New Staffing Rules Published Amidst the Current SNF Staffing Crisis
Overview
The Centers for Medicare and Medicaid Services (“CMS”) recently published a final rule implementing required mandatory hours per resident day (“HPRD”) for various levels of nursing staff in nursing facilities and skilled nursing facilities (“SNFs”) through a phased-in approach. Although the existing federal requirements to ensure SNFs have “sufficient staff” to meet residents needs and well-being remain, these mandatory staffing minimums further complicate SNF operations while still facing massive staffing shortages.
Key Deadlines
• August 8, 2024 - All SNFs, are required to document an update to their annual facility assessments pursuant to 42 CFR 483.70(e) to determine what resources are currently necessary to care for residents competently in day-to-day operations as well as emergencies.
• May 11, 2026 - Non-rural facilities will have 2 years to increase their registered nursing staff (“RNs”) to ensure at least one RN is present and on-site 24 hours a day, 7 days a week. Rural facilities have 3 years, until May 10, 2027, to meet this requirement.
• May 10, 2027 - Non-rural facilities will have 3 years to adjust their staffing to ensure overall staffing meets 3.48 HPRD, with a minimum
of 0.55 HPRD for RNs and 2.45 HPRD for nursing assistants (which includes certified nurse aides, aides in training, and medication aides/ technicians). Rural facilities have 5 years, until May 10, 2029, to meet this requirement.
• May 10, 2028 – Date by which Medicaid-certified nursing facilities and intermediate care facilities for individuals with intellectual disabilities will be required to comply with the staffing requirements.
Notably, CMS did not impose any mandatory HPRD requirements for licensed professional nurses (“LPNs”) and licensed vocational nurses (“LVNs”), citing a lack of correlation between increased quality of care with an LPN/LVN HPRD requirement. However, LPN/LVN hours can apply to the overall 3.48 HPRD minimum.
Exemptions
A SNF provider may qualify for an exemption to the staffing rule if it: 1) it is located in a region where the provider-to-population ratio is at least 20% below the national average, and 2) it demonstrates good faith efforts to hire and retain staff, and 3) it demonstrates financial commitment
to retain direct care staff. “Good faith efforts” can include documented job postings, job vacancies and job offers extended for prevailing wages, as well as written staffing plans. “Financial commitment” will be evaluated by the amount spent on nurse staffing relative to revenue.
If granted an exemption, the SNF must post a notice of its exemption status at the facility, inform each current and prospective resident, and send a copy of the notice to State Long-Term Care Ombudsman. Additionally, exemption status will be published on Care Compare. Exemptions are not available to SNFs with staffing-related violations, SNFs that have failed to submit PBJ staffing data, or Special Focus Facilities. Adds to Existing Requirements
It is important to note that although minimum staffing ratios will become an important marker of sufficient resident care, the new rule supplements, and does not supersede or replace, the current requirements that a facility have “sufficient staff” to meet residents needs safely and
By Meredith Duncan, J.D.
Ellie Tucker, J.D. Polsinelli, PC
Take a Keto-Break See pg. 10
Join 250,000+ professionals who get free Continuing Medical Education (CME) with Texas Health Steps Online Provider Education. Choose from over 50 CME courses developed by trusted Texas experts, for experts like you. Quick courses and case studies on topics such as Medicaid guidelines, ethics and mental health, and more are all available 24/7.
Oncology Research
Understanding the Eating and Nutrition Challenges Faced by Cancer Patients
FBy David George, M.D., Texas Oncology–Kyle, South Austin
or people undergoing cancer treatment, their body may respond in unexpected ways. One concern many patients bring up is being able to get proper nutrition and navigate the everyday tasks of preparing food and eating.
Cancer itself, as well as various treatments such as chemotherapy and radiation, can have a profound impact on appetite, taste, digestion, and mental capacity or energy.
Struggles with eating faced by cancer patients
Cancer and its treatments can test the body, leading to a variety of eating-related issues and side effects that can not only make it difficult to
consume enough calories and nutrients, but impact overall quality of life. These can include:
• Loss of appetite
• Nausea
• Dehydration
• Taste changes
• Mouth sores
• Difficulty swallowing
• Gastrointestinal problems
• Changes in weight
For some patients, the mental toll of cancer can also affect their appetite.
Depression is common, and feelings of sadness, tiredness, or low energy can interfere with daily life and one’s ability or desire to eat and drink. Others may have trouble with physical movements, making it difficult to prepare or cook food. In addition, brain fog, mental exhaustion, or emotional exhaustion can make thinking about eating or meal planning difficult.
