Potentially harmful medication administration errors are very rare in assisted living settings, the result of a study of 12 facilities in three states suggests.

Assisted living facilities are a less expensive alternative to skilled nursing facilities, offering residents more independence and a homier environment. Medication errors are a concern in these settings, lead investigator Dr. Heather M. Young of Oregon Health and Science University in Ashland and her colleagues say, because aides with no licensing or professional training are typically charged with distributing drugs to residents.

To investigate the prevalence of medication errors, the researchers observed 29 unlicensed assistive personnel giving out medications to 510 assisted living residents at facilities in New Jersey, Oregon and Washington. They watched 56 “medication passes,” including both day and night shifts, for a total of 4,866 observations.

Young and her team observed 1,373 errors, for an error rate of 28.2 percent. But 70.8 percent of the errors were time-related, meaning a patient didn’t get a drug within an hour of the scheduled dosing time. Once time was removed from the analysis, the error rate was 8.2 percent.

Other causes of errors included wrong dose (12.9 percent), skipped dose (11.1 percent), extra dose (3.5 percent), unauthorized drug (1.5 percent) and wrong drug (0.2 percent),Young’s team reports in the Journal of the American Geriatrics Society. Only three of the errors observed had potential clinical significance, according to the researchers, and none of the errors were considered “highly likely to cause harm.”

None of the time-related errors involved giving medications for which timing was crucial, such as insulin. Because medication is typically given out to assisted living residents twice a day at a standardized time, the researchers say, “a high number of wrong-time errors is not surprising, and given the lack of clinical significance of the errors observed, is probably not a meaningful indicator of quality.”

The researchers did find that errors were more likely to occur with riskier medications, like insulin or the blood thinning drug warfarin, which are typically given to patients “in less stable and predictable conditions.”

They suggest that prioritizing the administration of high-risk drugs, as well as the care of patients with more complex health issues, could help prevent serous medication errors and improve the quality of care.

State funding cuts that affect about 120 assisted living facilities in Maine that care for 4,000 needy residents couldn’t have come at a worse time, the head of the Maine Health Care Association said.

MHCA President Richard Erb said the cutbacks, which took effect Aug. 1, stunned members of his organization. The association represents more than 300 providers of assisted living and residential care services, as well as nursing care, rehabilitation and other services.

“This is probably one of the strongest reactions I have seen from our members to any policy change. It began with confusion and became mixed with frustration, and anger, I would have to say,” Erb said.

The state Department of Health and Human Services cut funding that was being paid to assisted living facilities’ operators to ensure that residents with illnesses would not lose their beds during periods of prolonged hospitalization.

Erb, who has been trying to help those facilities deal with rising fuel and food costs, said that when the Legislature adjourned in April, he understood that most bed-hold costs resulting from hospitalizations of up to 30 days would be reimbursed.

Erb told Maine Public Radio that he’s not aware that any of the 4,000 Mainers who live in the assisted living facilities classified by the state as private, non-medical institutions will lose their beds as the result of the policy change.

However, he added that those facilities, known as PNMIs, are under a huge amount of pressure to retain staff while facing rising food and fuel costs. Erb said he questions whether some of the assisted living centers will be able to continue to hold residents’ beds as they face the potential loss of as much as $77 a day per patient that was formerly reimbursed.

DHHS Commissioner Brenda Harvey said the state has tried to help the assisted living centers by increasing payments by $1.52 per-day-per-resident along with some boarding costs. Harvey said she had been under the impression that Medicaid would continue to reimburse the state for its bed-hold expenses.

Nursing homes are increasingly evicting residents to help their bottom lines,according to an analysis in The Wall Street Journal. The Journal admits there is no agency tracking nursing home evictions in the U.S.

Complaints of improper evictions have doubled over the last decade to 8,500 in 2006. Those at greatest risk of being kicked out depend on Medicaid, according to the Journal, which reimburses nursing homes at roughly half the rate of Medicare. In lieu of these low-income residents, homes are opting for short-term residents whose visits are fully paid by Medicare for up to 100 days, the newspaper found. The nursing home industry, in responding to the allegations, said evictions are not common and when they occur, they happen for legitimate reasons, the newspaper reported.

Federal law requires a home give a resident at least 30 days notice before evicting him or her, and allows for only six possible reasons for eviction: they are healthy enough to return home; they require care not offered at the nursing home; they risk the health of other residents or staff; they endanger the safety of other residents or staff; they do not pay their bills; or the nursing home closes. The Journal asserts that, in many states, up to one in seven evictions does not meet those criteria.

To read the Wall Street Journal Story, visit http://online.wsj.com/article/SB121806702698918693.html.

The American Association of Homes and Services a nursing-home association is calling for an independent panel to come up with new methods for overseeing nursing facilities. The association’s task force issued 31 recommendations Tuesday, highlighting steps that can be taken until such a panel can be convened.

“The frustration of good providers has reached a boiling point,” said Tim Veno, executive director of the Kentucky Association of Homes and Services for the Aging, and a task force member. On Tuesday, the American Association of Homes and Services for the Aging (AAHSA) issued its report, “Broken and Beyond Repair: Recommendations to Reform the Survey and Certification System.”

 ”Our short-term suggestions alone won’t bring the system back to the intent of OBRA 87-achieving optimal, quality-based, resident-centered care-but they will tide the system over until broad systemic change can occur,” said Bonnie Gauthier, CEO of Hebrew Health Care in West Hartford, CT, and co-chair of the 20-member task force. Immediate changes needed, according to report authors echoing years-long provider sentiment, include better public reporting of survey results, joint education of providers and surveyors, and greater overall consistency in the process.

