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Anthony Cirillo

Anthony's Assisted Living Blog


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Gene Sequencing Will Help Identify Alzheimer's Sooner

Monday June 2, 2014
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I attended a briefing for the Health Affairs April release of its issue "The Long Reach of Alzheimer's Disease." I will report on the briefing starting today.

Richard Hodes, Director, National Institute on Aging, National Institutes of Health opened the briefing. He started by reviewing the Alzheimer's statistics, which we have reported on previously and then touched on the National Plan to Address Alzheimer's Disease. He shared some of the latest advances in finding a cure. Steeped in this is finding and mapping the genes associated with risk. These have only lately become available because of the Human Genome Project. With PET scans, researchers can better visualize the plaques and tangles associated with the disease.

In short, they can start to identify those at risk for the disease well before it shows up. That allows people to prepare for the possible consequences. Of course opponents argue that it could be sending people into a tailspin, those who may never actually manifest the disease.

Gene sequencing will continue to grow in the future. Partnerships with 10 bio pharma firms and other non-profits will expand the team addressing the disease including international partners. A central web portal is helping to tie all of this information together. Clearly progress is being made and funding is picking up for research.

Keep in mind that most of the emphasis is finding a cure for the disease. One of the bigger issues is living with the disease and caring for the patient and their caregivers. The final question from the audience hit that squarely on the head. A person asked what funding is going to care of the caregiver. He answered by saying research continues on ways to address that. Well research is fine but there are resources out there already in the private sector. Perhaps they need to establish a clearinghouse for those!

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Does Pay for Performance Work? Depends on Who You Ask.

Friday May 30, 2014
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According to a report in McKnight's Long-Term Care News and Assisted Living, most nursing home administrators do not believe that pay-for-performance initiatives lead to improved resident care or stronger bottom lines.

A study in the Journal of Aging and Social Policy, reported on survey results of 2,400 administrators conducted by the University of Pittsburgh and RAND Corp. About two-thirds worked in states that already had instituted a pay-for-performance (P4P) program, such as the Medicare Value-Based Purchasing Demonstration. These programs reward nursing homes for meeting certain quality goals and withhold payment from poor performers.

The "most significant" finding was that very few administrators believe pay-for-performance improves care quality, the authors wrote. Dissatisfaction with the quality measures used could explain administrators' skepticism about how well pay-for-performance can drive improvement. The statement "the right amount of quality indicators are used" garnered a summary score of only 10, on a scale in which 100 would indicate total agreement. Many respondents also did not agree that the most appropriate indicators are being used.

Minnesota seems to have found a way to make pay for performance meaningful. Minnesota's Performance-Based Incentive Program funds nursing home-initiated quality improvement projects for 1 to 3 years through increases of up to 5 percent in the operating per diem rate charged to Medicaid and private-pay residents.

As reported on the web site of the Agency for Healthcare Research and Quality, the program has engaged a high proportion of Minnesota nursing homes in QI activities; meaningfully improved the quality of nursing home care; and had a positive impact on quality improvement processes, teamwork, and communication.

In the program's first 5 years, nearly three-quarters (74 percent) of the State's nursing homes had either participated in a project or applied to the program. During this period, DHS approved 89 projects involving 199 facilities. Both qualitative and quantitative data show that pay for performance has led to significant, sustained improvements in the quality of nursing home care in Minnesota.

  • During the first four rounds of funding, 95 percent of the funded projects (63 out of 66) met their performance targets. Only three projects (conducted at four facilities) did not meet the targets and consequently lost a portion of their project funding.

  • Before implementation the quality of care (as measured on a weighted average of 23 measures) in the 174 Minnesota nursing homes that later participated was similar to that of the 199 facilities that did not. In both groups, scores had been trending upward at similar rates over time. During the 4-year period after implementation (2007 to 2010), scores improved significantly in nursing homes that participated while remaining flat among those that did not.

  • In a survey, 42 percent of project leaders felt that their funded projects had a very significant, positive impact on quality in the areas targeted. They also reported that the projects are having a lasting impact that extends beyond the end of funding.

  • There was a positive impact on processes, teamwork, communication, and staff-resident relations.

As these programs will continue to become standard, it is important for providers partnering in accountable care organizations to be clear and consistent in determining quality goals that are important for resident care and safety.

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Maya Angelou - The Rainbow in the Clouds - Reposting in Tribute to Maya (RIP)

Thursday May 29, 2014

"When it looks like the sun isn't going to shine any more, God put a rainbow in the clouds. Each one of us has the possibility, the responsibility, the probability to be the rainbow in the clouds."

