engaging & educating nursing home families &...

of 13 /13
+ The Consumer Voice 2016 Annual Conference Engaging & Educating Nursing Home Families & Ombudsmen to Improve Dementia Care Richard Mollot, Long Term Care Community Coalition www.nursinghome411.org

Author: doandan

Post on 20-Apr-2018

219 views

Category:

Documents


4 download

Embed Size (px)

TRANSCRIPT

  • +

    TheConsumerVoice2016AnnualConference

    Engaging&EducatingNursingHomeFamilies&OmbudsmentoImproveDementiaCare

    RichardMollot,LongTermCareCommunityCoalition

    www.nursinghome411.org

  • + WhatistheLongTermCareCommunityCoalition?n LTCCC:Anonprofitorganizationdedicatedtoimprovingcareandquality

    oflifefortheelderlyandadultdisabledwhoareinlongtermcare(LTC).

    n Ourfocus:Principally,residentsinnursinghomesandassistedliving.

    n Whatwedo:SystemicResearch,Analysis&Advocacy.n Researchandanalysisonfederalandstatelawsandregulationsaffecting

    nursinghomeandassistedlivingcare;n Educationandengagementofstateandfederalpolicymakers&regulators;n Educationandtrainingofconsumers,families,LTCOmbudsmen,providersand

    otherstakeholders.

    n CoalitionmembersinNYincludeLTCOmbudsmanPrograms,AARPNY,theAllianceofNYFamilyCouncils,severalAlzheimersAssociationChapters,othersenioranddisabledorganizations.

    n RichardMollot:JoinedLTCCCin2002.Executivedirectorsince2005.

    2

  • + TodaysProgramnDescriptionofLTCCCsproject:Engaging&EducatingNursingHomeFamilies&OmbudsmentoImproveDementiaCare.

    nReviewofsomeoftherelevantstandardsthatfamiliesandombudsmenshouldbeawareof,andthetoolswehavedevelopedthatYOU canusetosupportresident-centeredadvocacy.

    nTimefordiscussion,questionsandanswers.

    3

  • + AbouttheProjectn Poordementiacareisapersistent,widespreadproblem.

    n Toomanynursinghomescontinuetousepowerfulanddangerousantipsychoticdrugs:n Closeto20%ofUSnursinghomeresidentsaregivenantipsychotics,thoughlessthan

    2%willeverhaveadiagnosiswhichCMSconsidersappropriateforthesedrugs.

    n AntipsychoticshaveanFDAblack-boxwarningagainstuseonelderlypeoplewithdementiaduetohighriskofParkinsonism,falls,strokes,heartattackanddeath.

    n Antipsychoticsarenotindicatedforso-calleddementiarelatedpsychosis.

    n Antipsychoticsarenoteffectiveformorethanaveryshortperiodoftimeonso-calledBehavioral&PsychologicalSymptomsofDementia.

    n Despitefederallaw,toomanynursinghomesuseantipsychoticsasachemicalrestraint,tosedateresidents(inplaceofprovidingthecareandservicesresidentsneed).

    n Toomanynursinghomestreatdementiabehaviorsasadisease,ratherthanascommunication.

    n InspeakingwithLTCOmbudsmen,Residents&Families,wefrequentlyfindthattheyknowwhensomethingiswrong,butoftendontknowaboutthelawsandstandardsthatcansupportthemingettingtheirproblemfixed.

    Attheendofthepresentationwewillprovidelinkstoresourcesondementiacare&antipsychoticdruggingratesforallUSnursinghomes.

