Tuesday, May 03, 2016

National Nursing Home Week!

National Nursing Home Week will be observed May 8-14 this year.  Each year, the week that begins with Mother’s Day is recognized as National Nursing Home Week.

This year’s theme, established by the American Health Care Association, is “It’s a Small World with a Big Heart.”  The theme celebrates the great diversity found among nursing home residents and staff.  Increasingly, nursing homes are becoming educated on the provision of culturally appropriate care.  A few years ago, I talked with an administrator from New York City who said, “I’m the Catholic administrator of a Jewish nursing home where I have Muslim employees providing care to Buddhist residents.” 

In another urban nursing home, there were several employees in housekeeping and laundry who were immigrants from the same country.  They wanted to become United States citizens.  Several residents were retired teachers.  They made a deal:  tutoring in exchange for lessons about their native culture.  These ladies gave sessions on their native food, dress, dance, art, music, holidays, etc.  It was a great experience that strengthened their relationships.  The residents celebrated with them when they became citizens.  Indeed, big hearts know no cultural, geographic, or religious boundaries.

Nursing home residents are increasingly using the internet.  They can keep up with family members who live at a distance, share with friends through social networking, and learn from educational sites.  Internet availability is shrinking the world of seniors. 

Residents are often honored for the contributions that they have made to their families, communities, and the world.  By listening to their stories, we can often discover extraordinary talents and influence that they have had. 

During this week, nursing homes around the country will celebrate in a variety of ways.  We recognize and honor both residents and employees.  Often, devoted long-term care workers put in long hours under challenging circumstances to assure that residents get the care they need and deserve.  Be sure to express your appreciation to long-term care staff, residents, and volunteers this week.  

Contributed by Phil DuBois, CNHA, FACHCA, SJC Program Manager, LTCA

Tuesday, April 19, 2016

Good Samaritan Laws

What do you think of when you hear about Good Samaritan Laws?  A duty to help those in need?  Protection when you provide CPR to a stranger?  Many people have heard of the law, but few are aware of how different the laws are from state to state.

Good Samaritan Laws are state statutes, which means that individual state governments have approved these laws in their states.  Some states choose to use the law to provide immunity to those who assist in emergency situations while other states actually require bystanders to help.  Here is a relative breakdown:
  • Most of the 50 states provide immunity to those who administer care in emergency situations
  • 8 states provide no immunity to private individuals not meeting certain criteria
  • 24 states provide immunity for physicians rendering emergency care in a hospital
  • 6 states exclude rendering emergency care in a hospital from Good Samaritan coverage
  • 2 states require a duty to assist; if it is a reasonable emergency, physicians must assist
  • (Source: http://www.aaos.org/news/aaosnow/jan14/managing3.asp)
What does this mean for the average citizen who wishes to help out in emergency situations?  The answer is not clear, unfortunately.  A quick internet search will help you find the Good Samaritan Law in your state.  Most states will protect individuals who choose to assist injured people in emergency situations, as long as they use reasonable precautions and are of sound mind (i.e., have not been using drugs or alcohol).  The best advice is to offer help if you feel comfortable doing so at the time, but always be aware of your safety, as well.

Provided by Valerie J Connor, MA CCC-SLP, Adjunct Faculty, Saint Joseph's College.

Wednesday, April 06, 2016

Technology and Health Risk

Technology is proliferating our world.  It has many great uses and it has made our lives easier in many ways; however, it can cause significant health problems if it not used within moderation.  These problems can affect both children, teens and adults, but technology overuse can be more harmful to developing brains.

