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Healing with High Tech:

GET ON THE TELEMEDICINE TRAIN OF 2018

SCARY GUT FEELING

This stomach superbug has healthcare providers at a loss

GRACEFUL AGING

This beauty salon is rejuvenating LTC residents everywhere

HEALTHY CHOICES Are on-staff dietitians worth it?


Upfront Healthcare // November 2017

PENNED

“The simple things are also the most extraordinary things, and only the wise can see them.” -Paulo Coelho, The Alchemist ”Always be Humble and Kind.” -Tim McGraw Have you ever been to the beach and gotten lost in the sound of the waves against the shoreline? Been comforted by the laugh of a child, and moved to emotion from her cries? Felt a tear down your cheek after seeing someone you’ve missed? The simple things in life can elicit the most emotion, yet are the things we can easily ignore if we are not careful. We get caught up in a lot of things: work, relationships, daily struggles. But life is short. The industry of healthcare is a rude awakening of the direction life can go. So many times, we see the ill effects of the quick and fast lifestyle that we lead. But we are all here for exactly that reason. Where can we help and how can we do it?

Executive Director Joseph Kubulak editor-in-chief Becca Blau assistant editor Mayer Silver creative Rebecca Lieberman Joy Hoberman advertising Britt Goldberger

I watched a great movie with my wife recently, called Collateral Beauty. Without going into the story (which is excellent, by the way), I took to one quote in particular: “We are here to connect…Life is about people…every decision we make is because we long for love, wish we had more time, and we fear death.” Isn’t that the reason we are in this together? We are not here only for business. We’re here for the impact that we all can make on this little part of the world that we call our home, our life. The people around us are our reason and, for the most part, they all have turned into extended family. We are in the place and we have the opportunity to make the most impact in this world. We are in an industry that is seeing cuts and squeezes that pop up right and left. The one commodity which is priceless is the smile of someone that we have just helped. Whether we got them through a tragedy, patiently listened, or just held their hand. Life is pretty simple if you boil it all down. And it is these simple gestures that make it extraordinary.

publisher GCNY Marketing

Share a smile, or an extended hand or ear. We are in an industry that allows us to do that with huge benefits: the love and respect of all those around that we serve and are dedicated to.

MAIN OFFICE: 1449 37th Street | Suite 507 Brooklyn, New York | 11218

So remember that time is a gift and love is always there…and just remember to be always humble and kind.

October 2017

God bless you as always!

Joe Kubulak V.P. of Operations and Business Development, SpecialtyRx


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CONTENTS

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Industry Currents Is Cleanliness a Health Risk? pg 6 New Screening Tests for Alzheimer’s, pg 8

10 16 30 Renovating Rehab

Beauty Queens

Music of Memory

Adapting your building to support subacute care

This salon thinks that LTC residents should feel beautiful, too.

One organization’s on-key initiative in the fight for memory

19 The Virtual Doctor Is In The Telemedicine Transformation

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Food for Thought Are on-staff nutritionists necessary?


Upfront Healthcare // November 2017

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Upfront Healthcare // November 2017

MEDICINE

UTI “Superbugs” are Fueled by Antibiotic Use Urinary tract infections are common in long-term care facilities due to the widespread use of urinary catheters. Catheters can introduce bacteria from the skin into the urinary tract, causing elderly patients to become sick. Now the medical community is warning facilities that the rise of antibiotic-resistant “superbugs” makes UTIs an even greater concern for those with weaker immune systems. Antibiotics may treat UTIs, but prescribing the wrong antibiotic can make other bugs that often lurk in a patient’s body a more pressing threat. In a study published in the Proceedings of the National Academy of Sciences, researchers observed more than 200 nursing home patients, 40%

of who had more than one MultiDrug Resistant Organism (MDRO) present in their bodies. All patients in the study were urinary catheter users, and were treated with one of 50 antibiotics. The study’s findings included 3 key insights: •

Attempting to treat one MDRO with antibiotics ultimately encouraged others present in the body to grow even more dangerous.

MDROs seemed to interact very specifically with other species of MDRO.

Treating one MDRO with antibiotics increased the risk of being infected with another.

The data collected in this study was used to create a map of interactions among bacteria and their associations

and interactions with certain classes of antibiotics. Given the prevalence of multiple organisms in healthcare facilities, the researchers concluded that it is time to begin thinking about “superbugs” as “members of an antibiotic-resistant ecosystem in healthcare environments.”

