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Steven A. Brigance The State of Long Term Care March 5, 2013, UAMS Resident Conference.

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Presentation on theme: "Steven A. Brigance The State of Long Term Care March 5, 2013, UAMS Resident Conference."— Presentation transcript:

1 Steven A. Brigance The State of Long Term Care March 5, 2013, UAMS Resident Conference

2 The Eldercare Language Maze LTC (Eldercare) vs. Acute Care CCRC; Independent/Residential Living; ALF; SNF; Memory Care; Rehabilitation REITs, Chains and Mom and Pops Patients vs. Residents Medicaid and Medicare

3 As a Physician What’s Your View of LTC? Based on your own personal or professional experience in LTC, what do you believe is working and what is not working? What needs to change? What can you as a physician do to bring constructive change? How do you do that?

4 ONE VIEW of The State of LTC LTC In This Country Is A Threat To Our National Integrity!

5 The Salient/Sentinel Facts are Nebulous in Acute Care; They are Mostly Non-Existent in LTC Somewhere between 4 and 6 million people in LTC Housing Most are 65 or older, BUT the fastest growing group is between the ages of ( now 15% in nursing homes alone) Medical Errors affect 25% of the hospital admits; up to 100,000 die each year from medical errors (IHI; New England Journal of Medicine) 4OurElder’s estimates, based on all available data and personal experience, medical and other errors affect 50% of nursing home residents On top of medial errors throw in abuse, neglect and violence and the magnitude of the eldercare problem becomes obscene (one study reports that 50% of nursing home staff ADMITTED to mistreating—abuse, neglect, violence—older patients WITHIN 1 year prior to the study)

6 Josie’s Story Jack & Dot’s Story

7 What’s Wrong with LTC?—My View Hiring, training, disciplining, rewarding, firing Wrong focus—care and service gets lost in the “bigger picture” of “filling beds” Acuity levels vs. the level of care the staff can legitimately provide (based on both quantity and quality of that staff) is too often ignored Budgets too often predominate The regulatory/legal system is worse than ineffective in the healthcare setting How we view the elderly--“too little too late”

8 What Has Not Worked The litigation culture—P’s, D’s, Caps The Government at any level Surveyors Ombudsmen Self-policing Consolidations/ “Operational Efficiency” Insurer’s demands Great Policies and Procedures

9 WHAT WILL WORK? Informed Consumers who demand great care and service for people who still matter Caregivers at every level who are unwilling to let bad care and service--a lack of dignity and respect-- slide Teamwork Better hiring, training, retention practices Transparency Accountability

10 One “Clean-up” Effort and an Industry’s Predictable Response Skin Assessment Program in Michigan The Big Chain lawyers chime in…. And It’s “Through the Looking Glass”

11 As a Physician What’s Your View of LTC? Based on your own personal or professional experience in LTC, what do you believe is working and what is not working? What can you as a physician do to bring constructive change? How do you do that?

12 What is a Physician’s Role in a LTC Home? Does it make a difference whether you are a Medical Director or “just” a Visiting Physician? Does it matter if your role is personal as opposed to professional? How and Why?

13 What is the Proper Role of the Medical Director in a Nursing Home? To Fill the Beds? To Make the Administrator Look Good? To Cover for Staff Deficiencies? To Get Patients for Her Own Practice? Would anyone ever even ask these questions in an acute care environment?

14 What To Do For Your Elderly Patients Fulfill Your Medical Obligation Fulfill Your Legal Obligation Fulfill Your Existential Obligation If You Don’t, Who Will?

15 Red Flags for a Physician or Consumer Staff Cues Turnover Fear Charting The Administrator Resident and Family Cues Anything with Priority over Care and Service, Dignity and Respect

16 10 Tips for the Consumer 1.Find out how important care and service is at every level—from the owner to the maintenance person. 2.Review and authenticate the administrator’s (and other key staff members’) qualifications and track records. 3.Look at the record-keeping practices of the administrator -- and her time in the building generally and with residents particularly. 4.Talk to the owner or a senior manager above the administrator if you can. 5.Find out everything you are getting for your money and trust no promises of “extra care” that are not in writing. 6.Be “hyper-vigilant.” 7.Do NOT depend upon the state to enforce any of your loved-one’s rights. 8.Make sure you know your loved-one’s rights, 9.Knowing when to leave is hard, but don’t ignore the signs that suggest it may be time. 10.Avoid threats -- and avoid lawyers and lawsuits “like the plague.”

17 My 10 Tips Adjusted for the Physician (Visiting or Medical Director) 1.Encourage great care and service—dignity and respect—by demanding transparency and accountability 2.Ensure the medical and care staffs are qualified 3.Ensure charting is complete, accurate and timely done 4.Know the “Boss”—the administrator, the owner, the senior manager AND, particularly, the “brand” 5.Know what the patients are paying for and ensure they get it 6.Be a hyper-vigilant team player--without threats, direct or indirect 7.Know the patient’s rights and see that they are not abridged for someone’s convenience 8.Never depend on the state to find or fix problems 9.Know when a patient should be moved somewhere else 10.Care for your patients in a way that makes lawyers irrelevant

18 What Eldercare Needs Clear eyes to see things as they are AND how they can be Caring minds to grasp the problems and help create solutions Brave hearts to take bold, sometimes unpopular stands when and where necessary Strong voices to say (or to get others to say) what needs to be said when it needs to be said Willing hands to lift YOUR part of the load Courageous, Determined spirits to stick it out


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