by Tim Gieseke MD, CMD

Recently, a nurse practitioner I work with sent me information on a tool kit specifically designed for free training modules for nursing personnel in our facilities.  My initial review of the website was favorable.  Several CALTCM members on the State Dementia task force have reviewed it and believe it is may be of value in your efforts to improve the care provided to you dementia patients.  We will be placing a link to this web site on our LTC resource page, since we have not fully vetted the web site, please let us know what you find of particular value.

by Robert M. Gibson, Ph.D., J.D. and Rebecca Ferrini, MD, MPH, CMD

As you know, there are some residents in long term care facilities who lack capacity to speak for themselves and have no friends or families to speak for them. These can be called “unbefriended.” As an alternative to formal conservatorship, California passed a law in the late 1990s called Health and Safety Code (HSC) Section 1418.8 (also known as the Epple Bill) permits the facility interdisciplinary teams, comprised of not only the physician, but also “a registered professional nurse with responsibility for the resident, other appropriate staff in disciplines as determined by the resident's needs, and, where practicable, a patient representative” to provide daily decision-making for these residents under strict conditions. The law eliminates the need to go to court for every decision which is both impractical and fairly pointless, given that the courts nearly always support the opinion of the experts.  Furthermore, it provides safeguards by involving multiple people in decisions and in its documentation requirements.  Many facilities find this a useful alternative to costly, unreimbursed expenses of private e conservators. However, some advocacy groups take issue with this law.

by Rebecca Ferrini, MD, MPH, CMD

What is behavioral activation and how can it apply to skilled nursing homes? In a traditional sense, behavioral activation can be thought of as changing behavior and habits to make improvements in the mood. For depression, you may encourage to take a walk or go to a ceramics class, even though they do not want to, and then gradually find that the activity becomes self-perpetuating and the habit is formed and the individual has a purpose, a routine and a connection to something outside themselves. -In the parlance of modern slang--"just do it" and -"fake it until you make it" both can apply to the concept of behavioral activation. Behavioral activation differs from traditional activity programs, because there is an active approach to get specific people to come, stay and attach to the leader and other participants, who all work together to create something unique and special to that group.

by Dan Osterweil, MD, FACP, CMD

I read with interest and some amusement the recent article in Caring for the Ages by Joanne Kaldy and the accompanied Editor's note from Dr. Steinberg.  Citing the Joint Commission alert on "alarm fatigue" which has wisely recommended steps to curb "alarm fatigue" in the hospital setting, this recommendation was based on data related to alarm-related adverse events, 80 of which resulted in death.  Others resulted in permanent loss of function, and  five led to unexpected additional care or an extended stay in hospital.  The editor's note tries to insert a sobering reality into the discussion which was full of opinions and limited evidence. Dr. Steinberg  struck a conciliatory note by pointing out to the value of various interventions and warning against a "black and white" approach to issues in our nursing homes.