What does this mean for healthcare providers? Researchers hope that the map will eventually be used to help healthcare workers choose antibiotics more strategically for individual patients. The right drug should kill not just one specific MDRO, but the many MDROs that are likely present in the patient’s system or in the facility nearby. If nothing else, the findings suggest providers should avoid administering antibiotics to patients with MDROs whenever they are not truly necessary. ●


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HEALTH

Is Cleanliness a Health Risk? Link established between disinfectant exposure and COPD A study conducted by the French National Institute of Health and Medical Research found that nurses who are regularly exposed to disinfectants have an increased risk of developing Chronic Obstructive Pulmonary Disease (COPD). The study followed more than 55,000 female registered nurses in the United States who regularly use disinfectant chemicals to clean surfaces within their work environments. From 2009 through 2017, researchers studied nurses who had no history of COPD. They found that nurses who used disinfectant chemicals to clean surfaces at least once per week had a 22% increased risk of developing the disease, and the risk increase rose as high as 32% with the use of certain named disinfectants. The disinfectants associated with a higher risk of COPD were:

Glutaraldehyde

Bleach

Hydrogen peroxide

Alcohol

Quaternary ammonium compounds

The study’s authors stress that this is an association and not a direct cause. For facility administrators, this study requires an awareness of disinfectants in use on their watch as well as the frequency of worker exposure to the chemicals. In a statement, lead researcher Orianne Dumas, Ph.D, said, “Our findings provide further evidence of the effects of exposure to disinfectants

on respiratory problems, and highlight the urgency of integrating occupational health considerations into guidelines for cleaning and disinfection in healthcare settings.” The researchers presented their findings at the European Respiratory Society International Congress on September 11, 2017. What we think the future holds? Hopefully, these findings will boost interest in developing safer disinfectants with fewer chemical irritants. Botanically derived germ killers may very well nudge bleach off supply shelves in the near future. Come 2018, we’re looking forward to cleaner air, and a healthier staff. ●


Upfront Healthcare // November 2017

INDUSTRY

Cutbacks Cut Deep: What Healthcare Spending Looks Like for 2018 The House Appropriations Committee approved a bill to fund the Departments of Labor, Health and Human Services, Education and Related Agencies (Labor-HHS) for fiscal year 2018. The allocation in the bill amounted to $5 billion less than allocations for FY2017, which inevitably spells cuts to the federal workforce, education, and health programs. The programs affecting older Americans contained in the LaborHHS bill include: •

Administration for Community Living

Older Americans Act Title III

Programs •

Native American Nutrition, Supportive Services, and Caregiver Support

Elder Justice and Adult Protective Services

Aging and Disability Resource Centers

Prevention and Public Health Programs

Senior Corps

Block Grant Programs Supporting Older Adults

Ouch! What next?

Before the spending allocations take effect for FY18, the House and Senate must pass identical spending measures. Thankfully, the Senate is considering its own Labor-HHS funding bill. If the chambers cannot agree on spending measures, they may choose to either extend current spending levels into next year, or to draft a funding bill that rolls multiple appropriation bills into one “omnibus” bill. For the latest updates, visit www. n4a.org, where the National Association of Area Agencies on Aging releases details of FY18 funding as they become available. In the interim, fingers crossed. ●


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New Hospice Comparison Website Raises Efficacy Concerns Hospice Compare, a new website from the Center for Medicare & Medicaid Services (CMS), publishes data from hospice providers with the goal of opening conversation pathways about hospice among care providers, patients, and families. The site compiles data from nearly 4,000 hospice providers based on seven quality measures: •

Addressing patients’ beliefs and values

Treatment preferences

Screening for pain

Assessing pain

Dyspnea screening

Dyspnea treatment

Patients treated with opioids who are given a bowel regimen

ranked—before rankings were published. CMS, however, will take steps to improve the site’s rankings. Officials say new data from a Consumer Assessment of Healthcare Providers & Systems Hospice survey will be added to the website next year. This, they say, should differentiate the providers more accurately.

