An increasing number of older adults are spending their end of life in the nursing home, and many are being hospitalized in the last few months of life. This is often unwanted by patients and their families. We hypothesize that identifying patients...
At San Francisco Veterans Affairs Health Care System (SFVA) Community Living Center (CLC), most veterans have dementia plus co-occurring mental illness. Many demonstrate distressed behavior that interferes with care. CLC restorative care and mental...
The Sunflower Memory Center Long-Term Care Community Living Center had seen an increase in falls. We recognized that our post-fall process was not optimally implemented or utilized, and the decision was made to explore this element to reduce our...
Deaconess Health System developed a post-acute embedded Nurse Practitioner (NP) program in partnered skilled nursing facilities (SNF) to improve patient transitions and coordination of care. This model has improved patient care, lowered 30-day...
Background Streptococcus pneumonia is a significant cause of morbidity and mortality in adults who are immunocompromised and of advanced age. It is the standard of care to vaccinate all high-risk adults (18-64 years) and adults 65 years and older...
Management of diabetes in post-acute settings needs special considerations. Hypoglycemia in the skilled nursing and rehabilitation facilities can lead to readmissions and complications including falls. Current EHR care-sets may not make a...
Levindale Hebrew Geriatric Center and Specialty Hospital brings together a Long-Term care facility as well as an acute care specialty hospital. Acute care hospital (120 beds). Long Term Care (210 beds). High Risk Patient Population. Chronic Wounds...
Sepsis is one of the leading causes of hospital admissions of skilled nursing facility residents and is associated with poor outcomes. Prompt recognition and timely treatment is essential. A key component of early sepsis recognition is the nursing...
Heart failure (HF) is a leading cause of mortality and hospital readmissions in the United States. A large proportion of these patients are readmitted from skilled nursing facilities (SNF). The implementation of quality initiatives, such as staff...
In 2018, the Department of Veterans Affairs (VA) implemented the Life Sustaining Treatment Decisions Initiative (LSTDI), a national, multi-pronged program to support clinicians in conducting Goals of Care Conversations (GoCC) with seriously ill...
