Tag: nursing homes

Can Innovation Fix Kidney Failure?

Kidney failure is a serious problem in the United States. Nearly 800,000 Americans were living with end-stage renal disease (ESRD) in 2018. That same year, the total Medicare spending on ESRD patients reached $49 billion. While the industry has tended to focus on the needs of their active, middle-aged dialysis patients, the reality is that 80% of ESRD patients are older than 65. Many of them are nursing home residents. Nursing home residents need tailored dialysis care. It’s time to change the game and innovate to fix kidney failure.

The best treatment for ESRD is a functioning kidney transplant, but only 30% of ESRD patients are able to receive one. The rest undergo regular dialysis. Despite the convenience that in-home dialysis would provide, 86% of dialysis treatment still occurs at outpatient clinics. This arrangement is hard on nursing home residents for several reasons. Outpatient treatment poses an extra infection risk to older, vulnerable patients. Traveling to a dialysis clinic is disruptive, confusing, and time consuming for nursing home residents. Transportation is especially hard for older folks who can no longer drive or whose nursing home does not provide them with transport to a dialysis clinic. Finally, acute residents can struggle to find placement at outpatient clinics due to their extra needs.

Both nursing homes and their residents would benefit from the provision of on-site dialysis. On-site treatment frees up hours of time the resident would have spent traveling to a clinic. Having dialysis on-site also results in better collaboration of care, fewer readmissions to the hospital, and stronger relationships with hospital partners. Nursing homes that provide transportation for their residents can cancel the cost of up to $411 every round trip their residents would have made. Homes with on-site dialysis can also accept higher acuity patients than those which lack the service.

In choosing what type of dialysis to provide innovation for kidney failure for nursing home patients, 3-day dialysis is preferable by far to the daily option. 98% of nursing home dialysis patients are already accustomed to 3-day outpatient dialysis. Switching them to daily treatment requires changes in prescription, leading to confusion and potentially disrupting the continuity of care. Daily dialysis carries greater risk of potentially leading to hospitalization or surgery. This is because the risk of complications like difficulty surrounding the blood-access site, blood clots, and aneurysms are more common in daily dialysis. While 3-day dialysis can occupy 9-12 hours of a patient’s time per week, daily requires a time commitment of anywhere between 10 and 21 hours. Those who opt for 3-day dialysis have more time for other therapies and social activities.

Though the quality of care is first priority, it is understandable that nursing homes must also be wary of the cost of their services. The truth is that 3-day dialysis is more cost effective than daily dialysis as well. For the same initial investment, on-site dialysis provided every 3 days gives treatment to 3 times more patients than daily dialysis does. The same 6 chairs can serve 36 patients in 3 day dialysis compared to 12 patients in daily treatments.

August 3, 2021
How Telemedicine is Changing Nursing Homes

As we are all aware, nursing homes suffered a great deal during the height of the pandemic, and even long after many things were getting back to normal, nursing homes still lacked the staff they needed to fully meet the medical needs of their patients. In fact, 10% of patients who enter a nursing facility for post-acute care never see a physician during their stay. Sadly, this statistic leads to poor medical outcomes and higher re-hospitalization rates.

28% of patients who do not see a physician in the nursing home will be re-hospitalized and 14% will die within 30 days of being admitted. However, if a patient does have access to a physician, those percentages are cut in half.

Telemedicine is Changing Nursing Homes

The best thing that nursing homes can do right now is to employ on-site APRNs and incorporate telemedicine into their daily operations.

According to one study, the presence of an on-site APRN can reduce hospitalizations by 48% and can lower costs by 40%. In fact, if every nursing home in the US employed an APRN, Medicare costs could be cut by nearly 2.8 billion dollars per year.

One of the ways that APRNs benefit patients, staff, and budget is their ability to recognize early signs of infection and help other nursing staff do the same. Acute conditions like pneumonia, urinary tract infections, and severe dehydration can all be treated in the nursing home if problems are detected early enough. Flare-ups of chronic conditions such as congestive heart failure, uncontrolled diabetes, and COPD and asthma are also conditions that don’t require hospitalization with early detection.

Having a combination of on-site APRNs as well as incorporating telemedicine can help put any nursing home facility at the top of their game inpatient care.