More than three-quarters of the hospices on the website scored over 90% on six out of the seven quality measures, which raises questions about the efficacy of the ratings. One concern is that the providers listed on the site were given time to familiarize themselves with the quality measures by which they’d be

For now, experts caution against placing too much faith in the site’s data. In the September 2017 issue of McKnight’s Long-Term Care News, Karl Steinberg, M.D., who works with the National Quality Forums on quality measures, said the ratings should be taken “with a grain of salt.” ●

underwent minimally invasive eye scans to detect amyloid deposits at the back of the eye. Amyloids are the proteins found to be linked to plaque buildup in the brain, which is indicative of Alzheimer’s.

crosses the blood-brain and blood-retina barriers to light up any amyloid deposits present.

Mind’s Eye There’s a new screening test for Alzheimer’s disease

Those thought to be at risk for Alzheimer’s currently undergo invasive, expensive brain scans to detect its presence. A new eye scan could change all that. In a study published in JCI Insight, 16 research patients

Patients drank a solution containing curcumin (a substance found in the spice turmeric). The substance’s natural fluorescence

Researchers hope this retinal imaging could be used to more affordably and comfortably detect early risks of Alzheimer’s. At the least, it would help determine who needs the traditional brain scans and who may be able to forgo the expense and hassle. ●


Upfront Healthcare // November 2017

RENOVAT YOUR REHAB How—and why—to adapt your building to support subacute care


TING

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Upfront Healthcare // November 2017

MAKING YOUR BUILDING SUBACUTE BY J O H N W. B AU M G A R T E N

John Baumgarten, R.A., AIA, LEED AP, is president and founder of the firm of John W. Baumgarten Architect, P.C., an award-winning, full-service architectural firm serving proprietary and not-for-profit healthcare and senior care organizations. JWB specializes in the master planning of complex phased nursing home modernization projects, providing an integrated approach to architecture, interiors and engineering. Mr. Baumgarten has more than 30 years of experience working in the field of healthcare architecture. One of his greatest assets is the ability to see “the total project” and to integrate program, budget, infrastructure, and aesthetics to produce a unified and cohesive design that is approvable, buildable, and beautiful. Learn more at JWBArch.com. As a senior care professional, you have probably been spending a good part of your time in recent years dealing with wave after wave of changes in the managed longterm care environment (MLTC). You have no doubt become expert in negotiating contracts with ACOs and in fighting the “Battle of the Bundle Your focus has been on getting your organization motivated and trained to handle heavier care and subacute residents. So you and your organization are ready…. Is your building ready?

YES, YOUR BUILDING!

A heavier case mix requires more “care area” (more square footage per resident) than a baseline geriatric census. Depending on your ACO contracts and/or care plans, your building’s infrastructure and systems may also need to be modified to support subacute care. Regulatory changes and market forces that parallel MLTC are also impacting your building and its bones.  I will discuss these impacts across the full breadth of a typical LTC Center

Building starting with where the first impression of your organization is formed: at the curb. AT THE CURB

Upgrading your building’s curb appeal is not mandatory, and your ACOs in most cases could care less what your building looks like. You most likely are not going to get “better rates” if you dress up your building’s facade. So why do it? My clients who upgrade their facades and public spaces do it essentially for one reason: branding.  Although the MLTCs/ACOs


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are dictating when a resident with a hip or knee is eligible for a subacute stay, your residents and their families still have a choice, and you want them to choose your organization. One of our more typical “curb appeal”

upgrade just the main entrance facade of your building. This gives you curb appeal where it counts the most. We strongly recommend that our clients replace their windows in conjunction with an EIFS upgrade as this allows for waterproofing materials to be wrapped behind the window for a better installation.

“Clients upgrade their facades and public spaces essentially for one reason: branding.”

PHOTO: JOHN W. BAUMGARTEN ARCHITECT W ITH ICON INTERIORS

BROOKSIDE HE ALTHCARE & REHABILITATION CENTER.

upgrades is a lobby renovation that also includes a nicely appointed family room as an extension of the admissions suite. Fireplaces, wet-bars, flat screens, and comfort seating are typical amenities in this family lounge. A facade upgrade is a big commitment, but can go a long way in improving your customer’s perception of your organization and its brand. The most common approach to sprucing up your building’s exterior is to “re-skin” it by applying an exterior insulation and finish system (EIFS). EIFS is essentially synthetic stucco applied over a rigid foam insulation board and a plastic mesh. EIFS comes in an almost infinite number of colors and can be sculpted into many forms and shapes, giving your architect the design flexibility to present any number of motifs for you to consider.   A good balance of budget and aesthetics is to

