The study looked at whether 576 adult patients and their proxies—family caregivers such as spouses or children—describe symptoms they’re experiencing and quality of life, which can affect the care they receive. Within this finding, they were more agreement on physical symptoms than psychological symptoms.
When looking at group averages, researchers also found that patients’ self-reports and caregiver reports were in line with each other because the information over, or under, reported averaged out.
“Unlike blood pressure and blood sugar, symptoms like pain, depression, or anxiety can’t be objectively measured,” Kurt Kroenke, MD, a faculty member within the IU School of Medicine and primary care physician, said in a release.
“Our group is very interested in symptoms—signs you can’t measure with an x-ray or a lab test. The only way to determine severity is with validated scales and if patients can’t report for themselves, then the proxy’s report is an important tool available to the clinician treating the patient.”
Caregivers tended to overestimate patient impairment at lower levels of symptom severity and underestimate it at higher levels. Caregivers under a lot of stress were found to be more likely to overreport the patient’s symptoms.
In situations where the patient is reporting this information themselves, additional information from their caregivers that agrees or disagrees with the original report may still be used when providers make treatment decisions, Kroenke added.
“Similar to what occurred during the pandemic, when we used rapid COVID tests rather than the more accurate PCR test to make decisions about travel or attending events or other issues, because rapid tests were the best we had on hand, when patients can’t complete a symptom scale, proxy reports, while not the best, are the best available and provide valuable information,” Kroenke said.
Black family members are more likely to seek aggressive treatment for their loved ones in a nursing home, new study says.
The percentage of Black nursing home residents and those under 65 years old transferred to outside facilities is higher than the 25% of residents overall that are transferred at least once, according to a new study by the University of Missouri.
Transferring 25% of residents at least once results in a cost of $14.3 billion to Medicare, according to a federal report by the Office of Inspector General
Looking at data from the Missouri Quality Initiative, the research team specifically looked at repeat transfers of four or more instances. Within this group 32% of transfers were Black residents; however nationally, about 14% of nursing home residents are Black.
“That, to us, was a pretty compelling statistic,” Dr. Amy Vogelsmeier, associate professor for the University of Missouri’s Sinclair School of Nursing and one of the study's authors, told HealthLeaders. “And then the same was the significant number of residents who were under the age of 65 who were transferred repeatedly.”
Past studies have shown that Black residents who are transferred typically have more chronic conditions, and financial constraints often interfere with the care they receive. Vogelsmeier mentioned in a news release how some studies found that Black family members are less likely to have conversations about the goals of their loved one’s care and are more likely to seek aggressive treatment.
“It could be distrust in the healthcare system, it could be providers making assumptions that they don’t want to discuss these things, which could be rooted in structural racism,” she explained. “So, these topics should be further investigated going forward to ensure racial equity in the healthcare industry.”
There are no criteria nursing homes follow when determining whether a resident should be transferred, and Vogelsmeier added that it often depends on the equipment and staff the nursing home has available. In some instances, the residents or their family members will insist on them being transferred, or the resident’s provider or physician may want them to be.
“What we know is that around half of transfers are likely avoidable, meaning they could have been safely cared for in the nursing home had the resources been there,” Vogelsmeier said. “But in terms of what decides when a resident goes, that’s variable across the board.”
The study also found that residents under the age of 65, as well any resident with the full code designation, were more likely to be transferred than others. When a resident’s heart fails or they stop breathing, staff will act based on whether they’re designated full-code or do not resuscitate (DNR), with the full code designation meaning they can initiate CPR to attempt to resuscitate them.
“What we think happens is that people sort of make the assumption that if my family member is [designated] do not resuscitate, that they won’t get the necessary treatment or the best types of treatment, simply because they’re not full code,” Vogelsmeier said. “And that’s not the truth.”
For residents designated DNR, resuscitation attempts such as CPR and the potential trauma from transferring them can cause more harm, especially for those who are frailer with chronic or multiple conditions.
