While long-term care continues to struggle between providing opioids for residents in pain and the ramifications from a national epidemic of overdoses, multiple attorneys general are now asking the courts to decide whether the pharmaceutical companies who marketed the drugs and downplayed their addictive nature should be held responsible for the consequences of the crisis.

Alaska Attorney General Jahna Lindemuth (Ind) filed a lawsuit in October against Purdue Pharma, the makers of OxyContin, alleging that the state’s opioid epidemic is largely caused by the manufacturer’s campaign to “persuade doctors and patients that compassionate treatment of pain requires opioids and that opioids can be used long-term to treat chronic pain without causing abuse and addiction.” 

The lawsuit follows similar recent lawsuits against Purdue and other opioid manufacturers and distributors filed in Illinois, Ohio, Oklahoma, Mississippi, New Jersey and Washington state, as well as in several counties and cities across the nation. 

A study last year in Medical Care estimated the annual cost of opioid overdose, abuse and dependence at $78.5 billion. 

These lawsuits appear to be one way for jurisdictions to try to recoup some of these costs, though some defense lawyers note that opioids are regulated by the U.S. Food and Drug Administration, which may pose a fundamental weakness to the claims. 

How these lawsuits might affect the ability of long-term care patients to obtain access to pain medications was unclear at press time.

It’s possible that some of the suggested mitigation techniques for the epidemic — including greater adoption and oversight of state prescription drug monitoring programs and the promotion of non-opioid based therapies for pain — could make it harder for seniors to access necessary pain medicines. 

The American College of Health Care Administrators announced 37-year long-term care veteran Bill McGinley, CNHA, CALA, CAS, FACHCA, as its new president and CEO last month.

McGinley, who has worked as both a nursing home administrator and assisted living director, told McKnight’s one of his top priorities for the group will be combating declining membership. His tenure officially begins Dec. 4. 

ACHCA Board Chairman Steve Fromm called McGinley a “stable force” in the industry who “knows the role and the life of an administrator.”

A vaccine that combines genes from four strains of influenza may one day serve as a universal flu shot, researchers said in November.

The shot, developed by a team at the Nebraska Center for Virology, helped mice survive lethal doses of nine different flu viruses. Mice that received traditional vaccines or nasal sprays became sick and died.  

It’s unclear whether the shot could work in humans, but it’s a positive step toward an inexpensive vaccination that provides lifelong protection, said lead researcher Eric Weaver, Ph.D. 

Medicare payments would decrease for for-profit and freestanding providers under a proposal being considered by the Medicare Payment Advisory Commission designed to accelerate reimbursement adjustments.

Changes to pay formulas would begin as early as 2019 and proceed in incremental stages until 2021 under a MedPAC plan under consideration. Current pay rates would be blended with proposed ones from MedPAC’s site-neutral post-acute pay system to determine interim compensation.

Nonprofits and hospital-based providers would see increased pay rates, officials projected.

Commissioner David Grabowski, Ph.D., said the skilled nursing facility prospective payment system was handled similarly.

“My sense is that was a positive, and I think going here, in that same incremental fashion, could also be a positive, whether that’s kind of one-third in 2019 and then two-thirds in 2020 and then the full step in 2021.”

MedPAC was to resume discussion on this topic and others at its December meeting, which then leads into January voting. 

President Donald Trump chose a former pharmaceutical company executive in mid-November to take over as the nation’s top health official.

Alex Azar served as the president of drug maker Eli Lilly until January 2017. He also worked as general counsel and deputy secretary for the Department of Health and Human Service during President George W. Bush’s administration.

Observers told Politico that Azar strikes them as a “near-diametrical opposite” of his predecessor Tom Price, M.D., who resigned in September.

LeadingAge said it looked forward to collaborating with Azar, while the American Health Care Association lauded him as an “experienced leader.”

If confirmed, Azar — a frequent critic of the Affordable Care Act — will be tasked with leading efforts to repeal the law, which lawmakers plan to revisit in 2018.

Nonprofit providers could be ravaged by a Republican tax plan winding its way through Congress, industry leaders said in November.

The House’s tax plan would change individual tax rates, eliminate some credits and repeal individual deductions for things such as medical expenses. The Senate’s bill varied slightly, but GOP leaders were confident differences could be reconciled.

“Those who are older will find the loss of the medical deduction a bitter pill to swallow. And for our members, providers of services to older people, this could be devastating,” said LeadingAge CEO Katie Smith Sloan. 

The organization said it opposes any bill that eliminates tax exemptions for affordable housing or changes charitable deductions. 

When it comes to skilled-care staffing, the future outlook is bleak. If it’s possible, the situation for nurses might be even worse.

