail older adults to a facility for postacute care as soon as possible. Similarly, many skilled nursing facilities are incentivized to extend the posthospitalization period of care and to transition the patient to custodial nursing home care. The resulting overuse of institution-based skilled nursing care may be associated with various adverse medical, social, and financial consequences. Care management interventions for more efficient and effective skilled nursing facility use must consider the determinants involved in the decisions to admit and maintain patients in skilled nursing facilities. As we await health care reform efforts that will address these barriers, opportunities already exist for care managers to improve the current postacute transition processes.

scholarly journals Variation in Employment of Therapy Assistants in Skilled Nursing Facilities Based on Organizational Factors

2020 ◽  
pp. 107755872095257
Author(s):  
Tracy M. Mroz ◽  
Arati Dahal ◽  
Rachel Prusynski ◽  
Susan M. Skillman ◽  
Bianca K. Frogner
Keyword(s):  
Rural Areas ◽  
Skilled Nursing Facility ◽  
Cost Effective ◽  
Organizational Factors ◽  
Skilled Nursing Facilities ◽  
Organizational Characteristics ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Therapy Services

Employment of therapy assistants enables skilled nursing facilities to provide more therapy services at lower costs. Yet little is known about employment of therapy assistants relative to organizational characteristics. Taking advantage of publicly available Medicare administrative data from 2016, we examined the relationships between organizational characteristics of skilled nursing facilities and employment of therapy assistants. Therapy assistants represent approximately half of the therapy workforce in skilled nursing facilities. Regression analyses indicate significantly higher percentages of therapy assistants are employed in facilities that are staffed by contract therapists, provide more therapy, have more total stays, operate in rural areas, and are located in states with certificate of need laws or moratoria. Skilled nursing facility quality was not significantly associated with employment of therapy assistants. As new payment mechanisms change incentivizes for therapy in skilled nursing facilities, employment of therapy assistants may be a cost-effective way to continue to provide services when necessary.

Unit Management of Depression of Patients with Multiple Sclerosis Using Cognitive Remediation Strategies: A Preliminary Study

2001 ◽  
Vol 15 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Robert J. Mendoza ◽  
David J. Pittenger ◽  
Cheryl S. Weinstein
Keyword(s):  
Multiple Sclerosis ◽  
Skilled Nursing Facility ◽  
Treatment Protocol ◽  
Cognitive Remediation ◽  
Short Version ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing

Multiple sclerosis (MS) is a chronic, often progressive neurologic disorder char acterized by cerebral and spinal cord lesions. Patients with advanced MS often re quire continuous supervision in a long-term skilled nursing facility. Many of these pa tients experience clinical levels of depression. For this experiment, we randomly assigned MS patients living in a skilled nursing facility to either a control condition or an extended treatment protocol. The protocol consisted of assigning individual cer tified nursing assistants (CNAs) to each patient, in-service training for the CNAs, and the use of memory notebooks. All patients completed the short version of the Beck Depression Inventory and several measures of cognitive functioning at the start and end of the study. The results indicate statistically and clinically significant improve ments in the depression of patients in the treatment but not in the control condi tion. These results led to recommendations for the treatment of MS patients living in long-term skilled nursing facilities and for additional research. Key Words: Multiple sclerosis—Long—term care—Depression—Memory notebooks—Cognition.

A Prospective 12-Month Study of Prescriptions in Long-Term Care Nursing Facility Residents

2019 ◽  
Vol 34 (3) ◽  
pp. 206-214
Author(s):  
Edward L. Schneider ◽  
Jung Ki Kim ◽  
Diana Hyun ◽  
Anjali Lobana ◽  
Rick Smith ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Los Angeles ◽  
Long Term Care ◽  
Medical Center ◽  
Full Time ◽  
Nursing Facilities ◽  
Geriatric Population ◽  
Nursing Facility ◽  
Term Care

