Health and Disability

Nursing Facilities, Staffing, July 2017 Residents and Facility Deficiencies, 2009 Through 2015

Nursing facilities are one part of the long-term care delivery system that also includes home and community based services, but their relatively high cost has led them to be the focus of much attention from policymakers. Medicaid plays a major role in financing nursing facility care in the United States, and recent policy proposals to limit federal financing for Medicaid may lead to cuts in eligibility or scope of coverage for long-term care services. In addition, new regulations, effective November 2016, aim to address longstanding challenges in quality and safety in nursing facilities.

As the demand for long term care continues to increase and new policy proposals and regulations unfold, the characteristics, capacity, and care quality of facilities remain subjects of concern among consumers and policy makers. This report provides information on recent trends in nursing facilities in the United States, drawing on data from the federal On-line Survey, Certification, and Reporting system (OSCAR) and Certification and Survey Provider Enhanced Reports (CASPER), to provide information on nursing facility characteristics, resident characteristics, facility staffing, and deficiencies by state from 2009 through 2015.

Additional detail on the survey and methods underlying the data in this report are provided in the Appendix at the end of the report. This information enables policymakers and the public to monitor and understand recent changes in nursing facility care in the United States and helps highlight areas of ongoing concern for ongoing policymaking

'Just What We Dreamed.' New Vertex Drugs Show Dramatic Benefit Against Cystic Fibrosis

https://goo.gl/8RmHVF

Three different three-drug regimens all provided dramatic results against cystic fibrosis, a fatal disease of the lungs and digestive system that afflicts 75,000 people worldwide. The results are a step forward both for the drugs’ maker, Vertex Pharmaceuticals of Boston, Mass., and a long-awaited victory in the quest to use genes to develop new drugs.

“This is just what we dreamed would someday happen,” says Francis Collins, the director of the National Institutes of Health, who led the discovery of the cystic fibrosis gene two decades ago. “This is a remarkably happy moment to see how far this has come and how incredibly encouraging this news is.”

A toddler's brain damage has been reversed over a year after near drowning

https://goo.gl/wc9q6y

Physicians used a series of oxygen treatments, like hyperbaric oxygen therapy, to significantly reverse the 2-year-old's brain damage after she was in the water for 15 minutes.

To "wake up" her brain, doctors gave Carlson oxygen at a pressure higher than the general atmospheric pressure — increasing the amount of oxygen in her blood and repairing her damaged tissue in a sealed, pressurized hyperbaric chamber.

"The startling regrowth of tissue in this case occurred because we were able to intervene early in a growing child, before long-term tissue degeneration," hyperbaric specialist Paul Harch from LSU Health New Orleans said in the case report published by Medical Gas Research.

Don’t EVER Use Turmeric If You’re On Any of The Following Medications

https://goo.gl/FKtSV2

It’s a well-known fact that turmeric is one of the most effective health-boosting substances available today. Its active ingredient, curcumin, is a natural compound with anti-inflammatory, antioxidant, as well as heart disease-and-cancer-fighting properties (1, 2, 3).

Other studies have indicated that taking medicinal doses of turmeric may even protect your brain. This is because turmeric boosts Brain-Derived Neurotrophic Factor (BDNF), a growth hormone that prevents depression, Alzheimer’s disease, and dementia (4, 5).

Compared to other pharmaceutical treatments, turmeric has a generally low risk of adverse effects (6). It almost sounds too good to be true. So is it? Can you take turmeric with medications?

Large Study Confirms Elevated Risk of Diabetes When Prescribed Antipsychotics

https://goo.gl/g9q6JW

A large longitudinal cohort study out of Denmark, recently published in the American Journal of Psychiatry, corroborates previous evidence that antipsychotics increase the risk of developing diabetes in people diagnosed with schizophrenia.

Numerous medications have been associated with elevated risk of diabetes. Antidepressants, for example, are understood to reduce pancreatic insulin secretion, which is believed to increase the risk of developing diabetes. This elevated risk has also been demonstrated in children and youth exposed to antipsychotics.

The authors of the present study point out that the prevalence of diabetes mellitus is 4-5 times higher in people diagnosed with schizophrenia. Similar to the theory surrounding antidepressants, it is believed that impaired glucose tolerance and increased insulin resistance can explain some of the elevated rates of diabetes within individuals diagnosed with schizophrenia who are prescribed antipsychotics. Moreover, abnormal glucose tolerance has been shown to be more prevalent among individuals diagnosed with schizophrenia than those without.

Implementing MTM for COPD

https://goo.gl/W5HDDH

Chronic obstructive pulmonary disease (COPD) is a preventable disease in which persistent respiratory symptoms and airflow limitations worsen with time. COPD is the fourth leading cause of death in the world. The treatment of COPD includes various inhaled therapies as well as preventive measures, such as smoking cessation and immunizations. Patient education is crucial to the management of COPD. Medication therapy management (MTM) can play a role in helping patients learn how to manage COPD and decrease complications. Successful MTM interventions can improve patient care and provide a positive impact on the star measures of both pharmacies and healthcare plans.

Medication therapy management (MTM) services have demonstrated impact in a number of areas, including cardiovascular diseases, mental health, and transitions of care.1 MTM services are defined as a service or group of services that optimize therapeutic outcomes for individual patient and include activities such as immunizations, disease state coaching, and medication therapy reviews.2 The purpose of this article is to provide the pharmacist with a brief overview of chronic obstructive pulmonary disease (COPD) and identify areas within an MTM encounter the community pharmacist can capitalize on to improve management of this disease state.

