As demand for hospice care has increased, so have the number of programs nationwide. Today, there are about 4,700 providers, up from about 3,300 five years ago, according to NHPCO. While the majority of providers are nonprofits, the for-profit sector is growing, accounting for 47.1 percent of hospice agencies last year.

Hospice is intended for any person who has a terminal illness and a prognosis of six months or less to live. Depending on the needs of each patient, care can include pain management, medications, medical supplies and equipment, and assistance with the emotional, psychological, and spiritual aspects of dying. A hospice team usually consists of nurses, home health aides, social workers, bereavement counselors, and clergy, as well as a hospice physician and the patient’s personal physician.

The benefit for Medicare and Medicaid patients is remarkably magnanimous. Medicare pays out $601 per patient per day for inpatient hospice care (and $789 per day for the typical patient who gets 24-hour home care), yet there are no copays, deductibles, or out-of-pocket expenses for the beneficiary. Private insurer hospice benefits offer a variety of hospice services, though they’re typically not as generous, according to the Hospice Association of America. To get Medicare or private insurance to cover hospice care, a patient needs only a physician’s referral. Hospice care is usually provided in the patient’s home. It can also be made available at a special hospice residence designed with a homelike atmosphere, or in assisted living or skilled nursing facilities.

Slipping and falling can cause more than just a cut orbruse.Tumbles are costing Albertans some serious coin.

The province says it wants to change that.Today, it’s launching Finding Balance, an awareness campaign aimed at educating seniors on the importance of leading healthy lifestyles.The program will include lessons on improving health and wellness, as well as tips on making homes safer.

“Those who have cared for parents or grandparents know that as seniors age they are more likely to fall and suffer an injury,” Premier Ed Stelmach said in a news release.

“In fact, falls are the leading cause of injury-related hospital admissions for older Albertans, so this campaign focuses on educating our seniors in avoiding the potentially very serious consequences of losing their balance.”

According to the Alberta Centre for Injury Control and Research, seniors falling cost the Alberta economy almost $88 million in 2003.

At that rate, the figure could swell to $250 million by 2033, the province warns.

In 2006, tumbles led the charge of injury-related hospital visits, officials said. About 20 such admissions were logged in Alberta each day.

Of course, saving cash isn’t the only concern, said ACICR’s associate director.

Kathy Belton said those involved in the initiative will likely lead to a healthier flock of seniors who will be able to enjoy independence and a higher quality of life.

It was recently annoced that The Robert Wood Johnson Foundation, one of the nation’s largest healthcare foundations, plans to award $2.3 million in grants for research to improve the quality of nursing care in America. Grants of up to $300,000 will be given to eight research projects as part of the foundation’s Interdisciplinary Nursing Quality Research Initiative, a program designed to produce and collect information on how nurses contribute to the quality of care patients receive.

The foundation, which recently made the announcement, hopes to analyze how nurses contribute to high quality patient care among multiple providers and across many care settings, including long-term care.

Nurses comprise more than half of the nation’s caregivers, but little research exists showing the connection between their efforts and improved quality of care for patients, according to the foundation This round of grants, which will be rolled out over the next two years, is the third stage and final stage of the initiative, which his so far given $19 million for nursing research.

More information is available at www.rwjf.org.

A new study results further prove scientists’ warnings about the risks of stroke involved with giving elderly patients antipsychotic drugs. There is an increased risk of stroke with both typical and atypical antipsychotics, said study author Dr. Ian Douglas, a research fellow at the London School of Hygiene and Tropical Medicine. Similar findings date back at least six years, according to other researchers.”This risk is substantially higher in patients with dementia than those without. These findings need to be factored into prescribing decisions made by doctors caring for patients with often-distressing and difficult-to-treat psychiatric symptoms,” Douglas said.

Douglas and a colleague studied nearly 6,800 individuals who were taking antipsychotic drugs and had suffered a stroke. Those taking the drugs were 1.7 times more likely to suffer a stroke. The rate more than doubled, to 3.5 times more likely, for dementia patients taking antipsychotics. Study findings were published late last week in the British Medical Journal online.

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.

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.

Did you know that 80% of all strokes are preventable?The National Stroke Association’s stroke prevention guidelines help you learn how you may be able to lower your risk for a first stroke.The Stroke Prevention Guidelines were established by National Stroke Association’s Stroke Prevention Advisory Board, which includes an elite group of the nation’s leading experts on stroke prevention.

National Stroke Association suggests you ask your doctor for advice on how to best use the following guidelines.

Stroke Prevention Guidelines:

1.  Know your blood pressure.Have your blood pressure checked at least annually. If it is elevated, work with your doctor to keep it under control.High blood pressure (hypertension) is a leading cause of stroke.You can check your blood pressure at your doctor’s office, at health fairs, at home with an automatic blood pressure machine, or at your local pharmacy or supermarket.

