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Palliative care providers have explored diverse routes to improve quality and access to their services in 2024. Below are five under-the-radar stories that, while important, didnt make our most read this year. SMI patients with serious physical illnesses often have less access to appropriate medical care and mental health services.
A dearth of coordination or integration between rehab teams and palliative care teams routinely forces some patients into a cycle between the hospital and the nursinghome in their last year of life. These results appeared in a 2019 New England Journal of Medicine study titled “Rehabbed to Death.”
PACE programs offer a comprehensive approach to care for participants who meet certain eligibility criteria, mainly to seniors who have significant medical and non-medical needs to help them age in place and avoid the hospital or nursinghomes. PACE programs are definitely open to capitated arrangements — per-participant, per-month.
As background, we discuss Manju Kurella Tamura’s landmark NEJM paper that found, contrary to expectations, that function declines precipitously for nursinghome residents who initiate dialysis. So, for example, you know, we see somebody coming in from the nursing. A nursinghome. Let it be (hint hint).
Summary Transcript Summary Often podcasts meet clinical reality. That’s why we do this podcast- to address real world issues in palliative care, geriatrics, and bioethics. But rarely does the podcast and clinical reality meet in the same day. Lynn Flint, author of the NEJM perspective titled, “Rehabbed to Death,” joins Eric and I as co-host.
For the purposes of your program, what definition do you use for community-based palliative care? Oftentimes it’s either combination of home visits and telephonic services. Sometimes they might be doing consultations either inpatient or in the nursinghome or in assisted living. There’s a variety.
Mariah 03:51 I like the SAMHSA definition as sort of a guiding definition for it, and I’m happy to read it. Well, being a pretty comprehensive definition. Kate 11:33 Yeah, I mean, definitely more indirect pathways than direct. Alex 00:03 This is Alex Smith. Eric 00:04 And Alex, we have somebody in the room with us.
Finally, we discuss Michelle Oddens study, which used a target trial emulation approach to investigate the effects of deprescribing antihypertensive medications on cognitive function in nursinghome residents. Emily 06:11 Yeah, we definitely have a pill for every ill. Go ahead, Connie. Eric 32:14 Yeah, I love that.
In contrast to geriatrics, the evidence base for palliative care lagged clinical growth, in part because palliative care has no centralized “home” at the National Institutes of Health. Clinical growth of geriatrics programs has lagged academic research, despite the rapid aging of the population. . By diagnosis? By prognosis?
Furthermore, direction to external websites is not an endorsement from AAHPM or HPNA, or the Annual Assembly. Palliative Care the Next Generation: How the Service May Grow and Evolve AccentCare , a portfolio company of private equity firm Advent International, is another example. We’ve got a very large palliative care practice,” Rodgers told PCN.
If you develop dementia, odds are you will spend the last months to years of your life in a nursinghome or assisted living facility. This study explored nursinghome organizational factors and staff perceptions that are associated with the variation in care for residents with advanced dementia. Rehabbed to Death.
He previously served as president of the National Association for Home Care & Hospice (NAHC) for 38 years prior to its affiliation with the National Hospice and Palliative Care Organization (NHPCO) in 2023 and was heavily involved in the establishment of the Medicare Hospice Benefit. This was not thrust upon the community.
Hayden Jordan, director of palliative care for senior care provider PruittHealth Home, has been named a 2022 Future Leader by Hospice News. . The program is designed to recognize up-and-coming industry members who are shaping the next decade of senior housing, skilled nursing, home health, and hospice care.
Eric: Definitely MAID- Alex: Eric knows, MAID in Canada Eric: Medical Aid In Dying in Canada. Eric: One out of six hospices, so there is financial concern, not just again with hospices, nursinghomes, and now physician groups. So, in front of us today, we have a variety of hot sauces and chicken wings. Anne: Right. Alex: Oh no.
We start off part one by interviewing Michele DiTomas, who has been the longstanding Medical Director of the Hospice unit and currently is also the Chief Medical Executive for the Palliative care Initiative with the California Correctional Healthcare Services. I’ve known Michele a long time, since the Joint Medical Program. Michele: Yep.