One takeaway from the study is the importance of the role advanced practice nurses (APRNs) play in nursing homes and skilled nursing facilities. While they provide guidance and leadership to support staff and work with physicians to coordinate treatment, they weren’t always consulted when it came to deciding if a patient needed to be transferred, the study showed.
“We know just from a larger study that the APRNs were really effective in keeping the majority of residents that they were working with in the nursing home reduced,” Vogelsmeier said. “One thing it told us was that the majority of residents, we were able to keep out of a hospital, and that was a good thing, but what we wanted to do was examine those that actually did get transferred to understand why particularly if they went repeatedly.”
The framework outlines ways the industry can change in approaching the advancement of equity and how organizations can see results.
The Robert Wood Johnson Foundation convened a coalition to develop recommendations for the healthcare industry to advance its goal of increasing equity in care delivery.
The recommendations within the framework were developed through a process centered in the realities and opportunities healthcare leaders have identified, along with the perspectives of individuals who have experienced health inequities.
"Healthcare leaders have made a significant shift in how they view the importance of equity, but operationalizing the commitment requires a very bold and comprehensive approach," Donald Schwarz, MD, MPH, MBA, senior vice president at the Robert Wood Johnson Foundation, said in a statement. "Ultimately, it requires taking actions to improve the community, patient care, workforce policy and other areas. Achieving equity in healthcare is multi-pronged and must ultimately be integrated throughout all operations."
The framework, Schwarz said, outlines ways the industry can change in approaching the advancement of equity and how organizations can see results.
Its five core principles include:
Mission – Commit to a mission of improving health and well-being
Equity – Systemically pursue health equity and racial justice
Community – Authentically partner with community
Power – Share resources, voice, and power
Trust – Earn and sustain trusting relationships
These principles apply to everyone who pays for or delivers care and represents the aspirations of the groups and individuals that engage with the healthcare system.
Additionally, within the framework, there are four roles organizations must play and leverage in order to achieve equity:
Provider
Employer
Partner
Advocate
"Long-standing structural and systemic challenges within healthcare are well-known, but the pandemic underscored the imperative to confront root causes of health inequities,” Karen DeSalvo, MD, co-convener of the 'Raising the Bar' Stewardship Council, said in a statement. "'Raising the Bar' solicited input from all sectors and everyone who shares concerns about the current healthcare system, and they all see the need for bold action, but direction on concrete steps to take has been lacking. Now there is a clear framework to guide the work."
Jason Zachariah and Aaron Lewis, who have both served in leadership roles for the organization, were recently promoted.
LifePoint Health has promoted two of its current leaders to serve as executive leaders for the healthcare delivery network.
Jason Zachariah, who previously served as president of integrated solutions, will now serve as the organization's executive vice president and chief operating officer. Aaron Lewis, who served as senior vice president of care continuum and business transformation, will now serve as executive vice president of growth and integrated solutions.
"Jason and Aaron are two accomplished leaders who prioritize quality patient care while maintaining a commitment to growth and constant innovation that improves healthcare delivery within the communities we serve and beyond," LifePoint CEO, David Dill, said in a statement.
Zachariah and Lewis' promotions follow the retirement of LifePoint's previous president of hospital operations, Victor Giovanetti, who has been with LifePoint for almost a decade.
As executive vice president and COO, Zachariah will lead LifePoint's operations in their key lines of business, which include acute care, rehabilitation and behavioral health, quality and clinical services, and integrated revenue management.
Prior to joining LifePoint in 2021, he served as president and COO of Kindred Healthcare, a post-acute healthcare services company which was acquired by LifePoint in 2021.
"It has been and honor to be a part of the growing LifePoint team the past several months, and I’m eager to work more closely with our acute care hospital teams as well as our rehabilitation and behavioral health teams to advance our mission of Making Communities Healthier," Zachariah said in a statement. "Healthcare is at a pivotal moment, and I believe that LifePoint is poised to pave the way for how care is delivered across the continuum in communities across the country."
In his new role as executive vice president of growth and integrated solutions, Lewis will maintain some of his current responsibilities, while also overseeing the functions of integrated solutions, along with the organization's marketing, development, innovation, and information technology.
