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.
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.
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.
An increase in the health of the elderly population has produced a spike in the number of elderly that undergo surgery at an older age. Elderly who are candidates for major surgery often run great risks that are increased when partnered with frailty. Frailty in s can increase the risk of complications during medical procedures and surgery, or with the prescription of medications. Yet, within the surgery population, frailty is believed to be seriously under recognized, leading to a lack of proper preparation of these patients. Diagnosing an elderly patient with frailty early on can seriously reduce the risk of unforeseen complications post medical procedures.
Older adults living in assisted living facilities often require assistance with medication management. A recent study analyzed the roles in assisted living medication management and satisfaction with unlicensed assisted personnel (UAP) as medication aides, a commonly used approach to decrease staffing expenses. The results of the study detail medication management roles, empirical confirmation of existing assisted living nursing profession standards, and satisfaction with the role of UAP as medication aide from all perspectives. A few clinical implications from the study were creating a supportive environment for medication aides (i.e., UAPs), the significance of the role of the Registered Nurse as a facilitator of assisted living medication management, and the necessity for collaboration and interprofessional team development across various settings.
The aging population in Japan is the fastest growing in the world—by 2035, one out of every three people will be over the age of 65. With such a rapidly increasing aging population, combating age-related health issues, like physical and mental frailty or illness, is becoming critical. It is crucial that older adults maintain as much functional independence as long as possible. Thus, it is important that long-term care facilities, such as assisted living communities, be able to identify incident disability risk factors for their residents.
The use of hospice care has been on a continuous rise for the past 10 years, with 1.5 to 1.6 million people using hospice every year. The majority of this use is by older adults. Although most people in hospice are provided care at home (66%), a significant minority (7%) reside in care facilities such as assisted living settings. Furthermore, by 2015, 27 million people will be 65 years of age and older, and many of them will be residents of assisted living facilities.