Three new items have been added to Section N of the MDS, that will have a major impact on the policies and processes you have used in the past regarding medication reconciliation and administration.

• N2001: Drug Regimen Review (Assessed on Admission)
• N2003: Medication Follow-up (Assessed on Admission)
• N2005: Medication Intervention (Assessed on Discharge)

Although this new item may seem to be commonplace in your facility already, there are scenarios which frequently arise, that may interfere and render your processes inadequate. These fundamental concepts will be required for Medicare Part A covered residents but are considered a best practice for any payer source.

Greetings, ACHCA colleagues!

I sincerely hope your summer has been an enjoyable time for you and your communities; it seems like just yesterday that we were gathering in Orlando for the ACHCA Convocation! Although roughly four months have elapsed since that time, much has been happening with your association.

There is another common change in us as we grow older: we slow down. This change is probably most obvious in our physical activity. But it is part of our mental life as well. Psychomotor speed, as psychologists often call it, is required by many activities. This is the pace at which we carry out all steps of an action, from sizing up the situation, figuring out what we want to do about it, and finally doing it.

Activities and tests that place a premium upon speed often show the old person at a marked disadvantage. He does however perform as well as younger people. But does performance in those circumstances reflect intelligence? When activities or mental tests are designed so that speed is not a significant factor, then the difference between old and young becomes much slighter. The old person reveals his ability to learn, think, remember and solve problems when not being rushed and when allowed to proceed at his own pace.

Do you often ask yourself what gives your skilled nursing facility its identity or what makes it stand out amongst competitors? If your patients, residents, and staff come to mind, you’re on the right track. But, now what?

Your facility is a story unfolding across all customer touch points.

In spite of language losses suffered by an individual with Alzheimer’s, many skills that support communication are remarkably preserved and remain for a long time. When working with the AD individual, the caregiver should keep in mind six abilities that are nearly always preserved.

1) The Use of Procedural Memories
Individuals with AD begin to lose memory for words, information and events quite rapidly, but procedural memory, or the knowledge of how to perform familiar tasks remain relatively intact until the later stages of dementia. The research suggests that this is because procedural memory is the most elemental of human memory systems and is the only memory system capable of operating independently. This system can sustain some very complex human activity such as walking, washing hands, or even driving a car. Procedural memory is like a computer program whereas other types of memory are like data stored in the computer. Alzheimer patients begin to lose data rapidly but still function. They may forget where they are going, but they still know how to walk. They may forget what they are saying, but they still know how to talk.

• The look on the face of the five-year-old as he boards a school bus for the first time and the look of apprehension on the face of his mother.
• The last lingering touches of two lovers who cannot bear to let each other go.
• The moment when one must board that jet and fly off to a new life elsewhere.
• The apprehension that this could be the last time they shall see each other and that chill of final separation.

The following is an excerpt of a discussion I had several years ago with the daughter of a man (her father) who had recently passed away.

“The last time I saw my father I guess I knew it might be the last time. We talked a little about this and that…nothing important. It was as if we both had agreed to keep it that way because we both knew, and we knew that we knew.

Definition: Perspective “a view of things (as events) in their true relationship or relative importance” (The Merriam Webster Dictionary)

Some years ago I had a conversation with a resident in a facility where I was the head of the Nursing department. She was close to her 100th birthday. I asked her what she made of her life in general. She promptly replied: “Can’t tell yet! I am still making my life!”

A person who appears demented may be tormented by grief and anxiety. His demented behavior may have been brought about by emotional pain. A grieving person at any age is less able to pay close attention to everything that happens around him. He takes less care in grooming and dress. He has less emotional energy to welcome new opportunities or to respond to challenges. He feels uncomfortable with his body. His mind may be constantly uneasy or tortured.

Loss and grief are common in old age as death removes loved ones. An old person may have suffered other significant losses, of occupation, residence, physical mobility, belonging, or usefulness – all of which produce a grief response.

Without question, working in long term care is demanding and stressful. In addition to the intrinsic stressors staff must face daily in nursing homes, often they must also struggle with managers who add to the stress. It takes only one thoughtless supervisor to create a work environment that goes from bad to worse in an instant.

Unfortunately, there are managers and supervisors in long term care who may lack self-awareness or the desire to evolve into better leaders. They may intentionally create “power distances” between themselves and their employees. This distance may also signal that they may be unapproachable.