Lewis joined LifePoint in 2018 as the senior vice president of physician enterprise and strategic growth, and prior to that served as senior vice president of strategic growth for RCCH HealthCare Partners, a healthcare services company which merged with LifePoint in 2018.
"I have seen the company grow and evolve while constantly striving to find new ways to support its teams and its communities," Lewis said in a statement. "We have many great opportunities ahead and I’m excited to work with our leaders, clinicians, partners and communities to think about healthcare differently and expand the care and services people receive close to home."
VNA has been providing home health services in Florida since 1976 and has served Tampa General patients for more than two decades.
“Our team has a deep understanding of the diverse and complex needs those patients of a Level 1 Trauma Center may have,” Jennifer Crow, CEO of VNA said in a statement. “Our long-standing expertise and VNA’s mission to serve all patients with quality home health care align perfectly with Tampa General Hospital’s commitment to providing world-class care.”
The partnership, TGH Home Care powered by VNA of Florida, will provide services for Tampa General patients and other individuals in the surrounding community who need home care. The partnership will allow patients to stay within the TGH network for their care, said Adam Smith, executive vice president and chief ambulatory officer for Tampa General.
“Staying within Tampa General means our patients can make a seamless and safer transition home. They remain our patient, which means they can more easily access the combined resources of an academic medical center and an experienced home care agency, that supports improved quality, outcomes, and overall patient experience,” he said.
TGH Home Care powered by VNA of Florida will offer in-home personal care and nursing services, which include home health aides, skilled nursing, rehabilitation, chronic disease management, and medical social services.
“With electronic medical record integration, our patients will receive the benefit of continuous care coordination as they work towards regaining their independence, with caregiver and family support at home,” said Elan Melamed, senior director of ambulatory experience and operations for TGH. “This new TGH service also offers patients access to nurse navigators who can provide ongoing support as patients progress and return to the community.”
Patients in the Hillsborough, Pasco, Pinellas, Polk, Manatee, Hardee, and Highlands counties will have access to TGH Home Care powered by VNA of Florida.
The updates will go into effect in October to allow facilities and surveyors time to train.
The Centers for Medicare and Medicaid Services (CMS) has issued a number of updates for long-term care facilities regarding health and safety standards that must be met for their participation in both programs to continue.
The updates come as part of the Biden administration’s initiative to promote safety and improve the quality of long-term care facilities throughout the country.
“As the COVID-19 pandemic highlighted, we have a pressing moral responsibility to ensure that residents of long-term care facilities are treated with the respect and dignity they deserve,” Chiquita Brooks-LaSure, CMS administrator, said in a statement.
The following is a summary of the most significant changes (per a CMS press release):
Abuse and neglect – clarifies compliance, abuse reporting, including sample reporting templates, and provides examples of abuse that, because of the action itself, would be assigned to certain severity levels
Admission, transfer, and discharge – clarifies requirements related to facility-initiated discharges
Mental health/substance use disorder (SUD) – addresses rights and behavioral health services for individuals with mental health needs and SUDs
Nurse staffing (payroll-based journal) – uses payroll-based staffing data to trigger deeper investigations of sufficient staffing and added examples of noncompliance
Resident rights – imports guidance related to visitation from memos issued related to COVID-19, and makes changes for additional clarity and technical corrections
Potential inaccurate diagnosis and/or assessment – addresses situations where practitioners or facilities may have inaccurately diagnosed/coded a resident with schizophrenia in the resident assessment instrument
Pharmacy – addresses unnecessary use of non-psychotropic drugs in addition to antipsychotics, and gradual dose reduction
Infection control – requires facilities to have a part-time infection preventionist (IP); though the requirement is to have at least a part-time IP, they must meet the needs of the facility and physically work onsite
Arbitration – clarifies existing requirements for compliance when arbitration agreements are used by nursing homes to settle disputes
Psychosocial Outcome Severity Guide – clarifies the application of the “reasonable person concept” and severity levels for deficiencies
State Operations Manual Chapter 5 – clarifies timeliness of state investigations, and communication to complainants to improve consistency across states.
