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Glass of Water

Maintenance of adequate hydration may seem like a simple task, but given the increase in medications and changes due to aging, seniors are at a high risk for dehydration. Here are some tips for hydration.  

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Assisted Living Spotlight10

Inpatient Rehabilitation Hospital Patients Have Better Outcomes Industry Sponsored Study Claims

Friday April 18, 2014

Can dedicated rehabilitation hospitals reduce readmissions more effectively than nursing homes? This sponsored study suggests yes. What do you think?

A study released at a meeting of the March meeting of the American Medical Rehabilitation Providers Association (AMRPA) shows that patients treated in inpatient rehabilitation hospitals and units had better long-term clinical outcomes than those treated in nursing homes.

The ARA Research Institute, an affiliate of the AMPRA, commissioned Dobson-DaVanzo & Associates, LLC, to conduct a retrospective study of inpatient rehabilitation hospital and unit patients and clinically similar nursing home patients to examine the downstream comparative utilization, effectiveness of post-acute care pathways, and total cost of treatment during the five years following the implementation of the 60 percent rule.

"This study shows that patients treated in inpatient rehabilitation hospitals and units have better outcomes, go home earlier and live longer than those treated in skilled nursing facilities," said Bruce M. Gans, M.D., AMRPA board chair, and executive vice president and chief medical officer of Kessler Institute for Rehabilitation.

Key Findings

The study's key findings show:

  • Over a two-year episode of care, inpatient rehabilitation hospital and unit patients clinically comparable to skilled nursing facility patients, on average: returned home from their initial hospital rehabilitation stay two weeks earlier; remained home nearly two months longer; stayed alive nearly two months longer.

  • Of matched patients treated: inpatient rehabilitation hospital and unit patients showed an 8 percent lower mortality rate than skilled nursing facility patients; inpatient rehabilitation hospital and unit patients with 5 of the 13 diagnostic conditions showed significantly fewer hospital readmissions than skilled nursing facility patients; inpatient rehabilitation hospital and unit patients made 5 percent fewer emergency room visits per year than skilled nursing facility patients.

See the full study.

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The staff experience: employees have human needs too!

Wednesday April 16, 2014

Here is an excerpt from my recent Hospital Impact blog. In essence, healthcare must heal itself before it can heal others.

This month's blog post extends from both my January and February posts. In January, I shared how short-sighted financial decisions hurt patient experience. In February, I discussed my new role as primary caregiver to my mom, suggesting that instead of focusing on patient experience, we should look at the human experience.

One comment on the January post serves as a good segue for the rest of this piece.

"Health and wellness, just as death and dying, affect all of us. Clinicians and administrators share in the wins and defeats in healthcare. As nurses, we need to be in the mix, collaborating with various stakeholders, while holding the hand of another human being to ease their suffering."


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Quality Indicators No Good If Staff Does Not Understand Them

Monday April 14, 2014

A survey in the Journal of Research in Nursing shows that most nursing home staff do not fully understand the meaning and value of MDS 3.0.

A survey was used to measure clinical leadership's perceptions of staff understanding of the minimum data set (MDS) quality indicators (QIs) and ways to improve staff understanding of this system, as well as specific perceived training needs among Department of Veterans Affairs (VA) nursing home care unit (NHCU) clinical leadership.

An online survey using structured (quantitative) and open-ended (qualitative) items was conducted in 97 VA NHCUs nationwide. A total of 289 leadership staff including directors of nursing, medical directors, MDS coordinators participated.

Most respondents rated their frontline staff as having "good" to "fair" understanding of how the Quality Indicators are computed through MDS data. Lack of involvement with the MDS is the greatest barrier to greater understanding, the respondents indicated. Workers are often excluded from MDS processes, and there is a lack of training, the researchers found.

Respondents recommended education/training, involvement, reinforcement and other methods to increase understanding. Of specific training strategies/needs, the most frequently identified were using the MDS as a clinical assessment tool.

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22 Percent of Medicare Beneficiaries Experienced Adverse Events During SNF Stays

Friday April 11, 2014

More of this will happen if SNFs don't get their act together.

The Office of the Inspector General conducted a series of studies from 2008-2012 about hospital adverse events, defined as harm resulting from medical care. This work included a Congressionally mandated study to determine a national incidence rate for adverse events in hospitals. They continued that work by evaluating post-acute care provided in skilled nursing facilities (SNF). SNF care is second only to hospital care among inpatient costs to Medicare. What they found - almost one on four people experience an adverse effect during a SNF stay.

The study estimated the national incidence rate, preventability, and cost of adverse events in SNFs by using a two-stage medical record review to identify events for a sample of 653 Medicare beneficiaries discharged from hospitals to SNFs for post-acute care. Sample beneficiaries had SNF stays of 35 days or less.

An estimated 22 percent of Medicare beneficiaries experienced adverse events during their SNF stays. An additional 11 percent of Medicare beneficiaries experienced temporary harm events during their SNF stays. Physician reviewers determined that 59 percent of these adverse events and temporary harm events were clearly or likely preventable. They attributed much of the preventable harm to substandard treatment, inadequate resident monitoring, and failure or delay of necessary care. Over half of the residents who experienced harm returned to a hospital for treatment, with an estimated cost to Medicare of $208 million in August 2011. This equates to $2.8 billion spent on hospital treatment for harm caused in SNFs in FY 2011.

The OIG recommends that:

  • AHRQ and CMS raise awareness of nursing home safety and seek to reduce resident harm through methods used to promote hospital safety efforts.

  • There be collaboration to create and promote a list of potential nursing home events-including events not commonly associated with SNF care-to help nursing home staff better recognize harm.

  • CMS should also instruct State agency surveyors to review nursing home practices for identifying and reducing adverse events.

This report would indicate that nursing homes are failing as quality partners to hospitals in reducing readmissions. And that spells opportunity for assisted living and even skilled home health providers to fill the gap. After all, being in a nursing home is not much better than being in a hospital in terms of your likelihood to acquire an infection or other illness. A less acute setting coupled with the right care might be the right recipe in reducing readmissions.

McKnight's Long-Term News and Assisted Living editor staff writer Tim Mullaney has an interesting take on this too.

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