Disaster Preparedness at our Annual Meeting

by Timothy Gieseke, MD, CMD

Late last year, I wrote an article for the WAVE about my experience as a clinician during the Santa Rosa Apocalypse.  That article caught the attention of a palliative care leader on the East Coast because of her experience with Hurricane Irma as an out of area concerned relative.   We are now preparing a Webinar on this subject for the Coalition for Compassionate Care of California (

Regional disasters are becoming the new norm.  CMS expects us to be prepared for the likely disasters in our communities.  I am so pleased that Jocelyn Montgomery will be presenting on this topic at our annual meeting; she is an expert on this subject and a passionate teacher.

As I have been preparing for my Webinar, I am impressed by how many issues should be addressed in a facility disaster plan.  As a non-expert, this is a preliminary checklist I have developed for the CCCC webinar.

Don’t wait until disaster strikes.  Come to our annual meeting and hear from an expert.

See you there,

Tim Gieseke MD, CMD


Best Practices in Diabetes Management

by Timothy L. Gieseke, MD, CMD

Through my work with the Endocrinology Department in Tirana, Albania, I have developed an interest and expertise in the care of persons with Type 2 Diabetes.  However, this is a rapidly changing field, so I attended the online Webinar from AMDA on 3/7/18 with great interest. Dr. Naushira Pandya is a former President of AMDA and a recognized expert on this subject in the PA/LTC setting.  She was a part of the latest ADA update on diabetes care in our setting, January 2016.

I’ll share a few pearls below, but encourage you or your facility to listen to the power point presentation.  It’s available at: .  It’s free for AMDA members, but $99 for non-members.  Here are some pearls:

1.     Some of the variability we see in finger-stick glucose measurements is likely due to errors administering insulin by syringe or pen, wrong size needles, wrong angle of injection, & failure to rotate site or injecting into lipodystrophy or atrophy sites.  She has 3 slides with detailed recommendations for reducing these errors. For facility training the FIT UK Forum for Injection Technique UK, is quite helpful. It’s available at

New Frontier for Medically Complex Homebound at the Last 2 Years of Life

by Dan Osterweil MD, FACP, CMD

In an announcement on April 9, 2018, Health and Human Services Secretary Alex Azar appointed former Landmark Health CEO Adam Boehler as Director of the Centers for Medicare and Medicaid Innovation and as Deputy Administrator of the Centers for Medicare and Medicaid Services.  CMS Administrator Seema Verma made the announcement to staff by email on Friday, CMS confirmed. Boehler is founder and CEO of Landmark Health, a company that provides home-based medical care. Landmark is a medical provider group specialized in caring for complex, chronic patients. Our doctors and providers drive to patients where they live, bringing care through house calls. This home-based medical care is designed to help patients stay well and stay home. We have a multidisciplinary team and collaborate with our patient’s health plan to care for the whole patient, bringing medical care, behavioral health, palliative care and social support services to patients in the comfort of their own home—wherever and whenever they need it. This may be marking a true new direction in how HHS is viewing innovation in health delivery. Away from brick and mortar delivery systems like nursing homes, and other chronic care facilities and back to the home.

Challenges with Insulin administration: How to avoid an IJ!

by Flora Bessey, PharmD, BCGP

Those of us who have been in long-term care for awhile have seen the evolution in the treatment of diabetes, specifically insulin options. From “regular (short-acting)” to “NPH (intermediate-acting”) to “long-acting” to “analog (rapid and long-acting).” Patients with type 2 (or type 1) diabetes, and their health care providers, now have many options when choosing insulin.

Until recently, in our setting the administration of insulin was accomplished exclusively the “old-fashioned” way: with a vial and syringe. In the non-institutional world, however, patients were able to access an administration platform that is less cumbersome, and easier, for a non-clinician to utilize: insulin pens.
The Problem of Chronic Non-Cancer Pain

by Timothy Gieseke MD, CMD

Since the CDC guidelines for managing pain were published in early of 2016, state medical boards are increasingly scrutinizing physician practices to insure that we are managing acute and chronic pain in a way that minimizes the risk for opioid addiction and drug overdose death.  I have attached the CDC Summary Fact Sheet for these guidelines which unfortunately provides little guidance for the care of chronic non-cancer pain patients who are already on potentially unsafe doses of opioids.  The guidelines discourage a daily MME (morphine mg equivalents) > 50, but many of the patients I receive from the acute hospital for rehab are already on MME > 90- 100, which has an 8 times greater risk of accidental overdose. The CDC has a nice handout for Calculating Total Daily Dose of Opioids for safer opioid prescribing.  The CDC has a free new mobile app for android and apple phones called “CDC Opioid Guideline” which has a calculator within it.

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