A few weeks ago, I had the pleasure of sitting in on an orientation for our client, Rowntree Gardens, a faith-based Continuing Care Retirement Communities (CCRC) that provides a full range of integrated onsite services to meet the changing needs of people as they age. Randy Brown, CEO, engaged Drive in our services because he understands the importance of their rich history and deeply rooted culture.

Together we are working to enhance their already strong culture and create a sustainable program to retain their top employees while also finding new ways to recruit the right candidates.

Have you ever heard an employee utter the words, “That’s not my job?” Or maybe you’ve secretly wished the ground would open up and swallow you when you heard how an employee spoke to a customer. Have you ever been on the receiving end of, “That’s not how we do things around here?”

What do all these things have in common? Culture.

Is it necessary that our lives place so much emphasis on employment, productivity, earnings?

Both disengagement and conflict theories give a lot of attention to the meaning of work. This I believe, is justifiable. The achievements and social status associated with occupation are major ingredients in the way we judge ourselves and others. When asked who we are, don’t we often answer in terms of our work?

Mobile mobility, on-demand access, and instantaneous communication have forever changed how individuals interact; changing how we define “membership.” The reality is that individuals no longer join an association because it is expected as a professional; they want to know that they are spending money on something that will be of value to them.  ACHCA recognizes this shift in membership perception. 

ACHCA leadership strongly believes that a foundational part of our member’s value proposition is their chapter infrastructure. Chapters should be where our members find community throughout the year, where they can engage at a local level and often where they can hone or strengthen their leadership skills through volunteerism. 

The new year brings new opportunities and challenges to the senior living industry. With all the changes in process, it’s a good time to revisit your strategy and evaluate what decisions can make you successful in 2018.

Investment in Senior Living

Def: Muse - to become absorbed in thought - Merriam Webster Dict.

For more than fifty years I’ve cared for countless sick elderly and disabled individuals in my capacity as a Registered Professional Nurse.

A new year is a great time to set goals (both big picture future goals and SMART goals for the current year). Here are DRIVE's top 10 must do’s for creating and sustaining a strong culture in 2018.  (Blog reprinted with permission.)

As you navigate these first few weeks of 2018 we recommend that you sit down with your team and consider what on this list you do really well and what you need to work as a team this year. If you need help getting starting let us know. We have facilitators who can not only help lead this discussion, but they can work with your team throughout the year to help you all achieve your goals.

“You’re looking pretty tonight.” Her eyes warm to the compliment. Automatically she checks her hair, newly washed and cut. Even after all these years she is still slightly nervous. But a date is still a date even when you are seventy-and-more. For his part, any tentative feelings are covered with pride and pleasure at being seen out with such a fine woman – much as he felt fifty years and more ago.

“Shall we go?”

Far too often, labeling a person as ‘senile’ is a thoughtless expression steeped in prejudice. ‘Diagnosing’ a person as ‘senile’ is accurate only when we mean there is a continuing pattern of progressively deteriorating thought and behavior coupled with a medically proven diagnosis of an irreversible brain disease. Careless use of this single word (senile/senility) suggests that we think we know what is wrong and there is nothing more to understand or to be done. This attitude is not justified even when the person is, in fact, suffering some form of a progressive cerebral change. But the attitude is particularly destructive when the individual is troubled, yet far from ‘senile’.

Even professionals are capable of making such errors. International mental health teams and researchers in the field of gerontology who have been studying this problem have discovered that many elderly persons who were labeled with the term senile/dementia have come to realize that the problem is, in fact, functional in nature. If this can happen, then people without professional or scientific training may be even more prone to error. Any sign of confusion or mental lapse in an elderly person may be erroneously taken as ‘proof’ of senility.

Definition: keen-minded – “mentally alert” – (Merriam-Webster Dictionary)

Why are some elderly people more keen-minded than others? In youth and middle age some people are more mentally alert and vigorous than others. Keen-mindedness tends to be habit forming: a combination of fortunate genetic endowment and a lifestyle that keeps the intellect well honed.

Despite the obstacles, love can triumph for the old as well as for the young. The importance of a sustained love relationship in old age is hard to overestimate. Sex brings more than direct physical gratification, although this by itself is not to be slighted. It also reaffirms each partner’s identity as a person who can offer something worthwhile, and who can be someone worthwhile to another person. The body is still a means of giving and receiving pleasure.

But there is another important function of sexual intimacy in old age. The old person is all too often ‘typecast’ to the outside world. He is the secondary character, belonging on the fringe of the real action.
We tend to remain at an emotional distance from him. Every day we walk past, almost through old people on the street, without clearly registering their existence as individuals.