Technology Statistics

u  56% of children 8-12 years old have cell phones; all but 4% have data phones (National Consumers League, 2012).
u  72% of children 8 and under have used a mobile device for a media activity
u  38% of children under 2 have used a mobile device
u  Children average 7.5 hours of entertainment technology time per day (American College of Pediatricians, 2014)

As of March 2013
u  78% of American teens have a cell phone (98% of adults ages 18-29)
u  47% of American teens have a smart phone
u  32% of American teens own an e-reader
u  23% of American teens own a tablet computer
u  74% use their phones to surf online
u  93% of teens have a computer or access to one(Pew Research Internet Project)
u  94% of teens were on Facebook
u  91% had posted a personal photo
u  92% posted their real name
u  75% of all teens text with 60 texts per day being the median number of texts in a day
u  Many teens sleep with their phones(Pew Internet Research Teenage Fact Sheet)

Technology Disparities
u  In 2013 access to smart phones for low income families from 27% in 2011 to 51%
u  Access to high speed internet increased 4% from 42% to 46%
u  Tablet ownership has increased from 2% in 2011 to 20% in 2013
u  In 2011 only 22% of lower income children had ever used a mobile device; in 2013 65% have done so.
u  In 2013 35% of lower income parents had downloaded apps for their children (Common Sense Media, 2013)

Technology’s Effect on Physical Health
u  Cognitive and neural functioning (Brain Health)
u  So much has yet to be determined—particularly about students who begin technology interactive in infancy
u  Young brains are more malleable than adult brains
u  Piaget constructivist theories: Piaget noted adaptation to environment is a biological function.  This includes assimilation and accommodation which directly involve the nervous system of a child.  Piaget felt the development of individual children should not be artificially “rushed (Chirico, 1997).
u  In 1989 Hyson, Hirsch-Pasek & Rescorla (Academic Environments in Early Childhood: Challenge of Pressure) studied 4 year olds and taught a control and experimental group academic and non-academic concepts.  The academic group overwhelmingly had less creativity which is an important component of problem solving later on. There were no difference in intelligence. This is an example that changes in brain development may in fact be detrimental in some other way.  When stimulus is presented at the wrong time or in an inappropriate manner, the neural connections may accommodate in a non-preferred way.  This is thought to be one of the causes of increases in attention deficit disorder. Media and technology can also do this.  Primarily studies have been on excessive television usage which negatively affect health and academic performance.  However, students engaged with technology do not engage in physical play as their ancestors did.  Some researchers feel this lack of interaction in the physical environment can be negative.
u  Potential Negative Effects
u  Much of the research in children and technology at young ages is based on television viewing
u  Negative Effect on Enterprise skills in preschoolers:  Lilliard and Peterson (2011) in Pediatrics found just 9 minutes of viewing something fast-paces (such as a video game) for 9 minutes caused immediate negative effects on executive function tasks (such as delay of gratification and building a tower).
u  Technology is being used to entertain toddlers (such as games on a Smartphone).
u  2010  Attention Disorders: Baveliar, Green and Dye (2014) In Neuron; American College of Pediatricians noted technology causes long-term changes in behavior/brain function.  However this can be positive or negative depending on what the stimulator is.
u  Excessive multi-tasking can impact attention
u  -7 studies have shown language delays in infants exposed to excessive technology  (Strasburger et al., 2010)

Additional Negative Effects
u  Sleep disorders
u  Disordered eating
u  Tendonitis in the thumb
u  Back/Neck problems
u  Generalized health complaints (technology overload)
u  Texting when driving a car (more accidents)
u  Lack of Activity
u  Obesity (has doubled)
u  Diabetes
u  Early Onset Heart Disease
u  Decreased motor development
u  Lack of Interaction Within their Environment
u  Decreased sensory stimulation
u  Failure to achieve child development milestone (contributing cause)
u  Increased risk of smoking due to media exposure
u  Drug and alcohol abuse
u  Early sexual activity (due to exposure to media, predators, sexting, etc.)

Positive Social and Emotional Effects of Technology
u  Computer/internet access in the home can enhance academic achievement and happiness
u  Exposure to educational media at a young age has positive effects (science-based versus quasi educational); in order to be effective they must elicit direct participation and should not be passive
u  Increases feeling of social connectedness which can positively impact well-being (when done with friends and not strangers) (Strasburger et al., 2010).

