Health and Disability

Highlights:

1.  In 2007, the average number of registered nurses hours per resident
was 0.6 hours - a little more than a half an hour per resident.  This
represents a 14% decline between 2001 and 2007.


2.  There was a 7% increase of residents with dementia (to 45.6% of the
total residents) and a 33% increase of residents with other psychiatric
diagnoses (21.4% of total residents).



3.  The good news is that fewer people were either in bed or physical
restraints.  The bad news is that the form of restraints has shifted to
"chair bound."  56% of all residents were chair bound.



4.  More than 94,000 residents (nearly 7% of the entire nursing home
population) have pressure sores.



5.  More than 114,600 "deficiencies" were issued for violations of federal
regulations and requirements.  There was an average of 7.5 deficiency
violations per nursing facility in 2007.  UCSF noted that there was a wide
range in the average number of deficiencies, suggesting that state
enforcement varies widely.



and much more.....

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/

Although The Nursing Home Reform Act, passed in 1987, established residents' rights and quality standards for nursing homes nationwide, serious concerns remain about quality of care and quality of life for nursing home residents. The "culture change" movement is working to radically transform nursing home care, and help facilities transition from institutions to home. This report presents results from the Commonwealth Fund 2007 National Survey of Nursing Homes, fielded to examine the penetration of the culture change movement at the national level and measure the extent to which nursing homes are adopting culture change principles and practicing resident-centered care. Results are mixed, with much room for improvement. The survey highlights important lessons, including the finding that the more a nursing home has adopted culture change principles, the greater the benefits that accrue to it, in terms of staff retention, higher occupancy rates, better competitive position, and improved operational costs.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Some nursing facility administrators and physicians have raisedconcerns about the increased administrative burden of workingacross multiple Part D prescription drug plans (PDPs), citingthe possibility for adverse resident outcomes and financialburden on facilities when PDPs reject drug claims for residents.We examined data on claims in rejected status for one largelong-term care pharmacy as of December 2006. There was considerablevariation across PDPs in both rejection rates and reasons forrejection.

ALBANY—The New York State Department of Health has awarded $800,000 to 16 nursing homes to support implementation of an evidence-based best practice shown to significantly reduce pressure ulcers.

Known as “On-Time Quality Improvement for Long Term Care,” the approach to preventing pressure ulcers was developed by the federal Agency for Healthcare Research and Quality (AHRQ).

A pressure ulcer (also called a bedsore) is an area of skin that breaks down when a person stays in one position for too long, putting pressure on the same spot without shifting weight. They occur most often in people who are bedridden or in wheelchairs, even for a short time after surgery or an injury.

“The State Health Department is pleased to work with AHRQ and nursing homes across New York on this important effort to improve the health and well-being of nursing home residents in the state,” said State Health Commissioner Richard F. Daines, M.D. “In addition to creating pain and suffering, pressure ulcers can become infected, causing fever, confusion, weakness and even death. They are also very preventable, and costly to treat.”

Nursing home residents at highest risk for pressure ulcers are those in a coma and others who can’t move around or change position on their own. Among this high-risk population the incidence of pressure ulcers is 14 percent in the state (the U.S. average is 12 percent). Among low-risk patients in New York, the incidence is 2 percent (the same as the national average).

The “On-Time” program uses health information technology (HIT) to collect, analyze and promptly report back to staff the information they need to identify which nursing home residents are at risk for pressure ulcers and to track the results of their efforts to reduce risk. It has been implemented, tested and refined in more than 35 nursing homes across the nation and produced an average decrease of 33 percent in prevalence rates in the nursing homes that implemented the model.

Elderly nursing home residents receive relatively few cancer care services, including screening, surgical treatment, or hospice care.

Few studies have examined cancer treatment and care among elderly patients residing in nursing homes. Yet as the U.S. population ages, more people will move into nursing homes, many of whom will later be diagnosed with cancer. Cancer risk increases as people age.

Cathy Bradley, Ph.D., of the Virginia Commonwealth University Massey Cancer Center in Richmond and colleagues assessed the cancer care received by elderly nursing home residents who were insured by Medicaid. Using data from the Michigan Tumor Registry and Medicare records, they identified 1,907 nursing home residents diagnosed with cancer. They analyzed the patient data by cancer stage at diagnosis, type of cancer, survival time, and whether the patient received surgery or hospice care, as well as other variables.

