Another FYI:

CLEVELAND — The Ohio Department of Health has ordered hospitals and long-term care centers statewide to begin reporting cases of a deadly bacterial illness in weekly reports to their local health departments.

Clostridium difficile, also known as C-diff, is a bacterium that resides in the colon and can cause diarrhea and colitis. U.S. public health officials warned this month that a more virulent strain has grown resistant to antibiotics. The germ was blamed last year for 100 deaths over 18 months at a hospital in Quebec, Canada.

The facilities will be required to submit weekly reports from Jan. 1 to June 30. The reports will be forwarded to the state.

The bacterium has caused 21 deaths in the Cleveland area, most in 2005, The Plain Dealer reported earlier this month. The newspaper reported that state health officials have been reluctant to require reporting on the spread of C-diff, despite urging from federal authorities.

More about the recent CDC rules for infection control.

U.S. health officials are preparing new hospital infection control guidelines to slow the growing spread of bacteria that has become resistant to antibiotics.

The Centers for Disease Control and Prevention will release the new hospital rules within three months, Michelle Pearson, chief of the National Center for Infectious Disease’s prevention and evaluation branch, said in an interview at an infectious disease meeting this month in Washington, D.C. The new rules will intensify sterilization requirements for health workers, increase testing of patients who may harbor dangerous germs, and may call for hospitals to create special quarantine wards.

Researchers are concerned especially about antibiotic resistant bacterial infections that arise in hospitals and spread to homes and crowded workplaces. The microbe, called methicillin-resistant staphylococcus aureus, or MRSA, is creating a health hazard in the United States, dwarfing the threat posed by the H5N1 avian flu, said Steve Projan, vice president of protein technologies for Wyeth, the drug maker that markets the Tygacil antibiotic.

“This is a hyper-virulent virulent bug,” Projan said in a press conference at the Interscience Conference on Antimicrobial Therapy and Antibiotics. “While we’re very concerned about H5N1, we do have in front of us today this outbreak of community-acquired MRSA.” Bacteria mutate constantly, sometimes in ways that allow them to overcome widely used antibiotics such as penicillin and methicillin. Doctors use stronger drugs, such as vancomycin, to treat the resistant infections. Other products that sometimes work against MRSA include Wyeth’s Tygacil and Cubist Pharmaceuticals Inc.’s Cubicin. Vancomycin is a generic drug sold by several companies.

About 2 million patients become infected inside U.S. hospitals each year, according to the Infectious Diseases Society of America. Staphylococcus aureus alone accounts for about 300,000 of those infections. About 40 percent of those germs can overcome methicillin, and about 12,000 of infected patients die, according to the CDC.

Increasingly, researchers are finding these drug-resistant infections outside the hospital, leading to concerns about widespread outbreaks of hard-to-treat microbes. Episodes of drug-resistant infections have occurred in the past year on professional U.S. football teams, including the St. Louis Rams, Baltimore Ravens and San Francisco 49ers, said Dan Jernigan, chief of CDC’s epidemiology branch at the National Center for Infectious Diseases. Infections have been seen among newborns in nurseries, he said.

The new threat of community-acquired MRSA’s has heightened doctors’ concerns about drug-resistant staph.

In some hospitals in San Francisco and Los Angeles, the new toxic strain is the leading cause of drug-resistant staph infections. More than half the MRSA’s at the Harbor-UCLA Medical Center are the community-acquired strain, according to a study presented Dec. 17 by Cynthia Maree, an infectious-disease specialist at the University of California, Los Angeles Geffen School of Medicine.

“That’s more than twice the rate we had in 1999,” she said in an interview at the conference. “When patients make repeat trips to the hospital with the same strain, health workers will sometimes clean the patient’s home” in an attempt to get rid of the source of infection, she said.

FYI:

Specialized volunteers are needed for the long-term care Ombudsman Program administered by the Florida Department of Elder Affairs, a statewide volunteer program that advocates for residents of nursing homes and assisted living facilities.

The volunteers will work with The Mid and South Pinellas Council. The program currently needs a registered dietitian, a pharmacist and an individual fluent in the Filipino language.

Ideal candidates are caring individuals who are willing to give 20 hours per month to the program. Successful applicants are approved by the Governor’s Appointments Office. Training is provided to investigate complaints, conduct inspections of facilities and effectively advocate for elders in long-term care settings. Ombudsmen are required to be free from conflict of interest.

Mileage reimbursement is provided at the state rate for all official ombudsman duties. Call 727-588-6912 or 888-831-0404.

Although this is about nursing homes in Britain, the same issues occur here in American nursing homes.