    4

  • + AbouttheProjectn In2013,weheldasuccessfulfull-dayconferenceondementiacare

    andreducingantipsychoticdrugging,bringingtogethernursinghomestaff,familymembers,ombudsmenandotherswhoworkwithresidents.

    n Tofollow-uponthiswork,LTCCCreceivedfundingfromtheSamuelsFoundationtoconductfocusedtrainingsfortwoyearswithtwonursinghomefamilycouncilsandwiththeAllianceofNYFamilyCouncils(www.anyfc.org).

    n Everymonth,wepresentashorttrainingatthefamilycouncilmeetingonarelevantnursinghomestandard,providingahandoutthatresidents,familiesandombudsmencanuseinthefuturetosupporttheiradvocacy.

    n Becauseotherfamilycouncilswereinterestedinthetrainings,webeganconductingwebinarseveryothermonth,opentoallresidents,familycouncilsandombudsmeninNYC.

    n Theprojectwillculminateinafreetoolkitforresident-centeredadvocacytoimprovedementiacareandreduceantipsychoticdrugging.

    Thefreetoolkitwillbeavailableonourwebsite,www.nursinghome411.org,inSpring2017.

    5

  • + NursingHomeStandards:ResidentsRights

    n Dignity:Everyresident,includingthosewithdementia,hastherighttobetreatedwithdignityand respect andtoliveinacomfortableenvironment.

    n NecessaryCare&Services:Everyresident,nomatterwhopaysforhercare,hastherighttoreceivethecareandservicesnecessarytoattainandmaintainhighestpossiblewell-beingandfunctioning.

    n InformedDecision-Making:Residentshavetherighttobeinformedabouttherisksandbenefitsofanymedicationortreatmentinlanguageheorshecanunderstand.

    n RighttoRefuse:Residentshavetherighttorefuseamedicationortreatment.

    n FreedomfromChemicalRestraints:Itisagainstthelawtogivemedicationsthatdonotbenefittheresident,suchasforconvenienceofstaff.

    6

  • + SelectedNursingHomeStandards:AntipsychoticDrugging

    CONSUMERFACTSHEET#6:ANTIPSYCHOTICDRUGGING

    Thisfactsheetdiscussestwooftheprincipalantipsychoticdruggingstandardsandhowyoucanusethemtoadvocateforyourresident.Followingarethestandardswithdescriptionsexcerptedfromthefederalregulations.[Thebracketsprovidethenumberfortherelevantfederalregulation(CFR).]

    STANDARD1:PHARMACYSERVICES1[42CFR483.45]- Residentswhohavenotusedpsychotropicdrugsarenotgiventhesedrugsunlessthe

    medicationisnecessarytotreataspecificconditionasdiagnosedanddocumentedintheclinicalrecord;

    - Residentswhousepsychotropicdrugsreceivegradualdosereductions,andbehavioralinterventions,unlessclinicallycontraindicated,inanefforttodiscontinuethesedrugs;

    - ResidentsdonotreceivepsychotropicdrugspursuanttoaPRN[dispenseasneeded]orderunlessthatmedicationisnecessarytotreatadiagnosedspecificconditionthatisdocumentedintheclinicalrecord;and

    - PRNordersforpsychotropicdrugsarelimitedto14days.STANDARD2:BEHAVIORALHEALTHSERVICES2[42CFR483.40]

    - Eachresidentmustreceiveandthefacilitymustprovidethenecessarybehavioralhealthcareandservicestoattainormaintainthehighestpracticablephysical,mental,andpsychosocialwell-being,inaccordancewiththecomprehensiveassessmentandplanofcare.Behavioralhealthencompassesaresidentswholeemotionalandmentalwell-being.

    - Thefacilitymusthavesufficientstaffwhoprovidedirectservicestoresidentswiththeappropriatecompetenciesandskillssetstoprovidenursingandrelatedservicestoassureresidentsafetyandattainormaintainthehighestpracticablephysical,mentalandpsychosocialwellbeingofeachresident,asdeterminedbyresidentassessmentsandindividualplansofcare.Thesecompetenciesandskillssetsinclude,butarenotlimitedto,knowledgeofandappropriatetrainingandsupervisionfor:(1)Caringforresidentswithmentalandpsychosocialdisordersand(2)Implementingnon-pharmacologicalinterventions.

    - Basedonthecomprehensiveassessmentofaresident,thefacilitymustensurethat.Aresidentwhodisplaysorisdiagnosedwithdementia,receivestheappropriatetreatmentandservicestoattainormaintainhisorherhighestpracticablephysical,mental,andpsychosocialwell-being.

