• Gaps Continue to Exist in Nursing Home Emergency Preparedness and Response During Disasters

    Wednesday April 25, 2012

    Federal regulations require that Medicare and Medicaid certified nursing homes have written emergency plans and provide employees with emergency preparedness training. In a 2006 report about nursing homes that experienced hurricanes, the Office of Inspector General (OIG) found that emergency plans lacked many provisions recommended by experts. In response, CMS issued guidance checklists for emergency planning of health care facilities, long-term care (LTC) ombudsman programs, and State survey agencies (SA). The OIG conducted this study released April 2012 to assess emergency preparedness and response of nursing homes that experienced more recent disasters.

    For this study, the OIG analyzed national survey data to determine compliance with Federal regulations. They also conducted site visits to 24 selected nursing homes that experienced floods, hurricanes, and wildfires in 2007-2010. They interviewed nursing home administrators and staff, local emergency managers, and representatives from State LTC ombudsman programs and SAs. They also compared the emergency plans of each selected nursing home to the CMS checklist for health care facilities.

    The OIG found that most nursing homes nationwide met Federal requirements for written emergency plans and preparedness training. However, they identified many of the same gaps in nursing home preparedness and response that were found in the 2006 report. Emergency plans lacked relevant information including only about half of the tasks on the CMS checklist. Nursing homes faced challenges with unreliable transportation contracts, lack of collaboration with local emergency management, and residents who developed health problems. LTC ombudsmen were often unable to support nursing home residents during disasters; most had no contact with residents until after the disasters. SAs reported making some efforts to assist nursing homes during disasters, mostly related to nursing home compliance issues and ad hoc needs.

    The OIG made three recommendations to CMS and one recommendation to Administration on Aging (AoA). CMS agreed with their recommendations to revise Federal regulations to include specific requirements for emergency plans and training, update the State Operations Manual to provide detailed guidance for SAs on nursing home compliance with emergency plans and training, and promote use of the checklists. AoA also agreed with their recommendation to develop model policies and procedures for LTC ombudsmen to protect residents during and after disasters.

    The top 10 disaster prone states, as ranked by historical statistics on disaster declarations are Texas, California, Oklahoma, New York, Florida, Louisiana, Alabama, Kentucky, Arkansas and Missouri.

    Sources: Department HHS Office of Inspector General; CMS; Long Term Care Ombudsman

    The National Long Term Care Ombudsman Resource Center link: http://www.ltcombudsman.org/issues/emergency-preparedness

    Office of Inspector General April 2012 Report:

    Nursing Home Emergency Preparedness and Response Report 2012

    OIG Memo to CMS April 13, 2012:

    OIG Emergency Memo April 13-2012

    CMS Emergency Preparedness Checklist:

    CMS Emergency Preparedness for Every Emergency checklist revised Sept 2009

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  • Pain vs. Behaviors

    Monday April 23, 2012

    It has been recently noted after review of numerous medical records a common trend has been identified.  Residents with impaired cognition are exhibiting behaviors i.e. screaming out, resisting care, removing clothes etc.  The residents are being assessed for behavioral interventions and some resident are being placed on psychoactive medications while pain is the cause of the resident's behaviors. Residents were not consistently assessed for pain during the behavioral assessment phase to rule out pain.  Facilities may want to review current systems and processes to ensure there is an evaluation of the resident for pain with the onset and/or increase in behaviors.   This will also help in the prevention of unnecessary drugs.  See article below.

    Management of Pain In Persons With Dementia  

    Pain is a common medical condition in older persons; especially residents in long term care (LTC) settings. Pain is defined as a sensory and emotional experience associated with actual or potential tissue damage. Chronic persistent pain occurs in 24% of LTC residents while only 29% are free of all pain. Most, i.e., 74%, demented nursing home residents have some pain and the majorities, i.e., 70%, are untreated or under-treated.

    Pain can have multiple origins; however, discomfort produced by musculoskeletal disease is the most common problem in the older person, e.g., arthritis 42%, bone fracture 12%. Untreated or under-treated pain can produce significant suffering as well as agitation and behavioral problems in persons with dementia. Regular administration of acetaminophen can reduce agitation in more than one-half of agitated, demented patients with pain.  

