A recent study compares mnemonic strategy and spaced retrieval thinking.
Mnemonic strategies can help individuals with mild cognitive impairments learn and retain information, says a new study conducted by researchers from the University of Michigan and Penn State College of Medicine.
Mnemonic strategy thinking allows an individual to connect what they're trying to remember to a word, phrase, or song. The study compared this method with spaced retrieval training, which uses procedural memory to help individuals remember things over increasing increments of time.
"Our research shows that we can help people with mild cognitive impairment improve the amount of information they learn and remember," Benjamin Hapstead, PhD, ABPP/CN, a University of Michigan professor of psychology and the lead and corresponding author of the study said in a statement. "However, different cognitive training approaches engage the brain in distinct ways."
The data gathered through the study, along with the brain scans of its 59 participants, showed which areas of their brain were active and how much. Over the course of three sessions, participants learned 15 "stimuli" with either mnemonic strategy or spaced retrieval training method.
Each participant had previously been diagnosed with mild cognitive impairment.
Mnemonic strategy training increased activity in areas of the brain often affected by Alzheimer's, which explains why that method helped participants remember more information for a longer period of time, according to Hampstead. Those using the spaced retrieval method showed reduced brain activity, which suggests that they were able to process the information more efficiently.
Hapstead's team worked with Krish Sathian, MBBS, PhD, professor and chair of Penn State's Department of Neurology. From the study, Sathian observed that cognitive training approaches will likely become more important and be used alongside new pharmacological treatments for individuals with neurodegenerative disorders.
A mild cognitive impairment doesn’t always lead to an Alzheimer’s diagnosis and Hampstead said that going forward, researchers and clinicians can use this information to identify the best non-pharmacologic treatment for their patients.
Adding strawberries to your patient’s diet, yoga, and movement-tracking devices can help with cognitive decline, recent studies say.
Three new studies on dementia are showing encouraging predictive and preventive measures that providers and caretakers alike can utilize.
Protect Your Brain With Berries
Strawberries may help prevent Alzheimer’s disease, researchers from Rush University Medical Center have found. A bioactive compound found in strawberries called pelargonidin has anti-inflammatory properties, which can reduce overall neuroinflammation.
Specifically, the study found the pelargonidin within the fruit to be associated with a low presence of “tau tangles,” which are described as a “hallmark” for the disease.
“While pelargonidin should be examined further for their role in maintaining brain health in older adults, this gives a simple change that anyone can make in their diet,” Puja Agarwal, PhD, one of the study’s authors said in a statement.
Find Your Seat and Your Center
A recent study out of Florida Atlantic examined a remotely supervised online chair yoga class for older individuals with dementia, assessing the individuals’ “pain interference, mobility, risk of falling, sleep disturbance, autonomic reactivity, loneliness.”
While chair yoga isn’t a necessarily a new preventive measure, the pandemic has kept many adults with dementia from being able to participate in an in-person setting.
Results showed the remotely supervised class to be a “feasible approach” for managing the physical and psychological symptoms in socially isolated adults with dementia.
“This finding is important, as older adults with dementia and their caregivers may be challenged in attempts to attend chair yoga programs at community facilities,” Juyoung Park, PhD, senior author of the study, said in a statement. “Our telehealth-based chair yoga intervention was found to be convenient for both participants and their caregivers because it was easily accessible from home and did not require transportation or getting dressed which reduced caregiver burden and stress.”
In a study of more than 600 participants wearing activity monitors, they noted significant differences in the movement patterns of participants with normal cognition and those with a mild impairment, or Alzheimer’s disease.
“We tend to think of physical activity as a potential therapy to slow cognitive decline, but this study reminds us that cognitive decline may in turn slow physical activity,” Amal Wanigatunga, PhD, MPH, the study’s lead author, said in a statement. “And we might someday be able to monitor and detect such changes for earlier and more efficient testing to delay and maybe prevent cognitive impairment that leads to Alzheimer’s.”
The new rating is based on six new measures, which include staffing and the rate of turnover over the course of a year.
The Centers for Medicare and Medicaid Services (CMS) has launched its enhanced Nursing Home Five-Star Quality Rating System, as part of the Biden-Harris administration’s goal to ensure nursing home residents receive reliable, quality care.
A revision of a previous system, the Five Star Quality Rating System uses data reported by nursing homes that shows weekend staffing rates for nurses, as well as turnover for nurses and administrators.
