The Centers for Disease Control and Prevention (CDC) is collaborating with the Food and Drug Administration (FDA), multiple state and local health departments, and numerous healthcare facilities to investigate a multi-state outbreak of Burkholderia cepacia infections. These infections have occurred primarily in ventilated patients without cystic fibrosis and those who are being treated in intensive care units.
Preliminary information indicates that a contaminated liquid docusate product might e related to cases in one state. Until more information is available, CDC recommends that facilties not use any liquid docusate products for patients who are critically ill, ventilated, or immunosuppressed. Institutions with non-cystic fibrosis patients in whom there are B. cepacia infections should sequester all liquid docusate products.
Healthcare providers and laboratories should be on alert for B. cepacia cases occurring among non-cystic fibrosis patients and should inform infection prevention staff when these infections occur. Cases should be reported to state or local public health authorities.
CDC will provide an update to this announcement as they know more. Please direct all questions to CDC at firstname.lastname@example.org.
So what does this mean for the frail elder population? They are more susceptible to any infection, since their immune response has declined due to age and health. Infections such as influenza or norvirus (diarrhea) can be spread quickly, especially in residential facilities or day programs. B. cepacia (formerly known as Pseudomonas cepacia) is a gram-negative rod that commonly colonizes the lungs of patients with cystic fibrosis and is frequently multi-drug resistant. The challenge is getting a sputum sample to determine the bacterial etiology of the pneumonia. Frail elders have problems producing a sample.
Geriatrician, Dr. Elizabeth Landsverk states, "I think for the frail elder population, particularly those elders with dementia, all liquid ducosate - (Colace) - should be discontinued and replaced."
Elizabeth Landsverk, M.D. Geriatrician posted this article today on LinkedIn
CDC Alert issued on June 27, 2016
The role of a professional care manager evolves rather rapidly. I know.... I've done both Care Management and Case Management for the past eleven years. Although health reform ensures that care delivered is efficient, effective, and high quality, the role and function of both the professional care manager and case manager has never been more important.
According to LoNigro, senior vice president and chief clinical officer at Envolve People Care, part of the Centene Corporation where I worked as a Case Manager, one recent study found that only about 5% of adults who misused prescription Opioids in the past year, and only 17% of those with addiction ever receive treatment.
Case Managers are consummate team players, working with everyone from patients to their support systems, from physicians to nurses, social workers and pharmacists, to administrators, all on behalf of patients to ensure patient-centered care. Taking on this roll in a hospital setting can be challenging but it is always done. What is emerging is a collaborative model of patient-centered, accountable care, working toward creating a system that offers better care, better health and perhaps lower costs.
Team-based chronic care management on the other hand, offers models of interdisciplinary team-based care. If the moral measure of a society is the treatment of its most vulnerable, designed to enhance care for the chronically ill, this model has the potential to substantially enhance our moral standing. Care coordination is an essential activity to achieve the goals of better individual health, better population health and reduced health care costs. Both Care Management and Case Management strengthen healthcare's weakest link: Improving care transition. Guiding elderly patients to the care they need, when they need it, lies at the heart of their care which improves performance.
Posted on July 14, 2016, by Olga Brunner
Although I have attempted to enter so many other professions nothing else motivates and fulfills like knowing my elder care client, and working both with their healthcare professionals, the client's caregivers, and with the client's family members.
Tags: Case Managers Tackle the Opioid Epidemic, Hospital Care Management, Community Care Managers end of life conversations, Care Coordination for Seniors.
Your Comments Please?
This article recently appeared in Aging Today, a publication of American Society on Aging written By Eric Carlson and Fay GordonIn late 2015. A ProPublica investigation reported 37 incidents of long-term-care employees (employed by nursing homes and assisted living centers) sharing photos or videos of residents on social media, without the resident’s consent. In two-thirds of the incidents, the resident was unclothed, sitting on the toilet and-or being mocked by facility employees. In response to the report, three U.S. Senators have asked for increased federal oversight of privacy violations in long-term-care facilities.
The most troubling incidents share a perverse pattern: the employee takes an explicit photo of a resident, nude or in a private situation, and posts it to Facebook or Snapchat. The resident often has dementia or a comparable cognitive limitation, and is effectively unaware of the violation. As ProPublica points out, the residents’ lack of awareness allows the violations to happen in the first place, and likely leads such violations to be underreported.
