scholarly journals Dying in U.S. Nursing Homes with Advanced Dementia: How Does Health Care Use Differ for Residents with, versus without, End-of-Life Medicare Skilled Nursing Facility Care?

2012 ◽  
Vol 15 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Susan C. Miller ◽  
Julie C. Lima ◽  
Jessica Looze ◽  
Susan L. Mitchell
Keyword(s):  
Health Care ◽  
Nursing Homes ◽  
End Of Life ◽  
Skilled Nursing Facility ◽  
Health Care Use ◽  
Advanced Dementia ◽  
Nursing Facility ◽  
Skilled Nursing

Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

1999 ◽  
Vol 27 (2) ◽  
pp. 203-203
Author(s):  
Kendra Carlson
Keyword(s):  
Health Care ◽  
Supreme Court ◽  
Health Care Providers ◽  
Elder Abuse ◽  
Skilled Nursing Facility ◽  
Pressure Sores ◽  
Care Providers ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

scholarly journals 4569 Burden of illness in idiopathic pulmonary fibrosis: A real-world cohort

2020 ◽  
Vol 4 (s1) ◽  
pp. 24-24
Author(s):  
Erica Farrand ◽  
Harold Collard
Keyword(s):  
Health Care ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Real World ◽  
Index Date ◽  
Skilled Nursing Facility ◽  
Diagnostic Code ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Outpatient Visits

OBJECTIVES/GOALS: Studying IPF associated health care utilization (HRU) in real world settings, provides the opportunity to produce generalizable results that can directly inform models of care delivery. The objective of this study was to examine real-world differences in the natural history of annual HRU and treatment trends associated with IPF in a large, community-based population of patients with IPF, compared to matched non-IPF controls. METHODS/STUDY POPULATION: Cases of IPF were identified using case validated algorithms in the Kaiser Permanente Northern California adult population from 2000 to 2014. Each case was matched to at least one and no more than five non-IPF controls by age, sex, race/ethnicity and length of enrollment. The date of the first occurrence of the IPF-specific diagnostic code was considered the index date for cases and matched controls. Comorbidity burden and HRU was assessed in the five years pre- and post-index date, including hospitalizations, outpatient visits, use of diagnostic and monitoring studies and medications. Poisson generalized estimating equations models with robust standard errors were used to estimate adjusted case-control differences in HRU, accounting for clustering within matched sets. RESULTS/ANTICIPATED RESULTS: 691 patients were identified with incident IPF during the study period and matched to 3,452 control subjects. Demographics were well balanced between cases and controls due to matching. Patients with IPF had a higher burden of all selected co-morbidities and higher HRU compared to controls. In the pre-index period, IPF members had significantly higher rates of all diagnostic procedures (p < 0.001) and health care visits, with the exception of skilled nursing facility care (p < 0.001). The greatest relative difference was observed with use of Chest CT (RR = 245.94, 95% CI 117.04, 516.82). In the post-index period compared to controls, patients with IPF had higher rates of serial testing (p < 0.001) and inpatient and outpatient care including, all-cause hospitalization (1.55), emergency room visits (1.19), outpatient visits (1.18), and skilled nursing facility stay (1.35). DISCUSSION/SIGNIFICANCE OF IMPACT: Patients with idiopathic pulmonary fibrosis experience increased co-morbidity and healthcare resource utilization compared to controls. This increased burden extends beyond the index-period as previously documented and is true for a large real-world cohort. CONFLICT OF INTEREST DESCRIPTION: NA

Fluvoxamine for Stereotypic Behavior in Patients with Dementia

1997 ◽  
Vol 31 (5) ◽  
pp. 578-581 ◽  
Author(s):  
Brian Trappler ◽  
Luis M Vinuela
Keyword(s):  
Primary Care Physicians ◽  
Involuntary Movement ◽  
Skilled Nursing Facility ◽  
Advanced Dementia ◽  
Psychiatric Consultation ◽  
Alzheimer Type ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Noticeable Improvement ◽  
Primary Physicians

OBJECTIVE: To describe the effects of treatment with the selective serotonin reuptake inhibitor fluvoxamine on three patients with advanced dementia who developed a stereotypic movement disorder. CASE SUMMARY: Three patients in a skilled nursing facility were referred by their primary physicians for psychiatric consultation to assist with the management of stereotypic behaviors. The patients received a standard medical, neurologic, and psychiatric workup for dementia. Two of the patients were diagnosed with dementia of the Alzheimer type and the other patient was diagnosed with vascular dementia. All three patients were started on fluvoxamine 25 mg/d; behaviors were monitored daily by the nursing staff and their primary care physicians and weekly by their psychiatrist using the Abnormal Involuntary Movement Scales. The dosage was titrated upward weekly to a maximum dosage of 150 mg/d. RESULTS: Two patients showed complete resolution of their stereotypic behaviors by week 6. The third patient showed noticeable improvement with some residual movements after 8 weeks of treatment. CONCLUSIONS: Fluvoxamine appeared effective in the control of stereotypic behaviors in three patients with advanced dementia.

Home Health Care for Adults: A Tutorial for SLPs

2013 ◽  
Vol 18 (1) ◽  
pp. 7-13
Author(s):  
Megan L. Malone ◽  
Jennifer Loehr
Keyword(s):  
Health Care ◽  
Acute Care ◽  
Home Health Care ◽  
Outpatient Treatment ◽  
Skilled Nursing Facility ◽  
Home Health ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Speech Language Pathologist

Today, the settings in which a speech-language pathologist (SLP) can practice are as varied as the patients served. From the skilled nursing facility to outpatient treatment to acute care, SLPs provide services in more settings than ever before. One setting that is growing in need is the home health setting. The home health setting provides many benefits to an SLP and to the patients receiving services.

scholarly journals Challenges when caring for end-of-life patients with advanced dementia and pain: A qualitative study in Swedish nursing homes

2019 ◽  
Author(s):  
Tove Godskesen ◽  
Emma Lundin
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Nursing Homes ◽  
End Of Life ◽  
Care Staff ◽  
Health Care Staff ◽  
Common Symptom ◽  
Advanced Dementia ◽  
Good Communication ◽  
Individual Interviews

Abstract Background Of Swedish people with advanced dementia, the majority dies in nursing homes. Pain is a common symptom in patients at the end-of-life, and patients with advanced dementia often experience suboptimal and inadequate pain management. Compared to cancer patients, they receive fewer palliative care interventions. Although being largely responsible for the care of these patients, few studies address the experiences of registered nurses. Therefore, this study aimed to describe nurses' experiences of caring for end-of-life patients with advanced dementia and pain. Methods This study had a descriptive and explorative design. Individual interviews with thirteen nurses from twelve nursing homes in Sweden were qualitative and semi-structured. The content was analysed through inductive content analysis. Results Nurses described communicative, relational and organisational challenges. A major issue was difficulties to communicate with the patient, resulting in uncertain pain assessments. Other difficulties were to separate pain from anxiety, to balance benefits and risks in morphine administration, and to create good relationships with health care personnel and relatives. Relatives could greatly influence the assessment and management of pain, both as interpreters of pain behaviour and by questioning the care given. Facilitators of good pain management were good communication and relations with health care staff and relatives, having extensive professional experience, and knowing the patient.Conclusions This study highlights the need for nursing homes to employ specialist-trained nurses, who have the appropriate knowledge and skills to deal with the challenges in caring for end-of-life patients with dementia and pain. Additionally, there should be resources and strategies available for providing information to patients’ family members and for involving them in the decisional process, as they are often unfamiliar with the multitude of considerations involved in decisions such as whether to administrative morphine or not.

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