IN THE GYM

Your rehab suite is the engine of your subacute program. Rehab residents want to feel that they are working out in a health club instead of being treated in a nursing facility.  In some cases, we are more than doubling the size of rehab areas with a focus towards providing activities of daily living (ADL) suites that have the look and feel of a onebedroom apartment. Exercise areas are ample, open spaces with natural light that allow flexible treatment layouts with larger equipment and systems such as driving simulators and Zero-G.  In some instances, owners “go to the

next level” by installing a therapy pool, which almost always requires a physical addition to the building to house the pool, changing/toilet areas, and sophisticated dehumidification/ ventilation equipment. Extending the therapy program to the outdoors is also a popular upgrade. In this case, a driving simulator can be replaced with an actual car. Outdoor ADL elements include; ramps, curb, stairs, crosswalks, multiple walking surfaces, a therapy garden, and even a putting green. ON THE UNIT

Subacute impacts on resident units are driven by a combination of MLTC, regulatory requirements, and market forces. The vast majority of existing LTCs predate the Americans with Disabilities Act. As a result, most LTCs are not very wheelchair-friendly.  Given the influx of short-term rehab residents with mobility issues, accessibility upgrades are a practical matter as well as an ADA issue. Widening doorways and lowering


Upfront Healthcare // November 2017

nurse/reception station counter heights are readily achievable ADA modifications. Enlarging toilets and tub rooms however, are more costly upgrades that are also logistically more difficult to achieve.

From a market perspective, short-term rehab residents prefer private rooms, and a dedicated gym that is not part of the LTC geriatric program. WiFi, flat screen televisions, tablets, and in-room telephones are expected amenities.

Many LTCs get more “bang for their buck” by linking resident room ADA upgrades with a bariatric program. In these cases, we are also adding overhead lifts to better facilitate bed and toilet transfers.

Tub rooms are being transformed into spa rooms with glass tile accents, teak benches, and aromatherapy. Rehab residents also want a variety of amenity spaces such as libraries, game rooms, and Internet cafés.

A growing short-term rehab program also triggers the need to upgrade staff areas on resident units to handle the larger volume of admissions and discharges. We frequently are called upon to replan clinical core spaces more efficiently, taking advantage of codepermitted functional overlaps to create more charting and office space.

Depending on your case mix, your LTC may also be caring for respiratory residents. Operationally, it may be clinically necessary to install piped medical gases (oxygen, suction, air).  Committing to a medical gas system most likely will trigger some level of upgrade to your emergency power system as critical care power must be on a dedicated branch of the

“emergency tree.” Added emergency power demand may also trigger an upgrade to your emergency generator. Architecturally, respiratory units require more private rooms for infection control and most often require tub room alterations to allow for the installation of recumbent tubs. Getting your building “subacute ready” requires a thoughtful linkage of your case mix and care plans with the intended renovations to ensure maximum effectiveness. Working with an experienced senior care architect who can also recommend quality contractors is key to a successful renovation. ● 


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BEAUTY QUEENS BY I DY A P P E L

There’s nothing anti about aging, even though mass media will have us believe otherwise. The perception the media sells is that youth, beauty, fast-paced action and a simplistic persona are reality, and we buy it. All the time. But this constant emphasis on anti-aging has a real, negative, and even harmful impact on the aging and elderly in American culture.

their needs for a positive self-image entirely.

Across the board, media outlets like television, advertising agencies, newspapers, and magazines, devalue or even ignore the elderly population entirely, dismissing them as an audience or consumer base. But who says they won’t buy? Who decided that a 79-yearold woman doesn’t want to look and feel pretty or that an 83-year-old man doesn’t care to look stately and well groomed? Have we become that superficial that we not only underappreciate the wisdom and life experience the elderly offer us, but we have also gone so far as to dismiss

Each Salon PS is unique, but the same high standard of commitment and passion is shared by the professionals who operate the salons. Highly skilled hair stylists, manicurists and licensed massage therapists undergo specialized training on how to conduct themselves in an assisted living or nursing home facility. Their goal is to indulge the residents in an experience of elegance and beauty.