AIM: The most frequent use of medications in the geriatric population occurs in skilled nursing facilities. This quality assurance study prospectively examines the high number of prescriptions ordered for long-term nursing facility residents throughout their first year after admission. METHODS: The investigators prospectively followed 101 consecutive long-term-stay older adult residents at the Joyce Eisenberg Keefer Medical Center, a nursing facility of Los Angeles Jewish Home for the Aging (LAJH) over a 12-month period. Preadmission prescriptions were obtained for 91 residents, as well as prescriptions at 1 week, 1 month, 3 months, 6 months, and 1 year after admission. The number of prescriptions by staff physicians and outside physicians was examined. RESULTS: Over the 12 months following admission, the mean number of scheduled prescriptions increased significantly from 11.1 prior to admission to 13.0 by 6 months and to 13.3 by 12 months (P-value < 0.05). The residents who were hospitalized during the 12 months of observation received significantly more scheduled, as needed, and total prescriptions than those not hospitalized. Physicians employed full time by LAJH ordered significantly fewer additional prescriptions than physicians with outside practices. The patients of the staff physicians also had fewer hospitalizations than those of the outside physicians. CONCLUSION: This quality assurance study reveals a statistically significant increase in the number of prescriptions made in a long-term care setting over a 12-month prospective study. Patients of staff physicians received fewer prescriptions and were hospitalized less frequently than patients of physicians who practiced outside LAJH.

scholarly journals Choosing the Best and Scrambling for the Rest: Hospital–Nursing Home Relationships and Admissions to Post-Acute Care

2018 ◽  
Vol 38 (4) ◽  
pp. 479-498 ◽  
Author(s):  
Renée Shield ◽  
Ulrika Winblad ◽  
John McHugh ◽  
Emily Gadbois ◽  
Denise Tyler
Keyword(s):  
Skilled Nursing Facility ◽  
Care Needs ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing ◽  
Referral Rates ◽  
Hospital Nursing ◽  
Complex Patients ◽  
Hospital Referral ◽  
Complex Care Needs

Objective: We explored post–Affordable Care Act hospital and skilled nursing facility (SNF) perspectives in discharge and admission practices. Method: Interviews were conducted with 138 administrative personnel in 16 hospitals and 25 SNFs in eight U.S. markets and qualitatively analyzed. Results: Hospitals may use prior referral rates and patients’ geographic proximity to SNFs to guide discharges. SNFs with higher hospital referral rates often use licensed nurses to screen patients to admit more preferred patients. While SNFs with lower hospital referral rates use marketing strategies to increase admissions, these patients are often less preferred due to lower reimbursement or complex care needs. Conclusion: An unintended consequence of increased hospital-SNF integration may be greater disparity. SNFs with high hospital referral rates may admit well-reimbursed or less medically complex patients than SNFs with lower referral rates. Without policy remediation, SNFs with lower referral rates may thus care for more medically complex long-term care patients.

scholarly journals Clinical Courses and Characteristics of Residents During a SARS-CoV-2 Outbreak at a Central Indiana Skilled Nursing Facility

2020 ◽  
Vol 3 ◽  
Author(s):  
Lauren Albert ◽  
Kristi Lieb ◽  
Laramie Mack ◽  
Kathleen Unroe
Keyword(s):  
Older Adults ◽  
Case Reports ◽  
Skilled Nursing Facility ◽  
Nursing Facilities ◽  
Retrospective Case ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Increased Risk ◽  
Symptom Load ◽  
Retrospective Case Study