No shame or blame
For caregivers, family members, or friends who have a loved one
SHOULDN’T YOU BENEFIT
dealing with cancer, it’s important to avoid blaming or shaming them for not eating or having a loss of appetite. Avoid judgment and criticism and instead, be encouraging. Rather than nag or fight about eating, focus on providing options that are comforting and appealing.
Offer frequent healthy snacks and keep cool drinks or liquid meals within reach and in sight. Let your loved one decide when and what they want to eat. If the patient has issues with bitter or metallic tastes, try plastic utensils or straws. If the patient can’t or doesn’t want to eat, offer your company instead, and let them know you’re there
to support them, including when they do want to eat.
Helpful tips for when eating is a challenge
There will be days when eating presents no issues and days when even a small sip of water is unbearable. Remember to take each day one at a time. Consider these four tips to help nourish the body and minimize stress around eating:
1. Eat frequent, small meals. Instead of three large meals, have smaller, more frequent ones throughout the
see Oncology ...page 14
Semaglutide Lowers Cardiovascular Risk Regardless of Blood Sugar
UTSW-Led Analysis Shows Cardiovascular Benefits from Popular Weight-Loss Drug Don’t Depend on Reduction in Glucose Levels
Aweekly dose of semaglutide 2.4
mg significantly reduced the risk of major adverse cardiovascular events (MACEs) in people with overweight or obesity and cardiovascular disease but not diabetes, regardless of blood sugar level, according to a clinical trial including researchers from UT Southwestern Medical Center. The findings, published in Diabetes Care, also show the reduction in MACEs – a combination of heart attacks, stroke, or death from cardiovascular causes – isn’t due to the drug’s effect in lowering blood sugar.
“We showed that even people with completely normal blood sugar have the same benefits in reducing MACEs as people with blood sugar levels in the prediabetes range. This is very important information that
helps us understand which patients might benefit from the cardiovascular risk-lowering effects of this medicine,” said first author Ildiko Lingvay, M.D., M.P.H., M.S.C.S., Professor of Internal Medicine in the Division of Endocrinology and in the Peter O’Donnell Jr. School of Public Health at UT Southwestern.
Dr. Lingvay and her international colleagues collaborated in the Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity Trial (SELECT). This is the longest and largest study with semaglutide (a drug better known in the U.S. under its brand name Wegovy), designed to test its effects on MACE risk in people who have overweight or obesity with cardiovascular disease but no diabetes.
Semaglutide was originally approved in 2017 by the U.S. Food and Drug Administration (FDA) at a dose of 1.0 mg for adults with Type 2 diabetes and in 2022 for chronic weight management at a dose of 2.4 mg.
The main results of the
trial, published last year in The New England Journal of Medicine, showed a 20% reduction in the risk of MACE in 8,803 participants who took semaglutide, compared with 8,801 participants who took an see Semaglutide ...page 13
Ildiko Lingvay, M.D., M.P.H., M.S.C.S., is Professor of Internal Medicine in the Division of Endocrinology and in the Peter O’Donnell Jr. School of Public Health at UT Southwestern.
Mental Health
Texas A&M School of Nursing Leads
$1.5 Million Grant Addressing Neonatal Abstinence Syndrome
Initiative Offers Home Visits For Pregnant And New Mothers Navigating Substance Abuse Treatment And Recovery
By Maddie Spera
The Texas A&M University School of Nursing and key partners are preparing to launch a home-visiting program designed to curb neonatal abstinence syndrome (NAS) in the Golden Crescent area of Texas. The project is funded by a three-year, $1.5 million grant from the Health Resources and Services Administration (HRSA).
Golden Crescent Management of Opioid Risk in Mothers (GC-MOMS) is funded under the HRSA’s Rural Communities Opioid Response Program (RCORP), an initiative aimed at reducing morbidity and mortality related to substance use disorder and opioid use disorder in high-risk rural communities. GC-MOMS will focus
on NAS, which occurs when babies are exposed to drugs, like opioids, in the womb and experience withdrawal.
The School of Nursing is collaborating with the Texas A&M School of Medicine and School of Public Health to develop a custom curriculum for home educators to support pregnant and new mothers as they navigate substance abuse treatment and recovery. GC-MOMS’ 12-month program will focus on behavioral health, community risk factors and more.
Other partners include Golden Crescent-based Cuero Regional Hospital, a referral source for the GC-MOMS, and the Billy T. Cattan Recovery Outreach Center, which will provide peer recovery support services for enrolled families.
