by Tim Gieseke MD, CMD

In the August 1st edition of the WAVE, I wrote an article about “Developing Meaningful Objective Metrics” to help facilities narrow their network of post-acute nursing facilities {providers) assuming that the quality of the facilities’ performance would be the key issue.  In my area, I was aware that Kaiser had a preferred provider network, but was not aware that the 2 other local hospital systems had developed their own networks. I found out about one network from one of the preferred facilities’ intake coordinators (a point of their pride) and I just found out this week about the other hospital system having set up their network.  Both hospitals had done so without any public knowledge that it had occurred. Surprisingly, a facility that varies between 4 and 5 stars where I’m Medical Director, was not even contacted to be a part of any of these networks, and they are the only facility in that part of our county.

by Dan Osterweil, MD, FACP, CMD

The phenomenon of prescribing rehab services to some nursing home residents towards the end of their life was highlighted in a paper published in JAMDA and got wide citations in the New York Times and other publications. It was a courageous stance to shine a spotlight on the fact that between 2012-2016 NH’s in the State of New York were observed to provide rehab services in greater quantity to nursing home residents in their last month of life. While this data comes from one state, they resonated with data from CMS indicating a steep increase in the number of nursing home residents receiving high intensity of rehab services (at least 325 min/week) in the last month of life. This was almost a two-fold increase in this phenomenon in for-profit facilities compared to non-profit facilities.  While the authors and commentators focus on the economics and appropriateness of this phenomenon, it also indicates to a flaw in the way CMS pays for services in the nursing home. While some of the services seem excessive and inappropriate, they may point to need to find a way to be able to care for these patients who have functional and medical problems in post-acute care. The current reimbursement scheme does not recognize non-curative or non-rehabilitative services as eligible for SNF coverage, thus putting a huge burden on families who care for those complex patients who may be nearing the end of life and are not good rehabilitation candidates.

by Timothy Gieseke, MD, CMD

On the California State Dementia Partnership call in October 2018, I learned that CMS announced the release of the Updated Hand in Hand Tool Kit for Dementia Care.  The tool kit is available free to your facility, it is available for individual study or group teaching, on the following site: Click here to access tool kit.

In addition, the Music and Memory study, sponsored by CAHF in collaboration with UC Davis Betty Irene Moore School of Nursing (faculty Debra Bakerjian, Past CALTCM President),  shared preliminary results which document significant benefits, some of which were unexpected. Publication in medical journals is expected in early 2019. At our Northern California meeting taking place on Saturday, November 3rd, Dr. Bakerjian will present in greater detail, emphasizing the lessons learned in the Music and Memory project.

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.”