How Telehealth Platforms Will Reshape U.S. Healthcare Delivery

https://goo.gl/vFW0F2

Telehealth in the United States is entering a new phase of accelerating growth. Indicators of this next phase include: FDA approval of remote diagnostic tools; the rapid evolution of telehealth platforms focused on managing chronic conditions as well as achieving specific patient outcomes; the expansion of telehealth services offered by private and government operated healthcare systems (such as the Veterans Administration); and a new direct-to-consumer initiative by Samsung and American Well.

However, the telehealth industry is still young. In many ways, today’s telehealth industry is comparable to the Internet services industry, when the reigning speed of Internet access was 56.6 kbps. As far higher broadband speeds became the norm, entire industries were upended. Similarly, as the telehealth industry matures, healthcare delivery across our nation will experience disruptive shifts.

This article explores how telehealth will change the delivery of healthcare in the United States, and its impact on the organization of many activities now provided by local hospitals and health systems throughout the nation.

Elderly Dehydration: Prevention & Treatment

https://goo.gl/Bk10nQ

Watching for signs of illness in a loved one can be challenging. Some illnesses show up quite clearly, while others have a more subtle effect on daily living. Dehydration, depending on the severity, sometimes creates only small telltale signs while having a big effect on the body, especially in the elderly.

Dehydration occurs when a person loses more water than they take in. Adequate fluid allows the body to regulate temperature through sweating, maintain blood pressure and eliminate bodily waste. If severe enough, dehydration can lead to confusion, weakness, urinary tract infections, pneumonia, bedsores in bed-ridden patients or even death. Generally speaking, humans can't survive more than four days without water.

CAUSES OF SENIOR DEHYDRATION

Elderly dehydration is especially common for a number of reasons:

Medications
It's not uncommon for seniors to be on several medications at any given time. Some of these may be diuretic, while others may cause patients to sweat more.

Decreased Thirst
A person's sense of thirst becomes less acute as they age. In addition, frail seniors may have a harder time getting up to get a drink when they're thirsty, or they may rely on caregivers who can't sense that they need fluids.

Decreased Kidney Function
As we age our bodies lose kidney function and are less able to conserve fluid (this is progressive from around the age of 50, but becomes more acute and noticeable over the age of 70).

Illness
Vomiting and/or diarrhea can quickly cause elderly dehydration.

Addressing the Polypharmacy Conundrum

Can I get an amen for medication coordination?........

https://goo.gl/2T2nsB

Polypharmacy, the simultaneous use of multiple medications by a single patient for one or more conditions, has become a staggering problem in the United States. From 2000 to 2008, the percentage of Americans using at least one, two, or five prescription medications in the past month increased from 44% to 48%, 25% to 31%, and 6% to 11%, respectively. Prescription-related medication problems result in an estimated 119,000 deaths annually. Polypharmacy is especially problematic for the elderly. Eight or more prescription medications are used by 30% of this population daily, with an average of 18 prescription medications taken per year. In any given year, >175,000 elderly patients will visit the emergency room because of an adverse reaction to a commonly prescribed medication.

Many patients take medications to manage multiple chronic disease states. Clinical guidelines for these chronic diseases, such as hypertension, diabetes mellitus, chronic obstructive pulmonary disease, and heart failure, frequently include recommendations for multiple medications added in a stepwise approach. Therefore, adherence to these guidelines can quickly lead to polypharmacy. An example of this may be seen in a patient being treated for type 2 diabetes, hypertension, and dyslipidemia, which are three common comorbid disease states. If this patient is prescribed three antihypertensives, two antidiabetics, and one lipid-lowering medication, as is often seen in management of these diseases, he or she may already have achieved polypharmacy.

Use of multiple healthcare providers is common for the management of chronic diseases, including a primary care physician and various specialists. While each provider is responsible for completing a thorough assessment of the whole patient, a “silo effect” may occur in prescribing (i.e., concentrating only on one disease state). Additionally, patients may fill medications at multiple community pharmacies or through a mail-order pharmacy. This may cause pharmacists to fill prescriptions without knowing the patient’s entire medication regimen. Use of multiple providers and pharmacies to manage a patient without proper interprofessional communication can lead to therapeutic duplication or prescribing of medications with significant drug-drug interactions. If patients do not have at least one single provider who knows their complete medication regimen, the risk of polypharmacy increases greatly.

Therapeutic duplication can result from prescribing by multiple providers. Duplication of medications in the same pharmacologic class or use of medications in different pharmacologic classes with similar side effects can also occur. This situation can lead to cumulative effects, as well as increased risk of adverse effect severity. If patients experience adverse effects that are unrecognized or misinterpreted by the healthcare provider, a prescribing cascade can result. For example, another drug could be inappropriately prescribed to treat a side effect that would have been alleviated by discontinuing the causative medication.

Insurance pays little for caregiving of elderly at end of life

This is interesting because the end of life is so expensive for healthcare. Short-sighted?......

https://goo.gl/aUic3V

Unpaid family and friends provide the overwhelming majority of care to the elderly in their last year of life, according to a new study highlighting the need to expand supportive services to caregivers.

In 2011, 2.3 million caregivers tended to the needs of an estimated 905,000 older Americans in their final year of life, the report in Health Affairs found.

Nearly 9 in 10 of the caregivers were unpaid, and only 9 percent of dying older adults received money for caregiving from government or private insurance.

“Supporting caregivers is an urgent public health issue,” said lead author Dr. Katherine Ornstein, a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York City.

“We have a huge reliance on families throughout the course of serious illness, but especially at the end of life. It’s the most complex and challenging time, and it’s really the families who are involved,” she said in a phone interview.