Robin Page, PhD, associate professor at the School of Nursing, serves as project director. Project team members are Nancy Downing, PhD, associate professor at the School of Nursing; Kelly Wilson, PhD, professor at the School of Nursing; Carly McCord, PhD, clinical associate professor at the School of Medicine; and Heather Clark, DrPH, director of public health practice at the School of Public Health.
“The School of Nursing has a long history of serving at-risk communities under RCORP, and GC-MOMS represents an important opportunity to expand our outreach to more families
who need us,” Page said. “The Golden Crescent area is a ‘maternity care desert,’ which means families there don’t have access to important services that promote healthy pregnancies and positive post-partum outcomes. We believe a coordinated home-visiting program can provide essential support that helps remove barriers to care.”
The Golden Crescent area, which includes the counties of Calhoun, DeWitt, Goliad, Gonzales, Jackson, Lavaca and Victoria, is a designated health professional shortage
Healthy Heart Ready For Vacation? Eat Well and Enjoy Your Travels
with These Healthy Tips
By Michael Merschel American Heart Association
AlthoughYou’ve got your swimsuit, sunglasses and a beach- or hammock-worthy novel ready to go. But does your vacation checklist also have a plan for healthy eating?
Sure, escaping your routine might be the whole point of hitting the road. But eating well not only boosts your health, it also can energize your adventures as well, nutritionists say. Here are some of their ideas. Plan those snacks
For flyers in particular, finding healthy food in transit can be a challenge, said Katie Krieg, a registered dietitian in Dallas who’s also a travel agent.
Her solution is to pack snacks that will get past airport security checkpoints and keep her feeling full. Things like
Trail mix with less chocolate also works, said Theresa Gentile, a registered dietitian nutritionist in Brooklyn, New York, and spokesperson for the Academy of Nutrition and Dietetics.
Don’t wait to hydrate
Staying hydrated is important when traveling, so “the first thing is to prioritize getting your water in,” Moore said.
Moore suggested taking a refillable water bottle and hydrating fruits, like grapes and oranges. Speaking of being on the go …
Fruits, vegetables and other fiber-rich foods are, of course, part of a diet that’s good for the heart over the long term. But they also can address a more immediate concern many vacationers complain about.
“A lot of people do suffer with constipation when they travel,” Moore said. Fluids and fiber help alleviate it.
whole-grain crackers, carrots, apples, and unsalted popcorn are filled with fiber. And pairing unsweetened dried fruits with a protein and fat source increase satiety and energy levels, preventing blood sugar spikes and dips. Didn’t plan? Try this
Like Krieg, Marisa Moore, a registered dietitian nutritionist in Atlanta, believes in planning snacks. But if you didn’t pack any and find yourself stuck at a typical terminal or a highway convenience store, don’t despair. You still have options.
Divide and conquer
Krieg is a believer in ordering appetizers or in splitting dishes to get smaller portions. Not only does that leave room for a salad or vegetable side, it gives you the chance to sample more foods.
Balance with alcohol
If you choose to drink alcohol, hydration becomes extra important, Krieg said. So make sure you’re filling up on water.
Moore pointed out that although alcohol might make you feel more relaxed, it can interfere with sleep. So
“Sometimes if you go and look in the back, you might find a spare banana,” or a snack pack of fresh grapes, Moore said. see Healthy Heart...page 13
Hospital News
St. David’s Healthcare Facilities Named Among Nation’s 100 Top Hospitals by Fortune and PINC AI
St.David’s HealthCare announced today that all of its Austin hospitals were recently named among the nation’s 100 Top Hospitals® according to an independent quality analysis provided by PINC AI™ and reported by Fortune.
St. David’s Medical Center, including the campuses of Heart Hospital of Austin and St. David’s Georgetown Hospital was ranked as the No. 1 large community hospital in the nation; while St. David’s South Austin Medical Center and St. David’s North Austin Medical Center ranked among the top 20 large community hospitals. Researchers evaluated 2,601 short-term, acute care, non-federal U.S. hospitals and health systems to identify the 100
Top Hospitals in 2024.
“At St. David’s HealthCare, our team of doctors, nurses and staff are dedicated to providing exceptional care to every patient every day,” David Huffstutler, president and chief executive officer of St. David’s HealthCare, said. “We are honored to receive these accolades once again, as they underscore our commitment to excellence year after year.”
