TIP OF THE WEEK

10 Signs Your Quality Efforts for Depression May Not Be Working

1. Residents seem inactive and bored. When residents are inactive, they may be at risk for worsening symptoms of depression or anxiety. Residents sit at nurses’ stations because they want to be where the action is, right? So get them involved.
2. Your screening process does not include all newly admitted residents.
   All new nursing home residents are at risk for depression and anxiety due to recent and significant changes in autonomy and health status. Use validated screening tools, including a separate tool for residents with cognitive impairment.
3. There has been no staff education on depression in the past year.
   Many resources are available to assist your education efforts. Think about your pharmacists, hospice organizations, the Ohio Department of Health’s Technical Assistance Program, and local chapters of mental health organizations. Education and tools can be provided to assist your staff in improving their recognition and treatment of the symptoms of depression and anxiety in your residents. (The Ohio KePRO Depression Resource CD-ROM also has a special section on staff education. See the last page of this document for details about ordering this resource.)
4. Staff members do not implement non-pharmacologic treatments for depression or anxiety.
   Some symptoms of depression and anxiety can be resolved without medication or counseling or other therapies. One-on-one interventions or group activities can often alleviate these symptoms in your residents.
5. Social workers do not feel comfortable asking residents the questions involved in a depression screening.
   While some of the questions on the depression screening tools may be difficult to ask, social workers must focus on the benefit to the resident. It is better for the social worker and resident to be momentarily embarrassed than for the resident to continue to suffer from untreated depressive symptoms. Social workers should realize that residents are asked many other embarrassing questions (e.g., about incontinence) by the nursing staff, and should utilize their training to ask those questions in a sensitive manner.
6. You see a sudden spike in your QM scores for worsening symptoms of depression or anxiety.
   A sudden spike may not indicate a true change of condition, but may instead result from new staff members contributing to coding the MDS. If you recently installed CareTracker or a similar system, you should expect to see an initial spike in your QM scores for this (and other) measures, as more people are now noting the behaviors and symptoms included in the calculation of the mood scale score. Also, if you have a new social worker or other staff member responsible for coding this section of the MDS, they may be recording behaviors and symptoms more accurately than before, which will cause a spike. In both cases, your QM score should return back to normal levels after a few months; it should not remain elevated.
7. Social workers are not involved in the QI process.
   The depression quality measure is based on symptoms that can be influenced by various departments, including social services, nursing, activities, therapy, and dietary. A partnership between these departments is most likely to be effective in reducing scores on this QM.
8. The Quality Improvement Team doesn’t take time to look at the triggers for individual residents.
   Some residents may trigger for this measure because of such things as pain, loss of appetite, anxiety or other factors not necessarily related to depression. Understand the various items that contribute to the calculation of this QM, and then look at resident-specific information to determine the root cause of these symptoms.
9. Administrative team members believe that depression is an inevitable part of the aging process,
   so they don’t see a point in trying to assess or treat it in their residents. It is a myth that depression is a part of aging; don’t let biases or misperceptions affect the care your residents receive.
10. Your quality indicator of "Prevalence of little or no activity" is high.
    This may suggest that residents are not receiving consistent non-pharmacological interventions to help manage their depressive symptoms.

IN THE NEWS

 

CMS LAUNCHES MY HEALTH, MY MEDICARE CAMPAIGN

September 13 2006 - - CMS - - On September 13, CMS unveiled a new campaign, "My Health, My Medicare," which is meant to assist beneficiaries in the new Part D enrollment period, which begins November 15. The campaign also focuses on prevention and personalized coverage under Medicare and introduces new tools for beneficiaries' use. More information >>

 

 

SENIORS MORE LIKELY TO EXPERIENCE MEDICAL ERROR FROM PRESCRIPTION DRUG THAN YOUNGER PATIENTS, STUDY FINDS

September 14, 2006 - - Kaiser Network - - Patients older than age 65 experience a drug error rate nearly seven times greater than those younger than 65, according to an analysis released Wednesday by prescription benefit manager Medco Health Solutions, the AP/Detroit News reports.

 

For the study, researchers analyzed Medco's drug insurance claims from 2.4 million adults in 2004. Drug errors were noted in cases when a patient was prescribed a drug that was incompatible with medicines already being taken; when a drug could exacerbate another medical condition; or when an incorrect dosage was prescribed, according to Glen Stettin, Medco senior vice president. Researchers found that seniors were at the greatest risk of prescribing errors, and the error rate for seniors increased for those patients who were treated by more doctors and prescribed more drugs. Read more >>

 

 

EXPERTS URGE LAWMAKERS TO HELP EASE GROWING MENTAL HEALTH CRISIS IN SENIORS

September 15, 2006 - - LA Times - - Senior citizens have high rates of mental illness and the country's highest suicide rate when compared with other age groups, a panel of mental health experts told a congressional committee Thursday.

 

Appearing before the Senate Special Committee on Aging, the experts said poor access to mental health care, inadequate training for primary care physicians and even apathy among seniors was contributing to a growing mental health crisis among those older than 65. Read more >>

 

 

ELDERLY DISCRIMINATION IS AN AGE-OLD STORY

September 15, 2006 - - Monterey Herald, CA - - Age discrimination is widespread in health care, the media, the workplace and the marketplace, according to a study released earlier this year by the International Longevity Center-USA, an aging-issues think tank in New York City. A majority of older adults polled reported that they'd been ignored or experienced insensitivity, impatience and condescension from others based solely on their age.

 

The outcome can be more than just an embarrassing situation. Research shows that individuals receiving this treatment often end up with debilitating lowered self-esteem and self-confidence, as well as sub-standard health care. Read more >>

 

 

 

 

OHIO KEPRO EVENTS

TELECONFERENCES

September 27, 2006: How to Take the Pressure Off A panel discussion on pressure ulcers in nursing homes * This Wednesday * 1:30 to 3:00 pm Dial-in #: 1-800-895-1713 Conf ID: KePRO

October 18, 2006: Restraints have you in knots? Untie them. 1:00 to 2:30 pm

 

 

 

OTHER INDUSTRY EVENTS

 

ACCEPTING SPEAKER APPLICATIONS NOW

For the second annual conference, slated for March 20, 2007, the Ohio Person-Centered Care Coalition is seeking creative presentations that engage participants, encourage discussion, and give attendees new ideas for providing person-centered care in their homes. People right here in Ohio have some great stories to share and we want to hear them. The deadline for application is September 30, 2006, so submit your presentation idea today!

• Go to centeredcare.org for more information.
• Download the speaker application in Microsoft Word or in PDF.

PERSON-CENTERED CARE COLLABORATIVE OUTCOMES CONGRESS (PDF)

October 4, 2006 – Nursing homes participating in this one-year project to implement person-centered care strategies in their homes present their stories and progress to date. Who should attend? Anyone who is (or is thinking about) implementing person-centered care strategies.

 

Alzheimer’s Association Training Events

 

AOPHA Events

 

Case Western Reserve University School of Medicine Courses

 

Ohio Academy of Nursing Home Events

 

Ohio Health Care Association Events

 

OSHIIP’s Medicare and Part D Check-ups throughout Ohio until December 20, 2006 (PDF)

 

 

An archive of The Nursing Home Weekly Update is available on our Web site. Click here >>