Creating Heroes - An authentic path to person centered care

Guest video blog - Long Term Living Magazine

The PR Implications of a Bad Experience

Thanks to Jonathan Rosenfeld for calling this to attention. The narrator, while not totally compelling, nonetheless paints a story of life for his father in one nursing home. Think the experience is not important. This is the result when it is not.

Creating Heroes - The Authentic Path to Person Centered Care

What do a long term care facility and a fire house have in common? A lot actually. Dirty jobs, life and death, dark moments and light yet the firefighters culture thrives with little burnout and low attrition. Why is that? Firefighters create a supportive and celebratory culture that acknowledges the heartache (death around the corner) while celebrating joy. Long term care workers are confronted with their mortality every day but have little support to help them relieve fear, grief and sadness. When they are burned out they leave.

Person Centered Care in Perspective

See guest video blog for Long Term Living Magazine here.

AAHSA Party with a Purpose

AAHSA has a unique way to involve people at a grassroots level in the health reform debate as it pertains to long term care.

You can do your part by throwing a Party with a Purpose. These community gatherings will serve as a platform for conversation and action around long-term services and supports.

Find out more here.

Physicians Try To Put Gag Order on Patients

In the past five years more than 40 Web sites have begun reviewing physicians. Questions about their usefulness have fueled debate. As a defensive measure, some physicians are requiring patients to sign broad agreements that prohibit online postings or commentary in any media outlet. Medical Justice, a company that for a fee starting at $495 provides sample privacy agreements and monitors online comments for its 2,000 physician members.

Read more in this Washington Post article. Suffice it to say there are arguments on both sides of this thorny issue.

Freedom of speech probably trumps the “for” arguments. Word of mouth is here to stay. It can happen in a real conversation face to face or online. No real difference. The same useful or trivial information will be shared.

And that points to just how useful any of this is at the end of the day for your actual health, the “against” argument.

Hospitals spend millions advertising their quality ratings and positioning themselves to be featured in the U.S. News and World Report Best hospitals. Yet no one really understands an iota about the ratings and the criteria. Yet it forms a perception, maybe a wrong one. Same with physician ratings that paint a picture of a doctor more from the office experience than clinical ability. I rather know a primary care physician’s rate of correct diagnosis if you could measure it. Or tell me how many procedures of x y or z you have performed so I get a comfort level of your real expertise. Oh yeah how many people died under your watch? But that is not what these sites are touting.

They are touting in the physician’s case the experience and that is something that physicians need to pay attention to or they will lose patients to a practice that may be clinically equivalent but offer more in terms of a pleasing experience. John Swapceinski, a founder of RateMDs.com, says waiting time is a "huge issue" mentioned often, as are statements such as the doctor "never made eye contact and was out in 30 seconds."

I left a competent physician and now drive 40 miles out of my way for the experience of my primary care physician. Why? Well let’s start with he actually returns phone calls and spends time with you. This is simple people.

The public should take most of the information with a grain of salt. Unfortunately providers have to assess the damage to their reputations. "I'd love to have a Web site where I could complain about patients," one doctor said. Yeah, that’s the answer. For me it comes down to the experience. And that can be subjective.

It’s about how you would like to feel when the visit is said and done and how much you are willing to tolerate. Were you harried, worried, discomforted or were you assured, confident and bolstered. You may have a clinically fine doctor that offers the former experience and decide to put up with it. That is your decision. Or you may decide that feeling confident and supported in your healing journey is just as important as the practitioner’s clinical expertise. Then you might walk.

Language Skills, Social Networks Two Allies in Fight Against Alzheimer's

People with more developed language skills as young adults may be better able to stay sharp well into old age, even if they develop Alzheimer's-like abnormalities in their brains.

The findings suggest that this may be in part because their remaining brain cells become extra large to compensate. According to scientists, people's brains can adapt and change -- a phenomenon known as plasticity -- well into an individual's 80s and 90s. It's possible that neurons get bigger to compensate for damage done by the toxic proteins produced in Alzheimer's disease.

The results were published in the journal Neurology.

Scientists have wondered why some people with plaques and tangles in their brains characteristic of Alzheimer's have intact mental faculties their whole lives. Rush University conducted similar studies and found that people with the tangles and plaques in their brains that did not show symptoms were those who had broad social networks.

So this is making sense. Develop your language skills and use them to cultivate meaningful relationships.

Putting Person Centered Care in Perspective

Person Centered Care. Culture Change. A lot of jargon is being spewed in the continuum of aging services. What I have noticed though is that while the talk is good, the underlying tone is somewhat defeatist and negative and that can only spell doom for the industry.

While embracing the Eden Alternative or building Green Houses is great, there is something more fundamental that needs to take place - not hammers and nails but a shift in hearts and minds. When the shift occurs, natural positive movement occurs. What is that shift? Take a look.