This is the 15th consecutive year for St. David’s Medical Center, including Heart Hospital of Austin and St. David’s Georgetown Hospital, to be recognized as one of the nation’s 100 Top Hospitals, the sixth year for St. David’s North Austin Medical Center and the second year for St. David’s South Austin Medical Center. Additionally, it is the third consecutive year for St. David’s
Medical Center to be named the No. 1 large community hospital in the U.S. St. David’s Medical Center and St. David’s South Austin Medical Center were also recognized as two of 26 facilities to receive the 100 Top Hospitals Everest Award. This award honors hospitals that have set national benchmarks for both fastest rate of improvement during the previous five years and the highest current year performance.
To create the list, an objective, quantitative analysis of publicly available data was conducted to identify the top hospitals in the United States. The primary purpose of the PINC AI 100 Top Hospitals program is to inspire hospital and health system leaders to pursue higher performance and deliver added value to patients and communities. The program leverages
Ascension Appoints Saurabh Tripathi as New Chief Financial Officer
Ascension, one of the nation’s leading non-profit and Catholic health systems, today announced that Saurabh Tripathi has been named as Executive Vice President and Chief Financial Officer (CFO), effective today.
This strategic hire follows the retirement announcement of esteemed CFO, Liz Foshage, whose significant contributions throughout her tenure have been instrumental in Ascension’s success. Ms. Foshage will continue as a valued member of the team and serve as co-CFO until September to ensure a seamless transition.
Bringing over 25 years of executive experience from Fortune 50 companies, Mr.
Tripathi is well-prepared to lead Ascension’s finance strategy, ensuring it aligns with the organization’s overarching Mission and strategic objectives. In his role as CFO, Mr. Tripathi will oversee all financial operations, including financial planning, reporting, tax and treasury functions, and shared services.
“We are thrilled to welcome Saurabh to Ascension as our new CFO. His extensive background and expertise in managing large-scale operations and his visionary leadership are exactly what Ascension needs as we continue to evolve and expand our services,” said Joseph Impicciche, JD, MHA, Chief Executive Officer of Ascension.
“His deep industry knowledge and proven ability to deliver substantial financial results will play a pivotal role in driving our Mission forward.”
transparent, nonbiased data to help inform strategies for sustained performance. Organizations do not apply to participate in the study, and award recipients do not pay to
Mr. Tripathi’s proven track record of leading complex organizations toward operational excellence and robust financial health makes him an ideal fit for Ascension. His previous leadership roles at Highmark Health, Fresenius Medical Care, General Electric, and Procter & Gamble have consistently demonstrated his see Ascension ...page 13
ability to drive strategic programs and achieve significant business outcomes. As CFO and Treasurer at
Saurabh Tripathi
Three Guys Walk into A Conference And…
By David Stein, Dr. Norman Chenven and Dr. Larry Wallace Jr.
The three of us had never met until we were on the same panel at a recent healthcare conference in Austin.
We realized that we were tackling the same big, gnarly problem in healthcare even though we come from very different places—a medical group, a community care coordinator, and a diagnostics company. The problem simply stated is: How do we remove barriers, make access to care easier, and reduce any fear and anxiety related to getting medical help?
The problem appears more acute in Texas than in many other states. The state recently ranked poorly in the U.S. for healthcare across 24 metrics spanning four key categories: access, outcomes, cost, and quality of care.
Given that the challenge of improving care is big and complex, we agreed that the place to start is preventive care, where we can
proactively monitor health and help diagnose diseases and issues early before they can progress into later stages. America spends more than 70% of its annual health budget on preventable, chronic conditions; 60% of Americans suffer from at least one chronic condition, and 40% have two or more, according to the Centers for Disease Control and Prevention. Getting creative to meet people where they are
What these challenges tell us is that there’s no one-size-fits-all when it comes to healthcare. People want options; they want flexibility; they want care to meet their personal needs both emotionally and physically. They also want some measure of control and a sense of trust.
Healthcare providers and patients alike can build on strategies working to address and break down barriers. Extended hours and retail locations for care clinics have become more mainstream. If we can embrace a mindset to approach each of the
key barriers in the same way we’ve addressed time constraints, we can change things.
Austin Regional Clinic has always focused on coordinating the care it provides, which has helped improve overall healthcare quality. Coordinated care is effective when it emphasizes the critical importance of preventive medicine and is responsive to patients’ needs. ARC’s nurse navigators proactively stay in touch with patients through various communication channels, such as email, texts, and most often the patient portal in its electronic medical record,
to answer questions, offer support and friendly reminders on preventive care opportunities. ARC has labs and blood drawing capability at all of its locations, along with X-ray services.
