In 2012, skilled nursing facility (SNF) care accounted for $26.8 billion of health care spending. SNFs are intended to provide a setting for stabilized transitions for older adults. However, research shows that between a quarter and half of Medicare recipients are readmitted from SNF rehabilitation back to the hospital within 30 days, amounting to $4.34 billion in expenses in 2006. These patients are often in poor health and well-being, with 1 in 11 elders dying while enrolled in SNF care. Although there is a great need, palliative care is not adequately used in SNFs.
Assisted Living Facilities Must Identify Preventable Causes for Hospitalization for Residents with Dementia
The prevalence of older adults with dementia disorders is rising and presents significant difficulties to care providers and policy makers aiming to ensure cost-effective, high quality care for those that are aging. Assisted living facilities (ALFs) are increasingly admitting older adults with dementia, and who often have significant comorbidity. Currently, between 40% and 60% of residents in ALFs across the United States have been diagnosed with dementia. The rapid growth of ALFs over the past few years reflects the more affordable cost of this residential option compared to long-term (i.e. nursing home) care (LTC), as well as individual preferences for more comfortable, home-like environments.
Legal Action Filed Against National Nursing Home Chain that Abuses Residents
Far too many nursing homes fail to keep their promise to provide quality care for their residents. With 300 Golden Living Centers nationwide, Golden Gate National Senior Care LLC is one such nursing home company that has failed to provide basic services to their vulnerable, older adult residents. Last Wednesday, authorities in Pennsylvania filed a legal action against the company, saying that Golden Living Center residents were left in soiled diapers for unacceptably long periods of time, were at high risk for bedsores, and were not bathed routinely. Residents were also not escorted to meals as required, often missing meals entirely, and staff have been proven to falsify records.
Residential Aged Care Facilities Should Identify Modifiable Markers to Mitigate the Need for Transfer to Hospital
The number of frail, older adults who require care in residential aged care facilities (RACFs) is growing. Cognitive and functional impairment, as well as significant medical comorbidity, is common among this population and are, thus, vulnerable to sharp declines in health.
Gaining a Deeper Understanding about Nursing Home Residents’ Decision Making Abilities Can Improve Their Quality of Life
Not only is it important for residents in long-term care facilities to have the power to make their own decisions in daily living for their well-being, the ethical and legal protection of their autonomy to make these decisions is imperative. Many nursing home residents’ ability to make their own decisions is impaired due to cognitive decline. A recent study identified potential markets of impaired decision making by exploring the link between a variety of nursing home resident characteristics (including gender, age, race, mood, falls, injuries, hospitalizations, duration of stay, number of activities of daily living (ADL) requiring assistance, and diagnoses of dementia, anxiety disorders, and depression) and impaired (vs independent) decision making.
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Nursing Homes Must Be Proactive in Helping Frail Residents Reach Optimal Physical and Nutritional Status
Physical frailty is prevalent among older adults living in nursing homes and assisted living facilities, as well as in the community. It is a medical syndrome with a variety of causes and contributors that is characterized by a decrease in strength, endurance, and weakened physiologic function that enhances a person’s vulnerability for needing increased dependency. Frailty has been associated with health-related detrimental events like mortality, disability in necessary activities of daily living (ADLs), and mobility disability, hospitalization, institutionalization, and falls in community-dwelling older adults. Unfortunately, there have not been many studies that have analyzed the commonality of frailty in institutionalized older adults and few interventions have focused on this vulnerable population.
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Tools Long-Term Care Facilities Can Use When Caring for Dementia Patients
Dementia is prevalent among older adults and requires expert care and decision making that draws from sound evidence. Evidence-based practice (EBP) is strongly established in health care and aims to ensure the best outcomes by implementing what is shown to be effective from research in clinical practice and service delivery. Although there are issues regarding the interpretation and application of EBP, there seems to be a consensus about the importance of identifying and assessing the evidence for its significance for care provision.
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Long-Term Care Facilities Must Assess Their Residents’ Preferences in Providing Person-Centered Care
To assess and honor the preferences of older adult residents is a fundamental aspect of person-centered care in long-term care facilities. Although researchers and practitioners have initiated the development of measures to assess nursing home residents’ everyday preferences, not much is known regarding how residents interpret and conceptualize their preferences and what specific clinical response must be given to balance health and safety concerns with preferences.
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Adequate Symptom Control Should Be One Of The Most Important Care Goals In Nursing Homes
Patients with dementia are often burdened by their symptoms, while adequate symptom control is crucial to maintain or enhance quality of life. Most Americans with dementia eventually become admitted to, and die in long-term care facilities. Prevalent and important symptoms at the end of life are pain, agitation, and shortness of breath. A holistic approach must be the focus of optimal symptom control due to the fact that symptoms may be interrelated (i.e. pain may be associated with agitation).
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Nursing Home Quality Star Ratings Indicate the True Quality of Nursing Homes’ Care
In the United States, over 15, 500 nursing homes that are Medicaid or Medicare certified or both provide care to approximately 1.3 million people. Nursing homes must meet federally mandated minimum standards as a requirement of Medicare and Medicaid payment. Many concerns regarding the quality of nursing home care and the adequacy of oversight and enforcement have been raised over the years. To address them, nursing home provisions under the Omnibus Budget Reconciliation Act of 1987 (OBRA 87) were enacted. Unfortunately, reports of quality problems in nursing homes have not ceased.
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