The consequences of lack of communication between hospitals and skilled nursing facilities (SNFs) are not new knowledge. According to a 2013 study, in the U.S. alone, more than 5 million patients transition from hospital to SNFs yearly. These transitions heavily rely on the thorough communication of healthcare professionals and paraprofessionals to ensure adequate care for patients. However, hospitals and local SNFs typically operate as separate entities causing a myriad of miscommunication. Communication issues that may happen between the facilities include incomplete, contradicting and/or mismatching verbal and written care plans. These problems may cause SNF staff to delay—or never deliver—proper care for patients, resulting in potentially fatal consequences. For example, noting the wrong medication can cause a stroke patient to relapse into another stroke and an avoidable hospital readmission. While many factors can be used as scapegoats to explain these mistakes, these problems are not new, and as professionals in the field, SNFs should establish better communication and points of accountability before accepting a patient to ensure the dignity and quality of care of patients. A recent study published by the Journal of the American Geriatrics Society by multiple medical doctors have indicated that a significant number of hospital readmissions from SNFs were likely preventable.

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As our population ages, there has been an increase in the number of elderly patients that undergo neurosurgical interventions. This increase is accompanied by aging risk factors, such as frailty, that increase the risk of complications post-surgery. A recent study undertook the task of surveying how recent falls affected patients who underwent a neurosurgical operation, focusing on a patient’s outcome relative to their fall history in the six months prior to their surgery.

The study’s overall findings were that patients with at least one fall six months prior to a neurosurgical procedure, had an increased risk of complications following their discharge. It specifically focused on the number of those discharged to a facility post-surgery, re-admittance rate, and the rate of complications. 18 % of those studied were discharged to a long term care facility after the operation, 17% were readmitted within thirty days, and 28% also had a complication arise within thirty days of their discharge date.

The results of this study give reasons to include fall history in preoperative risk assessments prior to any neurosurgery. While the frailty of an elderly patient is already considered in these assessments, it is important to include patients fall history since there reason to believe that these falls affect patients’ recovery. Neurosurgical procedures  As shown in the study there is a higher risk of complications that arise when a patient has suffered a fall.

Many people today use medication unnecessarily. The smallest flu or cold warrants the use of antibacterial medication that often does greater harm to our bodies. We ask our doctors for medications that cure common illnesses without thinking of the effects that these medicines may have on our bodies in the future. A rising concern in the medical field is the emergence of antimicrobial-resistant microorganisms (ARMs). Although resistance to antimicrobial organisms is a natural occurrence, over the years the cases of ARMs have been rapidly growing. The over-consumption and misuse of medication has created antimicrobial resistance on every continent.

An increasing worry is that soon common diseases, such as pneumonia and tuberculosis, will become fatal to those that acquire them. With an increased exposure to antimicrobial medicines, these diseases may continue to develop a stronger resistance to medications used now, creating a possibility that they may not work in the future. Resistant strains of bacteria are caused by inappropriate prescription of antibiotics when the patient truly doesn’t need them, or a misuse by the patient, for example stopping the use of the medication before the infection is fully treated. ARMs can cause post operation infections, result in limb loss, or complications in the central nervous system. A report  recently published by the OECD estimates that globally, at least 70,000 people die a year due to these resistant bugs.

Not only are ARMs a health risk, they have now become a financial burden. It takes hospitals more time, resources, and money to treat infected patients. The OECD report estimates that an additional 10,000 to 40,000 USD are spent treating patients infected by an ARM. In addition, global markets are also affected by these resistant microorganisms. In 2015 chicken sales in Norway dropped by 20% after news got out that a resistant strain of E. coli was found in the meat.

The regular use of physical restraints on patients in nursing home facilities without an appropriate medical reason or regard for their dignity and wellbeing is not only a strong indicator of poor quality of care, but also a sign of elder abuse and neglect.  Older adults with dementia in particular are affected by this organizational conduct and are vulnerable to debilitating physical and psychological side effects.  Moreover, it is a violation of their human rights. In the United States, a staggering 38% of senior patients in these types of facilities experience being physically restrained at least once every day.  Although a variety of organizations that strive to reduce or eliminate the use of physical restraints exists, most of their initiatives have not been successful.  However, a longitudinal, multidirectional psychosocial and educational program that was developed to promote patient-centered care for older adults with dementia and reduce the use of physical restraints was implemented in 41 nursing homes with positive results.