The current average wait time for a patient to see a doctor after admission is 3.2 days but increases to 8.1 days for rural facilities. This means that the median stay for patients is just 11 days before they are either re-hospitalized or death occurs. With telemedicine, all this can change. Telemedicine means that each nursing home has access to physicians they need. In large facilities, the nursing staff is augmented to make care available round-the-clock, and rural facilities that cannot employ on-site clinical staff can now have access to the physicians they need.

With APRNs and physicians working together through telemedicine, 83% of medical issues can be treated in the nursing home and hospitalizations due to acute encounters can be reduced by 17%. The most common diagnoses are things such as bleeding, pain, pneumonia, chest pain, seizures, and hypotension. Overall hospital readmissions can also be reduced by up to 70%.

Telemedicine has helped the medical community keep moving forward and treating patients without missing a beat through the whole pandemic. Telemedicine is changing nursing homes for the better. It is vitally important to our most vulnerable population that that same medical advancement be available and embraced by nursing homes across the country.

Via TapestryHealth.com

July 20, 2021
How the Nursing Home Industry Can Recover Through Cleanliness

2020 will be remembered as one of the worst years for the nursing home industry. Of the 500,000+ coronavirus deaths in the United States, over a third came from nursing home residents and staff. In some states, that figure is over half. Hundreds of thousands of nursing home residents and staff have died, affecting millions of friends and family members.

While the elderly and chronically ill are uniquely vulnerable to coronavirus, the actions of nursing homes contributed to the heavy casualties. Many facilities forced healthy residents to share rooms with residents who had tested positive for COVID-19. Experimental treatments were given to residents without their family’s knowledge, including antibiotic cocktails that had no effect on a viral disease. Furthermore, banning family visits to residents proved ineffective as nursing home staff became vectors for disease transmission. Even now there exist nursing home workers who refuse to accept the coronavirus vaccine. Taking all these missteps together, it’s no surprise that 1 in 2 Americans feel more negatively toward nursing homes than they did prior to the pandemic.

From falling occupancy to rising costs, 90% of nursing homes are in financial danger. As of right now, 65% of nursing homes are operating at a loss while 25% more have a margin below 25%. If their problems are not addressed in the near term, many long term care facilities will be forced to close their doors. This is a problem because despite nursing homes being deeply unpopular, they are a needed service for many senior citizens. As the American population ages, their services will be in greater demand than ever before.

Already, 3 in 4 adults have changed how they think about the future. 40% are now more willing to save for long term care while 33.3% have taken action to financially prepare for the eventuality. If nursing homes close today, they won’t be around for when these people need them most.

The Way Forward

Going forward, nursing homes need to disinfect both their facilities and their reputation. Cleanliness has grown to the #3 concern prospective residents have about long term care facilities. The two rankings above are staff attitude and responsiveness. Importantly, Black and Latino families rank cleanliness higher when looking for a nursing home. As more diverse generations age, cleaning will continue to be key.

Fortunately, there are several simple strategies nursing homes can introduce to improve their cleanliness outcomes. Promoting frequent and proper handwashing by staff, visitors, and residents can reduce the infections found on surfaces. One-step multi surface cleaner can erase the infections from surfaces altogether through consistent use.

These strategies are not just safeguards against coronavirus, but a whole host of other infections common in nursing homes, such as lower respiratory tract infections and sepsis Improved surface cleaning and disinfection may be able to reduce healthcare-associated infections by as high a percentage as 85%.

To survive pandemics, the future of nursing homes needs to be a clean one. See the following visual deep dive for more:

February 15, 2021
The Future of Nursing Homes

As the COVID-19 pandemic rages on, senior citizens have borne the brunt of casualties. This is especially true of those living in nursing homes, though the extent varies. As of September 2020, 25% of US coronavirus deaths occurred in nursing homes; however, 4-5 star nursing homes had 94% lower risk than their 1 star peers. When the current pandemic ends, those disparities will remain. As the Baby Boomer generation of America continues to age, nursing homes will house more people than ever in upcoming years.