The senior living industry is booming as it caters to wealthy seniors who are unable to continue living at home, yet do not require the intensive medical care provided in nursing facilities. A newly published report from Kalorama Information, ‘Long-Term Care Markets,’ details the transformation occurring in this $67.5 billion segment of the long-term care market and the factors that should lead to over 12% annual growth through 2012.

Several factors are contributing to this boom: the elderly population is growing at double or triple the rate of the overall U.S. population; today’s seniors want to remain active and as more of them retire with increased net worth, they can afford upscale assisted living facilities offering a broad range of amenities; facilities continue to open specialized communities that provide care designed for residents with mental illnesses, developmental disabilities, dementia and Alzheimer’s disease. In addition, the increased promotional efforts of assisted living and adult communities are leading to a shift in cultural norms and the stigma once associated with institutional living is slowing dissipating.

Unlike other long-term care facilities, assisted living is almost completely supported by private payments and residents typically meet the costs by selling their primary residence. However, managed care is becoming more involved, since nursing home care costs about double that of assisted living. Also more long-term care insurance plans are adding assisted living coverage, which should further spur growth.
“Ongoing cost containment has moved the market away from nursing home care in favor of assisted living and home care services, though all segments have experienced growth due to the general aging of the population,” notes Kalorama Information’s publisher, Bruce Carlson. “This trend will continue as pressure to reduce costs remains strong for managed care, Medicaid and Medicare.”

Kalorama Information’s report ‘Long-Term Care Market’ reviews and analyzes this increasingly important market in the U.S., covering four main segments: nursing homes, home healthcare, hospice care and assisted living. Market indicators, estimates, forecasts through 2012, a competitive analysis and key company profiles are included. For further information visit: http://www.kaloramainformation.com/redirect.asp?progid=11663&productid=1729220 .

A special type of positron emission tomography (PET) scan appears to detect abnormal brain proteins associated with Alzheimer’s disease.

Spotting early brain changes related to Alzheimer’s can be a daunting task. Abnormal proteins called beta-amyloid plaques are a hallmark of the disease, but the only surefire way to examine such changes is to perform a brain biopsy.

A growing body of evidence suggests that PET scanning using a novel brain-imaging agent called Pittsburgh Compound B (PiB) may help offer a definitive diagnose of Alzheimer’s disease in living patients. PET scans reveal functional information about the body, such as blood flow, metabolic problems, and chemical activity. PiB attaches to Alzheimer’s-related brain deposits; it is injected into a vein before the scan.

For the current study, researchers in Finland compared PiB PET scan results to brain tissue samples taken from 10 patients with severe dementia. Each patient’s brain biopsy was deemed medically necessary because they showed signs of abnormal fluid buildup in the brain — suspicious indications of a condition called normal-pressure hydrocephalus (NPH). NPH also causes mind and memory problems, and some patients with symptoms of the condition have brain lesions characteristic of Alzheimer’s disease.

Analysis of the brain tissue showed that six patients had beta-amyloid plaques, a telltale sign of Alzheimer’s disease. Each patient received an injection of PiB through a vein and then underwent a 90-minute PET scan. All patients with the Alzheimer’s-related plaques had a higher uptake of the imaging compound than those without the abnormal proteins. In other words, the brain areas afflicted by Alzheimer’s disease-related changes brightly lit up.

The findings appear online today and will be published in the October 2008 print issue of Archives of Neurology.

Sunrise Senior Living Inc., which filed its 2007 financial results Thursday, posted a $70.3 million loss for the year.

One of the nation’s largest senior living providers also announced it would reduce its growth plans.

The red ink in 2007 for the manager of 445 retirement communities compares to a restated profit of $15.3 million in 2006.

Sunrise expects to file its first quarter 2008 financial report later this month and its second quarter report by Sep. 10.

Citing the current state of capital markets, Sunrise said it would decrease by up to 50 percent its 2008 plan to develop as many as 3,400 living units. The company also set a goal of saving at least $15 million on an annual basis by starting a voluntary separation program for employees while cutting spending on consultants, vendors and administrative costs.

This month, Paul Klaassen said he will step down as chief executive after leading the company for 27 years. Sunrise has been struggling with accounting irregularities and accusations of insider-trading, according to McKnight’s Long Term Care News, an industry trade publication.

Marriage or having a partner cut the risk of developing dementia in half, a new Swedish research study showed.The Swedish study shows the importance of social interaction between couples. Researchers say single middle-aged people are more likely to develop cognitive impairment than their partnered counterparts.

Swedish researchers examined 1,449 Finnish people who were asked about their relationship status in mid-life and then again in 1998, an average of 21 years later. 139 of them had some sort of cognitive impairment, and Alzheimer’s had been diagnosed in 48 of these.

The study highlights a greater risk of developing cognitive impairment for all those who live alone, whether single, divorced or widowed. Social isolation or lack of personal contact also carries an increased risk of dementia and mental decline.

The results of the study were released yesterday at the International Conference on Alzheimer’s Disease in Chicago.

Even after other factors which might have an impact on dementia were adjusted for, researchers concluded that those with partners had a 50 percent lower risk of showing signs of senility in later life compared to those who lived alone. Lonely people had a double risk of dementia. Those widowed at a young age who stayed single faced a six times greater chance to develop dementia.

“Cognitive and intellectual stimulation has been reported to be protective against dementia in general,” said study author Krister Hakansson, of the Karolinska Institutet in Stockholm. “Living in a couple means that you are confronted with other ideas, perspectives and needs. You have to compromise, make decisions and solve problems together with someone else, which is more complicated and challenging. It is probably easier to get stuck in your own habits and routines if you live by yourself.”