Person-Centered Behavioral Approaches to the Management of BPSD

by Timothy Gieseke MD, CMD

In JAMDA, the Journal of Post-Acute and Long-Term Care (formerly the Journal of the American Medical Directors Association), I recently read an interesting article with Dr. Barbara Resnick as the lead investigator on the value of a checklist for auditing facility care plans for persons with dementia.  To quote this article, “Behavioral and Psychiatric Symptoms of Dementia (BPSD) occur in about 90% of persons with dementia over the course of their dementia. Close to 20% of residents  with dementia living in long-term care facilities have behaviors that interfere with daily living. BPSD contributes to poor quality of life, more rapid cognitive and functional decline, and puts residents at risk for inappropriate use of antipsychotics as well as other psychotropic medications (antidepressants, anxiolytics, and sedative/hypnotics). The use of psychotropic medications among individuals with dementia has been associated with more rapid physical and cognitive decline than would otherwise be anticipated and use of these drugs has led to little or no improvement in BPSD.”

MDS Section N Drug Regimen Review: What You Need to Know!

by Flora Bessey, PharmD, BCGP

The “Improving Medicare Post-Acute Care Transformation (IMPACT) Act” of 2014 is a law that, among many other things, hoped to address issues of rehospitalization. As of October 1st of this year, the MDS has a section addressing drug regimen review, “Section N,” that will be enforced. Are our facilities prepared? In a word, no.

Some background:  Per the Pharmacy Practice Act, the act of dispensing is the pharmacist’s validation that, based on all available information, the meds being dispensed are safe for the patient to take.  The pharmacist provides no written documentation of the review that takes place in order to safely dispense medications. The act of dispensing is the proof. In a perfect world, a dispensing pharmacist should be the one to do a comprehensive drug regimen review prior to dispensing any medication. In our world, it is rare that these pharmacists have all of the requisite information required. This situation is better when the patient/resident has an EMR, but often it is still incomplete.

CURES 2.0: Part 2

by Bruce Silver, MD

Since the last article about CURES 2.0, numerous questions have arisen, particularly as to what is a “facility.” Therefore, I will try to answer that question first.

The CURES 2.0 Program in California is mandatory beginning October 2, 2018.  The following are some of the regulations and policies that must be followed.  

Exceptions in Situations:  There are numerous exceptions to these rules including patients within the facility and certain exceptions for emergency room physicians.  A facility is defined per California regulations and appears to include most hospitals and nursing homes. A recent conference with the California Board noted that as far as nursing homes go, that while most of these may qualify as facilities, one needs to check the specifics of the nursing home.  Please check with the California Board to ascertain if the facility in which you are working is exempted.

Innovations in Care Transitions and Dementia Care

by Heather D’Adamo, MD

CALTCM continues to partner with you and your team to bring up-to-date strategies for addressing common and challenging problems in Post-Acute and Long-Term Care.

This year, we are pleased to collaborate with the Northern CA Gerontological Advanced Practice Nurses Association (NorCal GAPNA) to bring you a series of “best practices” that are designed to help you achieve better survey readiness by improving the quality of dementia care of older adults in your nursing home as well as strategizing patient-centered discharge planning and readmission reduction.

Reducing Unnecessary Hospitalizations of NH Residents

by Timothy Gieseke, MD, CMD

One of the blessings of being a Senior Clinician and long standing Medical Director of SNFs has been the luxury of having more time for exploring resources that may improve care in my facilities while spending less time on the direct patient care.  As a member of AMDA, The Society for Post-Acute and Long Term Care, I look forward to the free monthly webinars (  In August, the webinar was a very practical one on the Utilization of Civil Monetary Penalties to improve the quality of life of residents in LTC facilities.  In California, we have experienced the use of these funds through the Partnership to Improve Dementia Care in California and the Music and Memory Implementation program (attend CALTCM Fall CME program for the latest on this innovation).

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