by Mira Cantrell, MD

First of all, I would like to thank all two hundred CALTCM members who took time out of their busy schedules to attend the 38th Annual CALTCM conference held May 11 and 12 at the Omni Hotel in Los Angeles. I greatly appreciate your attendance, interest, active participation and your feedback that made the conference a success and will help us plan our future conferences. It also gives me a great pleasure to thank all members of the CALTCM Education Committee and our administrative staff for their hard work, enthusiasm and resourcefulness in organizing and executing this year’s conference.

By all accounts, the conference was very successful. The attendees appreciated the presentation of the most up-to-date topics, the format and the pace of the conference, and, most importantly, they told us that the topics had great relevance for their daily practice.  The poster session was received with great interest as well and it was a wonderful forum for the exchange of thoughts and ideas.

by Rebecca Ferrini, MD

Power wheelchairs are increasingly being requested and used by long term care facility residents. Residents often enter the facility with a power chair or scooter and hope to continue to use this vehicle while in the facility These chairs offer increased mobility and autonomy, but bring potential problems of fires, accidents, storage, repairs, and elopements, posing risk to the user, the other residents and the facility as a whole. Some facilities choose to prohibit power chairs, but for residents with extremely limited mobility and intact cognition (such as a young quadriplegic) this practice severely impairs quality of life and functional status. Others have implemented mandatory safety checks, individualized driving assessments, patient agreements and other policies to promote safety, One way to manage the chairs is to assure that residents and staff understand that the storage and use of the chair in the facility is a privilege, not a right, and that this privilege will be revoked if there are significant safety risks. Requiring a physician order (obtained only after the mechanical safety check and the driving assessment) is one way to assure safe operation. Driving assessments can be done with observation (skilled therapy or registered nurses can conduct this) and/or with a computerized wheelchair simulation program (e.g. wheels…) and should be repeated periodically and with any adverse wheelchair event. Problems can arise with power wheelchairs—such as use of the chair to leave the facility and purchase contraband for oneself or others, getting “stuck” in the community and needing help getting back, broken chairs, operating chairs too fast for conditions and how to “take away “ a chair from a resident with advancing dementia. Educating staff about their responsibilities to promote safety is important—for instance, staff should not place residents with delirium, sedation or intoxication in the chairs and should assure that those who operate t a motor vehicle while taking sedating medications are monitored and counseled on the risks. The facility can exert “control” over the situation through establishment of rules for operation and storage and enforcing them. We have developed a toolkit to help facilities think about the use of power chairs and better manage the risk associated with these chairs. This tool kit includes:

by Ryan Carnahan

The Iowa Geriatric Education Center is pleased to announce a new toolkit and training program to improve antipsychotic appropriateness in dementia patients.  The site includes clinical decision aids to help providers evaluate and manage problem behaviors and psychosis, available free for downloading, as well as a free continuing education program and resources for patient families.  Laminated hard copies and an Android app are also available.  The program is supported by the Agency for Healthcare Research and Quality.

by Chris Mlot MD, CMD

It’s been so long now, I hardly remember the exact year. 1993 to 1996, I was the Medical Director for FHP’s 99 bed freestanding SNF in Westminster Ca. Truth be told, besides the nursing home in Chicago that I had visited my grandmother in once, prior to 1993, I had never stepped foot into a nursing home let alone an HMO’s skilled nursing facility which was a clever disguise for a 99 bed med-surg floor. I had never treated a decubitus ulcer or dealt with a feeding tube. Sometime prior to 1996, a persistent and remarkable doctor from LA by the name of Wing Mar called me and convinced me that I needed to join the CAMD, the California Association of Medical Directors. He said it was a group of long term care doctors working to improve the care in nursing homes. Long term care, nursing homes, nursing home doctors- my curiosity was peaked.

I was on a steep learning curve as I became immersed in the mysterious and seemingly irrational world of long term care. I didn’t understand exactly how my facility fit into Long Term Care, as we processed about 180 new admissions a month and nobody stayed longer than 100 days. But we were subject to things like Title 22 and Resident Rights and a dreaded annual event called “Survey”. I was suddenly working with nurse practitioners, speech therapists, and a person called The Administrator. So I joined CAMD.