Articles Posted in Quality of Care

Japan is a country that has been known for its longevity and low ageing rate of 25% (compared to other countries), which has spurred a vast amount of age-related research pertaining to the Japanese population. Much of this research has placed significant attention of sarcopenia, along with the accompanying decrease in muscle strength and motor function, as these factors can lead to weakness and increase the need for nursing care for older adults. Past studies have shown that a systemic decrease in muscle mass is a marker for low nutritional status and less frequent physical activity. Moreover, associations between swallowing function and systemic disease, oral function, and nutritional status among the elderly who need nursing care have also been disclosed. However, not many studies have examined the connection between swallowing function and the systemic decreases in muscle mass.

Past studies have shown various risk factors for dysphagia among elderly people who need nursing care. For example, if a systemic decrease in muscle mass lowers one’s swallowing ability, their nutritional status could also decrease, leading to a vicious cycle. However, muscle mass can be enhanced by improving nutritional status and physical activity, and it may be an important guideline for examining swallowing rehabilitation in instances of dysphagia that are caused by aging. Thus, a recent study used skeletal muscle mass (as examined using the Skeletal Muscle Index [SMI]) as a marker of nutritional status and physical activity, and aimed to clarify the association between SMI and dysphagia in these patients. Continue Reading

Nursing home patients who receive what is deemed as “ultra high” therapy—at least 720 minutes per week—generate many nursing homes’ largest payments from Medicare. According to a Wall Street Journal analysis of billing records, Medicare’s ultrahigh rate was estimated to be about $560 per day in 2013. The estimate was $445 per day for “very high” therapy of 500 to 719 minutes and $325 for what was deemed the “low” category, 45 to 149 minutes.

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Older adult patients residing in nursing homes are often vulnerable and have limited life expectancy. As a result, critical thinking of desirability of future medical interventions is crucial. Advanced care planning (ACP) is often encouraged as a way to make decisions about future medical care. ACP calls for the continuous process of the patient and care provider making joint decisions about future medical care, in the event the patient is not able to consent to or refuses to receive treatment or other care. Several studies have shown ACP to have beneficial effects on end-of-life care, with a decrease in hospitalizations, enhanced patient and family satisfactions, greater concordance between patient’s past preferences and treatments received, and a decrease in distress of kin. The primary goal of ACP is to adapt medical care to the preferences and life goals of the patient.

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Approximately 20% of hospitalized patients are discharged to a skilled nursing facility for post hospitalization sub-acute care. The prevalence of frailty, unresolved acute health problems, a history of chronic illness, and various functional and psychological needs among these patients is high. The complexity of post-acute care needs has not matched the development of innovative and effective skilled nursing facility care models. Furthermore, no standardized systems of care have been implemented and care delivery at a given skilled nursing facility may vary significantly from that of others. Thus, it is no surprise that many skilled nursing facilities fail to go by evidence-based guidelines for medical management for various illnesses and health outcomes.

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Aging causes individuals to become more vulnerable to chronic diseases and functional disabilities, which in turn diminishes quality of life and incurs more healthcare costs. Thus, improving the health of older adults is a critical concern in healthcare. As the older population rapidly increases, so does the need for long-term care. Compared with elderly people in nursing homes, those in assisted living facilities have greater health potential. However, the care needs of older adults will need to be modified as their health and functional levels change.

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A nursing home in St. Paul, Minnesota is giving its residents something to smile about every day—an employee’s teacup poodle. Nala, who has become the nursing home’s perky mascot, lovingly interacts with the residents on a daily basis, riding the nursing home’s elevator and leaping onto wheelchairs and beds to greet patients. Although Nala is not formally trained as a therapy dog, she has never failed to bring joy and comfort to the older adult residents at the Lyngblomsten care home.

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It is well known that physical frailty is highly prevalent among older adults. A recent study has shown that people with early frailty and decrease in muscle mass can enhance both muscle mass and chair-stand time over a duration of 13 weeks. Improvements in handgrip strength and gait speed were also shown. These findings support the research reports that nutritional support, either by itself, or in combination with exercise, can greatly influence the improvement of muscle function in frail older adults.

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The prevalence of older adults with dementia disorders is rising and presents significant difficulties to care providers and policy makers aiming to ensure cost-effective, high quality care for those that are aging. Assisted living facilities (ALFs) are increasingly admitting older adults with dementia, and who often have significant comorbidity. Currently, between 40% and 60% of residents in ALFs across the United States have been diagnosed with dementia. The rapid growth of ALFs over the past few years reflects the more affordable cost of this residential option compared to long-term (i.e. nursing home) care (LTC), as well as individual preferences for more comfortable, home-like environments.

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Far too many nursing homes fail to keep their promise to provide quality care for their residents. With 300 Golden Living Centers nationwide, Golden Gate National Senior Care LLC is one such nursing home company that has failed to provide basic services to their vulnerable, older adult residents. Last Wednesday, authorities in Pennsylvania filed a legal action against the company, saying that Golden Living Center residents were left in soiled diapers for unacceptably long periods of time, were at high risk for bedsores, and were not bathed routinely. Residents were also not escorted to meals as required, often missing meals entirely, and staff have been proven to falsify records.

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The number of frail, older adults who require care in residential aged care facilities (RACFs) is growing. Cognitive and functional impairment, as well as significant medical comorbidity, is common among this population and are, thus, vulnerable to sharp declines in health.

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