Nursing Facility Law Updates in the Offing
Federal nursing facility law does not directly address social media—not surprising, considering the bulk of the regulations were finalized in the 1990s. Long-standing regulations require a nursing facility to support residents’ dignity and respect. A broad revision of these regulations is due to be issued later this year. Last year, in releasing a draft of those regulations, the federal government noted the potential misuse of cameras and social media, and explained that privacy violations through social media would be addressed by regulations proscribing abuse, sexual abuse, neglect and exploitation. Under language proposed in a draft regulation, a facility would be required to develop and implement policies that prohibit and prevent abuse, neglect and mistreatment of residents. By contrast, federal law in general does not address quality of care in assisted living. State law sets assisted living rules, so these rules vary considerably from state to state. That being said, most assisted living rules include provisions relating to dignity and respect, and the incidents reported by ProPublica likely would be recognized as improper under any and all state assisted living laws.
Smart Phones a Double-Edged Sword
From a management point of view, one option to combat social media violations is to forbid an employee from carrying any photography-enabled electronic device into a resident’s room. ProPublica published short descriptions of each incident, and several descriptions included the facility’s claim that the employee had violated such policies. Admittedly, having immediate access to a personal phone and camera is taken as a given in 2016, but that expectation can be reversed for facility employees who assist residents with dressing and bathing. Many hospitals have such policies in this area, although the policies have had to balance the risk of privacy violations against the benefit of cell phones used to share information with specialists and other authorized persons. Another choice for facilities is to train employees on resident privacy and dignity. Following the incidents in question, several of the facilities identified by ProPublica provided staff with training on social media, confidentiality and privacy. You might think that any employee already would understand the inappropriateness of photographing an unclothed resident, but this may not be true across the board, given the willingness of some people to take and distribute inappropriate pictures of themselves and their friends.
Also, employees should be informed that taking and distributing any picture without the resident’s consent is a privacy violation, whether or not the resident is in a compromising position. Finally, the training could discuss the penalties (potentially including termination) for taking and distributing an inappropriate picture of a resident, for those employees who might understand the rules but be inclined to violate them.
Thanks to Eric Carlson, a directing attorney and Fay Gordon, a staff attorney at Justice in Aging, a national organization with offices in Washington, D.C., Los Angeles, and Oakland.
Posted on July 13, 2016, by Olga Brunner
This is just so wrong on so many levels that I cannot understand how anyone could possibly do this to a senior who is in a facility and dependent on staff. What is this world possibly coming to when facility staff will stoop so low? I'm afraid this is just the tip of the iceberg........Your Comments Please?
Tags: Aging today; caregiving; technology; policy and advocacy; legal and ethical issues; education.
This article appeared on LinkedIn, published June 27, 2016 by Carole Larkin, Certified Dementia Consultant who is a personal friend as well as a Certified Care Manager. This was posted with her permission.
This is insider information taken from the leading academic journal in the United States called “Generations”. It is produced by the foremost academic and professional organization in America, The American Society on Aging. All content in their journal is researched and documented by the highest credentialed researchers in Aging topics. For more information on “Generations” and the American Society on Aging go to: www.generationsjournal.org and www.asaging.org. All information in quotation marks is directly from the Spring 2016 issue of Generations. (Volume 40 number 1)
Question: How many doctors specialize in diseases of the aging (and therefore know something about dementia)?
Answer: “There have been only 7,000 actively certified geriatricians for more than 10 years.” That’s for 46 million Americans over the age of 65 (as of 2015), never mind older adults with dementia. Geriatricians are doctors specifically trained in diseases in older adults. Not many- huh? Only “about 300 new geriatricians” are trained in medical schools each year. Not many- huh? Worse, “more than 40% “of fellowships for training geriatricians went unfilled for the last 3 years. And some current geriatricians are letting their certifications lapse.
Question: What does that mean? How does that affect me?
Answer: These are the specialists, along with neurologists, for elders with dementia (most people with dementia are elderly). Clearly there are not enough experts for the number of people who need their expertise. And there are less in the pipeline coming up, rather than more. Why? Geriatricians pay is lower than most other doctors, and loans to go to medical school can be well over $100,000! And of course the anti-aging bias we have here in America. Look at old wrinkled bodies? Ugh- I don’t think so! So, what are you left with? Your regular family doctor, of course, or the local clinic, or the emergency room. In other words, the general healthcare system.
Question: How much training do general healthcare system doctors get in older adult issues including dementia?
Answer: “Less than 3% of medical students choose geriatric electives, meaning most medical professionals will enter the field without any exposure to serving elders.” Also there is currently a “lack of faculty, lack of funding, lack of time in [an] already busy curricula (courses that have to be taken) and the lack of recognition of the importance of geriatric training.” In the past, in most medical schools there weren’t even courses in geriatrics at all, so if your doctor had been practicing for a while, chances are huge that they have no training in geriatrics (or dementia). And currently, there is no requirement to have any training in geriatric conditions to keep up their medical doctor certification, except in California, and that is limited to doctors who have over 25% of their patients are elderly.
Question: What does that mean? How does that affect me?