    1FormerlyFreeFromUnnecessaryDrugs[F-329-42CFR483.25(l)(2)(i,ii)].TheregulationprovidesexceptionstothePRN14daylimitationbasedonevaluationbyphysicianorprescribingpractitioner.2FormerlyNecessaryCareforHighestPracticableWell-being[F-309-42CFR483.25].

    AdvancingQuality,Dignity&Justice

    THINGSTODO

    Reviewmedications.Periodicallyrequestacompletelistofcurrentmedicationsfromthenursinghomeand/orreviewtheresidentsmedicationadministrationrecordskeptbythefacility(especiallyifunauthorizeddruggingissuspected).

    Careplanmeeting.Askforacareplanmeetingtodiscusstheneedforproposedantipsychoticdrugs.Usethecareplanmeetingtodetermineifthedrugisreallyneededandwhetherthehomehascarefullyconsideredallalternatives.Seebox,above,forQuestionstoAsk.

    Knowaboutfederalstandards&guidelines.Theyareanimportantresourceforknowingthestandardsofcareandlegalexpectationsforthetreatmentofresidents.Remember:Itshardtoadvocateforyourresidentsrightsifyoudontknowwhattheyare!

    Fileacomplaint.Ifyoudiscoverthatpsychotropicdrugsarebeingusedwithoutconsent,andyouarenotabletomakeheadwaywithfacilitystaff,youcannotifyyourlocalLTCOmbudsman[www.ltcombudsman.org]and/orfileacomplaintwithyourstatesurveyagency[https://www.medicare.gov/nursinghomecompare/resources/state-websites.html]and/oryourstateMedicaidFraudControlUnit[http://www.namfcu.net/medicaid-fraud-control-unit1.php].

    RESOURCES

    WWW.NURSINGHOME411.ORG.LTCCCswebsiteincludesmaterialsontherelevantstandardsfornursinghomecare,alistingofantipsychoticdrugnames,druggingratesandotherdataforallUSnursinghomesandmore.

    WWW.THECONSUMERVOICE.ORG.TheConsumerVoicehasnumerousmaterialsandresourcesforresidents,familymembersandLTCOmbudsmen.

    WWW.MEDICARE.GOV/NURSINGHOMECOMPARE.Thefederalwebsiteprovidesinformationonindividualnursinghomesnationwide.

    QUESTIONSTOASKWHENANTIPSYCHOTICDRUGSAREGIVENORPROPOSED

    1. Whatspecific,documentedsymptomsorbehaviorsprompteduseofthedrug(s)?

    2. Haveallpossiblemedical,emotionalandenvironmentalcausesbeenruledout(suchasfear,

    boredom,constipation,anunderlyinginfectionorchangeincaregivingroutine)?

    3. Whatalternativetreatmentshavebeentried?Whatotheralternativesarethere?

    4. Whatarethepotentialbenefitsandrisksofthedrug?

    5. Isthisthelowestpossibledosageofthedrug?

    6. Howwillthedrugeffecttheresidentmedicallyandmentally?

    7. Whatistheplannedtimeframefortreatmentwiththedrug?

    8. Whatistheplanforemployingnon-pharmacologicalapproaches?

    9. Whatistheplanforgradualdose-reduction?

    10. Whenandhowoftenwilltheneedforthedrugbereassessed?

    11. Howwillsideeffectsbemonitored?

    Remembertotakenotes.Includedatesofdiscussionsandwithwhomyouspoke.

    7

  • + SelectedNursingHomeStandards:ResidentAssessment&CarePlanning

    CONSUMERFACTSHEET#9:RESIDENTASSESSMENT&CAREPLANNINGTherearemanystandardswhichnursinghomesarerequiredtofollowinordertoensurethatresidentsreceiveappropriatecare,haveagoodqualityoflifeandaretreatedwithdignity.Intheabsenceofeffectivegovernmentenforcement,YOUcanusethesestandardsasabasisforadvocatinginyournursinghome.FollowingaretwoimportantSTANDARDSFORRESIDENTASSESSMENT&CAREPLANNINGwithinformationthatcanhelpyouunderstandandusethemtoadvocateforyourresident.[Note:Thebracketsprovidetherelevantfederalregulation(CFR).Thisinformationisincludedasareferenceforyouinthefuture.]