So, it’s definitely possible in sort of that oldest old category that there may be what we call silent aspiration, where someone aspirates, and then they don’t cough or clear their throat, so you actually wouldn’t even know that they’re aspirating. Raele: Yep, they definitely can be. Raele: Yes, definitely.
First, we talk with Christine, a researcher and geriatrician from the University of North Carolina, who recently published a JAGS article titled Overdiagnosis of urinary tract infections by nursinghome clinicians versus a clinical guideline. Imagine you receive a telephone call from the nursinghome about the following resident.
For a trial to have value, it should not exclude patients over age 80, or those with dementia, or patients residing in nursinghomes. Additional links mentioned in the podcast: Recent JGIM article on POLST in California nursinghomes, hospitalization, and nursinghome care Karl’s GeriPal post on appropriate use of POLST Enjoy!
Alex: We are delighted to welcome back to the GeriPal podcast, Katie Fitzgerald Jones, who’s a nurse scientist at the New England Geriatric Research Education and Clinical Center, and a palliative and addiction nurse practitioner at the VA in Boston. Katie, welcome back to GeriPal. Bragging rights. That was from our what?
Kaweah Health Hospice staff will oversee the hospice facility’s day-to-day operations and medical care, which will be provided by a team of nurses, home health aides, social workers and chaplains. The company cited swelling construction costs, rising inflation rates and the staffing shortage.
valproic acid and gabapentin), in nursinghomes, particularly patients with Alzheimer’s disease and related dementias. JAMA Surgery 2018 Gabapentin and mood stabilizers in the NursingHome Setting: Antiepileptic prescribing to persons living with dementia residing in nursinghomes: A tale of two indications.
RCFEs, boarding cares, nursinghomes. Eric: And how is assisted living community different than a nursinghome? One is they’re not licensed as a nursinghome, and they’re not federally regulated. Biggest differences, not licensed as a nursinghome, don’t have to have nurses.
When I’m on nursinghome call, the most common page I receive is for a blood sugar value. And we invited Tamryn Gray from the Dana Farber joins us to ask insightful questions, including: What blood sugar range should we target for patients in the nursinghome or hospice? Summary Transcript Summary Diabetes is common.
Alex: We’re delighted to welcome back Lauren Hunt, who is a Hospice and Palliative Care Nurse Researcher, an Assistant Professor of Nursing at UCSF. Melissa: It’s definitely true that that’s the incentive under nonprofit and for-profit. We are delighted to welcome Melissa Aldridge to the GeriPal Podcast.
She’s a hospice and palliative care nurse practitioner and Assistant Professor in the School of Nursing at UCSF. Lauren: Yeah, I think I can definitely see Joe’s point of view. Yes, my hair is definitely on fire. Eric: Alex, we have some great guests with us today. Alex: We have some wonderful guests.
I think the general definition that’s given is it’s the ability to bounce back from some kind of adversity. The example I give is, if you’ve ever walked into a nursinghome, or where there’s an activity happening for a group of people with dementia, that is a little depressing to me. This is Eric Widera.
Alex 00:30 And we are also delighted to welcome Eloise Theisen, who’s a palliative care nurse practitioner at Stanford and CEO and co- c ounder of Radical Health Clinician Network, which helps patients use cannabis to treat chronic and age related illness. To learn more about CME for other GeriPal episodes, click here.
Our experts include Katie Fitzgerald Jones (palliative nurse practitioner and doctoral student at Boston College), Zachary Sager (palliative care physician at the Boston VA and Dana-Farber Cancer Institute), and Janet Ho (physician at UCSF in addiction medicine and palliative care). Learn about using the low dose buprenorphine patch: .
The program is designed to recognize up-and-coming industry members who are shaping the next decade of senior housing, skilled nursing, home health, and hospice care. I definitely would not be where I’m at today without my family. What drew you to the hospice industry?