    Assessment and management of pain is an important responsibility of any clinical management team. Dementia patients are less likely to receive analgesics despite the fact that they experience suffering equal to cognitively intact individuals.  

    Source: Richard E. Powers, MD (2008) - Bureau of Geriatric Psychiatryhttp://www.alzbrain.org/

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  • Employee Rights Notice Posting

    Monday April 23, 2012

    April 30, 2012 is the new deadline for nearly all nursing facilities and assisted living communities to display posters informing employees of their rights under the National Labor Relations Act (NLRA), according to the National Labor Relations Board.  The notice should be posted in a conspicuous place, where other notifications of workplace rights and employer rules and policies are posted. Employers also should publish a link to the notice on an internal or external websites if other personnel policies or workplace notices are posted there.                         

    You may download and print the notice using the links below. You may also call 202-273-0064 and copies will be mailed to you free of charge.


    The poster is required to be 11 x 17 inches, in color or black-and-white. When printing to full size, be sure to set your printer output to 11 x 17. Or you may print the two 8.5 x 11 pages and tape them together.

    English Posters

    English Employee Rights Poster 11 x 17  English Employee Rights Poster 8-5 x 11

    Spanish Posters

    Spanish Employee Rights Poster 11 x 17

    Spanish Employee Rights Poster 8-5 x 11

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  • National Plan to Address Alzheimer’s Disease

    Wednesday April 11, 2012

    On January 4, 2011, President Barack Obama signed into law the National Alzheimer's Project Act (NAPA), requiring the Secretary of the U.S. Department of Health and Human Services (HHS) to establish the National Alzheimer's Project. The law also establishes the Advisory Council on Alzheimer's Research, Care, and Services and requires the Secretary of HHS, in collaboration with the Advisory Council, to create and maintain a national plan to overcome Alzheimer's disease (AD).

    Building on the preliminary work on this plan, on February 7, 2012, the Obama Administration announced a historic $156 million investment to tackle Alzheimer's disease.

    The draft of the National Plan is being submitted to the Advisory Council for consideration and input. It was also be open for public comment through March 30, 2012.

    To read the draft in its entirety click on the following link:

    Draft National Alzheimer's Plan 2012

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  • NCCAP National Examination

    Monday April 9, 2012

    The National Certification Council of Activity Professionals has implemented an examination that all NEW applicants must complete in order to apply for national certification at the ADC or ACC level(s) effective January 1, 2012. Please note that is will not affect those individuals already certified at any level with NCCAP prior to December 31, 2011.

    The test consists of questions from the nine topic areas and the 163 competencies defined in the MEPAP curriculum. Completion of the Modular Education Program for Activity Professionals, 2nd Edition will prepare the applicant for the exam. There will be 50 questions on the test and applicants will have one (1) hour to complete the test. Applicants must make a 70% to pass the exam. Comira and ACT testing centers will administer the examination and they are located throughout the United States and Canada.

    For additional information regarding the new testing policy and procedure please contact the NCCAP office or visit their web site at www.nccap.org

    Source: National Certification Council for Activity Professionals

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  • Disparities/Minority Health: Lower flu vaccination rates for black nursing home residents a cause for concern

    Monday April 9, 2012

    The average flu vaccination rate among nursing home residents nationwide was 72 percent during the 2005-2006 flu season. This was well below the Healthy People 2010 goal of 90 percent. A new study found that black nursing home residents have lower flu vaccination rates than their white counterparts. It found that over three consecutive flu seasons (2006-07, 2007-08, and 2008-09), the odds of being vaccinated were 14-16 percent lower for blacks than for whites within the same facility.This difference persisted even after excluding residents who were either offered but declined vaccination, or were vaccinated outside the facility.

    The Brown University researchers also found that nursing homes with high proportions of black residents had lower vaccination rates for both blacks and whites than did facilities with lower proportions of black residents. These facilities generally have a high proportion of Medicaid residents. Therefore, they have less revenue and fewer opportunities to cross-subsidize care with income from more profitable Medicare and private-pay patients.

