A foreign perspective on American nursing homes.

A report published November 21, 2006 by the Lewin Group indicates that the percentage of very senior adults (aged 85 or older) in nursing homes has sharply declined over the past two decades. The report, titled “Nursing Home Use by ‘Oldest Old’ Sharply Declines,” traces trends in nursing home admissions since 1985. The percentage of adults over 65 years of age in nursing homes decreased 0.6% since 1985, but the rate among those aged 85 or older dropped 7.2%. Meanwhile, the number of people in that age group nearly doubled. If seniors had continued to use nursing homes at the rate they did in 1985, the current nursing home population would be nearly 2 million. Instead, with a current nursing home population of 1.3 million, over 600,000 seniors have elected to not use nursing homes.

Interesting…One would gather that US nursing home population is growing. It’s not. And that’s not a bad thing.

Where have these people gone? The report indicates several factors contributing to this decline. An increase in the health and financial wealth of seniors has reduced the need for nursing home care and permitted seniors greater flexibility to choose their preferred services. At the same time, nursing homes have changed, focusing their long-term care on Medicaid residents and their short-term post-acute rehabilitation care on Medicare residents. Furthering the decline in nursing home use has been the substantial increase in the number of alternative long-term care facilities (e.g. assisted living facilities, residential care facilities for the elderly, group homes, and home and community-based services). With a population of 1 million residents, these facilities nearly rival nursing homes. The report also identifies increased availability of private long-term care insurance and active efforts by state legislatures as additional factors contributing to the decline in nursing home use.

I think we have a ways to go though…getting seniors and the elderly out of nursing homes is great…let’s bring them back home though instead of placing them into assisted living, group type homes. After all, home is where the heart should always be.

The decline in nursing home use has accelerated since 1999, when state and federal lawmakers imposed new initiatives to reduce the number of Medicaid recipients in nursing homes. One of these initiatives is the National Family Caregiver Support Program, part of the 2000 Reauthorization of the Older American’s Act. The Program allows states to provide a continuum of caregiver services to best meet caregivers and individual needs, making it possible for seniors with disabilities to remain at home and in their community longer. Other initiatives include President Bush’s New Freedom Initiative and Congressional funding for grants from Real Choice Systems Change, providing states seed money and assistance to shift the balance of senior care away from institutions and toward community living.

Wow…someone is actually crediting President Bush with an idea that is really good and that has worked well. Figures, this praise comes from another country.

Nursing home operators should keep these trends in mind when planning for the influx of Baby Boomers. According to the report, “[I]f the demand for nursing homes continues to decline at just half the rate of the national average over the past 20 years, the use rate among older adults would drop from a projected 3.2 percent to 2.5 percent in 2030.” Because maximum bed capacity and an increase in resident census is not guaranteed, providers should carefully consider their business model and projected plans for the next 10 and 20 years, as well as the growing market for alternative long-term care options. On average, compared to a skilled nursing facility, it is easier and quicker to obtain a license to operate and assisted living facilities or residential care facilities for the elderly.

I would heed this advice if I were a nursing home operator. For sure. The coming of the boomers might see the decline in the need for nursing homes, instead of the conventional thinking we will need more.

Across the pond they have identified a new strain of MRSA. It’s only a matter of time when we will see this in the US.

A healthy hospital worker died after contracting a deadly new strain of MRSA that had never before been reported as a cause of death in hospitals.

Four other workers at the same hospital also contracted Panton-Valentine Leukocidin-positive (PVL) MRSA, with two of their friends, said the Health Protection Agency. An investigation subsequently found that the strain had killed a patient at the hospital earlier this year.

The strain, which is particularly virulent, attacks healthy young people and can cause symptoms ranging from minor infections in the skin and soft tissue to a form of pneumonia that can kill in 24 hours.

The outbreak, which has only just been reported, was identified when a previously healthy female healthcare worker, named only as “Case One”, developed a severe MRSA infection and pneumonia and died after emergency surgery in September, the agency said.

The bacterium that she had contracted, PVL-positive MRSA, had never been found to cause a death inside a hospital. It was contracted by at least three other workers in two wards in a West Midlands hospital, and two of their friends.

It was also found to have caused the death of a patient at the hospital in March.

A statement from the agency said: “Eight cases of PVL- positive community-associated MRSA have been identified among individuals in a hospital and their close household contacts in the West Midlands. Four of these individuals developed an infection, two of whom subsequently died.”

Doesn’t sound good- these new germs keep mutating and turning into things we cannot treat.

This is something I have heard about recently. Where I work, the patients are sent out for the initial DX but promptly brought back to us. They get their treatments in my facility. Mind you this is in Canada- the story here. But we’re seeing here in the US too.

Hamilton, ON — There may be no advantage to taking nursing home residents to hospital for treatment of pneumonia. They can do as well if they receive the same medical treatment at their residence, a study conducted by McMaster University researchers and funded by the Canadian Institutes of Health Research (CIHR) has shown.

When nursing home residents are routinely hospitalized with pneumonia, they may become susceptible to other health risks, including a reduction in their quality of life and a decline in functional health. The transfers also place a major burden on the healthcare system in emergency departments and hospital wards, particularly during influenza season.

In contrast, treatment at home can significantly save health care costs, estimated to be $1,200 per patient treated for pneumonia.

“The data have important implications for the delivery of health care services for both long-term care facilities and acute care hospitals,” says Mark Loeb, principal investigator and professor of medicine and an infectious disease expert. “We estimate that implementation of the clinical pathway could result in a savings of $84 million Canadian annually. In the U.S., the cost savings could approximate $831 million annually.”