Negative Social and Emotional Effects
u  Technology stress: Mental Overload (Berntsson, 2000; Haugland, Wold, Stevenson, Aaoroe & Woynarowska, 2001; Rimpela et al., 2004) includes isconnecting people from nature, play and people.
u  Lack of social boundaries
u  Lack of sexual boundaries
u  Lack of social skills
u  Decreased sense of time
u  Lack of future thinking/decreased academic performance
u  Multi-tasking with negative effect on performance
u  Increase impulsivity (Park & Hyun, 2014)
u  Isolation/loneliness
u  Depression/lack of self-esteem
u  Lack of privacy
u  An altered sense of reality
u  Increased aggression
u  Decreased well-being

Technology Addiction
u  Under consideration for inclusion in DSM V
u  Knows an Internet Addiction Disorder
u  Prevalence between 0.3 and 38%
u  China and Korea have id’ed it as a significant public health threat(Cash, Rae, Steel & Winkler, 2012; Cao & Su, 2014; Leung & Lee, 2011))
u  Similar to a gambling addiction in the way it is viewed and treated
u  Boys are more prevalence than girls (Tang et al., 2014)
u  Technology addiction treatment centers popping up through Asia
u  Includes computer addiction, Internet dependence, compulsive Internet use, pathological internet use, problematic internet use.  The anonymity factor impacts behavior and causes people to do what they might not do otherwise
u  Activated pleasure pathway in brain

4 Components of Technology Addiction
u  Excessive internet use with a loss of a sense of time and neglect of basic drives
u  Withdrawal, including feelings of anger, tension and/or depression when the computer is not accessible
u  Needing better equipment, software, hours of use
u  Negative repercussions include arguments, lying, poor achievement and social isolation (Block, 2008)

  • American Academy of Pediatricians. (2014, February).  The media, children and adolescents.  Retrieved from www.acpeds.org
  • Block, J. J. (2008). Issues for DSM-V:iInternet Addiction. American  Journal of  Psychiatry, 165, 306-307.
  • Cash, H. Rae, C.D., Steel, A.H. & Winkler, A. (2012).  Internet addiction:  A brief summary of research and practice.  Current Psychiatry Review, 8 (4), 292-298.
  • Cawley, J. (2010, March).  The economics of childhood obesity.  Health Affairs.  Retrieved from http://content.healthaffairs.org/content/29/3/364.full
  • Common Sense Media.  (2013, Fall). Zero to eight:  Children’s media use in America 2013.  Retrieved at https://www.commonsensemedia.org/research/zero-to-eight-childrens-media-use-in-america-2013
  • Chirico, D. (1997).  Building on shifting sand:  The impact of computer use on neural and cognitive development. Donna M. Chirico. Waldorf Education Research Institute Bulletin. 2 1997: 13-19. Retrieved at http://www.allianceforchildhood.org.uk/uploads/media/RB2103.pdf
  • Health and Human Services. (2013, Nov).  Teen media use part 1:  Increasing on the move.  Retrieved from:  http://www.hhs.gov/ash/oah/news/e-updates/eupdate-nov-2013.html
  • iNACOL. (2013, February).  Key K-12 online learning stats.  Retrieved at http://www.inacol.org/cms/wp-content/uploads/2013/04/iNACOL_FastFacts_Feb2013.pdf
  • Ipsos Marketing Research. (2012). One in ten (12%) parents online, around the world say their child has Been cyberbullied, 24% say they know of a child who has experienced same in their community.  Retrieved from http://www.ipsos-na.com/news-polls/pressrelease.aspx?id=5462#.Tw6exyC2__s.twitter
  • Leung, L. & Lee, P. S. N. (2011).  The influences of information literacy, internet addiction and parenting styles on internet risks.  New Media and Society, 1-21.
  • Lilliard, A. & Peterson, J.. (2011) The immediate impact of different types of televisions on young children’s executive function, 128 (4), 644-649.
  • National Consumers League.  (2012, Julu 10).  Survey:  Majority of “tweeners” now have cell phones with many parents concerned about cost
  • No Bullying.com. (2014, September 18).  Cyber bullying statistics 2014.  Retrieved at http://nobullying.com/cyber-bullying-statistics-2014
  • OFCOM. (2013, October 3).  Children and parents:  Media use and attitudes report.  Retrieved from http://stakeholders.ofcom.org.uk/binaries/research/media-literacy/october-013/research07Oct2013.pdf
  • Park, C. J. & Hyun, J. S. (2014).  Internet literacy vs. technology addiction:  Relationship analysis with time perspectives of secondary school students.  Advanced Science and Technology Letters, 59, 23-26.
  • Pew Research Internet Project.  (2012, September).  Teens fact sheet.  Retrieved at http://www.pewinternet.org/fact-sheets/teens-fact-sheet/
  • Strasburger, V. Jordan, A.B. & Donnerstein, D. (2010, March 1).  Health effects of media on children and adolescents. Pediatrics, 125(4), 756-767.
  • Tang, J., Yu, Y., Du, Y., Ma, Y., Zhang, D., & Wang, J. (2014). Prevalence of internet addiction and its association with stressful life events and psychological symptoms among adolescent internet users. Addictive Behaviors, 39(3), 744-747.
  • U.S Department of Justice. (2013)  Fact and statistics:  Raising awareness about sexual abuse.  Retrieved at http://www.nsopw.gov/en/Education/FactsStatistics?AspxAutoDetectCookieSupport=1