Weekend Staffing
Case-mix adjusted total nurse (RN, LPN/LVN, aide) staffing levels (hours per resident per day)
Case-mix adjusted RN staffing levels (hours per resident per day)
Case-mix adjusted total nurse (RN, LPN/LVN, aide) staffing levels (hours per resident per day) on the weekend
Staff Turnover
Total nurse turnover, defined as the percentage of nursing staff that left the nursing home over a 12-month period
RN turnover, defined as the percentage of RN staff that left the nursing home over a 12-month period
Administrator turnover, defined as the number of administrators who left the nursing home over a 12-month period
CMS began posting weekend staffing and turnover rates on Medicare’s Care Compare website in January.
“Research and experience tell us that staffing levels and staff turnover can substantially affect quality of care and health outcomes for people living in nursing homes,” Chiquita Brooks-LaSure, CMS administrator, said in a statement. “This enhancement to the Five-Star Quality Rating System helps to better inform consumers and residents about the care each nursing home provides and encourages nursing homes to improve the staffing of their facilities to foster better outcomes for residents.”
According to CMS research, higher nurse turnover is associated with lower quality of care. It also notes that nurses who have been with a facility longer are more likely to notice small health changes in residents and do something before it gets worse. Additionally, administrators with longer tenures are more likely to have stable leadership, which fosters consistent policies and protocols to better serve residents.
The recommendations address improvements in quality, accessibility, equity, and affordability.
A new position paper from the Health and Public Policy Committee of the American College of Physicians (ACP) takes a closer look at the challenges in long-term care services and supports (LTSS).
LTSS challenges include COVID-19 safety, labor shortages, quality, and financing. The paper tackles these challenges by offering policy recommendations and asks policymakers and stakeholders to make improvements in quality, accessibility, equity, and affordability.
"ACP believes that the LTSS sector must be strengthened to ensure that patients can maintain quality of life, while also retaining their financial stability as they age," the paper said.
ACP recommendations include:
A multipronged public-private sector approach to reforming long-term care service financing, specifically, the development of a publicly funded, universal catastrophic LTSS insurance program and policies that would make front-end, private long-term care insurance affordable and accessible.
To address workforce shortages, policymakers and employers should offer comprehensive training, pay increases, benefit packages, and opportunities for career advancement and growth; as well as additional policies to assist unpaid caregivers through respite care, training, and reimbursement.
Evidence-based intervention to ensure and improve the quality of long-term care services
Conducting research on the effects of ownership status in the long-term care services sector, including quality of care, staff and patient safety, costs, and staffing ratios.
Funding, assistance, and staff support for nursing homes and other long-term care services organizations for emergency preparedness planning
According to the paper, government spending and demand for long-term care services increases as the population ages; with more than half of Americans turning 65 requiring some type of long-term care service.
"A new coverage program and reforms to the private insurance market will inject much-needed financial resources into the system, bolster the [long-term service workforce] and relieve the massive burden taken on by family caregivers," the paper's conclusion stated.
The system’s diversity, equity, and inclusion efforts elevate its dedication to its mission.
Atrium Health has ranked No. 1 as the best place in the nation for women and diverse managers to work by Diversity MBA magazine, after almost two decades of consistent effort.
Fernando Little, the Charlotte, North Carolina-based health system’s enterprise vice president and chief diversity officer, credits their success to their four-pillared diversity, equity, and inclusion (DEI) agenda as being tied to the organization’s mission: To improve health, elevate hope, and advance healing for all: patients, teammates, learners, and community.
When incidents of racial or social injustice arise, their longstanding DEI agenda strengthens the system’s posture in the communities they serve, Little said.
“I believe because our agenda has been around for so long it enabled us to respond to those instances with a sense of urgency, with a sense of compassion, but also with a plan to channel the emotion into a productive purpose,” he said.
Over the years, Little said, Atrium Health has intentionally addressed its culture and the values that shape it by seeking input from team members. In addition to the system’s DEI efforts, team members also noted the sense of belonging they felt as being a part of the organization’s overall culture.
The system’s office of diversity, equity, and inclusion continues to build on its DEI infrastructure which includes councils and resource groups for the different demographics team members belong to. Champions – team members who complete a diversity certificate program – often help further facilitate learning throughout the organization.
The first council was put together almost 20 years ago, consisting of five physicians of color who wanted to put on a diversity symposium for providers to discuss cultural competence and the importance of diversity in the healthcare industry. Since then, 10,000 team members are involved in either a council or resource group.