Additionally, CMS highlighted the benefits of reducing the number of residents in each room to prevent infections, emphasizing the importance of residents’ rights to privacy and a homelike environment.
The updates will go into effect on Oct. 24 to allow surveyors and facilities enough time to be trained on the new information.
The worker shortage continues to be a dangerous issue for California and previous solutions have been inadequate.
LeadingAge California, has been awarded more than $25 million by the California Health and Human Safety (CalHHS) Department of Health Care Access and Information (HCAI). LeadingAge is one of the nursing home industry’s largest trade groups.
The money will be dispersed over the next three years to fund the Gateway-In Project, a certified nursing assistant and home health aide training and development program to strengthen the healthcare workforce pipeline.
“The importance of The Gateway-In Project cannot be understated,” Jeannee Parker Martin, president and CEO of LeadingAge California, said in a statement. “Older-adult care facilities and home and community-based settings are facing severe workforce shortages. The Gateway-In Project will begin to change that story by cultivating the next generation of CNAs and HHAs as well as supporting those already in the field.”
Current pipeline development and training programs aren’t working to fill the demand, according to a release announcing the organization’s award. Out of all 50 states, California has the highest number of older adults. To meet the growing population, it’s projected that 275,000 direct care workers will be needed by 2026.
The Gateway-In Project is expected bring 2,700 CNAs and HHAs into the field. Training and certification will be provided at no cost to students, and retention incentives will be offered at the one, six, and 12-month periods.
Career development pathways, such as empathy and climate disaster modules will be offered, and participants will receive stipends for transportation, food, childcare, and ESL training.
Some 50% of the state’s CNAs working in nursing care facilities or community care facilities serve older adults. They, along with HHAs, are instrumental in these settings as caregivers and sometimes being the only other personal contact residents have outside of staff and family members.
Program graduates will be dually certified as a CNA and HHA, with the option to advance to licensed practical nurse and registered nurse training programs.
Dennis Matheis will succeed Howard Kern as president and CEO on September 1.
Sentara Healthcare has named its next president and CEO.
The nonprofit health system's board of directors has appointed Dennis Matheis to succeed Howard Kern as its top executive, following a national search.
In his new role, Matheis will focus on the system's strategic priorities, building on the quality, safety, and financial foundation established by his predecessor.
"Dennis is consistently innovating and thinking about ways to increase access to quality care, achieve greater success and outcomes, and develop new services to improve each patient's and member's individual experience with health and wellness services," Allan Parrott, board chair of Sentara's board of directors said in a release.
Parrott described Matheis as a "visionary" leader with a track record to prove it. He has spent the last 30 years in senior leadership roles throughout the healthcare industry with Anthem, Cigna, and Humana Health Plan, and most recently served as president of Sentara Health Plan and executive vice president of Sentara Healthcare since 2018.
Notably, he led Sentara Health Plans in its technology modernization efforts and implemented innovative models of care with provider partners. Matheis was also instrumental in Sentara Health Plan's joint ownership transaction of Virginia Premier with VCU Health System, according to the press release.
"I am humbled and excited by the opportunity to serve this great organization as its next president and CEO. The depth of talent and experience of our leaders and team members throughout Sentara is extraordinary," Matheis said in a statement. "Witnessing firsthand the sacrifice and dedication exhibited by phyiscians, nurses, and all team members in our hospitals and clinics throughout the pandemic was truly inspiring, and I look forward to working more closely with them. We will continue our tradition of delivering industry-leading quality outcomes while positioning Sentara for success in a rapidly evolving health care landscape."
Baxter Healthcare has issued a Class 1 recall—the most serious type of recall—for Volara systems issued between May 28, 2020 to April 19, 2022. The in-line ventilator adaptor of the OPTIMUS Handset 2 and OPTIMUS OLE AC Patient Circuit Kit may prevent home-use patients from getting enough oxygen.
Some risks affected patients may experience include choking on mucus or other airway secretions, infection in the lungs that can prevent oxygen from getting to the blood, brain injury caused by lack of oxygen to the brain, and death, according to the FDA.