Contributed by Dr. Colleen Halupa, Adjunct Faculty, Saint Joseph's College

Monday, March 14, 2016

Long-Term Administrator's Week!


Happy Long Term Care Administrator's Week!!
We extend heart-felt thank yous to Administrators in nursing homes and assisted living centers this week!
Kudos on a job well done!! 

Since 1994, ACHCA has sponsored this national observance each March.  This week we honor and celebrate the important role the administrator has in providing leadership for the delivery of quality, resident-centered care and a supportive work environment for staff. 
 For additional ways to celebrate LTC Administrators week, visit our website

ACHCA is lucky to have a member like you! Thank you for your dedication to advancing the profession and the quality of life for the most vulnerable members of our society!

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American College of Health Care Administrators
1321 Duke Street, Suite 400 | Alexandria, VA 22314
Ph: (202) 536-5120 | www.achca.org

Monday, February 29, 2016

Why is Health Information Management so Important?

The Health Information Management (HIM) professional is an expert in managing all aspects of patient health information. The comprehensive knowledge that the HIM associate possesses assists in all aspects of this position, including managing that health information through health records, administering computer information systems, and collecting and analyzing patient data. Also very important is the ability to comfortably and accurately use classification systems and medical terminologies.

The HIM associate must have the ability to document clearly and support an accurate diagnosis that confirms the patient’s clinical findings, progress, and finally, discharge planning. A clear understanding of the medical foundations of patient care includes basic pathophysiology, abnormal clinical findings, and anatomy and physiology. Understanding this information is paramount to the successful HIM associate’s assurance that coding is precise, and diagnoses and outcomes are exact.

Two courses in an HIM program of study include Pathophysiology and Anatomy and Physiology. An understanding of anatomy (what’s in the body) and physiology (how it works) is the basis of all medicine. If we know how the body works, how it is put together, and what can go wrong, we can then understand the treatments and interventions that are the basis of medical treatment. The study of Anatomy and Physiology bridges the knowledge of the intricacies of the human body to the complexities of managing the data and information to medically manage a patient.

The study of Pathophysiology examines the alterations in the normal functions of the body that affects individuals across the lifespan. Understanding the mechanisms of disease processes essentially give a HIM associate the ability to recognize abnormalities and alterations in function and enable him or her to identify code-able diagnoses and/or procedures. This must be supported by a strong working knowledge of anatomy, physiology, clinical disease processes, medical terminology and even pharmacology. 

It becomes very clear with the study of anatomy and physiology that the body works in a collaborative manner to maintain balance and equilibrium. Understanding the basic knowledge of the components of the body then allows us to recognize in more detail the processes that interrupt that balance and equilibrium. A strong understanding of pathophysiology means having that ability to recognize those interruptions of the normal physiologic processes.

