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The changing face of resident care

July 24, 2012
by Julie Thompson
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How LTC providers are meeting the needs of the next generation
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Right now, a 65-year-old man is learning to live life after having major hip surgery. Although he finds himself in a long-term care facility, his stay will be short in nature. In a few days he’ll go back to what feels comfortable and natural—his home, but not without the help he needs to complete his healing.

A unique back-to-home program—provided by the facility where he experienced his short-term rehab—will ensure he gets back on his feet quickly, and safely.

Across the country, a registered nurse is told she is about to be in charge of admitting a high-acuity patient and she prepares what she needs to administer inotropes to treat congestive heart failure. Infusion therapy is something she had limited knowledge of when she first took her job at the LTC community, but now she is confident and ready because of the education she received from the operator’s pharmacy provider. Around the corner, a family is touring a local CCRC campus and decides this might be the place for their loved one to call home. Here, they decide, mom will be able to maintain her lifestyle, which includes a weekly pedicure, aquatic therapy and occasional Skype chats with her grandchildren. While mom needs the additional care, they don’t want her to sacrifice what she has come to enjoy.

Each of these scenarios happen every day in LTC communities across the country, and in their own way, tell the story of how the industry is adapting to remain competitive and financially secure. LTC providers are investing more heavily in short-term rehab as a way to recoup shrinking Medicare reimbursements while taking on higher-acuity cases in order to keep residents out of the hospital. Meanwhile, they are giving wellness amenities and programs higher priority as families evaluate facilities with a more discerning eye.

Communities are reshaping double occupancy spaces into private short-term rehab units to accommodate the growing demand of younger seniors who need temporary placement after surgery. Pharmacy providers are creating comprehensive support services to equip and educate LTC staff to better handle the complex cases coming through their doors. And nearly every LTC facility is treating wellness space, equipment and programs as a necessity rather than a novelty.

It’s a continual work in progress, but most LTC operators and their service providers say the investments and changes are necessary to meet the needs of the next generation.

INFUSION THERAPY AND SUPPORT SERVICES GROW IN LTC

Pharmacy services companies are evolving into an even more comprehensive support system for LTC providers as the demand to care for higher-acuity patients continues to rise.

About three years ago, Omnicare Inc.—the nation’s largest pharmacy services and consulting company for skilled nursing and assisted living facility providers—started seeing a significant change in one specific area of service: infusion therapy. While IV services are nothing new to long-term care, the breadth and level at which they were being required to offer it was quickly changing.

Nurses who were once only required to administer simple IVs for antibiotics and hydration were finding themselves faced with much more complex cases that involved intravenous feedings and end-of-life medications. As a result, SNFs and short-term rehab units are providing care today that was once only offered in a hospital setting.

LTC providers are onboard with the reason for the shift—an attempt to reduce healthcare costs and slash hospital readmission numbers—but not all of them are prepared to handle it.

“The worst thing that could happen is that a facility admits a patient with IV orders and then their nursing staff is not able to provide the care needed,” says Tim Webster, RPh., MBA, senior director of infusion services with Omnicare. “This would result in the patient being readmitted to the acute care setting.”

Omnicare services about 10,000 skilled nursing and AL facilities across the nation. The company found that many of these facilities could benefit from resources like infusion policies and procedures that are critical for successful management of residents who are receiving infusion therapy.

As a result, Omnicare has gone beyond simply providing the medications to offering support services that help educate and equip staff to properly administer them. Through its infusion support, Omnicare began working with communities both internally and externally to put in place the tools, procedures and education needed to walk their staff through the difficulty of taking care of higher-acuity patients.

Over time, its program has gained momentum. Those who use Omnicare’s infusion service have access to a wealth of resources including skilled worksheets for nurses, infusion drug reference cards (based on the top 10 IV drugs it dispenses) and an entire library of documents. In the past 11 months alone, Omnicare has trained 16,000 nurses in its infusion education classes.

Corinne Bishop, RN, CRRN, CRNI, national director of infusion nursing at Omnicare, says she has seen LTC providers move to hire a greater number of registered nurses than licensed practical nurses because they know they need RNs to manage the increasing complexity of admissions. Still, if a new RN or LPN is hired at one of the facilities and they don’t have experience with infusion therapy, they are encouraged to participate in one of Omnicare’s classes.

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