Greetings!

Welcome to the Hartford Institute for Geriatric Nursing's February 2009 eNewsletter featuring articles, reference materials, useful links, calendar of events and other best practice information on the care of older adults.

This eNewsletter is sponsored by ConsultGeriRN.org.

ConsultGeriRN.org is the authoritative geriatric clinical nursing website of the Hartford Institute for Geriatric Nursing, New York University College of Nursing and the NICHE (Nurses Improving Care for HealthSystem Elders) program, (www.nicheprogram.org). ConsultGeriRN.org contains evidence-based protocols and topics for nurses and other healthcare professionals on the care of older adults. Content is updated regularly.

We would like to hear from you!

Topic Content By:
Lazelle E Benefield, PhD, RN, FAAN & Rachel L. Higbee, BSN, RN

Frailty is prevalent in older people and involves a progressive physiological decline of multiple body systems; caring for frail older adults is difficult and challenging because they have an increased burden of symptoms, are medically complex, and often have increased social needs. Frailty is a strong predictor of several negative outcomes including disabilities, institutionalization, and mortality. Frailty has also been linked to acute illness, falls, and increased vulnerability.

The identification of frailty in its early stage is important because interventions may potentially prevent or delay the clinical consequences of frailty. Interventions are directed to:

1. Exercise including resistance, strength, physical movement (gait and balance) training, and lingual exercise
2. Nutritional maintenance and/or supplementation
3. Maintenance of oral health
4. Environmental modifications
5. Family and professional caregiver education

Learn more about "Frailty" with references and resources by visiting ConsultGeriRN.org.

Join a live Webinar sponsored by the Advancing Excellence In America's Nursing Homes campaign on "Measuring Satisfaction and Integrating the Results in Your Quality Improvement Program." Learn the value of finding out what your residents and staff think and how you can use that information to provide quality improvement. The two part Webinar starts on February 3, 3:00 - 4:15 p.m. ET and the second program is on February 26 at the same time.

• View full registration details
• Join the Advancing Excellence in America's Nursing Homes campaign

People who have dementia are at risk for wandering away from the safety of the care setting and becoming lost in the community. Reported cases of people with dementia wandering off, even from locations such as hospitals, have become increasingly common. Preventing incidents in which the patient wanders away is critical because once a person with dementia becomes lost, she or he may die before being found. Three critical elements of prevention and action are accurate assessment of at-risk individuals, provision of intensive supervision, and implementation of a standardized search plan if a person with dementia is missing.

The How to Try This:® series is funded by the John A. Hartford Foundation to the Hartford Institute for Geriatric Nursing at New York University's College of Nursing in collaboration with the American Journal of Nursing (AJN). This initiative translates the evidence-based geriatric assessment tools in the Try This Assessment Series into cost-free, web-based print and video resources, for caring for older adults. This series can be viewed, downloaded, and shared without any fees. Articles may be printed and copied for educational use without copyright fees. View more information

Hartford Nursing Home Staffing Standard from 2000 Consensus Conference set the stage for the Center for Medicare and Medicare Services (CMS) new Five-Star Quality Rating System, which includes a staffing standard for the first time.

By Sarah Greene Burger, RN-C, MPH, FAAN
Senior Advisor on Special Projects, Hartford Institute

While the new rating system on www.nursinghomecompare.gov moves away from specific self reported staffing data for CNAs, RNs and Licensed nurses, it does set a specific staffing standard to receive the five star rating¹. In order to receive 4/5 points (highest), RN staffing must be at .55 hours per resident day and total staffing of 4.08 hprd. The Hartford recommended standard is total nursing of 4.55 hprd with RN staffing at 69 minutes or 1.15 hours².

The five-star rating is based on the following measures:

• Health inspection results based on a point system on the deficiency grid, the number of revisits to achieve compliance, and complaints
• The quality measure domain is based on seven long stay and three short stay quality indicators
• The staffing data

Learn more about the new five-star rating system:

• General Overview of Five-Star Quality Rating System (PDF)
• Five-Star Quality Rating System User's Guide (PDF)
• View more resources on the CMS Five-Star Quality Rating System page

To better understand the Medicare Five-Star Quality Rating System once you are sufficiently familiar with it, you should:

• Check the rating of nursing homes you're familiar with
• Compare this with your personal knowledge of the nursing home in question

¹Kramer, A. M., & Fish, R. (2001). ''The Relationship between Nurse Staffing Levels and the Quality of Nursing Home Care.'' In Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes. Report to Congress, Phase 2 final, chap. 2, pp. 1-26. Washington, DC: U.S. Department of Health and Human Services, Health Care Financing Administration.

²Harrington, C. H., Kovner,C., Mezey, M., et al. (2000). Experts Recommend Minimum Nurse Staffing Standards for Nursing Facilities in the United States. The Gerontologist, 40(1), 5-16.

To improve the working relationship between family caregivers and health care providers, the United Hospital Fund has launched the Next Step in Care website: www.nextstepincare.org. The website offers a range of guides and checklists most intended for family caregivers of persons with serious illness, with some specifically for health care providers, designed to make patients' transitions between care settings smoother and safer.

This website, the first stage of the campaign "Next Step in Care", will engage hospitals, nursing home rehabilitation facilities, and home health agencies, as well as patient advocacy groups and other family caregiver-focused organizations, in addressing a range of transition-related challenges. Many studies have shown that miscommunication and lack of coordination in transitions lead to errors, particularly around medication changes. The tools are expected to reduce confusion and anxiety for family caregivers, family members, or friends who provide or manage care as well as improve patient outcomes and reduce unnecessary rehospitalizations.

In addition to the new website, the Next Step in Care campaign will include quality improvement activities, some to be developed as collaboratives, in which teams from different health care providers work together to identify, implement, and share best practices.
For more information and to read the rest of this press release, visit the Next Step in Care website

About the United Hospital Fund: The United Hospital Fund is a health services research and philanthropic organization whose mission is to shape positive change in health care for the people of New York.