At first, I was not sure what her remarks to the 10,000+ attendees at last month's Leading Age convention meant.

Ah, but then she told her life story...

At 83 she has lived a lot of life.

She noted that there is a world of difference between being educated and being trained. Because what she or any of us lack from formal schooling we most certainly can make up through continuous learning. And through her life she continuously learned lessons about humankind.

At the age of 3, her parents sent her to her paternal grandfather. As one of the few black business owners, she learned lessons everyday in his store. She learned from her grandmother who did not believe in whining and complaining noting that when that happens there is a "victim" in the neighborhood. Her grandmother was never a victim and neither was she.

She noted that laughter and a cheerful spirit is good medicine. And then she made us laugh with a corny joke that had me laughing particularly hard because I heard the exact same joke from my father-in-law the weekend before. He is 84. Ms. Angelou is 83. Maybe it's generational.

In keeping with her good nature ribbing of a health conscious society she read her poem, The Health Food Diner.

Then more learning. She eventually moved back with her mom in St. Louis. Her mother's boyfriend raped her. She reported it. He was put in jail for one day and released. Then he was found dead and she felt she caused it. And she went silent for many years.

To go on about what she has accomplished is redundant. Google her. But what are those rainbows in my clouds?

They are the people who cared for her, who said I believe you can do it. She noted she had many rainbows, many teachers, and they are always with her, pointing to the invisibly "crowded" stage in front of her.

And then just as we were about to thank her, she thanked the audience for letting her be a rainbow in our clouds.

Whose rainbow in the clouds are you?

There were 10,000 rainbows shining in a dark auditorium last month in DC.

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Wednesday May 28, 2014

CCAL-Advancing Person-Centered Living is working with the University of Buffalo-Institute for Person-Centered Care on a research project funded by the Retirement Research Foundation and approved by the Internal Review Board at the University of Buffalo.

This is the second round of a survey which aims to develop agreement on priorities for dementia care, research and government from the perspectives of people living with dementia, family care partners and those who provide direct care. As someone with knowledge about dementia, we invite you to take part in this study. You may have responded to the first round - if so THANK YOU! If not, please add your voice by taking part in round 2.

You can call the number below to get help completing the survey over the phone. Or a paper survey and a pre-addressed, postage-paid envelop can be mailed to you if you would prefer this method instead of completing the survey online. The contact details are at the end of this message.

We will combine the views of everyone who takes part in the survey. We will use the information to help inform federal policy makers about what people feel is important and needed concerning dementia care to better inform and shape their priorities.

Your response by June 6, 2014 would be appreciated.

To take part online click here or go to: https://www.surveymonkey.com/s/CoalesceandConnect2

To complete the survey over phone contact:

Karen Love

Founder, CCAL-Advancing Person-Centered Living

(703) 533 3225

To request a paper version contact:

Dr. Davina Porock

Director, UB Institute for Person-Centered Care

(716) 829 2260

Or email dporock@buffalo.edu

Ceding Flu Shot Administration to Pharmacy Improves Compliance

Wednesday May 28, 2014

The Raising Immunizations Safely and Effectively (RISE) program took 14 long-term care facilities and had them cede control of vaccination-related policies and processes to a regional pharmacy. The facilities worked collaboratively with the pharmacy to implement and enforce these standardized policies and processes. The policy change significantly increased worker vaccination rates in participating facilities, enabling all facilities to reach the Healthy People 2010 goal of vaccinating 60 percent of workers in long-term care settings and several facilities to exceed the Healthy People 2020 goal of vaccinating 90 percent.

The University of Pittsburgh Medical Center created the RISE program, a network of long-term care facilities, in 2001. The new policy took effect in 2005, before the start of the 2005-2006 flu season. The Centers for Disease Control and Prevention (CDC) set the goal of having 60 percent of such workers immunized each year by 2010 and 90 percent by 2020. Yet worker vaccination rates remain well below these levels. Immunizing workers has been shown to reduce the risk of influenza illness and influenza-related deaths among LTC residents.

