Annals of Long Term Care

Currently, approximately 1.45 million individuals are receiving hospice care in the United States, but many more could benefit from hospice services. While hospice originated to support individuals caring for terminally ill relatives at home, hospice services under the Medicare hospice benefit (MHB) can also be accessed by individuals residing in nursing homes or assisted living facilities. Although the number of hospices participating in Medicare is rapidly increasing, there is still considerable confusion about hospice as a care option in the long-term care (LTC) skilled nursing setting.

Therapeutic drug monitoring (TDM) provides valuable data about the safety and efficacy of drug therapy. A lack of TDM has been associated with a significant proportion of preventable adverse drug events among elderly patients. A number of barriers to the performance of optimal monitoring exist in the long-term care (LTC) setting.

Joint contractures impair quality of life and lead to further complications and disability. In severe dementia, many patients are seen in a fetal position. This position causes flexion of the muscles at joints, causing the muscles to undergo shortening, resulting in degenerative tissue changes, and then leading to potential irreversible deformity. The authors discuss the development of joint contractures in Alzheimer’s disease (AD), where it is thought that the natural progression of AD terminates with patients in the fetal position.

Over one-third of long-term care (LTC) residents exhibit moderate-to-severe cognitive impairment. These residents are more likely to be inactive, require assistance with activities of daily living, have medical comorbidities, and be exposed to fewer opportunities to engage in functional and physical activities than peers who are cognitively intact or have only mild cognitive deficits. This article will discuss factors that influence the functional performance of older adults with dementia, and benefits and barriers to implementing a function-focused philosophy of care for LTC residents with de

Care transitions between Emergency Departments (EDs) and nursing homes (NHs) are often poorly coordinated, putting patients at risk for adverse consequences. Studies suggest that in over 90% of all NH-to-ED patient transitions, information essential to adequate emergency care is lacking. Communication by ED staff when patients are discharged back to NHs is often substandard as well. EDs often use electronic or paper discharge templates designed for ambulatory, community-dwelling patients, which are not sufficient for NH residents. This article presents a case to illustrate some of the pitfall