2. Find out if you have atrial fibrillation.Atrial fibrillation (AF) is an irregular heartbeat that changes how your heart works and allows blood to collect in the chambers of your heart.This blood, which is not moving through your body, tends to clot.The beating of your heart can move one of these blood clots into your blood stream, and can cause a stroke.Your doctor can diagnose AF by carefully taking your pulse.AF can be confirmed or ruled out with an electrocardiogram (ECG) (a recording of the electrical activity of the heart) which can probably be done in your doctor’s office.

3. If you smoke, stop. Smoking doubles the risk for stroke.If you stop smoking today, your risk for stroke will immediately drop.Quitting smoking can significantly reduce your risk of stroke from this factor.

4. If you drink alcohol, do so in moderation.Studies now show that drinking up to two alcoholic drinks per day can reduce your risk for stroke by about half.  More alcohol than this each day can increase your risk for stroke by as much as three times and can also lead to liver disease, accidents and more.

5. Find out if you have high cholesterol (a soft, waxy fat (lipid) in the bloodstream and in all body cells).Know your cholesterol number.If your total cholesterol level (LDL and HDL) is over 200, talk to your doctor.  You may be at increased risk for stroke.LDL, known as the “bad” cholesterol, is the form that builds up and causes plaque which may narrow arteries and limit or stop blood flow.  LDL can be inherited from your family members or be a result of your body chemistry.  It can also be the result of a diet high in saturated fats, lack of exercise, or diabetes.HDL is the “good” cholesterol that sweeps the blood and removes plaque.Lowering your cholesterol may reduce your risk for stroke.

6. If you are diabetic… Follow your doctor’s advice carefully to control your diabetes.Often, diabetes may be controlled through careful attention to what you eat.Work with your doctor and your dietitian (a health care professional who helps promote good health through proper eating) to develop a healthy eating program that fits your lifestyle.Your doctor can prescribe lifestyle changes and medicine that can help control your diabetes.Having diabetes puts you at an increased risk for stroke; by controlling your diabetes, you may lower your risk for stroke.

7. Exercise.Include exercise in your daily activities.A brisk walk for as little as 30 minutes a day can improve your health in many ways, and may reduce your risk for stroke.Try walking with a friend; this will make it more likely that you’ll make it a habit.If you don’t enjoy walking, choose another exercise or activity that you do enjoy, such as biking, swimming, golf, tennis, dance, or aerobics.Make time each day to take care of yourself by exercise.

8. Enjoy a lower sodium (salt), lower fat diet. By cutting down on sodium and fat in your diet, you may be able to lower your blood pressure and, most importantly, lower your risk for stroke.

9. Circulation (movement of the blood through the heart and blood vessels) problems.  Ask your doctor if you have circulation problems which increase your risk for stroke.
Strokes can be caused by problems with your heart (pump), arteries and veins (tubes), or the blood which flows through them. Together, they are your circulation. Your doctor can check to see if you have problems in the circulation supplying blood to your brain.

10. Symptoms.If you have any stroke symptoms, seek immediate medical attention.Read our article to learn more about stroke symptoms.

Nursing Home Aduse is a serious crime. Most states have laws that include criminal penalties for different types of elder abuse. Often, nursing home abuse is not reported  because the individual homes do not take elderly abuse seriously. Residents are afraid they will be embarrassed, hurt or declared incapacitated if they tell.

Who to Report Abuse to

If you or someone you love has been the victim of nursing home abuse, contact legal counsel to find out what your rights are. If someone is in immediate, life-threatening danger, call 9-1-1 immediately.

If the danger is not immediate, but abuse is suspected, you must tell someone. Contact:

• A doctor

• A family member you trust

• Local adult protective services

• Long-term care ombudsman for the appropriate state

• Local police

How to Report Abuse

It is everyone’s personal responsibility to report any suspected case of elderly abuse to the authorities. When making a call to report nursing home or senior living abuse, you should be ready to give the elder’s name, address, contact information and details about your concerns.

Some questions you may need to answer include:

• Does the elderly person have any known medical problems?

• What kinds of family or other social support system does the elderly person have?

• Have you witnessed any incidents of hitting, yelling or other abusive behavior?
If you are reporting abuse but are not related to the victim, calling a nursing home abuse hotline is your smartest choice. Each state has organizations that monitor these hotlines and can offer help.

If you are making a formal complaint against a nursing home or specific staff member, you should find a sitter to monitor them in your absence or remove them from the nursing home right away.
 

A jury Thursday awarded $1 million in punitive damages to the family of a 104-year-old woman who died after a short stay at Villa Valencia Nursing Home in Laguna Hills.

The judgment against the center’s owner, Virginia-based Sunrise Senior Living, comes two days after the same Orange County Superior Court panel rendered a separate $1 million verdict for negligence in the March 2005 death of Mary Kathleen Adams of Laguna Hills.

Sunrise Senior Living operates 440 senior homes in the U.S. and abroad – says it will appeal the decision.

The trial, which began in March, revolved around the physical decline of Adams, a retired teacher who admitted herself to the home after fracturing her leg.

Adams then developed pressure ulcers and was not given adequate treatment, such as daily skin checks, according to the lawsuit. She left the home after about two months, on Feb. 25, 2005, and died about two weeks later because of the ulcers, the lawsuit says.