Background/Objective: Older adults such as skilled nursing facility residents have increased risk of serious SARS-CoV-2 infection and comprise a large proportion of the COVID-19 pandemic’s deceased—the US Centers for Medicare & Medicaid Services report 232,831 cases and 38,518 resident deaths to date. Recent case reports reveal, as in other diseases, older adults may experience atypical symptomology, complicating identification of ill residents and efforts to slow transmission. While a few facility outbreaks have been characterized epidemiologically, little research exists regarding clinical timelines and trajectories which residents experience during COVID-19 illness.   Methods: From May 9, 2020-June 1, 2020, daily notes on each COVID-19 positive resident’s status (n = 69) were taken by the medical director of a central Indiana nursing facility. Combined with a retrospective resident chart review of this same period, these notes were examined for COVID-19 infection symptoms and illness timelines to descriptively categorize a number of common illness trajectories and symptoms seen in residents with SARS-CoV-2 infection.  Results: Residents fit four descriptive clinical timelines: concurrent symptom load with quick death (Avg 5.6 days) (n = 5), accumulating symptom load with gradual decline (Avg. 13.9 days) (n = 9), prolonged active symptom load with periods of stabilization and symptom reoccurrence (n = 42), and asymptomatic or atypical symptom load (n = 12). Most common symptoms were fever, hypoxia, anorexia, and fatigue/malaise. Of the 14 residents who died (20.3% of infected), 8 died in the facility and 6 died in the hospital.  Conclusion and Implications: This retrospective case study adds to literature describing the presentation and symptomology of SARS-CoV-2 infection in residents of skilled nursing facilities and aids efforts to evaluate resident presentation, prognosis, and disease course. Robust descriptions of expected clinical courses may support realistic expectations of disease progression for residents and their family members experiencing future outbreaks.

scholarly journals 2045. GAIN (Generating Antimicrobial Stewardship Initiatives in Chicago Skilled Nursing Facilities) Collaborative Survey Results: CDC Core Elements of Antimicrobial Stewardship Compliance Assessment in 27 Chicago Skilled Nursing Facilities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S687-S688 ◽  
Author(s):  
Amy P Hanson ◽  
Massimo Pacilli ◽  
Shannon N Xydis ◽  
Kelly Walblay ◽  
Stephanie R Black
Keyword(s):  
Antimicrobial Stewardship ◽  
Treatment Guideline ◽  
Skilled Nursing Facilities ◽  
Antibiotic Prescribing ◽  
Nursing Facilities ◽  
Term Care ◽  
Skilled Nursing ◽  
Core Elements ◽  
Director Of Nursing ◽  
Minimum Criteria

Abstract Background Antimicrobial Stewardship Programs (ASPs) in long-term care facilities is a Centers for Medicare and Medicaid Services requirement as of 2017. The CDC recommends that ASPs in skilled nursing facilities (SNFs) fulfill 7 Core Elements: leadership commitment, accountability, drug expertise, action, tracking, reporting and education. Methods An electronic survey utilizing REDCap was sent to the 76 Chicago SNFs representatives (Administrator, Director of Nursing, and/or Assistant Director of Nursing). Survey questions were adopted from the CDC Core Elements of Antimicrobial Stewardship for Nursing Homes Checklist. Results Twenty-seven (36%) of Chicago SNFs responded. Bed size ranged from 36 – 307 (median 150). Although 93% of facilities had a written statement of leadership support for antimicrobial stewardship, only 22% cited any budgeted financial support for antimicrobial stewardship activities. While Pharmacist Consultants visited all SNFs (most visiting monthly), only 33% of SNFs had an Infectious Disease Provider that consulted on-site. Dedicated time for antimicrobial stewardship activities was less than 10 hours per week in 78% of facilities, with half of all respondents reporting less than 5 hours per week. Treatment guidelines were in place for 63% of SNFs, 56% had an antibiogram, and only 7% utilized the Loeb criteria to guide appropriate antibiotic prescribing. Many facilities tracked antimicrobial stewardship metrics (93%) and reported out to staff (70%). Annual nursing training on antimicrobial stewardship occurs more frequently (85%) than prescriber education (56%). The top 3 barriers identified in implementing ASPs were financial limitations (33%), lack of clinical expertise (33%), and provider opposition (30%). Facilities’ compliance in all seven core elements varied from partially compliant (65%), majority compliant (19%), and majority non-compliant (16%). Conclusion Data from this baseline survey informed focused antimicrobial stewardship initiatives for the GAIN Collaborative. Targeted areas to incorporate into facility action plans include treatment guideline development, antibiograms, annual staff antimicrobial stewardship education, and adoption of the Loeb minimum criteria for antibiotic prescribing into clinical practice. Disclosures All authors: No reported disclosures.

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