|
|
|
Power struggles: Many problems and some solutions related to power wheelchairs in LTC |
|
by Rebecca Ferrini, MD
Power wheelchairs are increasingly being requested and used by long term care facility residents. Residents often enter the facility with a power chair or scooter and hope to continue to use this vehicle while in the facility These chairs offer increased mobility and autonomy, but bring potential problems of fires, accidents, storage, repairs, and elopements, posing risk to the user, the other residents and the facility as a whole. Some facilities choose to prohibit power chairs, but for residents with extremely limited mobility and intact cognition (such as a young quadriplegic) this practice severely impairs quality of life and functional status. Others have implemented mandatory safety checks, individualized driving assessments, patient agreements and other policies to promote safety, One way to manage the chairs is to assure that residents and staff understand that the storage and use of the chair in the facility is a privilege, not a right, and that this privilege will be revoked if there are significant safety risks. Requiring a physician order (obtained only after the mechanical safety check and the driving assessment) is one way to assure safe operation. Driving assessments can be done with observation (skilled therapy or registered nurses can conduct this) and/or with a computerized wheelchair simulation program (e.g. wheels…) and should be repeated periodically and with any adverse wheelchair event. Problems can arise with power wheelchairs—such as use of the chair to leave the facility and purchase contraband for oneself or others, getting “stuck” in the community and needing help getting back, broken chairs, operating chairs too fast for conditions and how to “take away “ a chair from a resident with advancing dementia. Educating staff about their responsibilities to promote safety is important—for instance, staff should not place residents with delirium, sedation or intoxication in the chairs and should assure that those who operate t a motor vehicle while taking sedating medications are monitored and counseled on the risks. The facility can exert “control” over the situation through establishment of rules for operation and storage and enforcing them. We have developed a toolkit to help facilities think about the use of power chairs and better manage the risk associated with these chairs. This tool kit includes:
|
|
Read more...
|
|
|
The “IA-ADAPT: Improving Antipsychotic Appropriateness in Dementia Patients” Clinical Tools and Training Program |
|
by Ryan Carnahan
The Iowa Geriatric Education Center is pleased to announce a new toolkit and training program to improve antipsychotic appropriateness in dementia patients. The site includes clinical decision aids to help providers evaluate and manage problem behaviors and psychosis, available free for downloading, as well as a free continuing education program and resources for patient families. Laminated hard copies and an Android app are also available. The program is supported by the Agency for Healthcare Research and Quality.
|
|
Read more...
|
|
Reasons to Become a CALTCM Member |
|
by Chris Mlot MD, CMD
It’s been so long now, I hardly remember the exact year. 1993 to 1996, I was the Medical Director for FHP’s 99 bed freestanding SNF in Westminster Ca. Truth be told, besides the nursing home in Chicago that I had visited my grandmother in once, prior to 1993, I had never stepped foot into a nursing home let alone an HMO’s skilled nursing facility which was a clever disguise for a 99 bed med-surg floor. I had never treated a decubitus ulcer or dealt with a feeding tube. Sometime prior to 1996, a persistent and remarkable doctor from LA by the name of Wing Mar called me and convinced me that I needed to join the CAMD, the California Association of Medical Directors. He said it was a group of long term care doctors working to improve the care in nursing homes. Long term care, nursing homes, nursing home doctors- my curiosity was peaked.
I was on a steep learning curve as I became immersed in the mysterious and seemingly irrational world of long term care. I didn’t understand exactly how my facility fit into Long Term Care, as we processed about 180 new admissions a month and nobody stayed longer than 100 days. But we were subject to things like Title 22 and Resident Rights and a dreaded annual event called “Survey”. I was suddenly working with nurse practitioners, speech therapists, and a person called The Administrator. So I joined CAMD.
|
|
Read more...
|
|
Dual Eligibles Coordinated Care Demonstration |
|
by Jay Luxenberg, MD
As California moves forward with plans to enroll all dual-eligible (those with both Medicare and MediCal insurance) into managed care, a milestone was reached with the announcement on April 4, 2012 of the first 4 counties that will serve as the pilot for statewide implementation. Of course, since the four counties chosen (Los Angeles, Orange, San Diego and San Mateo counties) house approximately 50% of all California dual eligibles, perhaps the term “pilot” is misleading. Also announced were an additional 6 counties that may be implemented at the same starting date (January 1, 2013) if authorized by legislation - San Bernardino, Riverside, Santa Clara, Contra Costa, Alameda and Sacramento.
|
|
Read more...
|
|
CMS to Hold off on Mandatory Consultant Pharmacist “Independence” |
by Flora Brahmbhatt, Pharm D, CGP
In October 2011, CMS indicated that it was considering mandating the separation of a facility’s consultant pharmacist from its long term care dispensing pharmacy. In April 2012, CMS reached the conclusion that this transition would be disruptive and would not solve the issue of chemical restraints.
Instead, CMS is extending the comment period and encouraging the separation but not insisting on it. CMS has restated the importance of paying “fair market” value for consulting services. Additionally, CMS is encouraging the consultant pharmacist and the facility to reach an integrity agreement to avoid any conflict in interest.
|
|
Read more...
|
|
|
|
|
<< first < Prev 71 72 73 74 75 76 77 78 79 80 Next > last >>
|
|
Page 75 of 80 |