Consider the role of a documentation specialist in an acute care hospital. This professional is considered an HIM associate, and reviews all physician documentation in the medical record on a daily basis while the patient is in the hospital. This review ensures that treatment regimens, diagnosis and plan of care are clearly and consistently present in the record. Upon discharge, this record is then reviewed by another HIM specialist to code, or assign very specific alphanumeric numbers that are tied to how much reimbursement is realized. Everything that happens to that patient must be present and detailed clearly in the medical record. A history and physical, the first time a medical diagnosis is identified in the record, every lab value, x-ray result and treatment plan and regimen must be coded. The HIM associate has skills to not only recognize abnormal lab values and the intricacies of medical intervention, they also begin to anticipate and investigate nuances of care that may lead to even more accurate management of the medical record that results in quality data administration.

Understanding the body in as many ways as possible gives the HIM associate the skills and competencies to become an essential part of a health care team. Never has the management of patient information and data been more crucial. Not only does the HIM professional offer skills that manage the medical record, but is instrumental in ensuring that information is complete, documentation is timely, and the information that is tied to reimbursement for services rendered is accurate. Having an understanding of how the body works, and then recognizing the intricacies of disease processes assists the HIM associate in assuring quality patient care.

 Submitted by Katie Cross, MSN, RNC-OB, Adjunct  Faculty BS HIM Program

Friday, February 12, 2016

Health Technologies & Elder Care

 GeroTechnology: An Introduction

As settings for long-term care become increasingly diversified, it is projected that there will be an increased reliance on family caregivers and technology within one’s home setting, especially during health status changes requiring extended care services.  A relatively new field, GeroTechnology (or GeronTechnology) engages technology companies, engineering and architectural firms, private entrepreneurial enterprises, research universities, governmental representatives, and members of the aging network – all working together to provide services that people need, when they need them, in the place they call HOME (Leading Age, 2016).   Rather than having to bear the expense of a nursing home, technology is being built into housing and products to improve person-environment congruence for older adults experiencing health status changes

As our senior population doubles over the next two decades, we face a daunting mission:  increasing the quality of care for a record number of elders while also striving to reduce the nation’s health care economic woes.  Many professionals argue that if we are to deliver quality care now and in the future, we must embrace the philosophy of a wellness revolution.  In other words, we will need to apply American innovation to wellness technologies that enable prevention, early detection, increased compliance, and new modes of remote caregiving and family support (Eldercare, 2015).

Home Care Technology and Aging-in-Place

By its very definition, home care helps people age-in-place.  In addition, home care technology provides essential tools to individuals on a widespread, cost-effective scale.   Telehealth or remote monitoring, an all-inclusive term, encompasses a range of high-tech applications that involve caring for patients remotely.  For example:

·               Monitoring an individual’s heart rate while that person is working out on a treadmill.

·               Transmitting a patient’s telemetry readings to a nurse via the Internet.

·               Virtually bringing a health care provider into a patient’s home via the digital use of a high-resolution camera.
(Hfaging, 2016).

As hospital stays have been shortened and more home care technology has become available, caregiving at home has come to take on many aspects of a mini intensive-care unit.  One interesting example is the MEDCOTTAGE – a mobile, modular medical home designed to be temporarily placed on a caregiver’s property for rehabilitation and extended care.  As noted on their Web page, the MEDCOTTAGE is a state-of-the-art hospital room with remote monitoring so caregivers can provide quality care and participate directly in their family member’s recovery (MedCottage, 2016).

Enabling Technologies and Chronic Care Management

A growing body of research indicates that care technologies can prevent premature institutionalization (and its related costs) while also giving older adults more control over their own health and living conditions.   The Center for Aging Services Technologies outlined several platforms that have demonstrated value for older Americans coping with chronic conditions.  Some of these include the following:

1.            Medication Optimization 

These platforms address medication non-adherence – a serious problem which is responsible for 33-69% of medication-related hospital admissions and 23% of all nursing home admissions. 

2.            Remembering to Take Medications

Many older adults have problems remembering to take their medications as well as remembering their timing and sequencing.  Medication reminder systems fall into several categories – passive organizers, commercial medication reminder services via phone or e-mail, and software for personal data assistance.

3.            Remote Patient Monitoring

These may include communication devices as well as weight scales, blood pressure monitors, assessment algorithms, and “clinician alerts” by remotely located health care professionals.  These are especially important in rural and medically underserved communities. 