How bad is it? This bad: The Bureau of Labor Statistics estimates there will be more than a million registered nurse openings by 2024. You can bet that many of those openings will be in the post-acute care environment.

For this we can thank two main causes: an aging nation and fast-approaching retirements for many now in the profession.

And it’s not like the pinch isn’t already being felt. A recent analysis by Reuters found that hospitals are now paying billions to find and keep nurses. Among the incentives being dangled are better pay, signing bonuses, free housing and even student-loan repayments. Skilled care operators also are beginning to offer recruiting sweeteners that would have been unheard of a decade ago.

Still, the trending is not good, and there does not appear to be a hopeful sign. Well, there may be one.  

Young adults comprising the millennial generation (those born between 1982 and 2000) are almost twice as likely as boomers to choose a nursing career, according to a Health Affairs study.

Millennials? What about those nasty stereotypes accusing them of being entitled, lazy narcissists still living at home? This is the future face of nursing? Maybe.

One possible explanation for millennials’ nursing interest is that many were spooked by the Great Recession of 2007, and they may be seeking careers less vulnerable to economic downturns.

Yes, many 18- to 34-year-olds watched the worst economic downturn in nearly a century from the sidelines. Still, it was  a jarring experience. Many saw their parents lose jobs, homes and a lifetime of investments — seemingly overnight.

Or it could be that a nursing career fits another stereotype about this group: that they want to perform meaningful work that makes a contribution. Let’s hope that’s the case. For when it comes to nursing, this sector will need all the help it can get. And then some. 

Patients discharged to a skilled nursing facility after trauma had lower odds of mortality when the facility had fewer beds per nurse, new research shows.

In addition, those who went into skilled nursing generally had worse outcomes than those who went home, according to University of Washington researchers. 

The goal of their retrospective study was to determine whether nurse staffing and patient density in nursing homes were associated with outcomes after a patient was hospitalized for trauma or surgery.

More than 389,000 patients who went to 3,700 Medicare-certified SNFs after trauma or major surgery between 2007 and 2009 were analyzed. 

Researchers found facilities with fewer beds per nurse resulted in lower rates of mortality for those with trauma or who had surgery, along with lower rates of readmission. 

Even when adjusting for patient characteristics, the authors concluded that there are “modifiable” SNF factors that can be targets for better outcomes.

“Staffing standardization and SNF specialization may reduce variation of quality in post-acute care,” they wrote. 

Long-term care nurses often feel isolated from the rest of the healthcare workforce, asking themselves, “Am I actually a nurse?”

That question, according to United Kingdom researcher Juliana Thompson, Ph.D., relates to how nursing home nurses often are focused on the resident, the care plan, and the social aspects of care, which can result in them wondering if their clinical skills are diluted.

Her study results, based on respondents from seven nursing homes in England, appeared in the Journal of Clinical Studies in October. Thompson is a senior lecturer in adult nursing at Northumbria University, Newcastle upon Tyne.

“There’s very much an aspect of believing a nurse is someone who does healthcare in the hospital,” she told
McKnight’s. 

TV dramas may be at the forefront of what nurses envision, complete with a life of running to a crash cart or treating trauma victims.

“Nursing has become medicalized and technical and that becomes sexy in some ways,” Thompson said. “The care and compassion side of it is less respected and valued.”

Many long-term care nurses also want to treat more medical issues for residents, she said, but they need more training. This could, in turn, reduce rehospitalizations. 

My administrator has asked me to lead the effort to prepare our Facility-Wide Assessment (FWA). What does this mean for me, as the director of nursing?

The FWA is mentioned more than 90 times in the State Operations Manual’s Appendix PP, “Guidance to Surveyors.” It’s a big deal in the new survey process. As DON, your participation in developing the FWA is required by regulation and imperative for reducing citations. Here’s what you should do:

Work with the administrator, governing body member and medical director to analyze your facility’s resident population — including residents’ diseases, conditions, physical and cognitive disabilities and overall acuity — to determine the need for resources, including staff, equipment, specialized training and the need for new contracts. 

Ask your MDS nurse to pull resident information from the Minimum Data Set, section I, or the Facility Characteristics Report (form CMS-672). Because these data sources can be up to three months old, be sure to include current resident data for your FWA snapshot.

Evaluate residents’ acuity to select competencies and education that cover the most prominent conditions. Consider drilling down to the unit level to determine staffing levels by competencies. 

Include residents’ dependencies with activities of daily living and their preferences. Do you need an additional lift? Do your resident referrals include individuals requiring culturally specific foods or activities? 

Be prepared to show surveyors your analysis with a detailed report. The process should result in a clear guide to the right equipment, staff, competency-based education program, actions in an emergency, technology and more.