“The reality is the demographic of our country is rapidly changing, and if you think about just the nation right now, the demographic makeup of where we are today is going to be different 10, 20, 30 years from now,” Little said. “It’s incumbent for healthcare organizations to keep up with that because there is a correlation to when your organization reflects the diversity of their patient population, [giving] you a competitive lift in terms of addressing health equity, eliminating health disparities, and making sure that there’s cultural competence in care delivery.”
Atrium Health continues to work to increase its organizational capability and accountability regarding its workforce reflecting the diversity of its patient population. In 2021, the office of diversity, equity, and inclusion implemented executive dashboards that showed each executives workforce and hierarchy so that they could track diversity in promotions, hirings, rate of turnover, as well as pay equity, engagement, and recognition in real time.
Being able to pinpoint the areas that needed work, the executives are then able to develop a plan of action with the assistance the team in Little’s office.
The system has also incorporated DEI efforts into its Impact 2025 strategic plan.
“There’s this bold goal to achieve transformative equity in terms of our leadership ranks and to make sure our workforce reflects the diversity of our patient population,” Little said. “Particularly our executive leadership ranks. By it being part of our Impact 2025 plan, it now is a measure for leaders and it can be tied into performance and incentive goal, and I think that’s a bold step that Atrium Health made in terms of its accountability.”
The donation comes as part of the system’s initiative to expand partnerships with HBCUs and HSIs.
HCA Healthcare has entered a four-year partnership with the University of Texas at El Paso (UTEP), beginning with a $750,000 donation to go toward the development of multiple graduate-degree opportunities healthcare.
The partnership is part of its 2021 pledge to donate $10 million to historically black universities (HBCUs) and Hispanic Serving Institutions (HSIs) to increase diversity within the healthcare industry, according to a press release from the health system. To date, HCA Healthcare has donated $3.75 million of its goal.
“We are excited to announce this partnership with UTEP to support the development of their graduate programs,” Sherri Neal, chief diversity officer of HCA Healthcare, said in a statement. “As the third in our series of commitments to HBCUs and HSIs, this demonstrates our continued efforts to develop a diverse pipeline of healthcare professionals and future leaders.”
UTEP is one of the nation’s largest HSIs, with 84% of its student body being Hispanic. The $750,000 donation will go toward the establishment of graduate nursing fellowships and the development of a graduate degree program to advance healthcare administration. Sixty students are expected to receive scholarships over the next four years.
“We are proud to work with UTEP to provide access to fulfilling careers in healthcare for the students of El Paso,” Jon Foster, president of HCA Healthcare’s American group, said in a release.
There will also be scholarships available for students to pursue graduate studies in nursing administration and management, in addition to other healthcare certificates and credentials.
Students will have the opportunity to intern at Las Palmas Del Sol Healthcare—HCA Healthcare’s hospital in El Paso—as well as at its facilities in Austin, Texas, and the system’s corporate office in Nashville, Tennessee.
“Health and human services is the fastest-growing employment sector in Texas,” said UTEP president Heather Wilson. “This partnership with Las Palmas Del Sol Healthcare and HCA Healthcare will help develop future leaders in healthcare to serve the community.”
New study shows serious lack of awareness and financial planning for at-home care programs by those 50 years or older.
Most people aged 50-79 prefer at-home care as they age, but nearly all—91%—have not proactively researched the care they may need as they age and 34% have not thought about their care needs as they grow older.
Those findings from a national survey by Cross Country Workforce Solutions Group, a division of staffing consulting agency Cross Country Healthcare, also revealed low awareness of existing managed-at-home care programs.
By 2030, some 21% of the American population will be at retirement age, and seek to distance themselves from traditional institutionalized care, the study says.
Providing transportation to and from appointments and getting medically necessary care are the two most requested at-home care services, according to the “Aging in Place” survey. With the average senior collecting $18,000 annually in social security, transportation costs and other financial burden can create barriers to accessing care, the study says, causing more seniors to wait until their condition is severe enough to require emergency medical care.
That’s why they need to become aware of programs such as the PACE Medicare program or the Living Independence for the Elderly (LIFE) program, both of which provide medical care and support services to the elderly, says the study.
“At-home care has proven to provide a better quality of life and outcomes for seniors requiring perpetual care, and it has tremendous potential to relieve some of the burdens our healthcare system will face with today’s aging population,” Pamela Jung, president of Cross-Country Workforce Solutions Group, said in a press release. “We believe that keeping seniors at home for as long as possible is a win-win for patients and the healthcare system.”
"For many, managed-at-home healthcare provides an alternative to offer more independence while optimizing individual care," Jung said. "It centers healthcare around a person's life rather than centering their life around healthcare. We believe that's the way it should be."
