Annals of Long Term Care

State and federal agencies regulate long-term care (LTC) organizations to ensure residents with diverse illnesses and varying levels of independence and function receive quality care. No state or federal standards, however, explicitly assure the comfort of individuals in the advanced stage of dementia, the most common terminal illness in today’s nursing homes. Through training, consultation, and evaluation, research teams from Arizona and Illinois succeeded in integrating a program of palliative care that emphasized comfort-focused strategies into advanced dementia care without compromising regulatory compliance. This article briefly describes the findings of these teams, both of which concluded that personalized comfort care improves the quality of life for advanced dementia residents while coexisting with, and even supporting, the intent of LTC regulations.

Although today’s long-term care (LTC) providers have an increasing number of vaccines at their disposal, it is not always easy to provide them to residents. As a result, many patients are not reaping the critical clinical benefits of vaccines and many providers are unable to obtain the associated direct and indirect financial incentives tied to vaccine use. In this article, the author discusses how LTC providers can achieve target health and financial outcomes, with an explanation of current clinical guidelines for adult immunization as well as Medicare coverage rules so that the “right” patients are identified and have access to the appropriate vaccines.

Lack of information about nursing home residents’ preferred activities, health-related issues, and facility limitations may prevent residents from engaging in personally meaningful activities. The authors developed a questionnaire that allows a systematic assessment of residents’ preferred activities and perceived obstacles to participating in those activities. By using the information obtained through the interview process, nursing home staff can take creative approaches to providing residents with activity choices individualized to their interests. Many residents stand to benefit as a broader range of options becomes available, allowing them to have more autonomy over their daily routine, which multiple studies have associated with better quality of life.

Primary symptoms of chronic mesenteric ischemia (CMI) include weight loss, postprandial nausea and pain, and sitophobia (fear of eating). An estimated 95% of patients have comorbid vascular disease, which is considered the primary cause of CMI. In patients with CMI, diagnosis and intervention are typically delayed a median of 15 months, as many patients are initially diagnosed with failure to thrive. CMI is often not considered until the patient’s functional ability starts to deteriorate. Surgeons are hesitant to attempt interventions for CMI in frail older adults, even though the disease process has caused the frailty in many cases. In addition to discussing the pathophysiology, presentation, diagnosis, and management of CMI, the authors present the cases of two elderly white women with CMI who had vastly different outcomes. These cases underscore the need to include CMI in the differential diagnosis of patients with failure to thrive.

Psychiatric disorders are common in long-term care residents. In the elderly, these disorders are often attributed to conditions associated with aging, such as Alzheimer’s disease, dementia, and other cognitive impairments. Rarely, the psychiatric disorder may be an underlying condition that manifested much earlier in life. Management of such cases may be more challenging, especially when it involves an individual who exhibits aggressive and immoral behaviors. While such cases are uncommon, they may be encountered more frequently as the number of individuals requiring dependent care services continues to grow. The authors report the case of an elderly man with a personality disorder and aggressive drug-seeking behavior. The patient was admitted to a nursing home for care, where he abused staff and made threats in attempts to gain access to opioids. The authors discuss the obstacles and ethical dilemmas that surround the care of such individuals, including in dependent care settings.