My wife and I have just returned from Africa. We had opportunities to get a glimpse at the new rainbow democracy that has emerged after the elections in 1994 following the abolition of the Apartheid regime. It has been to the credit of Nelson Mandela, who negotiated a bloodless transition aimed at preserving the infrastructure of this resource-rich country.

One cannot avoid seeing the social and economic challenges facing this country. Per published statistics, there is a 38% unemployment rate, and only 37% of households have a man in the house. With this as a background, I was honored to visit a poor neighborhood, Hanover Park, in the flatlands outside of Cape Town. I was asked to speak to staff of a long term care complex called Rehoboth Age Exchange.

by Flora Brahmbhatt, Pharm.D., CGP

Treatment of osteoporosis is a neglected subject in long term care. When a physician walks into a facility, no nurses run up to him/her and say “DOCTOR, Mrs. Smith has osteoporosis!” We are all busy taking care of more “emergent” problems (UTI’s, behavior issues, etc.) However, are we missing out on an opportunity to better serve our patients, and our facilities?

In 2011, the American Medical Directors Association (AMDA) took a huge step toward enhancing cultural competence by offering a conference session on a seldom noted topic -- Intimacy and Sexuality in Long Term Care. Participants discussed a variety of relevant issues, including challenges faced by Lesbian, Gay, Bisexual and Transgender (LGBT) elders considering long term care residency.

As the result of that interchange, a series of events began to unfold, culminating in the March 2012 AMDA ratification of a White Paper entitled "The Care of Lesbian, Gay, Bisexual and Transgender Persons in the Long-Term Care Setting".

Last week, while attending a symposium, a guest speaker (a former Director of Nursing/current Nursing Home Administrator) from Delaware, touted the benefits of hypodermoclysis.  Intrigued by her brief mention of this intervention and the prevalence of its use as an intervention for treatment of mild to moderate dehydration, I decided to review the topic and the potential benefits of its use in my facility.

Hypodermoclysis is the subcutaneous infusion of fluids and is frequently used In the treatment of palliative care patients.  Narcotics such as mophine sulfate and hydromophone are commonly administered subcutaneously using a continuous administration device or pump.  Hypodermoclysis offers value to the long term care setting as it can be administered by a Licensed Vocational Nurse (LVN) without special certifications.  An LVN requires additional certification to manage an Intravenous infusion; however, a subcutaneous infusion may be managed by an LVN without IV certification.   Other benefits of subcutaneous therapy include the ease of set up, lack of invasiveness and the patient’s ability to tolerate.