Long-Term Care Survey Alert

Published on Tue Sep 23, 2014 PDF

Here’s how technology can help you step up your game, improving care and survey results.

How smart is your dementia care? If the word “innovation” hasn’t been uttered in your recent conversations about care, consider assessing how your facility can begin to make more intelligent — and intentional — use of technology to benefit the delivery of dementia care.

A quality improvement approach that makes good use of new technologies can give you a competitive edge and an advantage at survey time. One area ripe for technology-based enhancement is care coordination between the acute and post-acute settings.

Care coordination is defined as the deliberate organization of patient care activities among two or more participants (including the patient and/or family members) involved in a patient’s care to facilitate the appropriate delivery of health care services.

At a recent forum sponsored by the Centers for Medicare and Medicaid Services (CMS), speakers addressed the need for enhanced communication and care coordination between the acute and post-acute settings as it relates to dementia care.

It is all too common for adverse events and avoidable complications to occur as a result of poor coordination among caregivers, health care professionals, and the patient during care transitions, stresses Leonard M. Gelman, MD, CMD, president of AMDA — The Society of Post-Acute and Long Term Care Medicine.

Case in point: An elderly resident who has been tapered off antipsychotic medications returns from an acute care stay with an antipsychotic drug back on his list of medications.

Technology can help limit such unfortunate — and citation triggering — events by fostering communication between levels of care. HealthyCircles by Qualcomm Life, for example, features secure messaging between health organizations, providers, patients, and family caregivers, as well as interactive forms that provide the ability to preregister patients online so that their needs and care can continually be assessed.

Thought leaders in long-term care are promoting greater use of technology. A Research Report released in June by the RAND Corporation, for example, calls for integrating web- and other technology-based services into dementia long-term care services.

The report, Improving Dementia Long-Term Care: A Policy Blueprint, calls for the use of patient monitoring technology to assist with dementia care — to prevent wandering or to alter care when health biomarkers, such as high blood sugar, indicate a problem, for example.

The RAND report also calls attention to the need to expand telemedicine and other web-based technologies to hard-to-reach populations. Medication management technologies, such as electronic pill boxes, are also recommended as ways to improve care while controlling costs.

Check it out: Read the full report at www.rand.org/pubs/research_reports/RR597.html.

CMS itself is supporting some initiatives related to technology and dementia care. The University of California, San Francisco and the University of Nebraska Medical Center, for example, have both recently received a $10 million grant from the Centers for Medicare and Medicaid Innovation to create a new web-based model of dementia care. One goal of the program is to help delay patients’ transition from home to the long-term care setting, but the virtual care system has applications for nursing homes as well as home caregivers. Once again, medication management will be one focus: the system will monitor medication usage and flag high-risk and inappropriate medications, as well as drug interactions.

Stay Connected

Technology can help improve functioning and quality of care simply by fostering good communication between residents and their loved ones in the community.  

Simple: Skype can easily be employed to promote, personalize, and enhance communication between the facility and family caregivers and friends — especially if a resident’s family members live out of town.  Additionally, some facilities are embracing video cameras as a way to provide important connections between facility caregivers and residents via direct video feed via a smart phone, tablet app, or on the web. 

Technology can also vastly expand opportunities for staff training and care innovation — in a cost-effective manner. 

Innovator: Leading Age Maryland sponsors short training teleconferences called What’s Working Wednesdays. The online forum features a short 15-minute informal presentation followed by a 15-minute question and answer session. The goal is to disseminate good ideas efficiently through readily available technology.

Although there are plenty of gains that can be made using technology, some improvement comes from dogged determination to improve care in timeless ways. 

Example: One Pennsylvania post-acute facility reported “a feeling of animosity” about clinical care creeping in between it and its acute care counterpart. To blame was a culture that fostered mutual distrust: the hospital continuously questioned clinical decisions at the post-acute level, and the post-acute providers criticized the hospital’s disease-focused approach to dementia care, which was often at odds with the long-term care setting’s more holistic approach. To prevent such a culture from undermining your dementia care, consider assigning one well-trained individual to oversee care transitions to sites to which the facility regularly transfers patients or from which it receives transferred patients.

Bottom line: Whether facilitated through technology or simply strong management and people skills, great dementia care requires ongoing communication and care coordination.