As an internist with a long standing interest in Gerontology, I have seen the necessity for SNF, Custodial Care, RCFE, and Home Care. However, most of my patients have not seriously considered the possibility that they might become dependent. Neither have they prepared for its potential financial impact.

SCAN Health recently conducted a focus group survey in which they asked "Baby Boomers" about their parents' health in the last years of life. They acknowledged that most of their parents had a prolonged period of declining health and function that required a great deal of support from the family. However, when these "Boomers" were asked how they thought their last years would go, most thought they would be healthy and functional up until a very short time prior to their death.

Jay S. Luxenberg, MD

I don't usually write book reviews for the Wave, but this book sent to me by the author, a friend, surprised me so much by how it changed my thinking about an under-addressed aspect of long-term care that I want to share it with our readers. It is called "Poor oral health, a potential new geriatric giant" and it is subtitled "Significant oral health (care) issues in frail older people." It was a result of the PhD thesis work of its author, Gert-Jan van der Putten, an Elderly Care Physician (what we would call a geriatrician) and researcher at Radboud University Nijmegen Medical Centre in the Netherlands. Gert-Jan's book reports many studies that he has done in care homes and nursing homes in the Netherlands, looking at the provision of oral health care and the correlates of poor oral health. In particular, he looks at screening tools for xerostomia and hyposalivation. He reports on how frequently nursing home residents are on medications that diminish salivation. He found lower rates of resting, chewing stimulated and acid stimulated saliva secretion in women in nursing homes compared to men, and found that polypharmacy correlated with a very acidic saliva production.

Dan Osterweil, MD, CMD, FACP | CALTCM President

Dear CALTCM members and friends,
It is hard to believe that another year has almost passed. Long Term Care however is an ever changing and dynamic field. We at CALTCM feel that the future may be challenging however we believe that with a collaborative effort between providers, government and the community we can overcome the hardships and deliver better service and outcomes.

In early October, CMS released a set of proposed new rules governing Medicare Part D-related issues, including relationships among pharmacies, pharmacists and other entities.  There is a 60-day period for open comments and concerns to be submitted before a final rule is promulgated.   You can read and comment on the full text of the proposed rule here.