scholarly journals Revisiting the Role of Physicians in Assisted Living and Residential Care Settings

2020 ◽  
Vol 6 ◽  
pp. 233372142097984
Author(s):  
Sarah Dys ◽  
Lindsey Smith ◽  
Ozcan Tunalilar ◽  
Paula Carder
Keyword(s):  
Residential Care ◽  
Assisted Living ◽  
Medication Management ◽  
The United States ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Life Planning ◽  
Crucial Component ◽  
End Of Life Planning ◽  
Services And Supports

As the United States population ages, a higher share of adults is likely to use long-term services and supports. This change increases physicians’ need for information about assisted living and residential care (AL/RC) settings, which provide supportive care and housing to older adults. Unlike skilled nursing facilities, states regulate AL/RC settings through varying licensure requirements enforced by state agencies, resulting in differences in the availability of medical and nursing services. Where some settings provide limited skilled nursing care, in others, residents rely on resident care coordinators, or their own physicians to oversee chronic conditions, medications, and treatments. The following narrative review describes key processes of care where physicians may interact with AL/RC operators, staff, and residents, including care planning, managing Alzheimer’s disease and related conditions, medication management, and end-of-life planning. Communication and collaboration between physicians and AL/RC operators are a crucial component of care management.

scholarly journals Implementation of a skilled nursing facility readmission review process

2018 ◽  
Vol 7 (3) ◽  
pp. e000245 ◽  
Author(s):  
Mallika L Mendu ◽  
Constantinos I Michaelidis ◽  
Michele C Chu ◽  
Jasdeep Sahota ◽  
Lauren Hauser ◽  
...  
Keyword(s):  
Review Process ◽  
Tertiary Care ◽  
Skilled Nursing Facility ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Academic Medical Centre ◽  
Skilled Nursing ◽  
Life Planning ◽  
End Of Life Planning ◽  
Major Factors

30-day readmissions for patients at skilled nursing facilities (SNF) are common and preventable. We implemented a readmission review process for patients readmitted from two SNFs, involving an electronic review tool and monthly conferences. The electronic review tool captures information related to preventability and factors contributing to readmission. The study included 128 patients, readmitted within 30 days from 1 October 2015 through 1 May 2017, at a tertiary care academic medical centre in Boston, MA, and two partnering SNFs. There was a discrepancy in preventability rating between SNF and hospital reviewers, with 79.7% of cases rated not preventable by the SNF, and 58.6% by the hospital. There was moderate positive correlation between the hospital’s and SNFs’ preventability ratings (rs=0.652, p<0.001). In most cases, the SNF reviewers felt that no factors contributed (57.8%), and hospital reviewers felt that issues with end-of-life planning (14.1%) and medical complexity (12.5%) were major factors. Despite the lack of strong correlation between SNF and hospital responses, several cross-continuum quality improvement projects were developed. We found that implementation of a SNF readmission review process employing bidirectional review by SNF and hospital was feasible, and facilitated systems-based improvement in the transition from hospital to postacute care.

Abstract NS22: Palliative Care in the Stroke Patient

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Theresa Hamm
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Hemorrhagic Stroke ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Equal Distribution ◽  
Comfort Care ◽  
Life Planning ◽  
End Of Life Planning ◽  
And Gender

Background and Purpose: Palliative and end of life care are gaining importance in the healthcare environment. Palliative care and hospice may be underutilized in this population. Evaluation of current process will determine opportunities for improvement. Methods and Results: Retrospective review of patients admitted over one year with the diagnosis of acute ischemic stroke (AIS) and hemorrhagic stroke was completed, assessing 575 records. This population included 491 AIS and 84 hemorrhages. Eighty-one AIS patients received t-PA. Discharge status distribution included: 269 to home; 114 to acute rehabilitation; 123 to skilled nursing facilities (SNF); 29 to hospice; and 42 died. Fifty-five patients had comfort care orders prior to discharge: 32 by hospital day two, 23 by hospital day three or later. AIS patients with comfort care orders had an average NIHSS of 17; hemorrhagic stroke patients had an average GCS of 5. Patients with comfort care orders were an average age of 72 years with equal distribution (AIS = 27; hemorrhage = 28) and gender (25 male, 30 female); majority were Caucasian (3 African American, 1 Latino, 1 Asian). Twenty patients with similar characteristics were discharged to SNF with no discussion of palliative care or hospice. A review of records revealed provider disagreement for long-term prognosis as a significant barrier to patient/family decisions regarding end of life choices, or supporting choices made by patients/family opting for palliative care. Conclusions: Based on these data, a palliative care nurse joined the stroke team, and the stroke coordinator joined the palliative care committee to assist in these conversations. Palliative care training for providers is on-going in the acute care setting, while outpatient providers are being engaged in utilizing The Iowa Physician Order for Scope of Treatment (IPOST).This document was designed to promote community care coordination and advanced care planning, in order to provide seamless communication and execution of individual care choices across the healthcare continuum. As these strategies are implemented, an increase in end of life planning is anticipated.

