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California nursing homes become more transparent

November 1, 2009
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California Gov. Arnold Schwarzenegger has signed into law a measure that works toward creating transparency in the ownership and management structure of skilled nursing facilities in the state.

Under Assembly Bill 1457, skilled nursing facilities are required to disclose to every new admission the name of the owner and licensee for the facility, as well provide contact information for the individual who is accountable for all aspects of patient care and facility operations.

Also, to ensure that existing residents are updated when a change of ownership occurs, the bill requires written notification to all current residents and their primary contacts.

“AB 1457 provides California an opportunity to address a serious problem detailed in dozens of investigations by reports in the media,” said Assemblyman Mike Davis (D-Los Angeles), author of the bill. “Each resident should know who is in charge of delivering services in every facility. This measure will require appropriate notification, which will help ensure quality care in nursing homes.”

In similar news, Schwarzenegger signed AB 215, which requires all California nursing homes that accept Medicare or Medicaid to post their Five-Star ratings from CMS in a visible, public location.

“Families trying to choose a nursing home for their loved ones need more information so they can compare quality of care information and make the right decision,” said Mike Feuer (D-Los Angeles), co-author of AB 215, which goes into effect on January 1, 2011.

Dementia…a terminal condition?

Scientists at the Institute for Aging Research of Hebrew SeniorLife, an affiliate of Harvard Medical School, published the results of its study, “Choices, Attitudes and Strategies for Care of Advanced Dementia at the End-of-Life,” or CASCADE, in the October 15 issue of the New England Journal of Medicine. The study diligently describes the clinical course of advanced dementia. The clinical course of the disease is not unlike that of other terminal illnesses, including pain, and other studies have suggested that people with advanced dementia are under-recognized as being at a high risk of death; therefore, they receive suboptimal palliative care to improve their comfort.

Lead author Susan L. Mitchell, MD, MPH, says, “As the end of life approaches, the pattern in which patients experience distressing symptoms is similar to patients dying of more commonly recognized terminal conditions, such as cancer.” As a result of the study, nursing homes need to improve the quality of palliative care they deliver to reduce suffering and to improve communication with families.

The CASCADE study followed the clinical course of 323 nursing home residents with advanced dementia residing in 22 Boston-area facilities for up to 18 months. Residents at the end stage of the disease process were nonambulatory, incontinent, spoke fewer than six words, and could not recognize loved ones.

Over the study period, 177 patients expired from complications such as pneumonia, fever, and eating problems. As end of life approached, common discomforts included pain, shortness of breath, aspiration, and pressure ulcers.

Dr. Mitchell, an associate professor at Harvard Medical School, and her team found that 96% of healthcare proxies considered comfort care the main goal. However, nearly 41% of patients who died during the study underwent at least one intervention, such as hospitalization, IV therapy, or tube feeding. Dr. Mitchell says, “Many of the patients in our study underwent interventions of questionable benefit in the last three months of life. However, when their healthcare proxies were aware of the poor prognosis and expected clinical complications in advanced dementia, patients were less likely to undergo these interventions and more likely to receive palliative care in their final days of life.”

More than five million Americans suffer from dementia and that number is expected to increase nearly threefold in the next 40 years.

The American Association of Nurse Assessment Coordinators is accepting nominations for the second annual Nursing Assistant of the Year Scholarship Program at http://www.nascholarship.com

Long-Term Living 2009 November;58(11):10

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