Improving Resident Outcomes

Improving resident outcomes starts with understanding residents’ clinical problems, care needs, and goals for care. Much of this is achieved through assessments, conducted upon admission and regularly throughout residents’ stay, including when there is a change in condition, so that proper interventions can be identified. Close attention to residents’ physical and mental capabilities between assessments is also important to ensure any changes are caught early and outcomes are improved. In this issue of Annals of Long-Term Care: Clinical Care and Aging^® (ALTC), we include several articles that provide insights on how resident outcomes can be improved through a variety of assessments and interventions.

The first article, “Hands-On Solutions for Long-Term Care Nurses Providing Oral Healthcare”, examines how nurses can improve the oral health of their residents. Although the connection between oral health and overall health are increasingly being understood, there are still major barriers to providing proper oral healthcare to long-term care (LTC) residents. One major hurdle is the high prevalence of cognitive impairment, with many such residents being more likely to demonstrate care-resistant behaviors. Paired with time constraints, this may lead to oral care being neglected, increasing the risk of oral infections, systemic diseases, and poor outcomes. In the article, which is part of our Ask the Expert series, Rita Jablonski, PhD, CRNP, provides insights on how to overcome some of these behaviors, such as through a method called chaining, in which the caregiver initiates the activity (such as tooth brushing) and then has the resident take over.

The second article, “Implications of New Oral Anticoagulants for Stroke Prophylaxis in Elderly Patients With Atrial Fibrillation”, examines the evidence for using some of the newer oral anticoagulants to prevent strokes. Although warfarin has been the gold standard for preventing strokes in patients with atrial fibrillation, it has several drawbacks, including a narrow therapeutic window and the need for coagulation monitoring due to the potential for a variety of food and drug interactions. Because many of the newer oral anticoagulants overcome these issues, they may seem appealing to LTC providers; however, they may not necessarily lead to improved patient care and outcomes. As the authors note, it is still unclear whether the new oral anticoagulants would provide elderly patients, particularly those with a variety of comorbidities and on multiple medications, with the same benefits observed in younger, healthier populations. If you think your residents would benefit from some of the newer oral anticoagulants, I encourage you to read “Antithrombotic Therapy for Atrial Fibrillation: An Update on Safety, Evidence-Based Treatment Decisions, and the New Oral Anticoagulants,” which was published in the February 2013 issue of ALTC. This article serves as a great companion piece, examining when and how these agents should be used in the vulnerable LTC population.

The third article, “Assessing Pain and Falls Risk in Residents With Cognitive Impairment: Associated Problems With Overlooked Assessments”, reviews the connection between falls and pain and provides assessment tools that can be used to better assess the risk of these problems among cognitively impaired residents. As the authors note, there is a high prevalence of both pain and falls among cognitively impaired residents, often attributable to their inability to clearly express their needs or report pain. The tools the authors provide enable the identification of nonverbal cues and take resident capabilities into account. Subsequently, these tools may provide a way to identify proper interventions and improve outcomes, though the tools have not yet been validated in larger studies.

Finally, we include a Medicare Update that examines how long-term care will be financed and delivered in the future. It outlines the recommendations submitted by the Commission on Long-Term Care to Congress last September. As the author notes, although many of the suggestions are unlikely to be implemented due to financial and legislative barriers, they may find their way into state and private long-term services and supports; thus, it is important for LTC providers to be familiar with them.

We hope you find the articles in this month’s issue useful. If you are interested in submitting an article to us for consideration, please see our author guidelines.

Thank you for reading!