Additional study highlights include:
70% of respondents said their preference for care as they get older is to remain at home with support.
57% of respondents have not considered a budget for what they may need for aged care services and support.
The time horizon for changing living arrangements decreases with age, with 59% of respondents in their 50s expecting a change in 16-plus years and 32% of respondents in their 70s expecting to make a change within the next five years.
The most in-demand managed-at-home-care services were transportation to appointments (45%), medical care (45%), shopping (36%), meal preparation (33%), and laundry (32%).
Costs are the most critical consideration in assessing managed-at-home care services, regardless of age (73%). Background checks on the care providers ranked second (66%), followed by the skill levels and services available (58%).
Participants reported that the information sources they would rely on for possible managed-at-home care services were friends and family (58%), online searches (58%), and their doctor (56%).
Visiting Angels’ Caregiver of the Year, Paula Perez, was recognized for her compassion in caring for her clients with dementia.
Four years ago, when Paula Perez decided to join Visiting Angels, a private duty service agency, part time, she would have never thought it would become her full-time job. However, she’d always had the calling to be nurturing.
Her own family situation prepared her well for the job. For years she served as a caretaker, alongside other family members, of her mother, who had dementia, and an adult grandson with cerebral palsy.
“When it happens to you in the family setting for the first time, you’re in shock. You start reading and trying to learn a bit more,” Perez said about being a caretaker. “When I got my position with Visiting Angels and got the dementia training, it just confirmed that what we were doing as a family had worked to some degree. And then it just expanded our knowledge of how to do it with clients.”
While Perez brought plenty of caregiver experience to the job from caring for her own family, Visiting Angels provided additional training through their Visiting Angels University program. The modules and videos are online, covering different situations including those where a client may have dementia. Caregivers also participate in a two-day in-person training course, where they review the different levels of dementia and Alzheimer’s.
Clients with the disease can be classified as different levels—gems, opals, etc.—with caregivers understanding that they can have the characteristics of more than one level. With dementia, Perez said, not everyone declines the same way, nor is everyone affected the same, so, caretakers must be ready to manage it, sometimes hour-by-hour.
“What worked yesterday may not work today. You have to be proactive, and you have to know what the signals are and how to redirect,” she said. “You don’t become combative, you don’t say no. We agree, we calm them down, and redirect.”
Perez offered three ways that caregivers can help clients maintain their dignity:
1. Treat the person in front of you
A client’s temperament can change daily, so it’s important to meet them where they are and move forward in a way that either reinforces their good mood or redirects their bad mood.
“If they’re happy, then we’re going to have a happy day. You have the weeping; you just hold their hand and understand and redirect them to a subject that they like, or something that they did, or photos,” Perez said. “I also find that if I let them think that they’re helping me that the attention isn’t on them, and their caregiving [nature] kicks in.”
2. Allow them to be as independent as they can
Allowing clients the autonomy to do things for themselves encourages their sense of independence.
“When it comes to bathing, I make sure that they handle the washcloth, that they dry as much as they can, and that they pick out what they want to wear,” Perez said.
“You make it seem like they’re making the choices and let them do as much as [they’re able],” Perez said. “We’re not looking at their disabilities, we’re looking at their abilities, and as much as they can do, they do.”
For clients with more limited capabilities, redirecting their attention or the situation is a method that’s usually successful. If it’s difficult for them to move around, simply sitting outside will give them a nice change of scenery, or even just talking to them about themselves.”
“The fact that they don’t feel like they’re a drain on the family, that they can do things, makes them happy,” she said. “They used to be very productive people and all of a sudden, they feel they’re not. And so, we have to be reinforcing and positive.”
3. Accept the person and abilities they have now
Perez will often share what she’s learned from experience and agency training with her client’s family members.
“I was able to show the family so they could learn,” she said. “Knowledge gives them power and they’re not afraid and then they learn to redirect as well.”
She encourages family members to continue to include their loved one in regular activities, showing them ways to adapt them so they’re able participate. When clients are more aware of things they can’t do, Perez said, it draws them further inward.
“We recall the person they were, instead of accepting the abilities they have now,” Perez said. “You hear a lot, ‘I can’t believe he was such a big, strong, working man and look at him now.’ OK, that was then, this is now. The hardest part is accepting the reality today versus the reality of them at their prime.”
The training and orientation period varies in length, depending on experience and skill set.
The role of a nurse comes with significant responsibilities, regardless of the area of healthcare in which they work.