Before implementation of this program, each of the 14 participating facilities had its own vaccination policies for residents and workers. Under the new approach, each facility ceded control of immunization policies and procedures, transferring them to their partner regional pharmacy. The regional pharmacy's medical director approved the pharmacy's policies and procedures, thus creating a standing order that applies to influenza vaccination administration. As part of the agreement, the facilities accepted this standing order and consequently do not require a physician order to administer the vaccine to workers. Participating LTC facilities agreed to eliminate the requirement that those receiving a vaccination sign a consent form, which is a proven barrier to workers being immunized. Participating facilities required any worker who chooses not to be vaccinated to sign a declination form that clearly states the risks of forgoing a vaccination, including the potential to spread a dangerous virus to family members, friends, and facility residents. Participating facilities agreed to offer influenza vaccines each year at no cost to their workers and to make vaccinations available on multiple days to workers on all three shifts in an easy-to-reach location within the facility.

The change in policy significantly increased vaccination rates among workers in participating LTC facilities, enabling all of the facilities to reach the Healthy People 2010 goal of immunizing 60 percent of workers and several to exceed the Healthy People 2020 goal of immunizing 90 percent.

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Long Term Care Quality and Innovation Center Announced

Monday May 26, 2014

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) announced a partnership with the Brown University School of Public Health to create the Long Term Care Quality and Innovation Center, an effort to continue finding innovative ways to improve quality of care in skilled nursing centers across the country.

While the Center will have several objectives, one of the most critical is to research and test best practices that improve quality in long term and post-acute care. The Center is charged with translating those best practices into real-world training and leadership programs that staff in skilled nursing centers across the country can use.

"Our profession is fortunate to have the opportunity to partner with a renowned academic and research institution to help develop and refine methods to improve quality in long term and post-acute care," said Leonard Russ, Chairman of AHCA's Board of Governors. "Quality is a top priority for providers. Through this center, we will disseminate valuable information that can help caregivers make real improvements in their centers."

Much of the outreach efforts will initially focus on providers that are still striving to meet important quality milestones. The Center will aim to link providers with high performers and offer leadership programs within the profession.

The Center will be housed in the Centers for Gerontology and Healthcare Research at Brown, where more than 20 faculty members and their students collaborate to study care for the elderly and chronically ill. Over the years their efforts have produced numerous nationally influential findings.

The new center will be governed by a five-person independent advisory board, with representation from the profession and Brown University.

To help launch the center, AHCA/NCAL has provided $1 million in initial funding. The Center will seek projects supported by government and private sector resources, with the goal of becoming self-sustaining over a period of three to five years.

Barry Winiker

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Engaging Residents / Patients Before, During and After the Care Experience Impacts Satisfaction

Friday May 23, 2014

Lessons from your hospital partners!

A session at American College of Healthcare Executives annual conference in March looked at "The ROI of Empowered Patients: Leveraging IT to Boost Patient Satisfaction Scores."

The role of MOOC, massive open online communities, that promote deep video-driven, interactive learning for patients is emerging and Summa Health showcased a platform it is using to engage patients before, during and after hospitalization. It can provide a blueprint for long term care providers willing to invest in technology.

A web-based interactive platform engages patients and families in preparing for surgery using voice and visuals. Specific programs are prescribed and an email with an access code is given to view the program online. The platform guides patients through the requirements for anesthesia and the surgical procedure and helps set patient expectations

Summa then performs 30,000 discharge phone calls annually. The calls reinforce healthy behaviors and help patients be more compliant. There is a 60% contact rate. The calls help reinforce healthy behaviors and help patients be more compliant to achieve better outcomes.

Over 19 months, 10,983 patients were prescribed a multimedia program. Of those patients who were admitted, 425 completed HCAHPS surveys. Across all nine HCAHPS questions, viewers answered with a higher percentage of top box answers than non-viewers. Patients contacted at home had lower 30-day readmission rates than those not contacted.

The takeaways long-term care providers might consider include:

  • Using video in non-crisis situations to educate families and those they are caring for about life in your community, easing fear while educating people and setting expectations.
  • Using the Summa model with rehabilitation patients in turn becoming a better partner to hospitals and reducing readmissions.

Summa Health

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The American Healthcare Reformation: What's Next?

Wednesday May 21, 2014

WalMart - your new healthcare partner!

William Dwyer presented a session at the recent annual conference of The American College of Healthcare Executives (ACHE) entitled "The American Healthcare Reformation: What's Next?"

He started the conversation asking whether healthcare executives in the room were more optimistic or less optimistic. Just six people answered more optimistic.

Using political change as a catalyst for healthcare change he prognosticated about the 2016 election. He speculated that Jebb Bush would be a likely Republican candidate with Chris Christie's star dropping. He even went as far as to say that someone could win the popular vote but lost the election.