Despite the upward trajectory of demand, nursing homes remain unpopular among Americans. Only 19% think nursing homes make seniors better off. Seniors have lots to consider, such as life insurance for seniors. Seniors don’t move into nursing homes because they want to, but because they can no longer care for themselves and lack the resources to pursue other alternatives. The average nursing home resident needs 4 hours of personalized nursing care every day due to diseases like Alzheimer’s or arthritis. Care that intensive is hard to achieve elsewhere.

Unfortunately, meeting senior’s medical needs currently comes at the cost of social isolation. Moving away from friends and routines causes depression in 40% of seniors, a statistic tied to worse health outcomes in a bitter feedback loop. Even before COVID-19, 55% said they didn’t see enough of their families, a sad reality that generates a sense of loss and abandonment in nursing home residents.

Nursing homes need to adapt. They must find ways to either increase social outcomes for residents or give seniors the tools they need to live independently. As Rosalie Kane, Ph.D. professor of health policy and management at the University of Minnesota, said, “nursing homes are places to live, in addition to clinical settings… Health care needs might be met at the expense of drastically changing someone’s daily life and routines for the worse. The challenge is to pay attention to quality of life as an outcome in itself, and see how health care may be related to quality of life.”

Advances in medical technology are improving the quality of nursing home care all around. Some innovations can even help seniors regain independence and return home. Current tech includes Solo-Step, a rehabilitation harness that prevents fall-related injuries and lets users move about more freely, and Aiva voice assistant, which gives seniors an easier way to communicate with other residents, family members, and caregivers from a distance. These devices are available now; the longer they’re on the market, the more chances they’ll have to proliferate. Future technologies include The Kidney Project, an artificial kidney that would remove the need for dialysis in recipients. These products give aging people a chance at a brighter future in spite of the current health crisis.

As Elaine Ryan, Vice President of Government Affairs for State Advocacy at AARP, says, “this pandemic has made us painfully aware that we can’t ignore our most vulnerable people. Americans always respond to a crisis. And there is hope that, with innovative ideas and bold action, they will again.”

December 28, 2020
How Is Data Fight The Spread Of COVID-19?

Is data the key to fighting the COVID-19 pandemic? As the old saying goes, to be forewarned is to be forearmed, and knowledge gives us the power to fight back. As this pandemic has been caused by a novel coronavirus that no one has immunity to or has seen before, getting as much information as possible distributed as quickly as possible is key to stopping the spread and ending the pandemic.

Statistical modeling has shown us that our best defense against the pandemic currently is social distancing. With information from the Spanish Flu pandemic a hundred years ago and the real-time information we are gathering from outbreak hotspots, we know that keeping people away from each other is the single most important thing we can do right now to stop the spread of COVID-19.

Cities that implemented social distancing earlier in their outbreaks showed significantly fewer cases per 100,000 residents as the disease progressed, and until there is a vaccine or a cure this is the best measure we can take to save lives.

Unfortunately there are places where people have a difficult time socially distancing themselves from one another, and nursing homes are one of those places. Residents of nursing homes are also at higher risk of complications and death from COVID-19, so preventing the spread in these populations has proven to be a crucial and monumental task.

Temperature checks of both residents and staff have been at the forefront of prevention measures along with closing down facilities to all but necessary staff. But once someone shows a temperature spike it may be too late. We know that people can carry COVID-19 for weeks without symptoms, spreading the illness to others without even knowing they are sick.

Across the world, various healthcare organizations and governments are working together to share and track data about COVID-19 in order to find new information about this virtually unknown disease.

The WHO has partnered with tech giants Facebook, Microsoft, and Twitter in order to find new data and ways of analyzing it. Even detecting the disease a few days earlier could significantly halt the spread because of the extremely virulent nature of the virus.

Tracking vital signs is the best we can do to protect the most vulnerable on top of the already strict social distancing rules, especially in nursing homes. But one company may have found a breakthrough in their data on nursing home dashboards.

Measuring a person’s pulse oxygen twice a day with a pulse oximeter has been shown to show decreases in oxygen levels that could be attributed to COVID-19, and these readings start to appear up to two weeks before a patient would first spike a fever. This method of early detection could help prevent the spread in close quarters high-risk facilities like nursing homes and could also have broader implications in the general population once the economy starts to reopen.

When it comes to halting the spread of COVID-19, the sooner we can find new and reliable information, the better we can fight the spread. Learn more about how data is being used to fight the spread of COVID-19 from the infographic below.

