Quality of life refers to non-medical outcomes of care, noted Tetyana Shippee, Ph.D., lead author and assistant professor of health policy and management in the School of Public Health at the University of Minnesota. These outcomes consist of being treated with privacy and respect, food satisfaction and relationships with staff.

Minority residents in the study reported lower quality of life compared to white residents, much of which was related to the difference in health needs of minorities. Data showed nursing homes with a higher population of minority residents had lower quality of life scores overall. 

“Our findings suggest that most of the racial differences in quality of life are not based on individuals’ race/ethnicity but reflect facility differences in how they serve the needs of minority older adults,” Shippee told McKnight’s. Nursing homes can use this information to come up with a new plan of action.

Facilities that had a higher proportion of minorities tended to have residents rely predominately on Medicaid and were located in poor communities. Geographical segregation could be a confounder in the relationship between resident’s race and quality of life, Shippee explained. 

The proposed bundle would begin with hospital admission and last 90 days after discharge.

All financial risk for the surgery, inpatient stay and care following discharge would be placed on hospitals, an update that experts say could weed out 1- and 2-star skilled nursing facilities from “favored” referral lists. Experts also predict the new emphasis on hospital accountability could cause 25% of low-star SNFs to close over the next five years.

The proposed five-year test is the first mandatory bundled payment model for hospitals, and will span over 75 geographic areas including larger markets like Los Angeles and New York. 

“Once you get to bundled payment, it really does prompt skill set and competencies that are different from what providers have been accustomed to,” Avalere Vice President Brian Fuller told McKnight’s.

Nursing homes should be able to test new approaches and analyze results by participating in any of the three pilots, but the overall audit score won’t negatively impact their survey process, CMS said.

Adequacy audits, which will start in the fall, will be run through the pilot to see if sponsor organizations are inappropriately denying services to beneficiaries.

A medication therapy management pilot audit, which will start in early fall, will analyze how programs are implementing enrollment and targeted and comprehensive medication reviews, CMS said. The results of this audit process will be used to improve sponsors’ performance in the program. 

The third pilot involves drugstore counter prescription rejections under Part D. Sponsors will be tested on problem solving strategies for when a prescription cannot be filled as written. The point-of-sale pilot will help weigh options for resolving rejections without an enrollee requesting a coverage determination from a plan, CMS said.

The proposal seeks to “accelerate” the adoption of IT that wasn’t available to facilities at the time of the last regulation revision, more than 25 years ago.

“The existing regulations don’t even conceive of electronic communications the way they exist today,” Shari Ling, M.D., Medicare’s deputy chief medical officer, said. “Also, there have been significant advances in the science and delivery of healthcare that just weren’t imagined at the time the rules were originally written.”

The 403-page proposal includes a “competency-based” approach to making sure facilities meet CMS requirements. Facilities would be required to assess their capabilities and resident population, and provide staff with the competencies to meet residents’ health needs, based on person-centered care plans. 

The proposal states that CMS believes most facilities already make these assessments, but that the changes will ensure they’re consistently performed and documented.

CMS is accepting comments on the proposal through September 14, 2015.

The Centers for Medicare & Medicaid Services has instituted a survey process to assess the accuracy and the compliance with the MDS scheduling process. 

CMS has already conducted pilot surveys in five states. The good news is that those pilot surveys showed good compliance with the MDS schedule and coordination. Improvement needed was reflected in four key areas including severity of injury with falls, pressure ulcer status, restraint use and late loss ADL coding.  

We are now facing a nationwide rollout of this process. Another component of this MDS focused survey is review of staffing in the facility to meet care needs. According to CMS Survey & Certification Letter 15-25-NH (sent on February 13, 2015), training for surveyors began in early April 2015 and states assigned a minimum of three surveyors to be trained. Deficiencies identified during these focused surveys will result in citations and enforcement actions. 

What can you do to prepare for these MDS-focused surveys? First, audit your MDSs to ensure the care process, which includes the completion of the MDS and functional risk assessments, continues with the completion of the CAAs (Care Area Assessments); includes the development of an individualized care plan; is implemented at the bedside; and finally, is periodically reviewed and revised as needed. 

Second, make sure the assessment process is being completed on a timely basis. That includes completing the MDS and CAAs within 14 days of admission; and completing an MDS when there is a Change of Therapy (COT) or an End of Therapy (EOT), with a Significant Change in Status (SCSA).

It is also essential that Entry and Discharge Assessments are completed timely and accurately. 

President Barack Obama has not nominated anyone to the 15-member board since it began, and Medicare spending has remained below targeted levels. The House bill is sponsored by Rep. Phil Roe (R-TN).

Its 244-154 vote garnered little Democratic support. Some Democratic legislators said they were against IPAB, but they noted with disapproval that the bill included cuts to the ACA’s Prevention and Public Health Fund.

“I don’t like where they come up with the pay-fors,” Rep. Gene Green (D-TX) told the National Journal.

The White House said the president would veto the bill if it reached his desk.

The House also passed IPAB repeal legislation in 2012, but it died in the Senate. Certain physician groups, including the American Medical Association and the American Gastrological Association, have long supported the repeal. 

The Congressional Budget Office has said IPAB probably wouldn’t have to recommend payment changes until 2022.

Also in June, the House also voted for legislation that would repeal the medical device tax. 

The office examined third-quarter fiscal year 2011 Medicaid Statistical Information System claims for 38 states with managed care programs. Around 70% of Medicaid beneficiaries receive services through managed care. Encounter data is information about the services provided to those beneficiaries in a Medicaid managed care program, which the government says is necessary for quality assurance and to prevent waste and abuse.