Answer: Chances are high that your family doctor and the doctors in the hospitals don’t have the knowledge that you think they do in relation to your elderly family member (especially one with a dementia). That means that you have to ask them how much actual training they have had over the years to know if you have to question their knowledge/advice for your loved one. Taking their knowledge/advice for gospel could be detrimental to your loved one’s health, if in fact they don’t know the intricacies of good care of elderly people. It can lead to medical mistakes, as they are now known. Things like misdiagnosis’s, non-diagnosis’s, the wrong medications prescribed, medications that react badly with the other medications given, too much medication, not enough medications, surgery advised when not needed, and no surgery prescribed when some is needed. The list of errors can go on and on.
Question: If my doctor doesn’t have the training what can I do?
Answer: Ask them to include a course in geriatric medicine for their next certification for their medical license.
Question: What about other health care personnel who deal with my loved one?
Answer: OK, let’s go through some professions.
As you can see, there is a severe shortage of all types of healthcare professionals trained in providing all types of healthcare to older adults, not to mention the subset of them with a dementia. You could call it a crisis, if you wish. And as more and more people enter the age group of elderly every day, it is reasonable to assume that it is going to get a lot worse before it gets better.
Question: What can I do to try and make things better?
Answer: Get loud and demand action of the right people. Who are the right people? Believe it or not, its Politicians! Generations says (and I agree), that there is “no political will” to do anything to address this crisis. Heck, the crisis isn’t even on anybody’s radar, no matter what political party you are talking about. Yes, you may hear about the Affordable Care Act, but guess what? The Affordable Care Act doesn’t even address the issue of next to no knowledge how to properly care for the elderly or how to get professionals interested in caring for the elderly, or in training others to care for the elderly.
It seems as long as our citizens allow the politicians to define the problem as an “individual family” problem, and not a reason to come up with any answers for the problem, then no headway can be made in getting the resources it would take to increase knowledgeable health care for the elderly. It’s got to become the politician’s problem too. How to do that? What about starting with a phone call, a text or an email to your local state and federal congressman and senator? Or maybe to your preferred political party candidate? It could be as simple as, “What will you do to address the lack of knowledgeable health care out there for our elderly? I want to know, and I vote.”
Below is a photo of the author, Carole Larkin. What do you think about the status of appropriate elder care by our health care system? Feel free to comment. Carole and myself have both taken care of a parent with dementia and really care about this issue. Thank you Carole for your contribution.
I've been to the moon. I' ve been burned. But more often I'm honored. I'm your American flag. With 13 stars for colonies clamoring for freedom, I was first flown at Fort Stanwix in New York in 1777 - and then carried into battle for the first time at Brandywine in Pennsylvania. By war's end, I was saluted as the emblem of a sovereign nation, new and free. I'm your American flag.
But challenges lay ahead. With 15 stars and 15 stripes, I survived shock and shell at Fort McHenry in Baltimore in 1814. With the aid of rockets' red glare and bombs bursting in air, I was spied from afar at dawn's early light by a patriot poet. I was then celebrated in sight and song by a fledgling nation. I'm your American flag.
A half-century later and with 33 stars and 13 stripes, I was saddened to see our nation divided. Our brothers' blood was spilled in battle north and south. But by war's end, President Lincoln's iconic words at Gettysburg prevailed - a unique nation conceived in liberty and dedicated to the proposition that all men are created equal. But that pledge was yet to be fulfilled.
I survived mustard gas and ghastly death in European trenches in WWI; I was carried into battle over frozen turf in Korea; I lost sons and daughters in the rice paddies and hell's jungles of Vietnam; I witnessed renewed conflict about taking me to faraway lands like Iraq and Afghanistan.
Often I'm inconspicuous, standing silently in the corner of a meeting hall or classroom but indeed I've fallen from favor for some incensed by actions our government takes. But I suffer in silence when abused or defiled for I represent all of our rights, including protesting and speaking our minds.
Most of all I represent the American spirit, our yearning for freedom, excellence and opportunity, I am not the flag of a ruling regime or royal family. I am the American flag, representing rights emanating from a higher and transcendent authority honored on our coinage.
Look up to me when you salute or stand at attention. Pledge yourself to fulfill lofty goals symbolized by my heavenly sky-blue field for 50 stars. Look up and salute with pride what the patriot poet hailed as a worthy star-spangled banner. May it forever wave over the land of the free and the home of the brave.
Above was Written by James F. Burns, Gainesville, Florida. Editor's note: James F. Buns is a retired professor from the University of Florida......Posted on: July 4, 2016
May you all have a very special 4th of July Holiday!
I Have worn many hats in my day: Nursing Home Assistant Admin and Activities Director, Assisted Living Admin, Case Management for the State-wide Medicaid Program, and Trainer for Dept of Elder Affairs.