Boomers ‘want to be involved in their own care’
LOS ANGELES: To treat a younger and more acute population, nursing home operators need to be aware that patients of this population are educated, health-literate, and want to be involved in their own care, requiring a multidisciplinary approach from clinical teams.
“This population probably doesn’t want to have a roommate and particularly one that might be 85 years old,” Robin Mitchell, Chief Nursing Officer at Diversicare said during a recent Skilled Nursing News webinar on clinical trends.
To meet higher expectations and more complex comorbidities, Mitchell emphasized the need for nurses to harness their critical thinking and assessment skills, encouraging them to transcend the confines of routine tasks.
She noted that her focus at Diversicare is on collaboration, particularly with nurse practitioners and physicians, both within the facility and through hospital partnerships, to elevate the standard of patient care.
And similar approaches are being implemented by other providers, such as Mission Health Communities, as they evolve for the future. Providers, including Mission, also are more focused than ever on meeting behavioral health care needs.
Furthermore, standard practices in clinical care are continuing to evolve, with clinicians driving innovative approaches related to some of the most common diagnoses in nursing homes.
Diabetes is among these diagnoses, with nursing home providers taking several steps to harness technologies and streamline their care practices for this condition, said Dr. Naushira Pandya, Professor and Chair of the Department of Geriatrics at Nova Southeastern University.
Critical thinking and assessment required
In order to meet the moment, with acuity on the rise, Diversicare is striving to recruit nurses with complex care experience, while bringing in educators to support and elevate the skill set of nurses already on staff.
“It used to be that nurses came into a nursing home and they pass meds. But we want to try to think about that differently,” Mitchell said. “We want them to use their critical thinking skills, their assessment skills.”
Mitchell said medication aides play a pivotal role in allowing nurses to shift their focus from the mechanical task of passing medications to more critical functions such as assessments and early intervention.
“We are using medication aides in many of our centers so that nurses can get away from just passing pills and doing those assessments to catch patients who maybe have a change of condition so that we avoid rehospitalization,” she said.
Furthermore, Diversicare is working more closely with partners in other parts of the care continuum.
“We are collaborating with our hospitals,” she said. “Sometimes we’re having those hospitals come to the nursing homes to educate on different kinds of diagnoses that they might be referring, training us on the skill that’s needed. But we want a higher level of skill set.”
Tina D. Thomas, senior vice president of operations at Mission Health Communities, also underlined the significance of ongoing education and development, incorporating career ladders, and celebrating the achievements of nursing staff.
“We look at our clinical programming, we look at our educational development, our recruitment systems, our nurse educators, and really try to pull together a holistic approach to meet the market demand and our education,” she said.
Thomas also underscored the increasing need for behavioral health programs within senior care facilities.
Thomas said Mission Health has some communities that are specialized in behavioral health, and she sees this as a growing need in her patient population. The need for behavioral healthcare, she said, ties directly back to specialized training.
“[We are] training the staff specifically to specific behaviors and looking at how we can grow and develop and be a part of that person’s life for the long term too, because it’s not a short term kind of program,” she said. “We see it as long term and we’ve had some really great successes.”
Current and future approaches to diabetes management
Drawing on her work as a researcher, Pandya illuminated the inadequacies in the current approach to diabetes management, particularly considering the complex medical needs of residents with diabetes.
Diabetes affects approximately one-third of patients in most long-term care settings, with these individuals often facing comorbidities, greater functional impairment, mental health challenges, and more significant instances of dementia and depression, she said.
Managing diabetes within this context is indeed a complex endeavor, she said.
“The big challenge I think we’re finding is that diabetes is still very hard work for nurses, and nursing assistants to take care of these patients,” she said. “I think we could do better in terms of streamlining therapies.”
She noted that, while some progress has been made, there remains significant variation in how diabetes is managed across different facilities, a variation that depends on factors such as facility culture, the competency of practitioners, and the motivation of leadership teams.
One of the key challenges Dr. Pandya highlighted is the continued use of sliding scale insulin. She pointed out that even with advancements in diabetes care, 15% to 20% of long-term care residents with diabetes still rely on this labor-intensive and less effective method.
Simplifying diabetes management is the way forward, with a focus on therapies that require fewer glucose checks, thus saving both time and resources.
“There’s a lot of other technology that’s possible to be used, but I think first we need to get comfortable with continuous glucose monitors,” she said. “That’s not to say everybody needs it.”
Collaboration was another key point, as Pandya stressed the need for partnerships with diabetes educators, endocrinologists, and other health care experts to provide comprehensive training for staff in long-term care facilities.
“We need to have partners for diabetes educators,” she said. “An endocrinologist, a primary care clinician who’s comfortable with this to train the staff.”
Diabetes care is indeed an area ripe for innovation, and Mission has been exploring options, Thomas said.
Mission is looking at glucometers that work on cellular service, with readings directly uploaded to electronic medical records. The organization also is considering an offering that would take the blood glucose reading from the EMR, analyze that along with some other parameters, and calculate the next dose of insulin.
“So then, in a few weeks, the resident has a steady regimen, [that involves] less fingersticks — just overall a better, healthier process for the resident,” Thomas said.
Adapting to a younger population in long-term care
The demographic transition to younger residents necessitates a reevaluation of care practices, Mitchell said. The younger residents present unique clinical and emotional needs.
The approach to accommodating younger residents is markedly different, as they might not have anticipated residing in a nursing home at their age.
“We always want to make sure that we have increased communications but these patients who are oftentimes highly educated, they are very health literate, and they are very involved in their patient care, more so sometimes in our older population, where we often communicate with their family members,” she said.
Amenities such as high-speed internet access and personalized in-room technology are now expected. This means that facilities must adapt to meet these expectations, accommodating residents’ needs for connectivity and information.
“[Baby Boomers] would want to have internet access that is quick,” she said. “We want to be able to potentially Netflix or stream. We want to be able to use our computers and have access maybe to a printer and an iPad, and so we have to think about that.”
Other elements of care and lifestyle, such as menu options, also need to be elevated for this population. And more than ever, care teams must be cognizant of the goals that patients have for themselves.
At Diversicare, the resident’s voice and goals are an important consideration in care plan meetings that occur 72 hours after admission, and clinical teams need to reckon with the fact that their goals for residents might not always align with the goals the residents have set for themselves.
“We’re having some really good successes with a younger population, but we have to recognize those [different variables in their care] as an interdisciplinary team, and be prepared to care for those residents at that age,” Mitchell said.