A 2009 OIG report found 15 states were not reporting encounter data to MSIS. In the latest report, eight of the 38 states did not report encounter data by the required deadline: Kansas, Massachusetts, Nevada, North Carolina, Pennsylvania, South Carolina, Utah and West Virginia. Another 11 states did not report data for all Medicaid managed care plans.

For five states — Missouri, New Mexico, Oregon, Virginia and Wisconsin — the OIG could not access encounter data because of blank, invalid or “dummy” plan identifications.

In 2011, CMS began a new national Medicaid dataset called Transformed Medicaid Statistical Information System. Most states were expected to start reporting to T-MSIS by this year.

The OIG recommended CMS withhold federal funds from states that do not submit encounter data, and that data should be more carefully monitored. CMS should validate that states are submitting encounter data with valid plan IDs, and provide feedback to states on how to improve the data. 

It was the mid-1980s and physical restraints and bed-bound patients were the norm in the Arizona nursing homes where she served as an intern and, later, an attending physician.

She had studied under some of the best gerontologists in London, where hospitals and long-term care facilities had long embraced the idea that the elderly should be encouraged to stay active.

“In those days, there was a stark difference,” says Pandya, professor and chair of the geriatrics department at Nova Southeastern College of Osteopathic Medicine in Ft. Lauderdale, FL. “The way we take care of older patients in America, it could still improve.”

Pandya finds herself in a unique position to affect change as board president of The Society for Post-Acute and Long-Term Care Medicine (AMDA). Since her appointment in April, she has taken part in White House summits on aging and antibiotic stewardship and helped publicize a campaign aimed at reducing unnecessary medical procedures.

She also continues in several clinical and teaching roles. She is medical director of Covenant Village, a CCRC, and a 120-bed Avante skilled nursing facility in Boca Raton, FL.

“Dr. Pandya is a phenomenal teacher,” says Meenakshi Patel, M.D., a member of AMDA’s State Presidents Council. 

Pandya considers inspiring passion in others in an industry known for its turnover one of her greatest challenges. 

“When I’m in a nursing home, I’m happy,” she says. “I want to know the stories of my patients, see them treated with dignity.”

After watching her work, her husband, Siddharth, took up a career in neuroradiology in his 40s. Her son is a second-year medical resident, and her daughter works as an organizational psychologist.

Since completing a University of Michigan fellowship combining geriatrics and endocrinology, Pandya has racked up more than $3 million in grant funding. She’s dedicated much of her research to bettering management of diabetes in frail, elderly patients, including a critical look at sliding-scale insulin and unneeded blood draws.

Fiercely protective of patients who may no longer be able to advocate for themselves, she wants others to recognize that technological ability shouldn’t dictate when invasive treatments are used. Palliative hospice services have their place in long-term care, she believes.

During AMDA’s annual conference in March, Pandya confessed her love of movies, good jewelry and Riesling wines. She says she enjoys Bollywood (and that she also might have a “crush” on actor Morgan Freeman).

A world traveler who is active in her community, Pandya is proud to have grown an outpatient clinic and to have made “person-centered care” more than a buzz-worthy phrase. She is using her platform to work with pharmacists, doctors and nursing organizations that can influence how the larger medical community treats the elderly.

“We have more clout if we speak with one voice,” she explains.

Resume

1979

Earns medical degree from Middlesex Medical School, University of London 

1980-1981

Completes internships in general and vascular surgery and general medicine and cardiology at two British hospitals

1983-1987

Completes residency work, followed by three years with Maricopa (AZ) Medical Center

1991-1995

Assistant professor of internal medicine, UMKC School of Medicine

1998

Completes dual fellowship in geriatrics and endocrinology at University of Michigan Medical Center

2003-2008

Directs Alexander Nininger State Veterans Nursing Home in Florida

2010

Becomes medical director of Covenant Village Care

2011

Takes on directorship of Avante at Boca

2015

Elected president of the AMDA board of directors. 

According to the Centers for Disease Control and Prevention over 200,000 people are admitted to the hospital annually with the flu and over 36,000 die of complications. Although it is a mundane task, according to the CDC, handwashing is the single most effective way to prevent the spread of infection. 

To make it work, make handwashing fun! Many companies have videos, posters or catchy campaigns or products to assist you with making it something to look forward to. For example, Glo Germ liquid or powder is a great way to show staff how easily germs are transferred. 

True story: I once put glow-in-the-dark powder on my hands and the pen that I had tied to a clipboard with the sign-in sheet for a program I was teaching on infection prevention. As employees came into the room, I shook lots of hands, brushed something off someone’s face and interacted. All the while, they were also signing in with my sabotaged pen. 

After the program started, I turned off the regular light in the room and turned on a black light. EVERYONE in the room was glowing someplace on their body. Some had hands, face, clothing — and many places we won’t mention that were glowing! 

From that day forward, I did not have to convince anyone how important washing their hands were to the safety and well-being of themselves, their residents and their loved ones. They witnessed it with their own eyes! 

Good luck, but remember to change it up — we all learn differently, but adding fun is definitely a must.

About 2,500 sex-related posts from 14 English-speaking online communities with a mean age of 64.5 were analyzed in the study, said Galit Nimrod, Ph.D., assistant professor in the Department of Recreation, Sport and Tourism at University of Illinois. 

“We found that people used these discussions to ask for advice, and sharing experiences,”
Nimrod told McKnight’s. “Once people are anonymous and invisible, people just go wild.”

Although posts generally did not have many comments, some attracted more than 1,000 views. Some of the seniors noted they had received little sex education in their youth. While many were worried about their health limitations, the communities helped them explore what was possible, such as masturbation or cuddling with a partner, researchers found.

“Treating older adults that they are ‘too old’ to have a sex life troubled me,” Nimrod said. “But in general, the communities had a great impact on the participants.”