The Volara system is used for clearing mucus out of airways, expanding the lungs, and to treat or prevent a partial lung collapse. Its in-line ventilator adaptor allows it to be used with ventilators in home care settings.
This recall applies to Volara systems with in-line ventilator adaptors or Volara patient circuit kits, with product model numbers PVLIHCBA, M08594, and M08594A. As of late June, 268 devices had been recalled in the US, one reported complaint, one reported injury, and two deaths associated with them, according to the FDA.
Hillrom, Baxter Healthcare’s subsidiary company, issued an Urgent Medical Device Correction letter to customers on April 26, which listed potential actions they may take, which includes monitoring for signs of respiratory distress and contacting their Clinical Support team at 800-397-9071.
Throughout her 25-year healthcare career, Sharn Barbarin, FACHE, has maintained an emphasis on nurturing people and fostering a strong culture.
It’s often said that healthcare is a calling, and from an early age, LaSharndra "Sharn" Barbarin, FACHE, knew she wanted to work in health administration.
While she had some family members who worked as healthcare professionals, it was her family members with chronic diseases that inspired her future career path.
"I have family members that have at least two forms of cancer, so we spent a lot of time in the hospital setting. Coupled with my mother's experience in the hospital, I got firsthand experience seeing the compassion that's provided by the caregivers,” Barbarin said.
She recalled as a child overhearing a conversation, when her mother was in the intensive care unit at a hospital, between a physician and nurse – the physician saying "she may not make it. These people don’t take care of themselves."
"I'm sure he didn’t know I was sitting inside the room, but that stuck with me. I remember having the wherewithal to question who are 'these people?'" she said. "Are they families of four? Are they low-income people? Are they African American people?"
Barbarin’s mother would eventually recover, and that moment became the foundation for her resolve.
"For me it became a calling of compassion. Always wanting to make sure everyone sitting inside of a hospital bed is provided and cared for with dignity and respect," she said. "As a loved one, it for sure sparked my real interest in wanting to be on the leadership side because I had this great interest in people."
After earning her bachelor's degree at Louisiana State University, she majored in industrial organizational psychology for her graduate degree at Tulane University. While at Tulane, which has a hospital part of the HCA Healthcare system, she received a scholarship opportunity that would allow her to serve as a post graduate fellow at an HCA hospital.
She would later begin her career at Medical City Las Colinas in Irving, Texas. While the facility was still under construction, she was able to think through and understand the importance of setting up a strong vision for an organization. After five years, she would then move on to Medical City McKinney where she was able to immerse herself in operating efficiency.
Later, at Medical City Lewisville, she reinvigorated her interest in master planning, nurtured her relationship with surgeons, as well as her commitment to other colleagues.
This month Barbarin was named chief executive officer for Medical City Arlington, set to assume the role on June 27.
"Here, in serving as CEO, I go back to defining the vision, defining the strategic direction of the organization, driving accountability, and discipline for delivering top performing patient experience and quality outcomes," she said. "Not just as an edict, but quite honestly as a component of our commitment and our promise to patients that we serve every day."
She describes her approach to leadership as a blend of influence and servitude, and prides herself on investing time and attention into her colleagues.
"It's important in today's environment that we are certainly providing each one of our colleagues the opportunity to have great fulfillment in what they’re doing today. But if you look at some of the literature around the various needs of members in any organization, it varies by generation," Barbarin explained. "What we’re finding is the younger generation wants to know what things they need to do today to prepare them for that next stage in their career."
Other ways she focuses on her colleagues is speaking with them one on one to ask questions, giving them the opportunity to ask questions of their own, and give feedback. She also takes the time to develop succession plans and growth track for individuals, including for colleagues not at the executive level in decision making.
"When I look at my experience over the last 25 years, I've bullet pointed aspects of strategy, business development, vision, patient experience, and quality," Barbarin said. "But the common thread through everything has been my reinforcement of the importance of a strong culture and investing in the relationship of colleagues every step of the way."
