Unconventional Strategies for Improving Care and Quality of Life
The care a patient receives can have a dramatic impact on his or her quality of life. In the long-term care (LTC) setting, there is a constant push to improve care quality for the vulnerable and complex patient population that calls this setting home. The Centers for Medicare & Medicaid Services (CMS) use a variety of quality measures to determine a facility’s rating on the Nursing Home Compare Website. These measures focus on assessing for undesirable conditions, such as the percentage of residents who were physically restrained. In addition, there is the incentivization of good care by tying compensation to specific clinical benchmarks via pay-for-performance programs. Although there are many protocols and standards in place to improve different facets of care, LTC providers sometimes need to look to unconventional strategies to achieve this objective. In this issue of Annals of Long-Term Care: Clinical Care and Aging® (ALTC), we include several articles that highlight how an unconventional strategy can improve care and quality of life.
In the first article, “Music at the End of Life: Bringing Comfort and Saying Goodbye Through Song and Story”, the authors provide an overview of music therapy and describe how it enabled them to provide their patient with enjoyment and closure at the end of his life. The patient was referred to the music therapy program after he expressed his love of music and drama to the social worker. Through this program, the patient could continue to enjoy what he loved and valued in life, while also fulfilling his final goal of completing his memoirs, which ultimately took the form of an opera. The patient’s wife was invited to some of these music therapy sessions, and the discussions that ensued gave him comfort and enabled him to close various chapters in his life. In addition, the recordings from the opera provided his family with considerable comfort upon his passing.
The authors acknowledge that it may not be possible for every nursing home, palliative care program, or hospice program in the United States to make professional music therapists available to their residents, but they note that musical interventions do not necessarily need to come from a professional program to have a positive impact on care. For example, volunteers could be enlisted to provide music to residents based on resident preferences, and healthcare providers could play soothing music for residents who are having difficulty sleeping or are undergoing painful procedures. While such services might not directly impact recognized quality measures or be incentivized, they can provide residents with comfort and fulfillment.
In our second article, “Medroxyprogesterone Acetate Treatment for Sexually Inappropriate Behavior in a Patient With Frontotemporal Dementia”, the authors describe how this unconventional treatment enabled their patient to be moved from their state psychiatric facility, where he received one-to-one monitoring, back to an assisted living facility, where he received less restrictive supervision by nursing staff, thereby improving his quality of life. The authors opted to try hormonal agents after psychotropic medications, including mood stabilizers, antipsychotics, and serotonergic drugs, failed to curb his sexually inappropriate behaviors. Prior to initiating medroxyprogesterone acetate (MPA), approval was obtained from the institutional ethics committee and from the patient’s healthcare power of attorney. In addition, to optimize this treatment and ensure the patient’s safety, complementary behavioral interventions were used and his hormone levels were regularly assessed. Based on their experience, the authors urge further research into the long-term outcomes and tolerability of MPA to treat sexually inappropriate behaviors in patients with frontotemporal dementia.
In our final article, “Putting the Nutrition-Focused Physical Assessment Into Practice in Long-Term Care”, the author describes how dietitians caring for LTC patients can improve care quality at their institutions by complementing their nutritional assessments with nutrition-focused physical assessments (NFPAs). As the author notes, although NFPAs are not new, their integration into clinical practice has been slow. Conventionally, dietitians review clinical and supportive data collected and recorded by other healthcare providers to identify any nutrition diagnoses, such as vitamin deficiencies and inappropriate weight loss, the latter of which is a CMS quality measure. The NFPA provides the dietitian with a systematic way to directly evaluate a patient, enabling a more comprehensive nutrition assessment to be conducted. Because LTC residents have such complex clinical pictures, the author notes that NFPAs can be particularly useful for this patient population by facilitating resident-centered, individualized care that promotes positive outcomes.
We welcome your thoughts on the articles in this issue of ALTC. Responses can be sent to our associate editor, Allison Musante, at amusante@hmpcommunications.com.
Thank you for reading!