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Malnutrition is one of the primary dangers for older adult residents living in long-term care settings.  Defined as the state of not having adequate food and micronutrient intake, malnutrition is common among elderly patients and can damage physical and cognitive functioning.  Nursing home and assisted living facility staff must protect their patients from inadequate micronutrient intake in order to help maintain their quality of life and avoid increasing their risk of morbidity and mortality. Multiple factors at the patient (e.g., dementia), staff (e.g., training, staffing levels during meals), and home (e.g. quality of meals) levels interact and contribute to the increase in risk of poor food intake.  Substantial research has shown that inadequate nutrient density of food is one of the top 10 deficiencies in nursing homes.  These facilities must improve their quality of meals in order to promote food intake and enhance nutritional status and quality of life of their patients. Studies that have focused on micronutrient needs for improving the health and quality of life of residents in long-term care have found that even at the meal planning level, much improvement is needed in regards to nutrient density.

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Innovative care environments are created for older adults with dementia to enhance patient-centered care.  Studies have shown that green care farms, which provide 24-hour nursing care, are an excellent alternative to traditional nursing homes.  These farms allow patients to engage in more physical activities and social interactions than residents in traditional nursing home settings, allowing them to have better quality of life and improved health outcomes.

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Some recent discoveries have shown that there is a need to redefine the National Pressure Ulcer Advisory Panel’s (NPUAP) definition of deep tissue injury.  Although etiological studies of deep tissue injury (DTI) primarily pertained to the characterization of biomechanical factors influencing its onset and progression, new findings suggest that the criteria of DTI should be evaluated and refined.  According to a recent article published by Ostomy Wound Management (OWM), there are several reasons why the current definition is insufficient:
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The prevalent use of forced arbitration agreements by corporations continues to plague our society.  Not only are they used in long-term care facilities like nursing homes, they are also used in big businesses such as banks.  Just last week, Wells Fargo took the heat in hearing rooms of congress and national television alike for scamming thousands of customers with fake accounts.

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After the Wells Fargo scandal earlier this year in which the company admitted that its bankers created millions of fraudulent accounts, Wells Fargo is once again in the public eye for its attempt to stay out of courts by forcing the customers of these fraudulent accounts into closed door arbitration agreements. When existing customers were set up with fake accounts, they were entered into a new contract that required any disputes to be handled through arbitration and out of the court room. This new contract left existing customers dealing with an agreement that they never signed. The unfairness of this situation has left many customers without the legal rights to address the issue of fraudulent accounts in the court room or through a class action. Several Democrats have expressed their concern at the unfairness of these arbitration agreements and have advocated for legislation that provides remedies to those who were forced into these binding contracts without their consent. For example, California state Senator Bill Dodd introduced a bill to “override forced-arbitration clauses in contracts created through fraud”. This type of legislation would allow law suits to be brought against companies committing fraud despite the arbitration agreements in the customer’s contracts.

An editorial by the LA Times also disagrees with Wells Fargo’s ability to force their customers into arbitration for accounts their customers did not create, especially when these arbitration agreements are usually meant to favor the business rather than the consumer. Leaders such as Representative Brad Sherman and Senator Sherrod Brown have proposed similar bills to that of Senator Dodd’s, hoping to bar banks from requiring arbitration agreements in the future. Since these arbitration agreements are an attempt by Wells Fargo to stay out of the court room and settle disputes privately, the Consumer Financial Protection Bureau has proposed to prohibit banks from blocking future class action lawsuits brought on by customers. This will allow class actions to serve as a check on bank’s actions.

Similar to Wells Fargo’s practice of forcing their customers into arbitration agreements before doing business with them, some nursing homes and skilled living facilities also have their incoming patients sign into similar arbitration agreements before being admitted. These types of agreements are unfair to residents of these facilities since they are denied full legal remedies in the event that they are wrongfully treated. If their needs are not taken care of properly or they experience abuse and/or neglect residents with an arbitration agreement often find it difficult to pursue legal measures against the facilities that wronged them. These arbitration agreements create a legal barrier around these facilities, aiding them in avoiding law suits if they commit elder abuse or neglect towards their residents.

Falling is a common occurrence and a serious problem among the elderly population.  A myriad of studies has found that the use of psychotropic drugs on older adult patients in nursing homes significantly increases the risk of falling.  A recent study published by the Journal of the American Medical Directors Association (JAMDA) examined the relationship between fall occurrence and the prescription of psychotropic drugs and various categories of psychotropic drugs, such as antidepressants, antipsychotics, and benzodiazepines, among a representative nursing home population.

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