    STANDARD1:RESIDENTASSESSMENT1[42CFR483.20]- Thefacilitymustconductinitiallyandperiodicallyacomprehensive,accurate,standardized

    reproducibleassessmentofeachresidentsfunctionalcapacity.- Afacilitymustmakeacomprehensiveassessmentofaresident'sneeds,strengths,goals,life

    historyandpreferences,usingtheresidentassessmentinstrument(RAI)specifiedbyCMS.Theassessmentmustincludeatleastthefollowing:o Identificationanddemographicinformation.o Customaryroutine.o Cognitivepatterns.o Communication.o Vision.o Moodandbehaviorpatterns.o Psychosocialwell-being.o Physicalfunctioningandstructuralproblems.o Continence.o Diseasediagnosesandhealthconditions.o Dentalandnutritionalstatus.o Skincondition.o Activitypursuit.o Medications.o Specialtreatmentsandprocedures.o Dischargepotential.o Documentationofsummaryinformationregardingtheadditionalassessmentperformed

    throughtheresidentassessmentprotocols.- Documentationofparticipationinassessment.Theassessmentprocessmustincludedirect

    observationandcommunicationwiththeresident,aswellascommunicationwithlicensedandnonlicenseddirectcarestaffmembersonallshifts.

    1The2016federalregulationkeepsthepreviousCFRnumber.ThepreviousF-tagforthisstandardwasF-272.

    AdvancingQuality,Dignity&Justice

    UsethischecklisttoidentifywhatisimportanttoYOUwhenyouhavearesidentassessment!

    LTCCCConsumerFactsheet#9:StandardsforResidentAssessment&CarePlanning

    STANDARD2:COMPREHENSIVECAREPLANS2[42CFR483.20(k)]

    - Thefacilitymustdevelopacomprehensivecareplanforeachresidentthatincludesmeasurableobjectivesandtimetablestomeetaresident'smedical,nursing,andmentalandpsychosocialneedsthatareidentifiedinthecomprehensiveassessment.

    - Thecareplanmustdescribethefollowingo Theservicesthataretobefurnishedtoattainormaintaintheresident'shighest

    practicablephysical,mental,andpsychosocialwell-being;ando Anyservicesthatwouldotherwiseberequiredbutarenotprovidedduetotheresident's

    exerciseofrights[suchas]therighttorefusetreatment. - Acomprehensivecareplanmustbe

    o Developedwithin7daysaftercompletionofthecomprehensiveassessment;o Preparedbyaninterdisciplinaryteam,thatincludestheattendingphysician,aregistered

    nursewithresponsibilityfortheresident,andotherappropriatestaffindisciplinesasdeterminedbytheresident'sneeds,and,totheextentpracticable,theparticipationoftheresident,theresident'sfamilyortheresident'slegalrepresentative;and

    o Periodicallyreviewedandrevisedbyateamofqualifiedpersonsaftereachassessment.- Theservicesprovidedorarrangedbythefacilitymust

    o Meetprofessionalstandardsofquality;ando Beprovidedbyqualifiedpersonsinaccordancewitheachresident'swrittenplanofcare.

    RESOURCES

    WWW.NURSINGHOME411.ORG.LTCCCswebsiteincludesmaterialsontherelevantstandardsfornursinghomecareandnumerousresourcesforconsumers,LTCombudsmen&caregivers.

    WWW.THECONSUMERVOICE.ORG.TheConsumerVoiceswebsitehasavarietyofmaterialsandresourcesforresidents,familymembersandLTCOmbudsmen.

    2The2016federalregulationkeepsthepreviousCFRnumber.ThepreviousF-tagforthisstandardwasF-279.