4.            Assistive Technologies and Home Modifications

Videophone products, for example, offer family caregivers the advantage of being able to see and hear their relatives.  Observing an elder performing basic tasks, such as sitting down and getting into bed, can provide important information about strength and balance.  Additionally, if an individual has changed or stopped routine grooming and self-care habits, it will be more apparent via video.  

5.            Remote Training and Supervision

For family caregivers who have to learn how to perform long-term care tasks and who also feel isolated, remote training has become increasingly beneficial, e.g., online tutorials, coaching sessions, and family support groups.

6.            Cognitive Fitness: Training and Assessment

Designed for working with cognitively impaired older adults with chronic illness, some of the available tools include counseling support instruments, electronic health records, and point-of-care computers.

7.            Social Networking and Loneliness:  Social Connectedness

Although not typically categorized as an illness, loneliness is a problem faced by many older adults in poor health who may live alone.  As research indicates, they have a very different experience of aging than those with family and social supports.

In such cases, technology can help elders feel more connected to those outside their homes.  As just mentioned, videophones can be a tremendous asset.  In addition, computer networks, such as the Internet, offer many opportunities for communicating with others.  Some services are designed specifically for people aged 65+.  They may offer social activities as well as host a variety of online discussion and enrichment topics, such as book clubs and virtual travel excursions.

8.            Social Media

Most health experts agree that the future of medicine will incorporate social media – Internet-based tools used for sharing and discussing information.  Such social media might include social networking sites, news and bookmarking, blogs, video sharing, photo sharing, and virtual reality.

For example, according to nation-wide survey findings of The Pew Social Research Center,  once someone is online, living with a chronic disease is associated with a greater likelihood of accessing user-generated health content, such as blog posts, hospital and physician reviews, and podcasts.  In general, it seems that older adults believe that others with the same condition are more likely to understand, be supportive, and offer wise advice (Pew Research Center, 2010).

An aging population and a growing number of individuals living with chronic conditions mean, in turn, an increased reliance upon family caregivers to provide front-line health care. Recent national reports indicate that these caregivers are becoming health information specialists – thanks to the internet, used in researching health conditions and treatments.  (Pew Research Center, 2013). 

Health Technologies in Nursing Facility Settings
          While this discussion has primarily focused on home-based care, I also want to add a few    comments about those technologies that are being implemented within nursing home settings.

·               Advanced Total Quality Systems – integrate several basic components such as nurse calls, wandering management, fall prevention, resident tracking, resident assessment, and electronic medication administration.

·               Advanced Bedding Systems – have embedded sensors for monitoring vital signs and sleep quality.

·               Comprehensive, Interoperable Electronic Health Records (EHRs) – allow security in sharing health information across various settings. 

As noted by many nursing home administrators, resistance to change remains one of the biggest obstacles to technology integration within a facility’s environment.  Having a long history of being manual and paper-based, it will require a cultural shift to a technology base. Education and communication are essential in addressing this challenge (Eldercare, 2015).  

The Future of GeroTechnology

While it is clear that future cohorts of older adults will have more options in health care, much will depend upon their financial resources. It seems clear that consumers who do not have adequate income will have fewer choices in the type or quality of services received.  It must also be recognized that use of these technologies (low-tech and high-tech) assumes a level of health literacy, as well as a willingness to embrace the required new learning.  Others caution us to be mindful of potential negatives, such as patients’ privacy / confidentiality issues and dissemination/access to personal information. 

Most agree that those health technologies that connect elders (in a long-term care facility or home) and their respective families will continue to experience increased demand.   However, among the challenges we face will be the ability to make these innovations seamless, easy to use, respectful, and affordable. 
Health Technologies & Elder Care

  • Eldercare (2015). Assistive Technology, Eldercare: Connecting you to Community Services. 

  • Georgia Institute of Technology.  Human Factors & Aging Laboratory (2016).     

  • The American Elder Care Research Organization (2014). Technologies to reduce care costs and allow safe aging at home.  Paying for Senior Care.

Blog Author:  Dr. Donnelle Eargle       deargle@sjcme.edu

With a background in geriatric rehabilitation psychology, Dr. Eargle teaches gerontology-related courses at Saint Joseph’s College. Standish, Maine.