The Importance of Communication for Protecting the Health of Long-Term Care Residents

Communication is the key to any relationship, and this is certainly the case for relationships in the long-term care (LTC) setting; both among health team members and between the health team and the older adults.

A major challenge for caretakers in LTC facilities is communicating with residents about their functional limitations while still allowing them to preserve their dignity and autonomy. Many older adults see driving as not only a means of transportation but also a demonstration of independence, especially for those living in retirement communities and assisted living settings. However, changes in health, functioning, and mobility associated with increasing age can adversely affect the ability to drive safely. It is the responsibility of staff members to familiarize themselves with the signs that a resident should retire from driving and to communicate their concerns to the resident and family members, while being sensitive to the emotional weight this transition can have. In this issue, Hilary D. Lum, MD, PhD, and her colleagues used a survey of 733,000 older adults who reside in US residential care facilities to determine how many of these residents continued to drive. In this small population of drivers, Lum’s team looked for indicators of health, functioning, mobility, and community activity involvement, that could indicate an increased risk of automobile accident involvement, unsafe driving, or the need to retire from driving. Their results confirm the findings of previous studies that suggest older adults often outlive their ability to drive safely. Open communication between residents, their family members, and their care providers is needed in order to identify the appropriate time to facilitate a residents’ retirement from driving and transition to other forms of transportation.

Studies have demonstrated that many hospitalizations of nursing home residents are avoidable and could have been prevented by better communication between primary care providers and nurses regarding changes in the resident’s medical condition. Nurses are aware of the intricacies of the transfer process, how family member requests influence care, the extent to which directives are discussed, and whether medical providers are offered the option to treat conditions within the nursing home. Susan M. Renz, DNP, GNP-BC, et al. report the outcomes of a quality improvement project to incorporate SBAR, a communication tool that provides a systematic approach for nurses to assess and record changes in resident status, into their facility’s practices. The authors describe the uptake of the intervention and its effect on unplanned hospital transfer rates. The improved communication that resulted from using the SBAR protocol led to a reduced number of hospital transfers overall and a reduced number of 30-day readmissions. The study provides an example of how improving the quality of information shared between care providers can have a substantial impact on patient outcomes.

In addition to changes in resident health status, another crucial moment in which quality communication between care providers is needed is when a new resident is being admitted to a long-term care facility. At the time of transition of care, the receiving healthcare professional must verify the appropriate indication for each medication prescribed to the resident. If the information necessary to determine the appropriate prescribing indication for each medication is not available, the appropriate step is for the receiving healthcare professional to contact the prescriber in order to obtain the correct information. However, all too often this is seen as an unnecessary or time-consuming step that is simply omitted; instead, the reason for medication use is assumed or guessed, leading to an unverified or inappropriate indication being recorded in the transitioning residents’ file. Such a healthcare workaround, in which a healthcare provider creates a mechanism to circumvent a block in workflow, can compromise data integrity and place patients at risk.

In this issue, Amie Taggart Blaszczyk, PharmD, CGP, BCPS, FASCP, and coauthors highlight this often-overlooked practice that contributes to missing or inaccurate indication information. They provide suggestions for encouraging communication between clinical personnel at the referring and receiving healthcare facilities to ensure the accuracy of patients’ medical information upon admission.

The articles presented in this issue of Annals of Long-Term Care: Clinical Care and Aging® demonstrate the need for “no-blame” cultures within LTC settings in order to encourage staff members to speak out about their concerns without fear of repercussions. The more personnel feel free to share information about residents’ health and safety, the better residents can be protected.