The Avila Institute of Gerontology held its annual October Long-term Care Conference on Monday, October 9–Tuesday, October 10, 2017. The goal of this year’s conference—titled “Making Today’s Decisions Tomorrow’s Vision”—was to provide attendees with information that would empower them to navigate the constantly changing health care and long-term care landscapes. Featuring speakers across the spectrum of health care and long-term care, the conference highlighted many important issues in those industries.
Jane Mack opened the conference with a presentation that appealed to leaders in health care and long-term care. This presentation reflected on the value of collaborative decision-making when seeking the most unified consensus—even if it may be imperfect. She began with an overview of the questions that must be asked when determining employee engagement, which focused on the importance of understanding the perspectives of those involved in the decision-making process. Mack then segued into suggestions for structuring a collaborative meeting, in which she stressed the importance of clarifying the roles of the individuals involved in the decision (i.e., support, inform, consult, responsible, approve) because there is greater cohesion when people are involved in decisions that impact them. Her discussion of the five levels of decision-making detailed different types of scenarios for making a decision and the dynamics involved in those scenarios. This segment of the presentation was an insightful exploration of how a decision comes to be made and included the advantages and disadvantages of each level of decision-making. Of course, no collaboration could function without the participants’ ability to listen. Mack supported this sentiment as she guided attendees through Otto Scharmer’s concept of “Four Levels of Conversation.”
Monday’s second presentation, “Technology & Innovation: Key to Thriving Aging Services,” emphasized the growing role that technology has played and will continue to play in the care industry. As presenter Majd Alwan of LeadingAge put it, "Technology is creeping on us, whether we like it or not!” During his presentation, Alwan shared how technology can support independence and supportive services in the elder population. He previewed emerging technologies in the fields of safety, telehealth, medication adherence, and environmental wellness. He also described how technology can assist with gathering health parameters that can potentially increase compliance, thereby reducing hospital admissions and adverse consequences. There are also engagement technologies available, which provide elders with a digital medium to connect, engage, and continue to enjoy life. When evaluating the integration of technology in operation, decision makers should keep in mind that “technology should be a strategy, or an enabler of other strategies."
In session number three, Philip McCallion discussed Lewy Bodies Dementia (LBD), which is the second most common type of progressive dementia after Alzheimer's. McCallion began by defining dementia and listing the various types. He then expounded on the features and symptoms specific to Lewy Bodies Dementia and how it is different from other types of dementia (e.g., Alzheimer's, Vascular, Parkinsons). He looked at how the different types of dementia develop in the brain—specifically, how the presence of protein alpha-synuclein is linked to the disease. Diagnosis can prove to be challenging due to the overlap of symptoms between the different types of dementia; however, an accurate diagnosis is vital to ensure that the appropriate evidence-based intervention is utilized to promote the best quality of life for the person, family, and caregivers. McCallion also discussed treatment of LBD; unfortunately, there is no cure at present time, but there are pharmacological and non-pharmacological treatments that can mitigate the effects of the disease. McCallion spent a significant portion of his presentation on behaviors of those with LBD and evidence-based interventions for those behaviors, prioritizing the preferences of the person at the center of care regarding their wishes for how they want to live.
On Tuesday, October 10, Janet Feldkamp introduced day two of the conference with her presentation, “Dramatic Legal & Regulatory Changes Affecting Post-Acute Care,” in which explained the interpretation of and suggested implementation strategies for the recent changes mandated by the Centers for Medicare and Medicaid Services (CMS). Feldkamp relied on her wealth of experience as she detailed the new federal regulations and connected them to real-life situations. Subjects Feldkamp focused on included the role of the resident representative as it relates to resident rights, abuse and neglect, implementation of a CPR policy, importance of sufficient staffing with appropriate competencies and skills, facility assessment, and best practices for developing a QAA/QAPI program. Feldkamp also provided an overview of the new long-term care survey process.
Next, Julie Trocchio, Senior Director at the Catholic Health Association of the United States, provided attendees with an update from Washington on the status of the Affordable Care Act, as well as new rules for long-term care as the demographic shifts toward an older population. She stated, "As faith-based providers, we are called to make eldercare a life-giving experience, ethics in practice and decision-making, and integrating Mission in LTC."
Alf Norwood, this year's Flos Carmeli award winner for Promoting Innovative Education for Compassionate Care, presented on the importance of distinguishing a diagnosis of depression in people over the age of 65, as untreated depression can lead to cognitive decline and ultimately convert to dementia. As Norwood noted, “Depression is not a normal part of aging. If left untreated, it may eventually lead to physical morbidity.” During the presentation, Norwood explained how to identify and diagnose depression using approaches such as the two-item depression screen and the Cornell scale for depression in dementia. This led to a discussion of the different types of depression (including persistent depressive disorder, bipolar disorder, season affective disorder, psychotic depression, and post/peri partum and premenstrual dysphoric) and what their causes are. Fortunately, as Norwood explained, there are treatments for many depressive disorders that can dramatically improve the condition of the person affected; in particular, he highlighted three behavioral interventions that have proven to be effective when approaching elders with depression: Cognitive Behavior Therapy (CBT), live review/reminiscence, and problem-solving therapy.
For the final session of the conference, Eric Krull and Melinda P. Avila-Torio presented “Casting Light on Circadian Rhythm,” which drew a link between light stimulation and dementia. Their presentation began with an overview of the projected rise in cost of overall long-term care through 2025, which would coincide with a rise in dementia. According to Krull and Avila-Torio, the circadian rhythm—the physical, mental and behavioral changes a person experiences in 24-hour cycle relative to light and darkness—is an often overlooked factor dementia. One reason that light is so important for the dementia population is that diseases like Alzheimer’s tend to cause vision impairment, which can become difficult to manage in low-light settings. Further, studies show that circadian rhythm disorders (CRDs) occur in over 60 percent of patients with dementia, causing high stress in caregivers and decreased quality of life for the persons affected. But, as Krull and Avila-Torio explained, using light effectively can alleviate some of the effects of dementia. Utilizing their background in architecture and interior design, Krull and Avila-Torio suggested techniques for harnessing natural light and designing with artificial light in long-term care settings. In one case study they presented, effective use of lighting in one 18-bed assisted living facility led to more frequent visitors enjoying longer stays, improved staff morale, and 89% resident participation in daily activities. In addition, staff observed fewer Sundowning effects, with residents experience better sleep patterns.