Rehabilitation Intensity and Patient Outcomes in Skilled Nursing Facilities in the United States: A Systematic Review

2021 ◽  
Author(s):  
Rachel A Prusynski ◽  
Allison M Gustavson ◽  
Siddhi R Shrivastav ◽  
Tracy M Mroz
Keyword(s):  
United States ◽  
Systematic Review ◽  
Patient Outcomes ◽  
Hospital Readmissions ◽  
The United States ◽  
Skilled Nursing Facilities ◽  
Functional Improvement ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
The Relationship

Abstract Objective Exponential increases in rehabilitation intensity in skilled nursing facilities (SNFs) motivated recent changes in Medicare reimbursement policies, which remove financial incentives for providing more minutes of physical therapy, occupational therapy, and speech therapy. Yet there is concern that SNFs will reduce therapy provision and patients will experience worse outcomes. The purpose of this systematic review was to synthesize current evidence on the relationship between therapy intensity and patient outcomes in SNFs. Methods PubMed, Medline, Scopus, Embase, CINAHL, PEDro, and COCHRANE databases were searched. English-language studies published in the United States between 1998 and February 14, 2020, examining the relationship between therapy intensity and community discharge, hospital readmission, length of stay (LOS), and functional improvement for short-stay SNF patients were considered. Data extraction and risk of bias were performed using the American Academy of Neurology (AAN) Classification of Evidence scale for causation questions. AAN criteria were used to assess confidence in the evidence for each outcome. Results Eight observational studies met inclusion criteria. There was moderate evidence that higher intensity therapy was associated with higher rates of community discharge and shorter LOS. One study provided very low-level evidence of associations between higher intensity therapy and lower hospital readmissions after total hip and knee replacement. There was low-level evidence indicating higher intensity therapy is associated with improvements in function. Conclusions This systematic review concludes, with moderate confidence, that higher intensity therapy in SNFs leads to higher community discharge rates and shorter LOS. Future research should improve quality of evidence on functional improvement and hospital readmissions. Impact This systematic review demonstrates that patients in SNFs may benefit from higher intensity therapy. Because new policies no longer incentivize intensive therapy, patient outcomes should be closely monitored to ensure patients in SNFs receive high-quality care.

Forensic Issues in Long-Term Care Psychiatry

2017 ◽  
Author(s):  
Marshall B. Kapp
Keyword(s):  
Assisted Living ◽  
Long Term Care ◽  
Psychiatric Treatment ◽  
Health Assessment ◽  
The United States ◽  
Assisted Living Facilities ◽  
Nursing Facilities ◽  
Care Providers ◽  
Term Care

This chapter focuses on medical-legal issues that may arise in the context of identifying psychiatric needs and providing psychiatric care for older persons in long-term care institutional settings, specifically residents of nursing facilities and assisted living facilities. Following general observations about the present regulatory climate in the United States governing nursing facilities and assisted living facilities, the chapter explores mental health assessment requirements for residents of those venues. Key legal responsibilities and restrictions regarding the psychiatric treatment of those residents are then discussed, as well as several areas of concern about potential exposure to litigation and liability on the part of long-term care providers. Finally, some of the most salient future legal and policy challenges confronting those who plan, fund, provide, and evaluate long-term care institutional psychiatric services are noted.

scholarly journals 2852. Epidemiology of Emerging Carbapenemase-Producing Organisms (CPO) in Chicago, Illinois, 2013–2018

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S73-S74
Author(s):  
Massimo Pacilli ◽  
Hira Adil ◽  
Kelly Walblay ◽  
Shannon N Xydis ◽  
Whitney Clegg ◽  
...  
Keyword(s):  
Public Health ◽  
Infection Control ◽  
Healthcare Facility ◽  
The United States ◽  
Resistant Organism ◽  
Molecular Testing ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Chicago Area

