Post-Acute and Long-Term Medicine: A Pocket Guide

353 Pages·2016·6.18 MB·English

by  Pamela A. Fenstemacher

Current Clinical Practice
Series Editor: Neil S. Skolnik
Pamela A. Fenstemacher
Peter Winn Editors
Post-Acute
and Long-Term
Medicine
A Pocket Guide
Second Edition
Current Clinical Practice
Series editor
Neil S. Skolnik
More information about this series at h ttp://www.springer.com/series/7633

Pamela A. Fenstemacher • Peter Winn
Editors
Post-Acute and Long-Term
Medicine
A Pocket Guide
Second Edition
Editors
Pamela A. Fenstemacher, MD, CMD, Peter Winn, MD, CMD
FAAFP Department of Family and Preventive
Chief Medical Offi cer Medicine
Living Independently for Elders (LIFE) Geriatric Assessment Clinic
University of Pennsylvania School University of Oklahoma
of Nursing OUHSC Family Medicine Center
Philadelphia , PA , USA Oklahoma City , OK , USA
Current Clinical Practice
ISBN 978-3-319-16978-1 ISBN 978-3-319-16979-8 (eBook)
DOI 10.1007/978-3-319-16979-8
Library of Congress Control Number: 2015953500
Springer Cham Heidelberg New York Dordrecht London
© Springer International Publishing Switzerland 2016
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Pref ace
Whether practitioners are still in training, recently graduated, or deciding to change
the direction or focus of their career paths, either by choice or necessity, they can
fi nd themselves immersed in the long-term care (LTC) arena. Any practitioner of
LTC can be overwhelmed when confronted by an LTC system that is both complex
and highly regulated, let alone taking care of patients that are challenging even to
the most experienced among us. These patients are challenging not only because
they have numerous chronic medical conditions and extensive and complicated
medication regimens but also because of advanced age and frailty. As experienced
clinicians, educators, and medical directors in LTC, we have written this guide for
practitioners in hopes of continuing to improve the quality of care provided through-
out the LTC continuum by imparting to practitioners the current knowledge in this
fi eld as well as the experience our chapter authors have acquired over many years
working in LTC.
B oth The Society for Post-Acute and Long-Term Care Medicine (AMDA) and
its state chapters continue to work tirelessly to meet the LTC practitioner’s needs.
Even the most experienced practitioners who have taken AMDA’s course on medi-
cal direction have commented on how much of the information on LTC care pre-
sented in the course is neither readily available nor frequently taught. The content
of this guide for practitioners is aimed at fi lling this void. The chapters of this guide
address the varied components of the LTC system as well as how to take care of the
patients and residents living within it.
Since the fi rst edition of the guide was written, the LTC system has continued to
evolve. The Center for Medicare and Medicaid Services (CMS) is promoting high-
quality cost-effective care through initiatives that encourage the use of innovation,
technology, and collaboration to improve quality. Accountable Care Organizations
(ACOs) and Population Health Management are two examples of CMS innovation,
focusing on prevention and early treatment of chronic medical illness. Chapters on
PACE, Nurse Practitioners, Clinical Nurse Specialists and Physician Assistants, and
the Department of Veteran Affairs Options were added to refl ect the increase in
community-based care that is being offered to our elders. The focus of some chap-
ters was shifted as well. The fi rst edition’s chapter on Acute Change in Condition
v
vi Preface
was changed to refl ect the increasing focus on Preventing Hospital Admissions and
Readmissions that is seen in LTC today. All of the chapters were updated to include
the latest innovations such as INTERACT II.
A s practitioners, we are all challenged by an ever-changing healthcare environ-
ment that entails bundling of healthcare services, value-based purchasing, transi-
tions in care, medication reconciliation (including the recent CMS Quality
Prescribing Initiative), PQRS reporting, HIPAA compliance (and possible audits),
different electronic medical records at different healthcare settings, and EMR mean-
ingful use. As editors of this guide, we hope these challenges will be less daunting
with the information provided in this guide.
The contributors to this guide are passionate about LTC and many have worked
within AMDA to create and disseminate a knowledge base for practitioners through
varied means such as AMDA’s clinical practice guidelines, conferences, and white
papers, all of which have served as resources to this guide. We hope that you fi nd
Post-Acute and Long-Term Care Medicine an invaluable resource to complement
your quest to optimize the care and living experience of your patients in LTC that
supports patient-centered care as well as patient choice, well-being, dignity, and an
improved quality of life.
T his guide is dedicated to Chris Laxton and the AMDA staff, and all our AMDA
colleagues who have mentored both of us over the years, many of whom have written
chapters for this guide.
Philadelphia, PA Pamela A. Fenstemacher
Oklahoma City, OK Peter Winn
Series Editor Introduction
T here is no better time for an update of L ong-Term Care Medicine. Individuals over
65 represent the fastest-growing portion of the population in the United States, con-
sume the highest proportion of the country’s healthcare dollars, and often live in
long-term care facilities or receive intensive outpatient home-based management
for the latter portion of their lives. The editors, Drs. Fenstemacher and Winn, have
extensive academic and practical experience in long-term care and have been
involved in leadership positions with the American Medical Directors Association,
which is the professional association for long-term care physicians. From this van-
tage point, they have selected authors who have both an academic and practical
perspective on issues most relevant to the patients we take care of in long-term care
facilities. The book’s emphasis is on giving the practicing physician an accessible
guide to understand and better manage the issues that come up in taking care of frail
elderly patients. The book goes over the changing environment and regulations of
long-term care. It does so by providing an expansive general overview of places and
processes of care as well as details of care including chapters on wound care,
dementia, delirium, rehabilitation, and many more.
T he book is readable, practical, interesting, and relevant. For this the editors and
authors are owed our thanks.
Neil Skolnik, MD
Professor of Family and Community Medicine
Temple University School of Medicine
Associate Director
Family Medicine Residency Program
Abington Memorial Hospital
vii

Contents
Home Health Care .......................................................................................... 1
Robert C. Salinas and Stefani D. Madison
Assisted Living and Residential Care............................................................ 13
Daniel Haimowitz
PACE ................................................................................................................ 37
Laura Trice
Department of Veteran Affairs Options for LTC ......................................... 47
Deborah Way
Behind the Scenes at Nursing Facilities ........................................................ 51
Richard G. Stefanacci, George Brown, and Shelley Reich
The Role of Practitioners and the Medical Director .................................... 73
Steven A. Levenson
Nurse Practitioners, Clinical Nurse Specialists,
and Physician Assistants ................................................................................. 91
Pamela Z. Cacchione and Reshma Shah
Common Clinical Conditions in Long-Term Care ....................................... 99
Naushira Pandya
Preventing Hospital Admissions and Readmissions .................................... 145
J. Kenneth Brubaker
Goals of Care and Prevention ........................................................................ 165
Cynthia Kuttner
Integrating Palliative Care into Practice ...................................................... 177
Peter Winn and Deborah Way
Weight and Nutrition ...................................................................................... 203
Todd H. Goldberg and Joel A. Levien
ix