    RelevantPointsFromtheFederalGuidelines

    Afacilitymustmakeanassessmentoftheresidentscapacity,needsandpreferences. Theassessmentmustincludeawiderangeofresidentneedsandabilities,including

    customaryroutine,cognitivepatterns,mood,abilitytoandmethodsofcommunication,physical,dentalandnutritionalstatus.

    Afacilityisexpectedtoprimarilyrelyondirectobservationandcommunicationwiththeresidentinordertoassesshisorherfunctionalcapacity.

    Inadditiontodirectobservationandcommunicationwiththeresident,thefacilitymustuseavarietyofothersources,includingcommunicationwithcarestaffonallshifts.

    Aresidentscareplanmustdescribetheservicestobefurnishedtoattainormaintaintheresidentshighestpracticablephysical,mentalandpsychosocialwell-being.

    Thecareplanmustbebasedontheassessment.Inotherwords,itmustcomefromtheresidentsneedsandabilities,nottheserviceswhichthenursinghomedecidestoprovidebasedonitsfinancial(orother)priorities.

    8

  • + 9WHY areAssessment&CarePlanningImportant?BECAUSE thisiswhenyourresidentsneedsaredeterminedandwherethefacilitysetsforthhowitisgoingtomeetthoseneeds.

  • + SelectedNursingHomeStandards:ExpectedPracticesforDementiaCare

    BasicStandardsofPracticeforGoodDementiaCare&AvoidingInappropriateAntipsychoticDrugging

    Earlierhandoutsinthistoolkitdiscussedtheimportantregulationsthatlayoutwhatnursinghomesarerequiredtodotoprotectresidents,includingthosewithdementia,frominappropriateantipsychoticdruggingandprovideeachofthemwithgoodandappropriateservicestomeettheirneedsasindividuals.ThishandoutfocusesontheBehavioral&PsychologicalSymptomsofDementia(BPSD):whattheyareandwhatthenursinghomeshouldbedoingtoaddressthem.

    ExamplesofBehaviorsThataResidentMightExhibitWhichResultsinAntipsychoticDrugging

    Aggressivebehaviortowardscarestaff,otherresidentsorlovedones

    Abnormal/repetitivevocalizations Sleepdisturbances Wandering

    Agitation,and/orrestlessness Screamingorcrying Repetitivemotoractivity Anxietyand/orDepression Delusionsandhallucinations

    SomeimportantthingstoknowaboutBehavioral&PsychologicalSymptomsofDementia(BPSD)

    TheonlyBPSDthatmayberesponsivetoorappropriateforantipsychotictreatmentareaggression,agitation,orpsychoticsymptomsthatposeanimmediateriskforharm.

    AntipsychoticmedicationsareonlymoderatelyeffectiveformostBPSDandshouldbetrialedasthelastresortforalimitedperiodoftimewhenthereisanimmediateriskofharm.

    Notallpsychoticsymptomsnecessarilyrequirepharmacologictreatmentofanykind(i.e.,hallucinationsthatdonotdistressthepersonwithdementia).

    Itisimportanttoconsiderothersocial,psychologicalandphysicalneedsthatapersonmighthavethatmayresultinBPSD,especiallypain,whichishighlyprevalentamongolderpersons.

    MostBPSDareresponsivetonon-pharmacologicalapproaches.Theapproachshouldbebasedonanassessmentofpossiblecausesandindividualizedtothepersonsabilitiesandphysical/emotional/socialneeds.

    2

    WhatStepsShouldBeTakentoAddressBPSD?

    Obtaindetailsaboutthepersonsbehaviors(nature,frequency,severityandduration)andrisksofthosebehaviors,anddiscusspotentialunderlyingcauseswiththecareteamand(totheextentpossible)resident,familyorrepresentative;

    Identifypotentiallyremediablecausesofbehaviors(suchasmedical,medication-related,physical,functional,psychosocial,emotional,environmental);

    Implementnon-pharmacologicalapproachestocaretounderstandandaddressbehaviorasaformofcommunicationandmodifytheenvironmentanddailyroutinestomeetthepersonsneeds;

    Implementthecareplanconsistentlyandcommunicateacrossshiftsandamongcaregiversandwiththeresidentorfamily/representative(totheextentpossible);and

    Assesstheeffectsoftheapproaches,identifybenefitsandcomplicationsinatimelyfashion,involvetheattendingphysicianandmedicaldirectorasappropriate,andadjusttreatmentaccordingly.