Abstract Background Emerging CPO in the Chicago area poses clinical and infection control challenges across the spectrum of care. Since November 2013, CPO are reportable to the Illinois’ Extensively Drug-resistant Organism (XDRO) registry. We examined trends in mechanism of resistance (MOR) among CPO reported through December 2018. Methods MOR reported into the XDRO registry were identified by clinical laboratories performing molecular methods on routine clinical cultures, by public health laboratories during point prevalence surveys (PPS) in response to clusters and as part of a project to assess CPO prevalence in high-risk Chicago area healthcare settings. Chicago patients with known MOR other than Klebsiella pneumoniae carbapenemase (KPC) are investigated by Chicago Department of Public Health (CDPH) to implement containment strategies and identify risk factors within 6 months of culture date. Results MOR was identified in 40% (1,216/3,587) of CPO-positive specimens collected from unique Chicago patients; 87% were KPC, 7% New Delhi metallo-β-lactamase (NDM), 5% Verona integron-mediated metallo-β-lactamase (VIM), 0.6% OXA-48-type carbapenemases, and 0.01% Imipenemase metallo-β-lactamase (IMP) (figure). Since 2017, 15 patients with CPO expressed more than one MOR; 14 were identified during PPS at ventilator capable skilled nursing facilities (vSNF) or long-term acute care hospitals (LTACH), and one was hospitalized in India. Among 156 patients with non-KPC CPO, the median age was 64 years (range, 20–97), 107 (69%) were identified from rectal screening and 49 (31%) were from clinical specimens, most of which were urine 23 (47%) or blood 6 (12%). Among 134 patients with risk factor history, 64% had history of tracheostomy (Table 1). Among 113 patients without documented travel outside of the United States, all stayed overnight at an Illinois healthcare facility; 62% stayed in a vSNF and 24% in an LTACH within 6 months of identification (Table 2). Conclusion We have increasingly detected non-KPC CPO in Chicago; however, estimates of prevalence are limited by lack of systematic surveillance and molecular testing. The high proportion of CPO patients without travel who stayed in vSNF or LTACH underscores the need for infection control training and surveillance in these settings. Disclosures All Authors: No reported Disclosures.

scholarly journals USING A UNIVERSAL SATISFACTION SCORE IN LONG-TERM CARE SETTINGS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S744-S744
Author(s):  
Nicholas Castle ◽  
Lindsay Schwartz ◽  
David Gifford
Keyword(s):  
Assisted Living ◽  
Long Term Care ◽  
Pay For Performance ◽  
Psychometric Testing ◽  
Satisfaction Score ◽  
Nursing Facilities ◽  
Term Care ◽  
Skilled Nursing ◽  
National Quality

Abstract The CoreQ (not an acronym) consists of a limited number of satisfaction items (3-4 items, depending on setting) that are used to create an overall satisfaction score for long-term care facilities. This measure has been used in assisted living (AL) and skilled nursing facilities (SNFs) and has been endorsed by the National Quality Forum (NQF). Briefly, the development and psychometric testing of the CoreQ will be described, including the rationale for producing an overall satisfaction score and correlation with important quality indicators like Five-Star. Using data collected over the past 3 years, comprising more than 100,000 respondents, the use of the CoreQ measure will be described. For example, the CoreQ scores are used in MA to allow providers to benchmark their performance. The use of the scores in this way will be discussed including how providers have used the scores for quality improvement. Some states have elected to use CoreQ in pay for performance and other state initiatives. A case study of how New Jersey uses CoreQ with SNFs will be presented, including distribution of scores and addressing data collection challenges. CoreQ can be utilized as a short customer satisfaction measure to allow providers to benchmark their performance, residents and families in decision-making, and states and others to use for accountability.

A Comparison of Emergency Preparedness Policies by Long-Term Care Setting Type in Ohio: Assisted Living Settings Lag Behind Nursing Homes in Key Areas

2020 ◽  
pp. 073346482090201
Author(s):  
Katherine A. Kennedy ◽  
Cassandra L. Hua ◽  
Ian Nelson
Keyword(s):  
Assisted Living ◽  
Emergency Preparedness ◽  
Disaster Preparedness ◽  
Long Term Care ◽  
Nursing Facilities ◽  
Community Based ◽  
Term Care ◽  
Skilled Nursing ◽  
Care Facilities

Skilled nursing facilities (SNFs) have received regulatory attention in relation to their emergency preparedness. Yet, assisted living settings (ALs) have not experienced such interest due to their classification as a state-regulated, home- and community-based service. However, the growth in the number of ALs and increased resident acuity levels suggest that existing disaster preparedness policies, and therefore, plans, lag behind those of SNFs. We examined differences in emergency preparedness policies between Ohio’s SNFs and ALs. Data were drawn from the 2015 wave of the Ohio Biennial Survey of Long-Term Care Facilities. Across setting types, most aspects of preparedness were similar, such as written plans, specifications for evacuation, emergency drills, communication procedures, and preparations for expected hazards. Despite these similarities, we found SNFs were more prepared than large ALs in some key areas, most notably being more likely to have a backup generator and 7 days of pharmacy stocks and generator fuel.

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