About Care Partners Exceptional hospice care since 1982, palliative - - PowerPoint PPT Presentation

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Jan 05, 2023 99 likes •356 views

About Care Partners Exceptional hospice care since 1982, palliative care since 2008 Our goals To support your staff and your operating procedures To enable the best care for your residents To increase family satisfaction

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About Care Partners

 Exceptional hospice care since 1982, palliative care since 2008  Our goals

 To support your staff and your operating procedures  To enable the best care for your residents  To increase family satisfaction

 Unique Focused Care hospice programs by diagnosis:

dementia, heart failure, chronic lung disease and cancer

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VIDEO

Carla Perissinotto, MD, UCSF Department of Geriatrics

https://youtu.be/FO2dUy-SMRg

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ODHS Provider Alert – Indoor Visitation

Issued 10/23/20 based on CMS guidance of 9/17/20

CMS Guidance ODHS Additional Guidance

No more than 2

visitors/resident at a time

No more than 20% of residents

(or max 5, whichever is lower), may have visitors at one time

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Applies as of 11/2 in counties where COVID+ rate is <10%

 ODHS Provider Alert

Audience Poll

(please use “Chat” to reply) Are you allowing family visits under these circumstances?

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COVID-19 Testing, Vaccines & Treatments

C. William Dronkowski, MD, Associate Medical Director, Care Partners
Omar Pandhair, OHSU, Care Partners Intern

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COVID-19 Test Types and Their Uses

Source: FDA: “Coronavirus Testing Basics”

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Abbot BinaxNOW

 A Rapid Antigen Test recently given FDA

Emergency Use Authorization

 It is an anterior nasal swab test that will

provide results in 15 minutes

 Administered by healthcare professionals in

point-of care settings

 Abbott will sell this test for $5 each  Studies have demonstrated the test to have

 97.1% Sensitivity (probability of correctly

identifying positive cases)

 98.5% Specificity (probability of correctly

identifying negative cases)

 In late August, per federal gov’t orders, 150

million tests were shipped to “nursing homes, assisted living facilities, home health, and hospice agencies”

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Best-Case Timeline (Estimated)

INITIAL EFFICACY & SAFETY NOV 2020 EUA** APPLICATION DEC 2020 3 VISITS/2 MOS ADMINISTRATION Q2 2021 EUA APPROVAL/ 1ST SHIPMENTS Q1 2021

Vaccine Status Update

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Two vaccines (from Pfizer & Moderna) produced by mRNA technology are currently close to releasing interim efficacy and safety data*

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These vaccines require two doses 1 month apart

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Two other vaccines (from J&J & AstraZeneca) produced with adenoviral vectors have each had a serious adverse event but are continuing in development

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HHS & OHCA announced pre-registration for vaccine distribution to LTCs 10/19

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Distribution to be managed by Walgreens and CVS

WHO also estimates Q2 2021

* 50% greater effect than placebo + 2 months of safety follow up since last dose **EUA = Emergency Use Authorization from FDA

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COVID-19 Treatment Update

Hundreds of drugs/combinations in testing, but few definitive results

 Overall COVID-19 death rate appears to be declining (papers from NYU and UK

being published this week), however

 Data have been limited and conflicting  Death rates in people over age 75 remain higher than in younger age groups

 What is known:

 Outcome of ventilation is generally poor  Steroids and anti-coagulants may be beneficial  Convalescent plasma data is mixed (Lilly antibody derived from recovered COVID-19

infected patients was discontinued due to lack of effect)

 Veklury (remdesivir) received full FDA approval on 10/23

 Based on time to recovery in hospitalized patients age 12 and older, but has not

demonstrated a clear survival benefit

 NIH is conducting follow-on studies (ACTIV-5) evaluating two approved monoclonal

antibodies used in autoimmune disease + remdesivir to see if mortality is improved

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Identifying residents who are suffering most from loneliness

Julia Salve, MN, FNP-C, ACHPN

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UCLA 3-item loneliness scale

WHAT: Screening Tool consisting of 3 QUESTIONS* that measure 3 dimensions of loneliness: relational connectedness, social connection, and self-perceived isolation: 1 - How often do you feel that you lack companionship? 2 - How often do you feel left out? 3 - How often do you feel isolated from others?

*Modified version created in 2004 from original 20 questions

WHO: Can be administered by caregiver or staff through an interview, assessment, or written questionnaire

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Simple Scale with 3 response categories Scores for each question are added together to give a possible range of scores from 3-9 Researchers have grouped people who score 3 – 5 as "not lonely" and people with the score 6 – 9 as "lonely" 3 4 5 6 7 8 9 *Source: Campaign to End Loneliness (UCLA Loneliness Scale, 2004)

RESPONSE SCORE Hardly 1 Some of the time 2 Often 3

Least lonely -- Most Lonely

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Screening Follow-Up

1 - For residents who report feeling hopeless or depressed and have little interest or pleasure in doing things, refer to healthcare provider for evaluation of depression 2 - Provide opportunities for social engagement or volunteering based on response score (More discussion to follow) 2 - Track evaluation results along with actions recommended to and taken by the older adult to measure their impact on the level of social engagement within the community

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Internal Approaches to Reduce Loneliness

Briana Rotter, DNP, NP-C, CNE, Care Partners

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Concept: Replicate small group setting of AFHs and Memory Care units in larger communities – “PODS”

Assess (new) resident history Include opportunities to for contribution Develop groups that foster relationships What forms of group participation are meaningful?

Source: The Need for a Social Revolution in Residential Care, K. Theurer et al. Journal of Aging Studies (2015) 201-210

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Resident Questionnaires – Grouping Tool

 Identify not only interests and preferences, but also habits,

introversion/extroversion and “helping” tendencies

 Move beyond joint activities to shared experiences and

“buddy” support functions

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Examples of residents for whom engagement should be prioritized (CMS)

 A resident who was living with

their family before recently arriving is struggling with the change in environment and lack

f family presence

 A resident who is grieving after

friend or family member passed away

 A resident who is experiencing

weight loss or dehydration due to lack of mealtime companionship and support

 A resident who used to engage

socially and is now experiencing emotional distress

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Facilitating Remote Interactions

Rochelle Speare, LCSW, Care Partners

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Pads are the preferred hardware for older adults

 ODHS announced that CMP funds can be

used to buy communications devices ($3K max/community)

 Pads may also be available to borrow from

different organizations (Care Partners has an iPad “lending library”)

 Many residents will become comfortable

managing the interface on their own after 2

r 3 sessions

 Those with cognitive impairment may need a

staff member to start the meeting and monitor the connection

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Beyond the Virtual Check-in: Meaningful Engagement

 Go through an old photo album and share memories  Listen to a concert or a few favorite pieces of music together  Have them remotely advise you with making a family recipe or with a household project  Schedule a regular date with several family members

for afternoon tea or coffee

 Do a good night FaceTime each evening  Create art together – send special materials like

pressed flowers or magazine photos in advance

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Audience Poll (please use “Chat” to reply)

What is the most important tool/program that you are

currently using to address loneliness?

What additional options are you considering?

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