Be Quiet Sharon Osbourne

OK I admit I watch America's Got Talent, even auditioned in Charlotte last year. Last night Sharon Osbourne, one of the judges, told a group of young singers and dancers that their material belonged in an elder folks home or something to that effect. Now even I admit that the group was a bit chessy.

However to imply cheesy and amateur to some of the music offerings in the continuum of aging services is to suggest that not a single one of those residents has sophisticated tastes and appreciates good music and performing when they hear and see it.

After all these are the same people that went to opera or went to see Sinatra. Yet cheesy and amateur is all they deserve I guess.

I know what I offer in these facilities is of a caliber they would have paid to see in their life outside the facilities they live. And there are many other fine entertainers (yes some cheesy and not talented as well.).

So Ms. Osbourne, why don't you join me in Philadelphia the week of August 10 during my 15 nursing and assisted living facilities and see what life and activities are really like in a place you have probably rarely if ever stepped into.

88 Year Old Mayor Can Teach Us A Lot About Life

This video will do more than anything I could ever say about aging. Thanks to my Facebook friend Angella Conrard who posted this video about a Canadian Mayor, 88 yrs young, 11 terms; city is debt free. As Angella says, our governments & politicians could take a lesson from this world elder. And so can we all about living a quality life. My mom will be 88 and until I saw this mayor I didn't think anyone had mom beat in terms of leading an active life.

Music and Healing - Growing Scientific Evidence

I have witnessed hundreds of times in nursing homes how a seemingly incoherent person can come alive during a performance. Anecdotal and observational evidence of the healing power of music abound. But now science is catching up. (Check this article at CNN about music’s therapeutic value.)

The article states, "Music seems to find re-routed paths and that is why it is such a useful tool in terms of helping people with different kinds of brain damage because it can help to find new pathways in terms of brain functioning." And this study isn’t the only one to affirm music’s healing properties.

Researchers in Finland have demonstrated that listening to music for several hours a day can enhance the rehabilitation of stroke patients.

At Colorado State University, researchers have used musical and rhythmic cues as a tool to improve the movement and balance of Parkinson's disease sufferers.

Not too long ago at a performance, a resident told me he recently had head and neck surgery and was ordered not to participate in activities. He wanted to be at my performance. I was touched and also told him I believed that the music was part of his healing. He agreed.

So what's my point? Tune in here.

CMS Five Star Friend or Foe - Guest Blog

Read our guest blog at Advance in Long Term Care Management.

New Test Claims to Detect Early Alzheimer's

Reporting in the June 10 issue of BMJ, researchers have developed a new self-administered cognitive test that is quick to use, examines 10 skills, and reportedly detects 93% of cases of Alzheimer's disease. Lead researcher and neurologist Jeremy Brown, MD, from Cambridge, the United Kingdom says that the test can be administered in a physician's waiting area and says that if there is time during the consultation to observe the patients filling in the test, this can also be a useful aid to diagnosis. His team found that with 10 minutes' training and a scoring sheet, a nurse without experience working in memory clinics was able to evaluate the test as accurately as a specialist. The significance of this test in part is the ability to administer it in the absence of an Alzheimer’s specialist, gerontologist or other similarly trained expert.

Investigators evaluated subjects from three hospitals including a memory clinic. They looked at 540 control participants and 139 patients with dementia or amnesic mild cognitive impairment. Of the 139 patients with dementia or mild cognitive impairment, 108 had Alzheimer's disease and 31 had degenerative dementias.

The test requires participants to write 10 answers on a double-sided card. The requested tasks evaluate a range of areas, including the patient's semantic knowledge, ability to calculate and name objects, and recall. A Web site is being developed for clinicians to download the new test, scoring sheets, and further instructions.

Globally approximately 24 million people have dementia, and it is estimated that the prevalence will double every 20 years. Cognitive tests are useful to diagnose dementia and to evaluate functional ability. Currently available cognitive tests do not satisfy criteria for widespread use by non-specialists.

Changing the Health Care Experience Through Telemonitoring

A big push in healthcare will start to focus on prevention, stabilization of chronic conditions, coordination of care and self responsibility.

In this blog, the author makes a great case for the importance of technology to the patient experience. In this case telemonitoring. To quote:

"Telemonitoring, in and of itself, doesn’t change lives. Telemonitoring is really just a 21^st century biofeedback service. Remote monitoring combined with the “just in time” teaching provided by our telemonitoring nurses give our patients the information they need to decide if they want to change their lives. Increasingly, our patients decide whether their chronic illness controls them or whether they, as much as possible, control it. Telemonitoring doesn’t cure disease, but it gives them another way to understand the information that we, the healthcare clinicians, have been giving them for weeks, months, and sometimes, years. "

So telemonitoring influences behavior far more than verbal and written instructions seem to provide. Sure we know the regimens and instinctively know what we should be doing but when your compliance is demonstrated it puts it in a different perspective.

Lesson for readers, our caregivers and elderly - embrace technology.