    Non-PharmacologicApproaches

    Nursinghomesarerequiredtomakechangestothecare,treatmentandenvironmentofaresidenttoappropriatelyaddressandalleviateBPSD.Followingaresomeexamplesofapproachesthatmightbetaken,dependingonthespecificneedsoftheresident:

    Clinical.Identifyingifaresidentisinpainoruncomfortableandtakingstepstoaddressandproviderelief.

    Environmental.Identifyingenvironmentalcausesandtakingstepstoaddressthem,suchasreducingnoiseorvisualstimulation,providinganareaforsafewanderingorcreatingahome-likeatmospheretoreducearesidentsstress.

    StaffTraining.Educatingcarestaffon:o Communicationskills;o Person-centeredbathing;o Minimizingandavoidingcare-resistantbehaviorsduringoralhygieneandwhen

    assistanceisprovidedwithdressingorotheractivitiesofdailyliving;ando Strategiesforunderstandingwhataresidentiscommunicatingandhowtorespondto

    hisorherneedsappropriately. Activities.Justlikepeoplewholiveoutsideofnursinghomes,residentsneedtobeinvolved

    inactivitiesthatareengaging,nomatterwhattheirphysicalormentalabilitiesmaybe.Musicandarttherapy,structuredexerciseandrecreationprogramsandanimaltherapy(realorstuffedanimals)aresomeoftheactivitieswhichhavebeenfoundtobebeneficial.

    Behavioriscommunication.Behaviorisnotadisease.

    Formore information and resources to help you improvedementia care in your facilityplease visit www.nursinghome411.org. This website has a section dedicated toAntipsychotic Drugs & Dementia Care with links to resources that we and otherorganizationshavedevelopedtoimprovecareandsupportyouradvocacy.

    10

  • + IndividualAPDruggingInfo

    TheSASSystem

    FacilityName County ZIPCode NoAPDrugs GivenAPDrugsBALLENGERCREEKCENTER Frederick 21701 89.13% 10.87%BAYRIDGEHEALTHCARECENTER AnneArundel 21403 70.93% 29.07%WICOMICONURSINGHOME Wicomico 21802 92.59% 7.41%THEPINESGENESISELDERCARE Talbot 21601 89.15% 10.85%ST.MARY'SNURSINGCENTERINC St.Mary's 20650 88.49% 11.51%ARCOLAHEALTHANDREHABILITATIONCENTER Montgomery 20902 82.93% 17.07%FAIRLANDCENTER Montgomery 20904 79.07% 20.93%LONGVIEWHEALTHCARECENTER,LLC Carroll 21102 84.85% 15.15%FORESTVILLEHEALTH&REHABILITATIONCENTER PrinceGeorge's 20747 86.88% 13.12%MILFORDMANORNURSINGHOME Baltimore 21208 69.51% 30.49%MANORCAREHEALTHSERVICES-HYATTSVILLE PrinceGeorge's 20783 89.26% 10.74%NMSHEALTHCAREOFSILVERSPRING Montgomery 20902 83.93% 16.07%POTOMACVALLEYNSG&WELLNESS Montgomery 20850 54.48% 45.52%MANORCAREHEALTHSERVICES-CHEVYCHASE Montgomery 20815 91.73% 8.27%LONGGREENCENTER BaltimoreCity 21212 79.51% 20.49%LEVINDALEHEBREWGERCTR&HSP BaltimoreCity 21215 84.42% 15.58%KESWICKMULTI-CARECENTER BaltimoreCity 21211 93.81% 6.19%CITIZENSCARECENTER Harford 21078 83.85% 16.15%KENSINGTONNURSING&REHABILITATIONCENTER Montgomery 20895 63.28% 36.72%ST.ELIZABETHREHAB.&NSG.CE BaltimoreCity 21227 88.39% 11.61%MANORCAREHEALTHSERVICES-WHEATON Montgomery 20902 92.05% 7.95%NMSHEALTHCAREOFSPRINGBROOK,LLC Montgomery 20904 83.33% 16.67%MANORCAREHEALTHSERVICES-TOWSON Baltimore 21286 86.32% 13.68%GOLDENLIVINGCENTER-CUMBERLAND Allegany 21502 82.57% 17.43%ALICEBYRDTAWESNURSINGHOME Somerset 21817 92.19% 7.81%WOODSIDECENTER Montgomery 20910 93.90% 6.10%MANORCAREHEALTHSYSTEM-ADELPHI PrinceGeorge's 20783 87.88% 12.12%BELPREHEALTH&REHABILITATIONCENTER Montgomery 20906 65.43% 34.57%SALISBURYCENTER Wicomico 21804 80.50% 19.50%MANORCAREHEALTHSERVICES-DULANEY Baltimore 21204 85.59% 14.41%

