With the spotlight on activity professionals during Activities Professionals Week on Jan. 22-28, we asked Emilee Kulin and John Davis of Kindred Nursing and Rehabilitation – Mountain Valley to share the story of their highly successful activities program.
Kulin, the activities director, says that the residents at Kindred Nursing and Rehabilitation – Mountain Valley come from a small rural community of people who worked as miners, loggers, or in recreation fields. “Our residents are used to being active” she says, “so we try to give them activities that will fit that lifestyle. We have Tuesday night poker games, bingo, dominoes and happy hour. On Friday nights, we have a band that plays from 6:30 to 8:30.”
There has always been a struggle in the management of patients with diabetes. How do we reach A1c goals of less than 7% and at the same time avoid hypoglycemia? Are we allowing fear of hypoglycemia let us get too comfortable with hyperglycemia? Most protocols for managing high blood sugars require contacting prescribers when glucose levels exceed 300 or even 400mg/dl. Since symptomatic hyperglycemia starts at glucose levels of 180mg/dl, allowing blood sugars to elevate to such levels proves the point that we are too comfortable with hyperglycemia. On the other hand, no one would suggest a prescriber be contacted every time blood sugars are above 180mg/dl.
Kindred’s presence across the post-acute spectrum of care means that our patients can recover as fully as possible in the proper care setting. Bessie’s story is a good example. She was living comfortable at home in Jeffersonville, Indiana, and using a Bi-PAP machine when she developed respiratory distress.
On January 3, she was admitted to a short-term acute care hospital. There she was placed on a ventilator and underwent a tracheostomy. She also developed pneumonia, renal dysfunction and hypertension. Because she was unable to wean from the ventilator, Bessie’s physician chose to transfer her to Kindred Hospital Louisville for continued care.
At Kindred Hospital Louisville, Bessie was successfully weaned from the ventilator. She recovered from her pneumonia and her renal function improved significantly. By this point Bessie had gained strength with the help of physical, speech and occupational therapy, but her recovery was not complete.
We found this video on YouTube and thought that it did a great job summing up one of the most important themes of the 2011 Clinical Impact Symposium on Cardio-Pulmonary Rehabilitation across the Continuum. We would like you to share what you do in the most important 30 minutes you take for yourself today; you never know, you may inspire another reader with a unique way you stay active. Just add your thoughts in the comments.
23 1/2 hours, What is the single best thing we can do for our health?
Kara and Chris started off by comparing the importance of taking care of yourself as a healthcare provider to putting your oxygen mask on first before helping someone.
"Someday Isle" is the idea that we put off doing things that are better for us until someday, and in the meantime we are comfortable with the idea that someday we will do those things.
30.1% of people in Kentucky do zero exercise each week and the Mohr's have heard and seen all of the reasons, they shared one of their favorites:
The Mohr's challenged attendees to consider that exercise and strength training makes us happier and more able to care for our patients, friends and family.
Visceral adipose tissue or VAT fat was the target of Sharon Himmelstein's opening remarks, and for good reason: VAT fat releases chemicals that enter the liver and lead to diabetes and cardiovascular disease. Himmelstein explained that the amount of VAT is an indicator for diabetes.
The leading reasons for the spike in VAT in the world population is the change in eating habits over the last few decades. Convenience, advertising, erratic eating, and over eating have lead to VAT levels to shoot up.
Matt Sivret and Sally Brooks, MD addressed why outcomes matter greatly to Kindred Healthcare, measuring our organizational success through patient success, how to address outcomes across the continuum and why outcomes matter to our customers. Matt started by identifying the top seven reasons why outcomes matter:
Congestive heart failure is a very common reason for hospitalization, with over 1 million congestive heart failure (CHF) admissions per year; readmission rates are 30% at 30-60 days. Identifying methods to reduce the frequency of hospitalization and the associated costs are critically important.
Early exercise training may be useful in reducing morbidity and mortality in CHF. Aerobic and strength training are both key as muscle strength is a key predictor of long term survival, better than peak VO2.
The 6 min walk test is commonly used to measure functional capacity. A result under 300 meters is associated with increased mortality. The test is sensitive to changes in cardiac function, and a difference of 99 feet is considered the minimal improvement of clinical importance according to Ethel Frese.
There have been substantial improvements to Ventricular Assist Devices (VAD) since there original introduction as bulky external devices that required a suitcase-sized support device to be moved with the patient. VADs were originally thought of almost exclusively as a bridge to cardiac transplantation. Chris Wells shared that they may now be a bridge to recovery or even destination therapy, that is a long-term management strategy.
Most are left ventricular assist devices (LVAD), although right ventricular units also exist. All are independent of the cardiac rhythm evident on the EKG. Consequently, one can do therapy when the patient appears by EKG to be in ventricular tachycardia, ventricular fibrillation, or asystole. VADs require a variable range of anticoagulation. All are susceptible to infection, bleeding, thrombosis/stroke and mechanical failure.
The prevalence and pathopshiology of congestive heart failure is 25% of patients with heart disease. Evidence based dietetics practices approved by the American Dietetics Association (ADA) have been developed to guide the medical nutrition therapy for patients with heart failure.
Cindy Cassel educated the audience on how the ADA uses workgroups to develop disease specific guidelines, which recommend what should be done in terms of nutrition and then how it should be delivered. In addition, the ADA has developed a guideline rating system that helps guide the dietician and patient on the strength of the guideline based on evidence base.
The ADA recommends that the treatment of heart failure symptoms should be based on a comprehensive nutrition assessment to maximize adequate intake and control for the symptoms of disease. In general the nutrition assessment of a heart failure patient should focus on protein needs (should be higher to save muscle) and energy needs.
Kindred Healthcare680 South Fourth StreetLouisville, KY 40202Phone: 502.596.7300Toll Free: 1.800.545.0749
Copyright © 2014 Kindred Healthcare, Inc., EOE