About Care Partners Exceptional hospice care since 1982, palliative care since 2008 Our goals To support your staff and your operating procedures To enable the best care for your residents To increase family satisfaction Unique Focused Care hospice programs by diagnosis: dementia, heart failure, chronic lung disease and cancer
VIDEO https://youtu.be/FO2dUy-SMRg - Carla Perissinotto, MD, UCSF Department of Geriatrics
ODHS Provider Alert – Indoor Visitation Issued 10/23/20 based on CMS guidance of 9/17/20 CMS Guidance ODHS Additional Guidance No more than 2 • visitors/resident at a time No more than 20% of residents • (or max 5, whichever is lower), may have visitors at one time
Applies as of 11/2 in counties where COVID+ rate is <10% ODHS Provider Alert Audience Poll (please use “Chat” to reply) Are you allowing family visits under these circumstances? - YES - NO
COVID-19 Testing, Vaccines & Treatments - C. William Dronkowski, MD, Associate Medical Director, Care Partners - Omar Pandhair, OHSU, Care Partners Intern
COVID-19 Test Types and Their Uses Source: FDA : “Coronavirus Testing Basics”
Abbot BinaxNOW A Rapid Antigen Test recently given FDA Emergency Use Authorization It is an anterior nasal swab test that will provide results in 15 minutes Administered by healthcare professionals in point-of care settings Abbott will sell this test for $5 each Studies have demonstrated the test to have 97.1% Sensitivity (probability of correctly identifying positive cases) 98.5% Specificity (probability of correctly identifying negative cases) In late August, per federal gov’t orders, 150 million tests were shipped to “ nursing homes, assisted living facilities, home health, and hospice agencies ”
Vaccine Status Update Two vaccines (from Pfizer & Moderna) produced by mRNA technology are currently close to releasing interim efficacy and safety data* These vaccines require two doses 1 month apart Two other vaccines (from J&J & AstraZeneca) produced with adenoviral vectors have each had a serious adverse event but are continuing in development HHS & OHCA announced pre-registration for vaccine distribution to LTCs 10/19 Distribution to be managed by Walgreens and CVS Best-Case Timeline (Estimated) WHO also EUA** INITIAL EFFICACY 3 VISITS/2 MOS EUA APPROVAL/ estimates APPLICATION 1 ST SHIPMENTS & SAFETY ADMINISTRATION Q2 2021 NOV 2020 Q2 2021 Q1 2021 DEC 2020 * 50% greater effect than placebo + 2 months of safety follow up since last dose **EUA = Emergency Use Authorization from FDA
COVID-19 Treatment Update Hundreds of drugs/combinations in testing, but few definitive results Overall COVID-19 death rate appears to be declining (papers from NYU and UK being published this week), however Data have been limited and conflicting Death rates in people over age 75 remain higher than in younger age groups What is known: Outcome of ventilation is generally poor Steroids and anti-coagulants may be beneficial Convalescent plasma data is mixed (Lilly antibody derived from recovered COVID-19 infected patients was discontinued due to lack of effect) Veklury (remdesivir) received full FDA approval on 10/23 Based on time to recovery in hospitalized patients age 12 and older, but has not demonstrated a clear survival benefit NIH is conducting follow-on studies (ACTIV-5) evaluating two approved monoclonal antibodies used in autoimmune disease + remdesivir to see if mortality is improved
Identifying residents who are suffering most from loneliness - Julia Salve, MN, FNP-C, ACHPN
UCLA 3-item loneliness scale WHAT: Screening Tool consisting of 3 QUESTIONS* that measure 3 dimensions of loneliness : relational connectedness, social connection, and self-perceived isolation: 1 - How often do you feel that you lack companionship? 2 - How often do you feel left out? 3 - How often do you feel isolated from others? *Modified version created in 2004 from original 20 questions WHO: Can be administered by caregiver or staff through an interview, assessment, or written questionnaire
Simple Scale with 3 response categories RESPONSE SCORE Hardly 1 Some of the time 2 Often 3 Scores for each question are added together to give a possible range of scores from 3-9 Researchers have grouped people who score 3 – 5 as "not lonely" and people with the score 6 – 9 as "lonely" 3 4 5 6 7 8 9 Least lonely -- Most Lonely * Source: Campaign to End Loneliness (UCLA Loneliness Scale, 2004)
Screening Follow-Up 1 - For residents who report feeling hopeless or depressed and have little interest or pleasure in doing things, refer to healthcare provider for evaluation of depression 2 - Provide opportunities for social engagement or volunteering based on response score (More discussion to follow) 2 - Track evaluation results along with actions recommended to and taken by the older adult to measure their impact on the level of social engagement within the community
Internal Approaches to Reduce Loneliness - Briana Rotter, DNP, NP-C, CNE, Care Partners
Concept: Replicate small group setting of AFHs and Memory Care units in larger communities – “PODS” What forms of group Assess (new) resident participation are history meaningful? Include opportunities Develop groups that to for contribution foster relationships Source: The Need for a Social Revolution in Residential Care, K. Theurer et al. Journal of Aging Studies (2015) 201-210
Resident Questionnaires – Grouping Tool Identify not only interests and preferences, but also habits, introversion/extroversion and “helping” tendencies Move beyond joint activities to shared experiences and “buddy” support functions
Examples of residents for whom engagement should be prioritized (CMS) A resident who was living with their family before recently arriving is struggling with the change in environment and lack of family presence A resident who is grieving after friend or family member passed away A resident who is experiencing weight loss or dehydration due to lack of mealtime companionship and support A resident who used to engage socially and is now experiencing emotional distress
Facilitating Remote Interactions - Rochelle Speare, LCSW, Care Partners
Pads are the preferred hardware for older adults ODHS announced that CMP funds can be used to buy communications devices ($3K max/community) Pads may also be available to borrow from different organizations (Care Partners has an iPad “lending library”) Many residents will become comfortable managing the interface on their own after 2 or 3 sessions Those with cognitive impairment may need a staff member to start the meeting and monitor the connection
Beyond the Virtual Check-in: Meaningful Engagement Schedule a regular date with several family members for afternoon tea or coffee Do a good night FaceTime each evening Create art together – send special materials like pressed flowers or magazine photos in advance Go through an old photo album and share memories Listen to a concert or a few favorite pieces of music together Have them remotely advise you with making a family recipe or with a household project
Audience Poll (please use “Chat” to reply) • What is the most important tool/program that you are currently using to address loneliness? • What additional options are you considering?
Other Questions?
THANK YOU! To learn more about Care Partners palliative and hospice services Call Heather Nash at 503-213-1097 or Visit our website at www.CarePartnersOR.org
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