In home health, while a nurse has greater autonomy in completing tasks, they’re also regularly interacting with their patient’s family and caregivers in their homes and must know how to knowledgeably navigate complex situations surrounding them.
“We get nurses from a wide variety of care settings with varying levels of experience, and we’ve developed a standardized training program that extended or accelerated based on each of those nurses’ needs,” Sheila Guither, manager of clinical practice and staff development for OSF Health, said.
Previously, Guither said, there had been a requirement for nurses wanting to come into the home care setting to have previous experience in nursing. However, they’ve found that some nurses who come to them as new graduates perform well in their roles.
The system’s training for home health nurses varies according to their skill and experience level, beginning with an initial three-week period. For those coming from other care settings, they split the orientation period to allow them more time to get acclimated with the more complex responsibilities. Nurses must also complete the OASIS assessment, which ensures that the nurse can properly assess and provide care to their patient.
“A nurse who has experience with wounds or IVs in the inpatient setting is going to translate really quickly into certain aspects of home health,” J. J. Guedet, vice president of business development and strategy for OSF Health, said. “We’ve had clinicians come over who’ve had really strong cardiovascular experience or pulmonology and when they’re on patients they’re familiar with, they’re going to be rock stars. But you never really know what you’re going to get because the geography of that we cover is so great that you’re going to have a smattering of others who just fall into the general category.”
The training includes wound identification, assessment, and care; in-home IV therapy; pediatrics; and components of case management, such as patient family engagement and navigating socio-economic challenges that arise.
To assess the nurse’s performance, their productivity is measured (how many visits they do within a certain period), as well as quality of care using OASIS to see how the patient progresses over the course of their care. Occasionally, leadership will join nurses on their visits with patients and assess their performance by observing their work and asking the patient and their caregivers questions.
“We like to say, we’re about 1% of their healthcare, because we go out and teach them what they need to do to provide their own self-care, and then they and their caregivers provide the other 99%,” Guither said. “So our nurses have to be well-trained to prepare our patients and caregivers to provide that self-care and they have to be skilled in identifying when they need to bring in other care team members, like a social worker or physical therapist.”
The metric of success for their training is reflected in staff retention, Guedet said.
“We really want to make sure that the nurses that we onboard are here a year from now, given the staffing crisis we find ourselves in with nurses in healthcare in general,” he said. “The emphasis is less on rushing someone out to see a patient, and a lot more intensive on building that experience where clinicians feel they’re set up to succeed.”
These measures, which have been posted on the CMS website for more than a decade, are used to calculate each nursing home’s star rating for the staffing section of the Nursing Home Five-Star Quality Rating System.
The new rating is based on six separate staffing measures. In a system similar to the Quality Measure (QM) rating, points are assigned based on the performance on each of these six measures. The points are then summed up, and the total staffing score is compared to staffing rating point thresholds to assign a rating of one to five stars.
The six measures, which apply to weekend staffing and staff turnover, are:
Weekend Staffing
• Case-mix adjusted total nurse (RN, LPN/LVN, aide) staffing levels (hours per resident per day)
• Case-mix adjusted RN staffing levels (hours per resident per day)
• Case-mix adjusted total nurse (RN, LPN/LVN, aide) staffing levels (hours per resident per day) on the weekend
Staff Turnover
• Total nurse turnover, defined as the percentage of nursing staff that left the nursing home over a 12-month period
• RN turnover, defined as the percentage of RN staff that left the nursing home over a 12-month period
• Administrator turnover, defined as the number of administrators who left the nursing home over a 12-month period
In examining the relationship between staff turnover and quality, CMS’ preliminary analysis found that homes with a lower RN, total nurse, and administrative turnover had higher Five-Star Ratings. Facilities with low administrative turnover are likely to have stable leadership, clear direction, and efficient operations, which can help staff provide more consistent care.
In 2020, the Office of the Inspector General (OIG) recommended that CMS look for ways to provide consumers with additional information on the daily staffing levels at nursing homes and their variability. The following year, the OIG, seeing the effects of the COVID-19 pandemic, further recommended that CMS report measures of nurse turnover “as soon as practicable.”
“Improving nursing home staffing is a top priority for CMS. There are many different factors that impact how nursing homes are staffed, and the PBJ program aims to help us understand these factors, how nursing homes are staffed, and how staffing relates to nursing home quality,” the memorandum stated.
“This information can then be used to inform future actions aimed at improving staffing to protect and enhance the health and safety of nursing home residents.”
