The Health and Well-Being of Patients and Staff in Long-Term Care

As providers, clinicians, and staff continue to strive for person-centered medical care for older adults, it is helpful to have continual reminders of the many differences that make each patient unique. Care for patients and residents should not only take into consideration their symptoms and diagnoses but also their social, economic, and cultural circumstances, which have a direct impact on their care preferences and needs. Providers should also take care not to forget an integral component in the mission to provide person-centered care: employees. Without the insight of an engaged and effective staff team, individualized, compassionate care is not possible. The articles in this issue of Annals of Long-Term Care: Clinical Care and Aging touch on areas of medical ethics, geriatrics-friendly emergency departments (EDs), and the importance of caring for long-term care (LTC) employees as well as residents.

The end of life (EOL) can be a be a challenging time for patients and their families. Clinicians from various health care disciplines, religious leaders and advisors, family members, caregivers, and friends are often involved. The family members may be of different generations, have different education levels, have differing knowledge of religious practices, and be of different branches of the same religion. The relatively recent advances in medical research and knowledge have given rise to the field of Jewish medical ethics. Authors Kenneth R Cohen, PharmD, PhD, BCGP, and colleagues examine the principles of Jewish medical ethics as derived from Jewish law and their intersection with secular medical ethics and secular law as it relates to EOL care. Understanding the medical team’s opinion and recommendation along with the overall physical condition and emotional wishes of the patient are key when serving patients from varying backgrounds.

Most individuals in the health care field are familiar with the Triple Aim framework for improving health care delivery outcomes through (1) improving the patient experience of care; (2) improving the health of populations; and (3) reducing the per-capita cost of health care. However, it has been proposed that a fourth dimension be added to the Triple Aim: improvement of the work life of health care providers, including clinicians and staff. In his LTC GPS column in this issue, Richard G Stefanacci, DO, MGH, MBA, AGSF, CMD, explores the ideas supporting the Quadruple Aim: health care employees who believe that leaders are concerned about them as a whole person—not just an employee—are more productive, more satisfied, and more fulfilled. He discusses this in relation to LTC facilities, demonstrating how leaders can apply this approach through innovative education, communication techniques, and tactics to show employees appreciation. 

Tailoring medical care and techniques to older adults with dementia is another area of concern as the US older adult population continues to grow. Clinical settings need to be prepared to provide care for adults with dementias, and employees should be given specific training. Dementia and mild cognitive impairment are commonly seen among older patients in the ED but are often not recognized or poorly addressed. A typical ED is not well-designed for older adults in general and particularly ill-equipped for a person with any form of dementia. Freddi Segal-Gidan, PA-C, PhD, explains why it is important for nursing and other LTC facility providers, staff, and caregivers to be aware of how older adults with dementia experience the ED. Education for LTC staff on the risks and benefits of ED treatment will allow them to prepare patients and families with practical strategies or hopefully avoid altogether a visit to the ED.

Finally, also included in this issue is a review of the management of rheumatoid arthritis (RA) in older LTC residents. RA is the most common autoimmune inflammatory arthritis in adults, affecting about 1% of the US general population. RA can occur at any age, but peak onset is between 55 to 64 years in women and 75 to 84 years in men. Nader Tavakoli, MD, CMD, FAAFP, and coauthors provide an overview of the optimal treatment of RA in older adults, taking into consideration current RA management guidelines, treatment and drug costs, and medication administration concerns specific to the LTC setting.