THOUSANDS of elderly people living in care homes are at serious risk of malnutrition, it is claimed.

Official inspection teams found more than 2,000 care homes for the elderly failed last year to meet minimum requirements for nutrition.

The shocking failings reinforce earlier findings that almost a third of residents are clinically malnourished.

The Government standards apply to both privately-run and state- owned care homes, which are subject to annual checks by the Commission for Social Care Inspection.

More than 250 care homes failed to meet required standards by a ’significant degree’ last year, with a further 1,842 homes narrowly failing to reach the standards.

Altogether, one in five care homes in England was classified as not up to scratch. Earlier this month, research by the British Association for Parenteral and Enteral Nutrition (BAPEN) estimated one in three residents of care homes is ‘clinically malnourished’.

Poor quality food and eating too little often because elderly people need help at mealtimes led to a range of health problems, said Professor Marinos Elia, chairman of BAPEN and one of the UK’s leading specialists.

He said malnutrition in longterm care homes costs the UK at least Pounds 2.6billion a year in remedial treatment. These new figures show the scale of the problem in this developed “land of plenty”,’ he said.

‘Around 30 per cent of patients in nursing and care homes are clinically malnourished, and it is likely to be much higher if you look at criteria such as vitamin levels.

‘It doesn’t take much for an elderly person to become undernourished but the consequences are serious.

‘They lose their strength and this has an impact on their ability to remain independent, as well as affecting mood, wellbeing and levels of anxiety.’ The latest figures, revealed in a parliamentary written answer, show that 255 homes about one in 50 failed to meet national minimum standards in 2004/05.

These included essential criteria for meals and mealtimes, such as three full meals a day, regular drinks and snacks, and special diets where necessary.

Mealtimes are supposed to be unhurried and staff should be ready to offer help where necessary to help maintain independent eating by residents.

Altogether 1,842 care homes one in six were judged to have ‘almost met’ the standard. The bulk of the remaining 8,259 care homes met the standard with 942 exceeding it.

Liberal Democrat Paul Burstow, who obtained the latest statistics, said it was ’shocking’ that almost one in five care homes did not meet even the ‘most basic of meal standards’.

He said that older people needed the same attention that Jamie Oliver’s school meals campaign had got for pupils.

He said: ‘It is a scandal that the Government does not even seem to know or care about the quality of food in care homes, but if independent research is true, urgent action is needed to put in place tough nutritional standards for care homes.’ A spokesman for the Department of Health said: ‘ Improving health and social care for older people is a priority area and we have invested in better services for older people.

‘The Commission for Social Care Inspection regulates care homes to make sure that they provide for the needs of their residents and will take swift action where inspectors have any concerns about the welfare of residents.’

CASE STUDY

ADA Birchall died in hospital weighing just three stone after her health collapsed at a councilrun care home.

The 91-year-old former mill worker, pictured above, was described by her family as looking like a ‘bag of bones’.

Her dramatic weight loss began after she was admitted to Butler Green House in Chadderton, Greater Manchester.

Her nephew, John Marsh, said she had severe arthritis but was free of any other disease and had always eaten healthily and looked after herself before entering the home.

But after six years at Butler Green House she weighed just 3st 12lb and had to be moved to the Royal Oldham Hospital.

By then she was unable to tolerate food. She would not be fed through a tube and died the following month, September 1999.

At an inquest her death was put down to bronchial pneumonia caused by malnutrition. An independent inquiry cleared the care home of any blame.

The nuts and bolts of managing a nursing home with few resources. This is an interesting article, even when I don’t like the actual content.

The St. Croix County Nursing Home will begin cutting the number of full-time nurses on staff as part of a plan to slow operational losses.

Consultants, who reported to the County Board last week, also suggested the county consider downsizing the facility, located in New Richmond, from 72 to 50 beds.

The department will immediately begin to implement the consultants’ operational recommendations with the intention of having the changes made by April 1, said Health and Human Services Committee Vice Chairman Ralph Swenson.

He said the changes will be evaluated for three or four months, and the committee plans to present recommendations to the County Board in August.

Consultant Mary Jo Graham said the Medicaid payments the nursing home receives are “significantly less” than its cost of caring for patients, and as with other county-owned nursing homes, the employee salary/benefit package is “eating them alive.”

The consultants suggested cutting about 10 full-time jobs and filling out schedules with hourly workers who wouldn’t get regular county fringe benefits.

Full-time nurses at the home get fringe benefits equal to 48 percent of their salary as compared to 25 percent for private industry nurses caring for the same type of patients, said Graham.

The county property tax levy for the home was $1.3 million in 2004. The consultants predict that levy will have to be doubled in five years if there are no significant changes in operation or major increases in state and federal reimbursements.

A little over a year ago, the home reduced from 129 to 72 beds. But, said Graham, so far this year the facility averaged only 69.5 patients a day and there are still vacancies at other nursing homes in the county.

The study was done by Graham and Barbara Gunderson, both directors with Wipfli, a national consulting firm.

Repeatedly emphasizing that the quality of care at the home is “excellent,” Graham said she and her associate are recommending nothing except that the operation become more efficient.

Nursing home funding problems are not unique to St. Croix County, said Graham. She said while the trend is to keep only the sickest patients in nursing homes, states haven’t increased their payments to cover the per-day cost of caring for those patients.

Graham said it is hard for a nursing home with less than 100 beds to be efficient, seven Wisconsin nursing homes closed in 2003, nearly 80 percent of all Wisconsin nursing homes received Medicaid payments less than their costs, and there are no nursing home rate increases budgeted for the next two years.

As funding sources diminish, many county boards are questioning their obligation to operate their own nursing homes, said Graham.

The county is legally responsible for care to developmentally disabled, mentally ill, drug dependent and infirm people, but that doesn’t mean it has to directly provide the care, added Gunderson. She said most of the patients at the county home are traditional nursing home patients who could go to private facilities.

“They need to be in a nursing home, but they don’t need to be in a county nursing home,” said Graham.

The consultants suggested integrating “specific task” nurses into the nursing hours, decentralizing the nursing program operation and reducing the number of nurses who are full time and receive the county benefit package.

The savings from reducing staff could be nearly $500,000 a year, according to Graham’s figures. Supervisor Daryl Standafer wondered if the county will have trouble developing a pool of nurses willing to work part time.

“It will take some aggressive work,” agreed Graham. She suggested mothers with children at home or older nurses who want to work fewer hours.

Other alternatives, she said, are to outsource operations and management and sell or close the nursing home.

The consultants estimated that downsizing to 50 beds would save the home about $770,000 a year, but noted that if the county transfers its licensed nursing home beds to another facility, the value at 72 beds is higher than 50 beds.

The consultants also advised that the county make timely decisions about operating the nursing home and have plans for communicating those decisions to all staff, residents and families, doctors, other county agencies and the public.

Laurel Crest’s license is at risk, and Cambria County officials are under state orders to correct deficiencies by March 15 or face a shutdown stemming from a fatal overdose.

Also, the state is imposing a $10,000 fine for deficiencies that caused the Dec. 3 death of the patient from a morphine overdose.

County commissioners and nursing home administrators were grim-faced Tuesday as they announced the state Department of Health’s findings and the sanctions imposed at Laurel Crest.

“We are fully cooperating with the state,” said Administrator Christopher Dear.

A team of state investigators was at the county-owned nursing home for a week in mid-December, following a complaint about the death of Eleanor Lee Kinnan of Revloc, age 70. She had been a resident at Laurel Crest for nearly eight months.

Her son, Jeffrey Kinnan of Armagh, has accused the nursing home and county officials of low staff levels that he says led to the medicine mistake.

A licensed practical nurse who administered the morphine later realized the dosage was improper, said administrators at Laurel Crest Rehabilitation and Special Care Center.

That nurse has been suspended with pay pending an investigation. At Tuesday’s press conference, Dear declined to comment on any personnel situation, including staffing and the suspended nurse’s status.

President Commissioner P.J. Stevens said that, although the outcome of the state investigation is negative, “We wanted to get it out to the public as soon as possible.

“It is now incumbent upon the administration of Laurel Crest to follow through. Our confidence is not shaken,” he said.

In a letter to Laurel Crest dated Dec. 22, the state lists five categories of deficiencies.

The two most serious, and the ones the state invokes in assessing the $10,000 fine, fault Laurel Crest’s quality of care and its pharmacy services.

Specifically, the state says that a doctor’s orders were not followed, and a doctor was not properly notified of the overdose.

The patient was “medically compromised” with multiple diagnoses including end-stage renal disease and cardiac issues, the state report says.

On Dec. 2, the day before her death, Kinnan declined “aggressive care,” including dialysis and hospitalization. A 10-milligram dose of morphine was ordered to be given every hour, the report says.

Instead, 40 milligrams were given, the report says. A physician was notified and ordered a drug to counteract the morphine.

But as the patient declined throughout the night, with shallower and less-frequent breaths, the physician was not called a second time. At 7:49 a.m., Kinnan was pronounced dead, the report says.

The second serious state charge is that Laurel Crest “failed to ensure that medications were used properly.”

Specifically, the report says the morphine was in a bottle that was not labeled specifically for that patient and did not contain the physician’s order.

Other deficiencies cited involved administrative procedures, record-keeping and other technical issues stemming from Kinnan’s death.

Since it opened in 1977, Laurel Crest has been no stranger to tough times, having experienced some staggering financial losses and two criminal investigations into residents’ deaths.

Between the late 1980s and the late 1990s, the facility consistently was cited by the state.

For two years in the late 1980s, it was put on four consecutive six-month provisional licenses and faced closing because of serious deficiencies. The home was in such trouble that it lost its federal Medicare reimbursement for months on end, causing losses estimated at $39,000 per week.

In 2003, the former commissioners were on the verge of selling Laurel Crest to Conemaugh Health System, but the sale was aborted.

The 386-bed facility had a net profit of about $1.7 million in 2004 and there are plans to expand its special-care units in a $5.8 million renovation project.

That is being financed by funds gained from the state in exchange for Laurel Crest giving up 166 beds.

Because of the overdose investigation, the state can levy further penalties. If the county does not correct the deficiencies by March 15, Laurel Crest will be denied Medicare and Medicaid payments, the letter says.

It’s really too bad these models of care cannot be adapted to work in the nursing home environment. This stuff could work but staff are too stuck in their own ways to want to make change. We forget that nursing homes are a service, not a lifestyle, offered.

FORSYTH - Moving into a long-term care facility doesn’t have to mean losing your identity, which is the premise behind an emerging type of community in Forsyth.

Hickory Point Christian Village, 565 W. Marion Ave., will open 18 private memory care suites called Haven House in February. The new option is for people age 55 and older with memory loss and who require supervision and assistance but do not require skilled nursing services.

Based on a “social model,” the furnished apartments and common areas boast of a homelike environment that encourages individuality, human interaction and holistic health.

“The focus is on their remaining abilities as opposed to their disabilities,” said Julie Evers, director of well being for Haven House.

Restaurant-style dining, for instance, allows them to choose items from a menu. The structure of the day also respects the residents’ preferences, such as getting up at 6 a.m. and making coffee or sleeping until noon and taking a bath at night. There are no visiting hours, as family and friends can stop by any time.

“It’s respecting their daily routine that they had in their community,” Evers said. “We are structuring the staff around them.”

The staff, from the administrators to the maintenance crew, is specially trained in memory care.

“We’re all universal workers, even though we have titles,” she said.

Read the rest of this article—>

This isn’t good. Sometimes lawmakers need to stand up to industry and do the right thing. Protecting the elderly from potential abuse by sex offenders seems to be a good thing. Far too often we see residents who just don’t belong in the average nursing home environment. I don’t know what the answer is- but this isn’t right.

A new Illinois law to protect nursing home residents from sex offenders and other ex-cons is being watered down because of industry concerns it’s too costly.

Under a proposed change to the Vulnerable Adults Protection Act, current nursing home residents would be largely exempt from criminal background checks unless they voluntarily confess to past crimes on a questionnaire. Another alteration would do away with a requirement that registered sex offenders automatically be banned from sharing bedrooms with other nursing home residents.

“The protections have been gutted. It’s now essentially the honor system,” said Cara Smith, policy director for Illinois Attorney General Lisa Madigan, who helped draft the legislation. “We wouldn’t settle for an honor system when it comes to protecting our children, and we shouldn’t settle for it when it comes to protecting vulnerable adults.”

State public health officials said the proposed rules, which could become final after a Jan. 18 vote, still have enough teeth to safeguard nursing home residents without being “unduly burdensome” to long-term care facilities’ budgets. An outcry from the nursing home industry over the cost of background checks — about $10 per person — helped spark the proposed modifications.

Checks only for new residents

The law’s fine print originally called for background checks on all 100,000-plus nursing home residents to help facilities protect residents from ex-cons. A Chicago Sun-Times investigation in April showed that 100 registered sex offenders — half of them age 50 or younger — and 61 parolees convicted of non-sex crimes were living alongside the elderly and ill in long-term care centers statewide.

Residents and sometimes the homes themselves had no idea these former criminals — not to mention an unknown number of other ex-cons no longer on parole or in the sex-offender registry — were living in their midst.

The changes in the law could continue to keep nursing homes in the dark about convicted felons such as Larry J. Sharp, 55, who was sentenced to 12 years in prison in September after repeatedly groping a 77-year-old fellow resident at Mercy Health Care Rehab Center in south suburban Homewood. Only after police arrested Sharp did nursing home staff learn he had served time for rape and aggravated battery.

The amended law would make background checks mandatory for all incoming nursing home residents. But people who already live in the homes would be checked only if nursing homes know they have criminal pasts, find their names on the state’s online sex-offender registries or have the residents fess up to criminal histories on a questionnaire.

Industry wants state to pay

“I can’t imagine that people are going to own up to the fact they have a felony conviction,” said Donna Ginther, a lobbyist for the senior advocacy group AARP.

Ginther said the changes to the law would allow too many ex-cons to go undetected and follow-up legislation is needed that addresses how to pay for background checks for all — an option Madigan’s office is weighing.

“We don’t know the scope of the problem,” Ginther said. “Worse yet, we don’t know where the problem is.”

Even though the law was passed in the summer, the changes are possible because an oversight panel of 12 lawmakers was authorized to hammer out final details. Upon hearing the industry’s concerns, the panel ordered the Health Department back to the drawing board.

Nursing homes are major political players in Springfield, with the industry’s two main trade groups contributing at least $700,000 to lawmakers in recent years.

One of those groups, the Illinois Council on Long Term Care, “has no objections whatsoever” to the intent of the law, said executive director Terry Sullivan. But the industry plans to push next month for legislation in hopes of working out remaining concerns. The group, for example, wants state agencies to conduct and pay for criminal background checks on residents before homes admit them.

Another key aim of the new law is to make residents and visitors aware that ex-cons are living in nursing homes by requiring facilities to post signs. Facilities also must acknowledge this by sending letters to residents or guardians.

Visits find notification lacking

A check of city and suburban nursing homes suggests this part of the law, which took effect in July, is largely being ignored.

In the past two months, Smith and other attorney general’s employees visited 11 nursing homes that housed sex offenders. Only two homes had evidence of letters being sent to residents. Six had posted notices, but only one of those signs was easy to understand, Smith said.

State health officials declined to comment about the attorney general’s findings but are planning compliance checks of their own. They’re also creating signs that clearly will state if ex-cons are on nursing homes’ premises.

Sullivan said there has been some “confusion” about notification requirements but that homes are taking the new law seriously.

“Any facility that takes a sex offender is very conscious of the enforcement spotlight,” Sullivan said. “They’re not going to take any chances.”

This is an great read, full of hope and inspiration.

Ten years ago, medical experts often wrote off patients who had suffered a severe stroke as untreatable. Even today, conventional wisdom is that recovery essentially stops sometime after the first year following a stroke — a dismal outlook for people who have passed that deadline.

But those assumptions are slowly being sloughed off as “old school” by a new breed of neurologists and therapists who say breakthroughs in stroke treatment — some developed in the Bay Area - - have proved to restore brain function in some of the most severe cases.

Stroke victims who a decade ago would have been sent to a nursing home are now being given a fighting chance by doctors who have seen remarkable, unexpected recoveries. Still, many caregivers hesitate to raise unrealistic hopes in family members.

“We’ve found that we might not be able to eliminate a disability, but we can soften the deficits much more than we once thought,” said Linda Goshgarian, an occupational therapist at Community Hospital in Los Gatos.

A stroke occurs when a blood vessel clots or ruptures, causing a lack of oxygen to the brain and sometimes seizures. Known causes include high blood pressure and hypertension.

Some people who seek treatment immediately recover with only mild damage and can return to their normal lifestyle. Others lose motor skills or the ability to communicate. The most extreme cases can be fatal or leave a patient in a permanent coma.

At least three East Bay companies are developing equipment that researchers consider important tools to limit brain damage at the onset of stroke and to restore communication skills lost by prolonged lack of oxygen to the brain.

Read the rest of this article—>

A man with Alzheimer’s disease wandered away from an assisted living home. He hasn’t been found yet and the search has been called off.

The search for an 86-year-old man suffering from Alzheimer’s disease was called off Tuesday after hundreds of volunteers completed a 30-hour rescue effort that began Monday morning.

Herbert Moore was last seen at the Carolina House assisted-living facility on Hastings Lane at 5:30 a.m. Monday, according to Elizabeth City Police Capt. G.F. Koch. Moore was discovered to be missing at 8:30 a.m. and authorities began searching for him at about 10:30 a.m.

Moore was convalescing at Carolina House after a recent medical procedure at Albemarle Hospital, according to Moore’s son, Herbert Moore Jr. He had been telling relatives he wanted to go back to his home on Loop Lane, off Millpond Road in Morgan’s Corner.

Moore is a World War II veteran and a father of nine. He is a retired longshoreman and minister.

Since retiring 22 years ago, Moore has enjoyed an active life, fishing, hunting and raising pigs, his son said. But his health had been deteriorating in recent years.

His son said it is difficult to know what state of mind Moore was in when he left the nursing home.

Read the rest of this article—>