    11

    Onwww.nursinghome411.org wepost,approx.everysixmonthsdatafromCMSonallAPdrugging non-risk-adjusted.

  • + IndividualSNFGeneralInfo

    ProviderName ProviderAddressProviderCity

    ProviderState

    ProviderZipCode

    ProviderCountyName

    OwnershipType

    NumberofCertifiedBeds

    NumberofResidentsinCertifiedBeds

    WRANGELLMEDICALCENTE P.O.BOX108WRANGELL AK 99929 Wrangell Government 15 14YUKONKUSKOKWIMELDER' 1100CHIEFE BETHEL AK 99559 Bethel Nonprofit-C 18 15PROVIDENCEKODIAKISLAND 1915EREZAN KODIAK AK 99615 KodiakIslandNonprofit-C 22 20PRESTIGECARE&REHABCE 9100CENTEN ANCHORAGE AK 99504 Anchorage Forprofit-Co 102 81UTUQQANAATINAAT 436MISSIONKOTZEBUE AK 99752 NorthwestAr Nonprofit-C 18 18PROVIDENCETRANSITIONAL 910COMPAS ANCHORAGE AK 99504 Anchorage Nonprofit-C 50 37PROVIDENCEVALDEZMEDIC 911MEALSAVALDEZ AK 99686 ValdezCordoGovernment 10 9CORDOVACOMMUNITYME P.O.BOX160CORDOVA AK 99574 ValdezCordoGovernment 10 10PETERSBURGMEDICALCENT P.O.BOX589PETERSBURG AK 99833 PetersburgC Government 15 14SOUTHPENINSULAHOSPITA 4300BARTLE HOMER AK 99603 KenaiPeninsuNonprofit-C 28 28PROVIDENCEEXTENDEDCAR920COMPAS ANCHORAGE AK 99504 Anchorage Nonprofit-C 96 96QUYANNACARECENTER 1100GREGK NOME AK 99762 Nome Nonprofit-C 18 18HERITAGEPLACE 232ROCKWE SOLDOTNA AK 99669 KenaiPeninsuForprofit-Co 60 48KETCHIKANMEDCTRNEWH 3100TONGA KETCHIKAN AK 99901 KetchikanGaNonprofit-C 29 20PROVIDENCESEWARDMED 2203OAKST SEWARD AK 99664 KenaiPeninsuGovernment 40 30SITKACOMMUNITYHOSPITA209MOLLERSITKA AK 99835 SitkaBoroughGovernment 15 10DENALICENTER 151019THAVFAIRBANKS AK 99701 FairbanksNo Nonprofit-C 90 72WILDFLOWERCOURT 2000SALMO JUNEAU AK 99801 Juneau Nonprofit-C 57 55MERRYWOODLODGECARE POBOX130 ELMORE AL 36025 Elmore Forprofit-Co 124 102MOUNDVILLEHEALTHANDR THIRDAVENU MOUNDVILLE AL 35474 Hale Forprofit-Co 68 62JACKSONHEALTHCAREFACI2616NORTH JACKSON AL 36545 Clarke Forprofit-Co 91 79CAMDENNURSINGFACILITY210PONDER CAMDEN AL 36726 Wilcox Forprofit-Co 95 74CYPRESSCOVECARECENTER200ALABAM MUSCLESHO AL 35661 Colbert Forprofit-Co 90 75MONTROSEBAYHEALTHAN HIGHWAY98 MONTROSE AL 36559 Baldwin Forprofit-Co 83 52WILLOWBROOKECOURTAT ONECROWNHUNTSVILLE AL 35802 Madison Nonprofit-C 59 51