Thankfully, there are individuals who intrinsically understand the value of positive self-image in the elderly population and have created enterprises to fulfill that need. Salon PS LLC partners with leading resident communities to deliver high quality salon services to residents in more 250 locations across the United States. They are committed to providing unparalleled service to seniors in their care facilities.

Generations Salon Services is another company that provides on-site salons to 300 facilities nationwide.


They are committed to serving the residents’ best interests and do so by staffing local, licensed beauticians who work well with a mature clientele and who are experienced with seniors’ needs and preferences. Their tagline is “It would be an honor to help enhance what is already a wonderful senior living experience!” On -site salons are definitely a selling point for families and seniors seeking to join resident communities.

Seventy is the new fifty and, yes, seniors do care about how they look and present themselves. When asked if beauty matters at any age, 94-year-old Judith Mittelman, a Holocaust survivor and great grandmother of many, responds, “I feel dignified and important when I wear makeup and have my hair done. At this age, it’s not the only thing I care about, but it certainly matters. When I’m well groomed, I notice that people treat me differently. They show more respect.

I try very hard to look presentable so that when my grandchildren come with their children to visit, they see that grandma is beautiful and dignified. This is very important to me.” Many may still search for the fountain of youth but until it is found, let’s embrace the aging process and the delicate beauty and grace that it brings, and let’s help our seniors look their best at any age. ●


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Upfront Healthcare // November 2017

Learn how doctors’ offices, hospitals, long-term care facilities, and other healthcare providers are entering patients’ homes, enriching their lives, and improving outcomes—without ever taking a step inside. Remember the good old days when a local doctor would be summoned directly to a person’s home? A friendly face would show up promptly, tend to the sick family member, write a script and provide warm reassurance before disappearing into the night. The memory waxes nostalgic for most, but in reality, the idea of true personal care is a distant dream of the past. Today, patients are met with crowded waiting rooms, hard-to-reach doctors and medicine dictated by insurance companies. No more familiar smiles. No more neighborly advice. This dismal portrait of American healthcare has become the stereotype. And as technology advances, people assume the problem is getting worse. To save time and resources, facilities are trading in live consultations for online forms. The sign that used to read “walk-ins are welcome” is now “schedule your appointment online.” But what if we told you this bleak vision of today’s doctors’ offices, urgent care facilities and nursing homes is not only exaggerated—but also completely mistaken? What if there was a way you could harness technology to deliver prompt, personalized care as easily and effectively as the cherished house call of

yesteryear? REMOTE ACCESS IS ROCKING HEALTHCARE

Ironically, as technology advances at breakneck speed, telemedicine (also known as telehealth, virtual healthcare, or e-health) is bringing us back to a time when we never had to leave our homes to get a professional opinion. These cutting-edge tools are enabling doctors and practitioners to assess, diagnose, and treat patients of all ages—and all around the globe— in real time, using a variety of two-way technologies for communication. The cold, sterile instruments a doctor once drew from his black leather bag have been replaced with digital software, examination cameras, and connective programs like Skype and Facetime. For nursing homes and long-term care facilities, these capabilities are revolutionary. Thanks to mobile medical devices and streaming technologies, patients with chronic diseases can have their blood sugar levels, blood pressure, and vital signs monitored from the comfort of their bedsides. The data can then be stored and reviewed remotely by doctors and other caregivers, saving precious time, and in many


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“WTELEMEDICINE HILE THE PRACTICE OF IS STILL

IN ITS INFANCY, THE TECHNOLOGY ITSELF IS NOT. IN FACT, YOUR FACILITY MAY ALREADY HAVE MUCH OF THE CORE EQUIPMENT IN PLACE.


Upfront Healthcare // November 2017

cases, avoiding unnecessary admission to the hospital. Best of all, tools for telemedicine are widely available. So, why are they so underused? THERE’S A HEALTHY SUPPLY OF NAYSAYERS

Whether care is happening in a private home or long-term care facility, patients and their caregivers all have access to the Internet, smartphones, tablets and other devices capable of administering various monitoring and diagnostic technologies. The problem, therefore, isn’t access. For many, the fear is that the equipment

THE NAYSAY ER S:

Unless you’re observing a patient’s symptoms in person, how can you really know? and programs are unreliable. Unless you’re touching a person’s forehead, feeling their pulse, and observing their symptoms in person, how can you really know? As telemedicine becomes more widespread, governing agencies are looking to ease these concerns by

calling for legislation and an updated code of ethics. The American Medical Association (AMA) states that, although models of care will continue to change and emerge, the ethical responsibilities of physicians have not. To that end,


