Evidence-Based Guidance to Help LTC Providers and Staff Enhance Care Delivery and Processes

Working toward better health care, several national organizations have identified questionable practices in their field and asked health care providers to “choose wisely” before using them. This effort, the Choosing Wisely campaign, is an initiative of the American Board of Internal Medicine Foundation in partnership with Consumer Reports that seeks to advance a national dialogue on avoiding wasteful or unnecessary medical tests, treatments, and procedures. Over 500 evidence-based recommendations have been generated from this effort. Several of the top areas of focus center around medication management, with specific implications for post-acute care and long-term care (LTC) providers. For their article, authors Daniel Z Mansour, PharmD, BCGP, FASCP, and Richard G Stefanacci, DO, MGH, MBA, AGSF, CMD, selected 6 Choosing Wisely focus areas based on their significance and prevalence in the geriatrics and LTC field and provide a review of best practices in each area. They then provide and apply 4 guiding principles to help providers succeed in enhancing care delivery in these areas; these principles are embodied in 4 quotations commonly heard in the medical field.

Communication with all members of the care team is important in order to improve care delivery. Part of communication may include understanding staff members’ various perspectives. In LTC, certified nurse aides (CNAs) provide the majority of care for residents with dementia. The responsibility can be challenging, as evidenced by frequent CNA staff turnover. Elizabeth M Long, DNP, APRN, GNP-BC, CNS, and colleagues recruited 20 CNAs across 3 nursing homes in separate cities in the southern United States and established 4 focus groups to gain a better understanding of the needs, caregiving styles, and experiences of CNAs working with residents with dementia. The study is part of a larger interdisciplinary project aimed at developing an online training program to improve everyday interactions between CNAs and residents with dementia. 

Finally, continuing her regular column focusing on caring for cognitively impaired individuals, Freddi Segal-Gidan, PA-C, PhD, discusses how providers can help family members decide if their loved one needs more comprehensive care in a residential facility. The literature often focuses on placement, or institutionalization, as an outcome to be avoided. This stigmatizes the decision-making process and may indirectly lead health care professionals to be reluctant to assist families who need guidance and support.