Dr. Mark Loeb and his colleagues at McMaster University’s Michael G. DeGroote School of Medicine conducted a randomized controlled trial of 680 residents in 22 nursing homes in the Hamilton area. They assessed hospital admissions, length of hospital stay, mortality, quality of life, functional status and cost.

They found that by following a defined standard of care to treat pneumonia, essentially bringing hospital care to the nursing home, hospitalizations were reduced by over half -� 10 percent of residents versus 22 percent in the group who had usual care. There was a substantial cost savings of more than $1,200 per resident, with no increase in mortality.

The defined clinical pathway included the use of oral antibiotics, portable chest x-rays, oxygen saturation monitoring, rehydration and close monitoring by a research nurse.

“The results of Dr. Loeb’s study point to ways seniors can receive the best available health care with the least possible disruption at a stage in their lives when any disruption can be a significant source of stress,” said Dr. Morris Barer, scientific director of the CIHR Institute of Health Services and Policy Research. “This study is a compelling example of how evidence gained through health research can save money and strengthen our health care system.”

Heh. Nursing home care in Europe is much worse than in America (sarcasm intended)

Bedsores, unchanged diapers and inattentive staff members are the rule rather than the exception at Copenhagen’s largest nursing home, according to a documentary aired on the national broadcaster Sunday night news magazine.

An undercover journalist, Marike Jensen, took a job at the Fælledgården nursing home and followed daily life for two months using a hidden camera. The results were shocking, said Jensen, who without prior training, was put in charge of caring for residents.

‘The people were so weak and it was so important to bring this out, I was able to justify doing this,’ said Jensen.

Jensen recorded scenes from the home and found that some of the home’s 250 residents were allowed to lay in the same diapers for up to 14 hours.

The scene from Fælledgården was not unique to Copenhagen, said Bjarne Hastrup, the director of DaneAge Association, the national interest group for the elderly. Cutbacks, a lack of qualified staff, personnel changes and substitute workers provided sub-standard service levels across the country.

People with family members at nursing homes flooded DanAge with emails after seeing the broadcast, he said: ‘We will now try to collect and organise the reports so we can gain an overview, and then we will send them on to ministers and mayors.’

Hastrup noted that relatives seldom complained about poor nursing home conditions, because they were concerned about the consequences.

‘Many people are afraid that a complaint might lead to a resident receiving less care and attention. At the same time both family members and residents build a relationship with caregivers and don’t want to complain about them.’

What’s in the news recently:::

Oregon nursing home could lose it’s license:

The state of Oregon is threatening to close an east Portland nursing home if the facility doesn’t get its act together. Citing three bad inspection reports in the last two years as well as several complaints that were found to be valid, the state on Jan. 18 informed St. Jude Specialty Care on Southeast 136th Avenue that it’s prepared to strip the home of its license. Such notices are very unusual and “a very big step for us to take, quite frankly,” said Elaine Young, nursing program director for the state Department of Human Services.

Brockton MA nursing home probed:

BROCKTON —The state Department of Public Health and local police are investigating allegations that a worker at a local nursing home abused a patient earlier this month. The DPH launched an investigation into St. Joseph Manor, a Brockton nursing home, after getting a complaint about the facility Feb. 4. Brockton police were called Wednesday to investigate the allegations. Anne Teri, chief executive officer at St. Joseph Manor, confirmed the state was investigating the Thatcher Street nursing home but declined to detail the allegations. “I can’t really comment about the investigation,” she said. “We take any allegations seriously.”

FL nursing home shut down after it failed FIRE safety drill:

PALM HARBOR - Dozens of elderly people are being forced from their homes, but state officials say it’s ultimately not a bad thing. Officials with the state Attorney General’s Office shut down the Long Shadow Inn, an adult living facility in Palm Harbor, because managers there failed a surprise emergency drill Thursday. During the drill, officials said, some residents were left unattended, several were trapped in wheelchairs on the second floor of the building, and at least four residents were never even evacuated.

Man found dead three days after leaving facility:

Searchers found the body of a missing Indiana man in a creek Monday, three days after he wandered from a nearby Rockville health care facility, authorities said. Robert E. Didelot, 62, was discovered just west of Lee Alan Bryant Health Care Facilities Inc., where he lived, said Parke County Sheriff Charles Bollinger. The facility, which includes a nursing home and residential facility, is about 2 1/2 miles east of Rockville. “It appears [he] was trying to cross a log jam and fell off into the water,” near Sanatorium Bridge, Bollinger said. Didelot was up to his neck in water, the sheriff said. An autopsy is scheduled today in Terre Haute Regional Hospital.

British Nurse under investigation:

A nurse alleged to have carried out “unprofessional” practical jokes in hospital put a patient’s glass eye in a cup of Coca-Cola, a disciplinary panel heard today. The accusations came at the start of an inquiry into 12 allegations of misconduct against Christine Mitchelson, including allegations of assault, racism and tasteless practical jokes. The 53-year-old nurse, from Newcastle upon Tyne, has denied all the charges, which are being examined by the conduct and competence committee of the Nursing and Midwifery Council (NMC) in London. She is not attending the hearing, citing ill health. The allegations cover the period between late 2001 and early 2004, when Ms Mitchelson was working at the Royal Victoria Infirmary in Newcastle. Her colleagues - including staff she was supervising - brought the complaints against her.

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.