    12

    Onwww.nursinghome411.org wepost,approx.everysixmonths,datafromCMSonallUSnursinghomesownership,quality,staffing,resident/familycouncil,penalties,deficiencies,substantiatedcomplaint.

  • + Resourcesn www.nursinghome411.org - Informationonarangeof

    nursinghomeissueswithasectiondedicatedtodementiacareandantipsychoticdrugs.ThewebsiteincludedLTCCCsreports,consumerguides andinformationonquality,staffingandantipsychoticdruggingforallUSnursinghomes.

    n www.medicare.gov/nursinghomecompare - Thefederalwebsiteprovidesinformationonindividualnursinghomesnationwide,includingtheirratesofantipsychoticmedicationuse.ItalsohascontactinformationonStateoversightagencies,LTCOmbudsmenandtheFederalNursingHomeComplaintForm.

    n Sign-upforLTCCCsquarterlynewsletter,TheLTCJournal,[email protected]

    n JoinusonFacebookatwww.facebook.com/ltccc.

    13

    /ColorImageDict > /JPEG2000ColorACSImageDict > /JPEG2000ColorImageDict > /AntiAliasGrayImages false /CropGrayImages true /GrayImageMinResolution 300 /GrayImageMinResolutionPolicy /OK /DownsampleGrayImages true /GrayImageDownsampleType /Bicubic /GrayImageResolution 300 /GrayImageDepth -1 /GrayImageMinDownsampleDepth 2 /GrayImageDownsampleThreshold 1.50000 /EncodeGrayImages true /GrayImageFilter /DCTEncode /AutoFilterGrayImages true /GrayImageAutoFilterStrategy /JPEG /GrayACSImageDict > /GrayImageDict > /JPEG2000GrayACSImageDict > /JPEG2000GrayImageDict > /AntiAliasMonoImages false /CropMonoImages true /MonoImageMinResolution 1200 /MonoImageMinResolutionPolicy /OK /DownsampleMonoImages true /MonoImageDownsampleType /Bicubic /MonoImageResolution 1200 /MonoImageDepth -1 /MonoImageDownsampleThreshold 1.50000 /EncodeMonoImages true /MonoImageFilter /CCITTFaxEncode /MonoImageDict > /AllowPSXObjects false /CheckCompliance [ /None ] /PDFX1aCheck false /PDFX3Check false /PDFXCompliantPDFOnly false /PDFXNoTrimBoxError true /PDFXTrimBoxToMediaBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXSetBleedBoxToMediaBox true /PDFXBleedBoxToTrimBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXOutputIntentProfile () /PDFXOutputConditionIdentifier () /PDFXOutputCondition () /PDFXRegistryName () /PDFXTrapped /False

    /CreateJDFFile false /Description > /Namespace [ (Adobe) (Common) (1.0) ] /OtherNamespaces [ > /FormElements false /GenerateStructure false /IncludeBookmarks false /IncludeHyperlinks false /IncludeInteractive false /IncludeLayers false /IncludeProfiles false /MultimediaHandling /UseObjectSettings /Namespace [ (Adobe) (CreativeSuite) (2.0) ] /PDFXOutputIntentProfileSelector /DocumentCMYK /PreserveEditing true /UntaggedCMYKHandling /LeaveUntagged /UntaggedRGBHandling /UseDocumentProfile /UseDocumentBleed false >> ]>> setdistillerparams> setpagedevice