May 7, 2020
Nurse Admits Murdering 11 Elderly Patients

An Australian man this week pleaded guilty to murdering 11 elderly residents of a nursing home where he worked briefly in 2011.

According to an Australian Associated Press report, 37-year-old Roger Dean admitted during his Australian Supreme Court trial to setting a fire that killed 11 residents of the Quakers Hill nursing home in Sydney. Dean started the fire in the early morning hours of November 18, 2011 by lighting an empty bed in the nursing home.

Some of the eleven residents who died were unable to move without assistance. In addition to the murder charges, Dean also pleaded guilty to injuring eight other nursing home residents in the fire.

The AAP report also states that Dean admitted taking prescription drugs from the nursing home. He had apparently been caught on a security camera entering a medication a storage room multiple times. The incident was reported, but police were not able to arrive immediately. Dean started the fire soon after, and then played the part of rescuer by helping some residents escape the flames. During the chaos, Dean managed to steal the facility’s drug logs, which he later destroyed.

May 27, 2013
Senior Prostitution Ring Busted at Nursing Facility

Police in New Jersey have arrested two residents of the Vicente K. Tibbs Senior Citizen Building in Englewood, New Jersey for running a prostitution ring for their fellow residents.

According to a New Jersey Record report, 75-year-old James Parham and 66-year-old Cheryl Chaney were charged for possessing drug paraphernalia and “maintaining a drug nuisance.” Parham allegedly provided residents of the nursing facility with access to crack-addicted prostitutes.

Residents had been complaining to police about the “drunks and addicts” that could be found wandering the facility. Stories from residents recalled non-residents sleeping it off in the lounge, used condoms being found in the recreation room, and late night disturbances that caused residents to lock themselves in their rooms. An undercover police investigation uncovered the wave of crime that had swept the building.

Police have now begun to patrol the entry to the building, turning away vagrants or arresting them for trespassing. The facility is funded by the Englewood Housing Authority, which has stated that it does not have the funds to provide security guards for the building.

May 15, 2013
Medicare Rule Could Increase Hospitalization, Shows Study

A new study shows that a medicare rule that blocks some nursing home residents from receiving simultaneous reimbursement for hospice and skilled nursing facility (SNF, a medicare-certified nursing home) care may be responsible for those residents receiving “more aggressive” treatment or hospitalization.

“This study is the first, to the knowledge of the authors, to attempt to understand how treatments and outcomes vary for nursing home residents with advanced dementia who use Medicare SNF care near the end of life and who do or do not enroll in Medicare hospice,” said researchers, whose study was published in the Journal of the American Geriatrics Society.

According to the study, around half of all nursing home residents with advanced dementia who are also dying have Medicare SNF care in the last 90 days of their life. However, those residents are not allowed under Medicare to receive hospice reimbursement for the same terminal illness. As a result, only 30% of residents with advanced dementia who have SNF care use hospice, compared to 46% of residents without SNF.

Researchers also found that residents who receive hospice care were far less likely to die in a hospital. Residents who received SNF and hospice at the same time were 87% less likely to die in a hospital, while residents who received hospice care after SNF were 98% less likely to die in a hospital.

“Unfortunately, given the high use of Medicare skilled care near the end of life and policy that prevents simultaneous Medicare reimbursement for skilled nursing and hospice care, aggressive treatments that may not be the preference of families or their loved ones are common,” said Susan Miller, lead author of the study and professor of health services policy and practice at Brown University. “What I’ve heard from physicians is that families may be advised about hospice, but when the family learns that by choosing hospice and thus giving up SNF they’d have to pay for the entire nursing home stay, they will choose SNF over hospice. One physician told me a story about a significant other who wanted hospice for their family member. It was cheaper for that person just to quit their job, stay home and care for the person and get hospice rather than to pay for nursing home care because the nursing home cost more than they were making.”

The study looked at the Medicare records of 4,344 SNF residents who had advanced dementia and died in 2006. Of those residents, only 1,086 received hospice care.

The Medicare Hospice Concurrent Care demonstration project mandated by the Affordable Care Act (colloquially known as “Obamacare”) will be investigating the issues raised by the study.

October 31, 2012