dementia care, cognitive decline

Perhaps you’ve seen them, idle and bored 'memory' care residents.  If you study the calendar at a typical dementia care setting (adult day, assisted living, or nursing home) – it is possible to find a time of day in when there are no facilitated activities underway. Before and after meals, perhaps – a time period stretching an hour or more. The TV is on or music is playing. The day or evening shift staff members are doing a variety of chores, nurses are dispensing and recording medication doses – and residents are wandering or seated, in wheel chairs perhaps, or perhaps they are repeatedly approaching and deflected from exits.  

We don’t see ourselves as aging with dementia – and neither did senior housing providers.  Chew on this thought from a senior housing strategist, who encourages providers to "look at entryways differently," Traci Bild says. "You often see a lot of furniture where people sleep in the lobby. Instead, make it a place where people can congregate to talk, rather than to sleep, by placing high top tables." Meanwhile, back at the reality ranch, where sitting at high-top tables, uh, may not work so well -- the average age of resident move-in to assisted living is now 87 -- says Allison Guthertz, Vice President, Quality Resident Services at Benchmark Senior Living: "These days when residents move in, they already need help with three to five activities of daily living (ADLs)."

Stick versus carrot: re-admission penalties emerge October 1st.  This may be much ado about nothing – but October is the month that hospitals begin being 'penalized' for readmitting the same patients within 30 days of discharge. What’s that mean in dollars and cents?  Well, by forcing hospitals to focus on what are euphemistically called 'transitions' -- cuts of anywhere from 0.42 percent to 1 percent in revenue loom. Or look at the flip side: CMS gets back $280 million from 2200 hospitals immediately.  And who are those pesky people who have been re-admitted? Surprise, they are disproportionately comprised of seniors, initially with diseases like pneumonia, heart attack and heart failure, with more diagnoses added each year.