Filtered by category: The CALTCM WAVE 2020 Clear Filter

2019 Novel Coronavirus (COVID-19)

By now, we have all been aware of an outbreak of respiratory illness caused by a novel coronavirus (COVID-19 ) that was initially detected in Wuhan City, Hubei Province, China. Is your facility prepared? Are you up to date on recommendations about staff, visitors and even residents who have recently returned from international travel?

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Are High-Quality Webinars a Part of Your Professional Development, Part 2?

In the last issue of the WAVE, I reported on the potential direct clinical value of an excellent AMDA Webinar on Sleep Disorders in Older Adults. In that Webinar Dr. Kitamura mentioned a number of factors which could aggravate restless leg syndrome (RLS).  One of those, the prescribing of SSRI’s directly applied to one of my older patients with RLS who was requesting Ativan, because her Ropinirole was no longer working.  A month prior, I had started her on Lexapro for depression and had recently advanced the dose to 10 mg daily. 

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Good News for Incapacitated Unrepresented Residents – Final Order Issued

On January 27, 2020, the saga that began in 2013 with a lawsuit against the California Department of Public Health (then captioned CANHR v. Smith) finally concluded, although some details remain to be worked out.  The bottom line is that in skilled nursing facilities, the Epple/IDT process, sometimes referred to as an Ethics Committee or Bioethics Committee (even though the composition of such a committee in nursing homes is rarely as robust as it is for hospital Bioethics Committees), is able to make decisions for incapacitated, unrepresented nursing home residents—including all psychotropics and end-of-life decisions—but a non-facility-affiliated resident representative must be part of the process.  

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Advice from an Emeritus Medical Director

As some of you know, 2019 ended with the closing of my Post-acute & Long-term Care practice.  In the process, I turned over the care of my patients to 3 other physicians and my 2 facility Medical Directorships to 2 of my colleagues.  Having been the Medical Director for over 33 years at my CCRC, I have had some time to reflect on this role, beyond the CMS expectations and AMDA guidelines ((  

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Flu Season: A Brief Update on this Year's Influenza Activity

As a service to CALTCM members, and to encourage our clinicians to actively recommend influenza vaccination to their LTC and community dwelling patients, we are sharing recent information on resurgence of Flu activity in California.
From the California Department of Public Health:
  • Deaths: 54 since Sept. 29, 2019
  • Outbreaks: 16 since Sept. 29, 2019
  • Laboratory: 27.7% positive
  • Outpatient Influenza-Like Illnesses*: Above expected levels
  • Hospitalizations: Above expected levels

For more information from the CDC on this years Flu activity, go to: