I saw this article at the Boston Globe the other day and was going to post it, but it’s gone. Found it at Red Orbit though.

Tens of thousands of nursing home residents must be sent to the hospital each year because of a breakdown in basic medical care at the facilities, specialists say, a scenario that exposes frail elderly people to unnecessary trauma and illness.

More than one-third of all hospitalizations of nursing home residents could be prevented if nursing staff recognized symptoms of increasing illness sooner and doctors were more readily available at the nursing homes, a new national study said.

“Things get overlooked until a hospitalization is unavoidable,” said Mary E. McKenna, the state’s chief consumer advocate for nursing home residents. “The quality of primary care . . . has not been up to what people expect.”

Now, there is a growing movement in Massachusetts and elsewhere to strengthen medical care at nursing homes and cut unnecessary hospitalizations.

A New Bedford nursing home began using telemedicine a month ago to give patients immediate access to doctors evenings and weekends. HealthBridge Management, which owns the nursing home, plans to expand the videophone doctor visits to many of its 14 other Massachusetts nursing homes over the next year. Already, the program has averted at least six trips to the emergency room.

More nursing homes are hiring nurse practitioners, some on call 24 hours a day, to provide intensive, hands-on primary care. Many of the nurse practitioners work with Evercare, a for-profit Medicare HMO that serves 6,300 nursing home residents in Massachusetts and tens of thousands more nationwide. A national study of Evercare’s impact on nearly 2,000 patients over two years found a 65 percent reduction in preventable hospitalizations. Evercare also pays doctors more than the typical rate, and its physicians see patients more often than average.

The state is targeting four conditions that frequently result in avoidable hospitalizations — dehydration, urinary tract infections, chronic pulmonary disease, and congestive heart failure. At workshops cosponsored by the state trade group for nursing facilities, nurses and aides are taught to identify subtle changes in patients’ health that may signal a developing problem and to intervene quickly and effectively.

Read the
rest of this article, there is much more. Very interesting stuff and so familiar.

Nursing Homes Magazine once again has an excellent article about food preparation, foodbourne illness and prevention of this.

Some highlights:

Residents of LTC facilities tend to be more vulnerable to foodborne illnesses than the general population. This is because of (1) age-related changes in their gastric pH, (2) the overuse of antibiotics that kill beneficial bacteria normally present in the body that provide protection against harmful microorganisms, and (3) the weakening of their immune systems by diseases and conditions (e.g., AIDS, diabetes, liver disease, and malnutrition), as well as medications and treatments that destroy or suppress immune cells (e.g., chemotherapy and radiation therapy). In confined environments such as nursing homes and other LTC facilities where these vulnerable residents live, foodborne pathogens can spread easily. Residents eat the same food from the same kitchen, share food, eat food brought in by visitors, eat during activities and special events, and save food from mealtimes—all factors that allow the chain of infection to flourish.

Foods to Avoid
To reduce the risks of foodborne illness, nursing home residents are advised not to eat the following foods:

* Raw finfish and shellfish (e.g., sushi or oysters)
* Hot dogs and luncheon or deli meats, unless reheated until steaming hot
* Raw or unpasteurized milk or soft cheeses
* Refrigerated pâtés or meat spreads
* Refrigerated smoked seafood, unless contained in a cooked dish
* Raw, lightly cooked, or unpasteurized eggs (e.g., sunny-side up)
* Raw or undercooked meat or poultry (e.g., a rare or medium hamburger)
* Raw bean and seed sprouts
* Unpasteurized/untreated fruit or vegetable juice

There is a lot more here to read. Go check it out; some of this info can be applied in our homes as well.

Indiana is looking for alternatives to nursing home care.

State officials hope a new program that raises reimbursement rates for certain alternatives to expensive nursing home care will increase choices for Indiana seniors.

The OPTIONS program, introduced Thursday by the Family and Social Services Administration’s Division of Aging, will encourage Medicaid recipients to consider adult foster care, adult day care, assisted-living services and home care.

In Indiana, only 25 percent of people requiring care choose an alternative to a nursing homes, while the national average is 41 percent, said Steve Smith, director of the Division of Aging.

“We need to tell people that those options are equal, and in everyone’s eyes, they should be seen as equal,” Smith said. “A patient’s physical and mental situation should drive that decision, not financial circumstances.”

Smith said the raised reimbursement rates will encourage providers to start new businesses or convert traditional nursing home care to less expensive alternatives. Officials said the initiative can be paid for by shifting money around rather than requiring additional funding.

There is an oversupply of nursing home beds, Smith said, and converting or closing facilities will help the state balance funding among all options and offer better care.

The McCurdy Healthcare Center, Evansville, was the first to take part in the program, converting from a 120-bed nursing home to 98 assisted-living apartments. Michael Weber, CEO and owner of Riverwalk Communities, which owns the center, said the facility was going to close, but the FSSA program allowed it to stay open.

“It was a win-win for us,” he said. “Instead of just closing the business and taking losses, we were able to continue to have services for assisted living. (The FSSA was) looking for pilot program, and this just kind of fit.”

Read the rest of this article—>

Nurses claim they were fired for speaking up:

CHARLESTON - Three Fayette County nurses say they were wrongfully fired from their jobs for speaking out about quality of care issues at a nursing home.

LPNs Hubert Atkins II and Michelle Gill and RN Pamela Givens filed their lawsuit June 28 in Kanawha Circuit Court against Beverly Health and Rehabilitation Services Inc. and RN Jean Lavender.

They “observed numerous quality of care issues pertaining to residents of (the) Glasgow facility including, but not limited to, nurses falsifying medical charts and substandard patient care,” they say in their complaint. “Plaintiffs repeatedly complained about the quality of care issues to managers and supervisors.”

Based in Fort Smith, Ariz., Beverly operates 354 nursing homes and 18 assisted living facilities across the United States, including homes in Kanawha and Fayette counties in West Virginia. Lavender, who also lives in Fayette County, was director of nursing services at Beverly’s Glasgow facility in Fayette County.

Read the rest of this article—>

New Clues to Neurological Diseases Discovered

WEDNESDAY, July 5 (HealthDay News) — Researchers have found that genetic abnormalities in molecules that regulate neuron growth may be at the root of Down syndrome and Alzheimer’s disease.

These molecules, known as neurotrophins, are taken up by neurons in sac-like carriers called endosomes and transported to the main cell body, where they take charge of neuronal development and connectivity by activating protein switches called Trk receptors.

Now, two separate reports in the July 6 issue of Neuron show that a malfunction of a single gene disrupts the transport of neurotrophins and that restoring normal levels of a Trk receptor could reverse the death of neurons.

“Neurotrophins are growth factors that maintain the health of neurons,” explained Susan G. Dorsey, an assistant professor at the University of Maryland Baltimore School of Nursing and lead researcher on the first study. “The thought has always been that the problem in neurodegenerative diseases has been a lack of supply of neurotrophins.”

“We argue that it’s not a supply problem, but it’s actually receptors on the cell surface malfunctioning,” she said. “This could become a new therapeutic target.”

“We found that neurons are very sensitive to the levels of neurotrophin receptors,” Dorsey explained. Receptors are what neurotrophins bind to so that they can be transported into the cell to support cell survival.

In a mouse model of Down syndrome, Dorsey’s team found there was an overproduction of receptors that blocked neurotrophins, which led to the death of neurons. “When we corrected that, cell survival was restored,” she said.

In terms of potential therapy, the focus may need to switch from trying to supply more neurotrophin to trying “to figure out how to make the neurons more responsive to the supply of neurotrophins that exist,” Dorsey said.

In the second study, Stanford University researchers looked more closely at a pathway in the brain that is critical in the development of both Down syndrome and Alzheimer’s disease.

This pathway is called the cholinergic system. “Most of the treatments currently available for Alzheimer’s target and attempt to make the cholinergic system more effective,” said study co-author Dr. Ralph A. Nixon, a professor of psychiatry and cell biology at New York University. Nerve growth factor has been found to be essential for the survival of neurons that are part of the cholinergic system, he noted.

In the study, the researchers found that, in the same mouse model used in the previous study, there is an alteration in the mechanism that transmits the nerve growth factor signal, Nixon said. “We have not known much about why, in Alzheimer’s disease, these neurons are vulnerable. This study identifies the gene that is related to the survival of neurons. So, it links a genetic cause of Alzheimer’s disease to a specific biochemical mechanism.”

Nerve growth factor has been tried as a treatment for Alzheimer’s, Nixon said. “The trials had to be terminated due to side effects,” he said. “The challenge is to find a way to deliver nerve growth factor in a way that would be effective and to control their levels so that they would have beneficial effects and not side effects.”

Commenting on the first study, Nixon saw a relationship in the genetic problems affecting the normal functioning of growth factors. “Both studies show that there are two different growth factors that are impeded from functioning in the correct way,” Nixon said. “It appears that problems with growth factors are really driving the destruction of neurons.”

Nixon thought that either adding more growth factor to overwhelm the lack of production or to flood the receptors may be a therapy in the future. Another strategy might be to target the cell receptors, he said.

One expert thinks that these findings may open a door to new treatments for Alzheimer’s disease.

“These two papers provide support for the role of growth factor abnormalities in the pathogenesis of neurodegenerative disorders, including Alzheimer’s disease,” said Dr. Murray Raskind, director of the Alzheimer’s Disease Research Center at the VA Puget Sound Health Care System.

“Although these have been subjects of study by Alzheimer’s disease investigators for decades, it has been difficult to link these intriguing factors that protect and promote neuronal integrity to mechanisms of disease. These new findings provide impetus to this field, and have potentially important therapeutic implications,” Raskind said.