Sixty-two percent of the nursing home residents with cancer had late or unstaged disease when they were diagnosed, and almost half died within three months of diagnosis. Among patients with late stage cancer, only 28 percent received hospice care. Patients aged 71 to 75 were three times more likely to have surgery than patients aged 86 and older.

"In recent years, Medicaid has spent more money on antipsychotic drugs for Americans than on any other class of pharmaceuticals," largely because nursing homes are "giving these drugs to elderly patients to quiet symptoms of Alzheimer's disease and other forms of dementia" -- conditions for which the drugs are not approved by FDA, the Wall Street Journal reports. According to CMS, 21% of nursing home residents who do not have a diagnosis of psychosis are prescribed antipsychotic drugs. "The growing off-label use of antipsychotic medicines in the elderly is coming under fire from regulators, academics, patient advocates and even some in the nursing home industry," the Journal reports.

Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging -- a not-for-profit industry group -- said, "You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they're out of it, and that is unacceptable." According to Teigland, her research shows about one-third of dementia patients in nursing homes in New York state are receiving antipsychotics, with some facilities dispensing the drugs at rates as high as 60% to 70% of patients.

WASHINGTON, Nov. 15 — Lawmakers in two hearings on Thursday proposed ways to force nursing homes to provide more details about ownership and to hold those owners more accountable when problems emerge.

The hearings were prompted in part by concerns that quality at nursing homes was declining as large chains were acquired by private investment groups.

Members of the House Ways and Means Health Subcommittee and the Senate Special Committee on Aging proposed measures to require nursing homes to disclose ownership and to require regulators to release information about poorly managed homes.

Kerry N. Weems, the acting administrator of the Centers for Medicare and Medicaid Services, which regulates nursing homes, offered several initiatives to improve oversight. His suggestions included releasing the so-called special focus facility list, which identifies homes that regulators consider among the nation’s worst. That list, which will be released Dec. 1, has not been public.

House Ways and Means Health Subcommittee Chairman Pete Stark (D-CA) announced today that the Subcommittee will hold a hearing to examine the effect of nursing home ownership trends on nursing home quality and accountability. The hearing will take place at 10:00 a.m. on Thursday, November 15, 2007, in Room 1100, Longworth House Office Building.

In view of the limited time available to hear witnesses, oral testimony at this hearing will be from invited witnesses only. However, any individual or organization not scheduled for an oral appearance may submit a written statement for consideration by the Subcommittee and for inclusion in the printed record of the hearing.

A nursing home resident who gets eyeglasses for uncorrected refractive error is less likely to suffer from depression than one with refractive error who did not receive eyeglasses, according to an article in Archives of Ophthalmology (JAMA/Archives), November edition.

Refractive error results in blurred vision - the back of the eye does not get the right amount of light.

The authors explain "Nursing home residents in the United States and other industrialized countries have high rates of vision impairment, with estimates ranging from three to 15 times higher than corresponding rates for community-dwelling older adults. Studies suggest that vision impairment in about one-third of nursing home residents could largely be reversed by treatment of uncorrected refractive error (myopia [nearsightedness], hyperopia [farsightedness], presbyopia [loss of focus])."

Cynthia Owsley, Ph.D., M.S.P.H., University of Alabama at Birmingham, and team carried out a trial involving 142 nursing home residents, aged 55 or more. 78 residents were randomly assigned to a group that would get eyeglasses one week after check-up, while 64 received eyeglasses two months after check up (at follow-up). At two months vision-related quality of life and depressive symptoms were measured at baseline.

At baseline the two groups had similar demographic and medical characteristics - they also had similar visual acuteness and refractive error uncorrected by eyeglasses. Two months later, distance and near visual acuity for both left and right eyes improved in the group that had been given eyeglasses, while the other group had no improvement in visual acuity.

During the two-month follow-up, the eyeglass group had better scores for general vision, reading, activities/hobbies and social interaction - they also displayed fewer depressive symptoms.