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hospitals, clinics, nursing homes, and insurers are responsible for developing policies that uphold the ethical guidance of organizations like the AMA and the American Telemedicine Association. In addition, they are responsible for making sure that their telemedicine software complies with HIPAA regulations. In short, there are protocols in place to safeguard the integrity of telemedical practices. Time will tell whether facilities are willing and prepared to adhere to them. TAKING ADVANTAGE OF THE TREND

Many of today’s skilled nursing and long-term care facilities are starting to recognize the use of telemedicine as a vital component to their future success and sustainability. Groups like TripleCare of Long Island City are dedicated to bringing these crucial technologies to geriatric and acute patient populations. Noticing the lack of after-hours care at many local facilities, the company’s founders decided to fight back against the “revolving door between hospitals and nursing homes.” Today, institutions of all sizes turn to companies like TripleCare for help integrating telemedical solutions into their everyday practices. Not so tech savvy? No problem. By working with a telemedicineenabled physicians group, facility administrators can improve patient outcomes, boost revenue, and increase their census, among other valuable benefits. Here’s a brief look at how these programs can maximize your facility’s potential.

HOW TELEMEDICINE IS TRANSFORMING THE FACE OF HEALTHCARE 1. The remote convenience is undeniable. Healthcare professionals

on staff can communicate and consult with specialists via phone and video, thereby keeping residents safe and comfortable in their quarters. This remote access also cuts down on the lost time and expenses associated with traveling to another location. Eluding the unnecessary trip to the hospital is always a plus, but many skilled nursing facilities are also using these technologies for other routine procedures. For instance, instead of transporting patients to a specialist’s office for their regular checkup, staff can facilitate care with today’s top physicians by relaying information right from their rooms. 2. Who doesn’t want a competitive

edge? Patients and their families

look primarily for quality care when choosing a facility, with convenient care being an added bonus. If your facility offers telemedicine, you gain a leg up by meeting both of these contemporary requests. Although the practice of telemedicine is still in its infancy, the technology itself is not. In fact, your facility may already have much of the core equipment in place. Enabling innovative communication between patients and their caregivers is not only expedient, but also extremely desirable. With the millennial generation stepping up to support older parents through

their golden years, it’s smart to cater to their technological savvy in any way possible. Not to mention, telemedicine is great for care coordination. 3. The savings are exponential.

According to a report published by Health Affairs, the average savings to Medicare for a nursing home that uses telemedicine is $151,000 annually. Since the average cost of telemedicine for a single nursing home is around $30,000, the real number of savings would be approximately $120,000 per year. Other studies show that telemedical tools help practices cut back on missed appointments, which can cost American offices upwards of $150 billion annually. If you also account for travel expenses, the cost of organizing, and housing paperwork, as well as funding overhead, it’s clear that everyone wins when technology works its magic. 4. Experts are always on call. When

conducting a web meeting through WebEx, GoToMeeting, Skype, or Facetime, patients have almost zero cost, while physicians pay only a small monthly fee. Not to mention, access is everything.

For years, individuals had to travel miles to the nearest big city in order to receive the best care. That means an elderly nursing home resident living

Today, onceunreachable leading professionals are just a videoconference call away.


Upfront Healthcare // November 2017

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on the shores of Long Island would have to suffer through hours of traffic to reach a specialist in Manhattan. Today, that leading professional is just a videoconference call away. 5. Hospital-ready equipment comes home. In past decades,

patients had no choice but to be admitted to the hospital in order to monitor their vitals. Beyond its role in communication, telemedicine also brings patients life-saving monitoring devices, which can be used in the home or in long-term care facilities. This revolutionary equipment observes and records data just like the modern machinery you’d encounter at a world-class hospital. But instead of live nurses making their rounds, the devices send the clinical data back to a centralized online location where professionals may access it at any time. This practice has proven to improve patient outcomes, especially for facilities short on staff hoping to prevent patient readmission. 6. Residents are connecting in new

ways. Maintaining a high quality of

care is always integral to a facility’s success. But do you ever find that your patients are experiencing other issues unrelated to their physical health? We’re not talking about mental illness, but a longing for friendship and camaraderie beyond the walls of your facility. Today, there are so many online social media tools at patients’ disposal. Introducing residents to these resources can help them connect to other people across the country who may be experiencing the exact same issues as they are. Forming these support groups can be crucial to your community’s morale.

