National Plan to Address Alzheimer's Disease: 2016 Update. Strategy 2.F: Ensure that People with Alzheimer's Disease Experience Safe and Effective Transitions between Care Settings and Systems

08/01/2016

Preventable Hospitalizations. CDC worked with partners to conduct a review of interventions related to dementia and decreasing preventable hospitalizations, as well as a systematic review of caregiver interventions. The findings from this review will help to inform the current state of evidence-based strategies and interventions related to the Healthy People topic area "Dementias, including Alzheimer's disease" and its objective "To reduce the proportion of preventable hospitalizations in persons with diagnosed Alzheimer's disease and other dementias." A publication that described the results is available.

For more information, see:

________________________________________

Nursing Home Strategic Plan. An in-person and virtual stakeholder meeting was held in January 2016 to help shape the goals of the CMS Nursing Home Strategic Plan. Stakeholders from academic institutions, advocacy groups (including AD/ADRD), trade associations, caregivers, government, professional societies, providers, and others participated. There will be future opportunities for stakeholders to participate as the Strategy evolves.

________________________________________

Improved Discharge Planning. CMS has proposed to revise the discharge planning requirements that hospitals must meet in order to participate in Medicare and Medicaid. The changes would modernize the discharge planning requirements by bringing them into closer alignment with current practice; helping to improve quality of care and outcomes; and reducing avoidable complications, adverse events, and readmissions. They would also implement discharge planning requirements of the Improving Medicare Post-Acute Care Transformation Act (IMPACT Act) of 2014, to improve consumer transparency and the discharge planning process experience. Through the IMPACT Act, certain facilities are required to develop a discharge plan based on the goals, preferences, and needs of each beneficiary. Under the proposed rule, hospitals and critical access hospitals would be required to develop a discharge plan within 24 hours of admission and complete a discharge plan before the beneficiary's return to home or transfer.

For more information, see:

________________________________________

Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents. This initiative has been underway since 2013 and has already shown reductions in avoidable hospitalizations. In 2016, CMS selected sites for a new phase of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents to provide practitioners with additional payments for multi-disciplinary care planning. Medicare currently pays physicians less for a comprehensive assessment at a nursing facility than for the same assessment at a hospital; this model equalizes payments between sites. Nursing facilities will offer additional treatment for common medical conditions that often lead to avoidable hospitalizations; there will be more practitioner engagement when a resident needs higher-intensity interventions due to a change in condition. Participating nursing facilities will also enhance staff training and purchase new equipment to improve certain capacities.

For more information, see:

________________________________________

Nursing Home Compare. With funding from the IMPACT Act in 2016, CMS will implement a quarterly electronic staffing reporting system for nursing homes that is auditable back to payroll to verify facility-reported staffing information. This new system will increase accuracy and timeliness of data, and allow for the calculation of quality measures for staff turnover, retention, types of staffing, and levels of different types of staffing.

________________________________________

Rhode Island's Financial Alignment Initiative Demonstration for Dual-Eligible Beneficiaries. CMS is partnering with the State of Rhode Island to test a new model for providing Medicare-Medicaid enrollees, including low-income seniors and people with disabilities, with a more coordinated, person-centered care experience. Under this model, CMS and Rhode Island have contracted with a Medicare-Medicaid plan to coordinate the delivery of and be accountable for covered Medicare and Medicaid services for participating Medicare-Medicaid enrollees. The model requires that the plan develop policies and procedures to train care coordination staff in dementia care management, including but not limited to understanding dementia, symptoms and progression, understanding and managing behaviors and communication problems caused by dementia, caregiver stress and its management, and community resources for enrollees and caregivers

For more information, see:

________________________________________

Hospice Referral after Inpatient Psychiatric Treatment of Individuals with Advanced Dementia from a Nursing Home. A publication by Drs. Epstein-Lubow, Tuya Fulton, Marino and Teno entitled Hospice Referral after Inpatient Psychiatric Treatment of Individuals with Advanced Dementia from a Nursing Home was published in June 2015. The report addresses the discharge disposition following inpatient psychiatric treatment for advanced dementia. The total population included 685,305 Medicare fee-for-service (FFS) decedents with advanced cognitive and functional impairment, with a mean age of 85.9 years who had resided in a nursing home. In the last 90 days of life, 1,027 (0.15%) persons received inpatient psychiatry treatment just prior to the place of care where the individual died. Discharge dispositions included 132 (12.9%) persons to a medical hospital, 728 (70.9%) to nursing home without hospice services, 73 (7.1%) to hospice services in a nursing home, 32 (3.1%) to home without hospice services, and 16 (1.6%) to hospice services at home. Overall, the rate of referral to hospice services for advanced dementia was relatively low.

For more information, see:

________________________________________