Journal of Hospice and Palliative Nursing, 22 (5):392-400 / PMID: 32740304. Summary Transcript Summary. Eric and I weren’t sure what to call this podcast – storytelling and medicine? Narrative medicine? We discussed it with today’s guests Heather Coats, palliative care NP-scientist, and Thor Ringler, poet. Schilling, L., SPONSOR:
I have done a lot of work on POLST and nursinghomes and I’ve seen POLST forms. I saw years ago in Oregon, a POLST form that had been on file in a nursinghome resident’s chart for seven years. Susan: Thanks so much, Alex. Welcome back, Bob. Bob: Thank you. Welcome back, Rebecca. Rebecca: Thanks for having us.
Some of it was definitely just trying to find new ideas in a way to be able to get into facilities and doctors’ offices. Hospitals and nursinghomes don’t want to get dinged for readmissions. Typically that hovered around 80 to 90 days, and we are seeing the trend moving in that direction. It was still a very virtual world.
The program is designed to recognize up-and-coming industry members who are shaping the next decade of senior housing, skilled nursing, home health, and hospice care. This isn’t going to be easy, and it most definitely isn’t a 9-5 job, but it is so worth it if you find a home with the right company — the right ‘work family.’
Kevin’s study looks at a period of time in the COVID pandemic when a large multistate nursinghome provider created a “nonessential medication on hold” (NEMOH) policy in order to conserve critical nursing resources and PPE, and to limit exposure risk for residents by reducing unnecessary contact. nursinghomes.
So we followed Gretchen Schwarze’s definition, which was 1% or higher inpatient mortality was considered high-risk. And we found out in our work that something like 70 or 80% of patients with dementia who have surgery come from the community, who are coming from home. Eric: What are some examples of that? Joel: Talk about it.
In a separate study in Chest , Lauren found pre-ICU frailty was associated with post-ICU disability and new nursinghome admission. So, maybe the person with advanced dementia is coming in from the nursinghome and nobody can find the living will from however many years ago. That will be the last one in his life.
And now I’m almost 90, so definitely I don’t need to do suffering. Louise 13:48 Definitely some thoughts, and I think slightly different for different people. Louise 15:47 Well, I think even in that example of choking in a nursinghome, you don’t actually require cardioversion or a breathing tube.
So I think when you start combining these trials and you’re faced with an older adult that the option would be to now put in a PICC line and send them to a nursinghome and then you can have a really sit down with the patient through shared decision making decide we stop at seven days. Lona: Absolutely.
Second, as we discussed in last week’s podcast , older adults, particularly those in nursinghomes, were far more likely to die than younger individuals. I was very excited about the opportunity, and very excited about everything that’s going on at AGS, so when she asked me, I said, “Yes, definitely.”
Alex: Today we are delighted to welcome Heather Coats, who’s a palliative care nurse practitioner and scientist and Director of Research at the Hospice and Palliative Nurses Association, or HPNA, an Assistant Professor at the University of Colorado and Schutz College of Nursing. Alex: This is Alex Smith. Heather: Sure.
James: Definitely not-. Eric: Yeah, this is definitely… If you grew up in the ’80s, this is the slow dancing song. Most of them are dealing with older adults with dementia who are living in the nursinghome or have severe dementia. Welcome back to GeriPal, James. James: Thanks for having me. Welcome back, Sei.
The following is a true nursinghome experience that my hospice patient shared with me about an unusual trip she said she had taken the day before I visited her: (Excerpt from my book Becoming Dead Right: A Hospice Volunteer in Urban NursingHomes ) “What did you do today?” Oh, I’ll definitely be going back.
So it might just be the case that there’s a lot of background GI complaints, that people could be taking them inappropriately, so there are definitely ways to minimize it. which is kind of the typical definition of osteoporosis at that time. Welcome back to GeriPal, Sei. Sei: Great. Thanks for having me. James: Yeah.
But they were specifically looking at nursinghome population. So you could definitely can do direct harm for many of these drugs if you stop them abruptly. There’s good data for de-prescribing more in the context of poly pharmacies or studies on nursinghomes is where the best data is.
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