Being more polarized than ever, he noted how the House of Representatives has voted more than 50 times to repeal the Affordable Care Act. Still he feels the law will survive, particularly if you make health care better in California, Florida, and Texas.

Scarily, there are statistics that show one in seven hospitals may stop taking Medicare patients, a practice that physicians have already started to employ. Looking at healthcare GDP approaching 21%, it is clear to him that tax reform will start to target the more affluent.

That is the backdrop he set for the audience as he then explored emerging issues and trends.

  • We are now spending about $8,000 per person in the U.S. for healthcare, dwarfing all other countries. One percent of patients consume 21% of the dollars. And we spend more on end of life care than anyone!

  • Employers are starting to shift their thinking when it comes to providing health insurance, already many weigh the cost of being penalized for not providing insurance to the cost of providing it. Many are sending employees to the health care exchanges.

  • Even Blue Chip companies are reneging on their promise to provide lifetime healthcare to retirees.

Dwyer offered three paths to healthcare survival.

  1. Ration
  2. Re-invent / Reform
  3. Ration / Reinvent

He believes that number three will be the solution.

It will be hard to support end stage renal disease in 85 plus population when the National Health Service in the U.K. stops care when someone's is in their 50's. Huron Healthcare Consulting predicts there is a 20-40% cost improvement opportunity in healthcare.

Value based purchasing will become even more important.

Nurse practitioners are growing and some states are enabling legislation to allow them to practice solo.

Outpatient care will continue to grow.

Retail medicine will continue to grow.

At the same time, WalMart is selecting destination sites in the U.S. for spine, heart and transplant surgeries, essentially re-energizing medical tourism within the States. They are not the first to do this. In essence, "healthcare is local" as an accepted norm may need to be reevaluated. Nursing homes may do better affiliating with WalMart for the rehabilitation work that ensues once a patient returns to the community.

He believes that health systems add value - access to capital, negotiating leverage, shared expenses, accelerate learning and innovation. So while Brookdale - Emeritus may alarm some it is probably good business, a key survival strategy, and ultimately can benefit resident care.

While little new was shared, it is important for long-term cafe providers to know what is taking place in the acute care world, which has spillover effect to the rest of healthcare.

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Antipsychotic Reduction Meets CMS 15% Goal

Monday May 19, 2014

In early 2012, in response to the persistently high rate of antipsychotic medication use in nursing home residents with dementia, CMS established the National Partnership to Improve Dementia Care in Nursing Homes, a unique public-private partnership that outlined a multidimensional strategy to address this public health issue.

Two new measures of antipsychotic medications were posted on the Nursing Home Compare (NHC) website beginning July 2012. The new measures included an incidence measure that assesses the percentage of short-stay residents that are given an antipsychotic medication after admission to the nursing home, and a prevalence measure that assesses the percentage of long-stay residents that are receiving an antipsychotic medication.

  • Over 18 months, the national prevalence of antipsychotic use in long-stay NH residents was reduced by 15.1% and every CMS region showed at least some improvement. Some States showed much more improvement than others, for example Georgia reduced their rate by 26.4% and North Carolina saw a 27.1% reduction.

  • Data as of 3/2014 suggest a slight increase in the percent of nursing home residents who received a diagnosis of schizophrenia, and a small decline in the use of sedative-hypnotics, as well as a significant reduction in antipsychotics during the initiative.

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Simple Communication Tip Eases Family Angst

Friday May 16, 2014

My mom is in an independent living facility in Charlotte and doing as well as can be expected. Given I spend a lot of time there, I pick up on the nuance of communication from different staff members. One thing I have observed is the way different staff members use language when calling family members on the phone.

One manager when calling me immediately says when I answer - "You're mom is fine." She then proceeds to tell me why she is calling for this non-urgent matter. Perfect. I already saw the caller idea was from the place and immediately think 'what happened now>'.

Another manager at the same place called. Recognizing the caller ID, I immediately pick up the phone. The tone is business like and monotone. She asks for me by name very slowly and deliberately. I respond. She takes her time asking a qualifying question. Now I am 45 seconds into the call and have no idea how mom is. Did she fall? Is she at the hospital?

Well it was none of that. Simply calling to settle a bill discrepancy.

See how one person knew how to immediately calm a family person and the other created angst? These are simple, correctable actions that can go a long way in fostering better communication with families.

More to come!

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