7. We’re breaking down barriers.

For so long, underserved and underprivileged communities have been denied access to healthcare due to a variety of factors. Whether it’s a language barrier or something as simple as lack of transportation, patients suffer when they can’t get help in a timely fashion. By embracing telemedicine, your facility can eliminate some of these obstacles for patients of all cultural and socioeconomic backgrounds. A nominal fee will grant them access to diverse professionals that may be unavailable to them for whatever reason, be it financial, geographical, or otherwise. 8. Hospitals are loving it. A keen facility administrator knows how vital it is to have a strong relationship with referring hospitals and urgent care facilities. In order to set your operation apart in the oversaturated marketplace, it’s important to show that you’re taking active measures to improve clinical outcomes and increase communication.

The most prominent hospitals in your region cannot be bought or bribed. Instead, you must impress them with advanced technological understanding and top-notch resident care. Incorporating telemedicine is just the first step in forming a long-lasting partnership with the facilities that can send you quality patients. 9. Staff gets the support they need.

No matter the size of your skilled nursing facility, staff can feel isolated at times. As your nurses and caretakers work hard to keep operations humming, they can lose sight of what matters most: ongoing education and healthy, meaningful collaboration and

communication with their peers. When working with telemedical tools such as remote conferencing, nurses report greater satisfaction with their jobs and have been shown to administer an all-around superior level of care. In particular, late-night workers often become frustrated and disillusioned; but with better access to experts via technology, they’re rediscovering their love for the profession. 10. More beds filled = more money saved. Although running a long-term care facility is endlessly rewarding, it’s also incredibly difficult to stay in the green when your patients are in and out of the hospital. Telemedicine helps you protect those precious dollars by supporting your operation in all of the aforementioned ways.

In fact, as TripleCare claims, “the service typically pays for itself after a single readmission is prevented each month.” Facilities facing severe financial crises may think they cannot afford to even entertain the notion of integrating new technologies. But in reality, telemedicine is coordinating care while cutting costs in the process. Nursing homes are always looking for ways to improve patient care as well as reduce the number of hospitalizations. Potentially avoidable readmissions are a huge waste of resources and expose residents to completely preventable health risks. Meanwhile, the problem of understaffing—especially after hours and on weekends—continues to be a significant source of facility conflict. The Kaiser Foundation predicts that together we can avoid nearly 70% of hospitalizations by adopting telemedical practices. ●


Upfront Healthcare // November 2017

Food for Thought How an on-staff dietitian can provide a fresh viewpoint about your residents’ nutrition BY I DY A P P E L


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It’s no secret the baby boomer population is aging, and they are aging in large numbers. In 2010, the World Health Organization (WHO) and the National Institute on Aging (NIA) estimated the world’s population of people ages 65 and older at 8%. By the year 2050, that number is projected to triple. In developed countries like the US, that translates into a 75% increase. It may be hard to believe, but in the next few decades there will be more centenarians being cared for than children. As nursing home facilities expand to accommodate this boom, special attention must be paid to the dietary needs of each resident. A properly monitored diet can help ensure that the senior does not become malnourished or vitamin deficient. Good nutrition also affects the ability for a senior to heal from a medical condition and promotes their overall emotional well-being. Federal law mandates that facilities staff a qualified dietitian either full/part time or on a consulting basis. Nutrition consulting firms are cropping up nationwide and facilities are turning to them to ensure that their patients’ daily dietary and nutritional needs are being met. A few of the benefits of hiring a nutrition consultant versus

employing a dietitian on staff are: • Access to a network of professionals with experience in the clinical and food service industry. • Elimination of employee benefit costs like paid vacation, paid maternity leave, 401K, paid sick leave, paid vacation, workers compensation, liability costs and employee tax. • Filling part time, temp or prn positions. On the other hand, a full-time dietitian may be able to: • Be more in tune to patients’ ever-changing needs and closely observe how they react to adjustments made to their daily diet plan. • Spend more time giving educational workshops to facility staff members and caregivers. • Develop relationships with the patients’ entire health team, making him or her feel supported and cared for in the environment Today, financial considerations drive our healthcare system more than ever. Management is tasked with weighing the cost benefits of adding personnel to their facilities. Dietitians and nutrition consultants have to demonstrate that they can deliver premium services while reducing costs. Meanwhile, administrators must recognize their value and what they bring to the table—literally. Elaine Farley-Zoucha, president and owner of EZ Nutrition Consulting, PC in Columbus, Nebraska, shares her