    The researchers suggest that low revenue, insufficient staffing, and poor-quality performance may all contribute to the lower vaccination rates in these facilities. They also point out that blacks are consistently more likely than whites to refuse flu vaccinations when offered. To completely eliminate racial differences in flu vaccination rates, educational programs that focus on elderly blacks and their families may be necessary, suggest the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS16094).

    Source: Agency for Healthcare Research and Quality  http://www.ahrq.gov/research/apr12/0412RA23.htm

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  • End of Life Care During the Last Days and Hours

    Tuesday April 3, 2012

    The Registered Nurses Association of Ontario (RNAO) and the guideline development panel have compiled a list of implementation strategies to assist health-care organizations or health care providers that are interested in implementing this guideline.  

    According to the RNAO, this nursing best practice guideline is a comprehensive document, which provides resources necessary for the support of evidence-based nursing practice. The document must be reviewed and applied, based on the specific needs of the organization or practice setting/environment, as well as the needs and wishes of the client. This guideline should not be applied in a "cookbook" fashion, but rather as a tool to enhance decision-making in the provision of individualized care. In addition, the guideline provides an overview of appropriate structures and supports necessary for the provision of best possible care.  

    The purpose of this best practice guideline is to provide evidence-based recommendations for Registered Nurses and Registered Practical Nurses on best nursing practices for end-of-life care during the last days and hours of life. The guideline does not replace consultation with palliative care specialists, who can support nurses to provide quality end-of-life care. The guideline is intended to be a resource to nurses who may not be experts in this practice area. It is acknowledged that individual competencies vary between nurses and across categories of nursing professionals. The inclusion of recommendations on clinical, education, organization and policy topics makes this guideline applicable to nurses in all domains and settings of practice  

    Source: Agency for Healthcare Research and Quality

    End of Life Care During the Last Days and Hours

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  • Antipsychotic Drugs Might Raise Heart Attack Risk: Study

    Monday April 2, 2012

    WEDNESDAY, March 28 (HealthDay News) -- Antipsychotic drugs can raise the risk of heart attack in older patients with dementia, a new study suggests.

    It's common to prescribe antipsychotics to older patients with dementia to control symptoms such as agitation, hallucinations and aggression. Previous studies have found that this use of the drugs may be linked to an increased risk of stroke and death from all causes.

    But until now, the risk of heart attack associated with the use of antipsychotic drugs in older people with dementia had been "poorly examined," wrote study author Dr. Antoine Pariente, of Universite Bordeaux Segalen in France, and colleagues.

    They looked at nearly 11,000 patients, aged 66 and older, in Quebec who were being treated with cholinesterase inhibitors for dementia and were also prescribed antipsychotics.

    Within a year of starting treatment with the antipsychotics, 1.3 percent of the patients had a heart attack. Compared to those not taking antipsychotics, the risk of heart attack among those taking them was 2.19 times higher for the first 30 days, 1.62 times higher for the first 60 days, 1.36 times higher for the first 90 days, and 1.15 times higher for the first year.

    "Our study results indicate that the use of [antipsychotic medications] is associated with a modest increase in the risk of [heart attack] among community-dwelling older patients with treated dementia," the researchers wrote. "The increased risk seems to be highest at the beginning of treatment and seems to decrease thereafter, with the first month of treatment accounting for the highest period of risk."

    The study, which found an association between antipsychotic use and heart attack but did not prove cause-and-effect, appeared online March 26 in the Archives of Internal Medicine.

    "Because [antipsychotic] use is frequent in patients with dementia ... the increased risk of [heart attack] may have a major public health effect, which highlights the need for communicating such risk and for close monitoring of patients during the first weeks of treatment," the authors concluded in a journal news release.

    Further research is required to learn more about why the use of antipsychotic drugs in dementia patients may increase the risk of heart attack, Dr. Sudeep Gill and Dr. Dallas Seitz, of Queen's University in Kingston, Ontario, Canada, wrote in an accompanying editorial.

    "Meanwhile, physicians should limit prescribing of antipsychotic drugs to patients with dementia and instead use other techniques when available, such as environmental and behavioral strategies, to keep these patients safe and engaged," they suggested.

    While the study found an association between antipsychotic drugs and heart attack risk, it did not prove a cause-and-effect relationship.

    SOURCE: JAMA/Archives journals, news release, March 26, 2012

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