perspective on the value of a nutrition consultant. “As a consultant, we are often able to focus more on the resident because we are not being pulled in as many directions as a full-time, on-staff person. Because we aren’t in any one facility on a daily basis, when we do come in either weekly or bi-weekly, we see our clients through a fresh pair of eyes. This enables us to provide them with very targeted, objective clinical assessments and nutritional interventions. Additionally, we are able to zero in on food safety and sanitation which helps the facility uphold all federal and state regulations that govern the daily operations of the food service department.” When asked if her team of registered dietitians and food service directors is able to maintain close relationships with the residents they serve, Ms. Farley-Zoucha responded in the affirmative. “We build relationships with residents during our visits by doing resident interviews and being present during meal service. This allows us to observe eating patterns or behaviors, address concerns with feeding, and make better recommendations for the resident.” Undoubtedly, the common goal of all nursing home staff both on and off site is to help the boomers transition into the next period of their lives seamlessly and in the best health possible. After all, don’t they deserve the best that their golden years have to offer? ●


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THE MUSIC OF MEMORY BY I DY A P P E L

“Music is moral law. It give soul to the universe, wings to the mind, flight to the imagination and charm and gaiety to life and to everything.” -Plato Music is a universal language understood between men and women, rich and poor, young and old. However, it is the elderly who uniquely benefit from its powerful impact. A few years ago, Henry, an elderly Alzheimer’s patient, became an online star when millions of viewers watched him burst out in song after first seeing him unresponsive and hunched over. His story and many similar stories are captured in the documentary Alive Inside, which follows Dan Cohen, a social worker who created playlists for people in nursing home facilities. He set out to show the world the strong link between music and memory. In a recent study, researchers took a sample of dementia patients and led half of them through a

singing session of selected classical songs while the other half listened to music being played. After the music therapy, cognitive and life satisfaction tests were administered to all the participants. The participants who sang actually scored higher than those who only listened, but one thing was crystal clear: Music had an amazing impact on brain activity and function. Much like you go to the gym to firm up your body, music is exercise for your brain. Here are a few effects that music has on an elderly patient’s brain: • Music evokes emotion, and that emotion brings back memory to even the most advanced Alzheimer’s patient. When seniors listen to music while performing everyday activities, they develop a rhythm that helps them recall the memory of the activity. Over time, this improves their cognitive ability. • Music aptitude and appreciation are the last remaining abilities in Alzheimer’s patients. Because of that, family and caretakers have a

way to still reach their loved ones even when the disease has robbed them of their cherished memories. • Through music, dementia patients can connect emotionally with their loved ones. Music is an invitation to dance which leads to physical closeness and touch. This connection bring a sense of security and memories. • Music reduces stress and anxiety; significantly lowers heart rates, blood pressure, and pain; and overall increases self-esteem, mood, sleep quality, mental alertness, and, as demonstrated above, memory. Music and Memory is a not-for-profit organization committed to bringing music into the lives of the elderly in nursing home facilities through digital music technology. When he realized that none of the 16,000 long-term care facilities in the US used iPods for their residents, Founder and Executive Director Dan Cohen created playlists for the residents of local nursing home. Needless to say, they were a big hit, but


it was only the beginning. Since 2010, Music and Memory has implemented personalized iPod music programs in hundreds of long-term care facilities across the nation and the world. Wisconsin was one of the first states to launch a Music and Memory Initiative, which enabled 100 nursing homes throughout the state to become Music and Memory-Certified Care Organizations. Many states have

followed which broadened the program significantly. Through ongoing research, results of the program consistently show that participants are happier and more social; they have better relationships with the nursing home staff, everyone enjoys a calmer and more supportive environment, and the staff spends less time on behavior management.

The program implementation has been met with widepsread enthusiasm and success. It’s incredible to think how something as simple and inexpensive as an iPod can bring so much joy and connection to the hearts and minds of the elderly population. Then again, it’s the music within that changes their lives one note at a time. �


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