Setting A New Bar for Patient Experience
The key to preventive care is continuous education and meeting people where they are. When we meet them where they are, they are more comfortable and have more trust in the information and advice they receive. Trust leads to action.
David Stein, CEO of Babson Diagnostics; Dr. Norman Chenven and Dr. Larry Wallace Jr. onsite at Healthier Texas Summit in Austin, TX
A Long-Term Ketogenic Diet Accumulates Aged Cells in Normal Tissues
Researchers Urge, ‘Take A Keto-Break,’ For Prevention
Astrict
“keto-friendly” diet popular for weight loss and diabetes, depending on both the diet and individual, might not be all that friendly.
A new study led by researchers at The University of Texas Health Science Center at San Antonio (UT Health San Antonio) and involving Houston Methodist researchers found that a continuous long-term ketogenic diet may induce senescence, or aged, cells in normal tissues, with effects on heart and kidney function in particular. However, an intermittent ketogenic diet, with a planned keto vacation or break, did not exhibit any pro-inflammatory effects due to aged cells, according to the research.
The findings have significant clinical implications suggesting that the beneficial effect of a ketogenic diet might be enhanced by planned breaks.
“To put this in perspective, 13 million Americans use a ketogenic diet, and we are saying that you need to take breaks from this diet or there could be long-term consequences,” said David Gius, MD, PhD, assistant dean of research and professor with the Department of Radiation Oncology in the Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio, and associate cancer director for translational research at the institution’s Mays Cancer Center.
He is lead author of the new study titled, “Ketogenic diet induces p53-dependent cellular senescence in multiple organs,” published May 17 in the journal Science Advances. Other authors also are with the Department of Radiation Oncology and Mays Cancer Center, as well as the Sam and Ann Barshop Institute for Longevity and Aging Studies, Center for
Precision Medicine, School of Nursing, and Division of Nephrology in the Department of Medicine at UT Health San Antonio; and both the Houston Methodist Cancer Center and Houston Methodist Research Institute. Too much of a good thing
A ketogenic diet, popularly known as keto-friendly, is a high-fat, low-carbohydrate diet that leads to the generation of ketones, a type of chemical that the liver produces when it breaks down fats. While a ketogenic diet improves certain health conditions and is popular for weight loss, pro-inflammatory effects also have been reported. The new study shows that mice on two different
ketogenic diets, and at different ages, induce cellular senescence in multiple organs, including the heart and kidney. However, this cellular senescence was eliminated by a senolytic, or a class of small molecules that can destroy senescence cells and prevented by administration of an intermittent ketogenic diet regimen.
“As cellular senescence has been implicated in the pathology of organ disease, our results have important clinical implications for understanding the use of a ketogenic diet,” Gius said. “As with other nutrient interventions, you need to ‘take a keto break.’ ”
Ensuring ‘Pediatric Readiness’ in Emergency Departments Costs Little and Saves Lives
TotalThe price tag for making hospital emergency departments ready to provide basic care to children is minimal — ranging from just $4 to $48 per patient — while significantly improving survival rates, according to a new study published this month in the Journal of the American College of Emergency Physicians Open. The study is among the first to analyze the financial impact of adhering to national guidelines on pediatric care in emergency departments.
Researchers highlight that the low cost of implementation is justified by the substantial benefits. Hospitals with high pediatric readiness can reduce mortality by up to 76%. Yet a recent evaluation shows that many emergency departments are still not fully equipped to handle critical pediatric cases.
So, what’s keeping them from leveling up to accommodate children?
“Our nation’s hospitals have a vital need to invest in pediatric readiness within emergency departments,” said lead author Katherine Remick, M.D., an associate professor in the Department of Pediatrics at Dell Medical School at The University of Texas at Austin who specializes in improving emergency care systems for children. “But it hasn’t happened yet because while more than 80% of children are seen in community EDs, the majority see fewer than 5 to 10 children per day. In addition, pediatric readiness is not required for hospital licensing, and many EDs use their limited resources to prioritize other items over pediatric care.”
Understanding the Price Tag For most EDs, the annual hospital costs to achieve pediatric readiness
Age Well, Live Well
Raising Awareness about Alzheimer’s
EngagingJune is Alzheimer’s and Brain Awareness Month, which provides an opportunity to learn more about Alzheimer’s disease and how to start a conversation with someone who is showing signs of the disease.
Alzheimer’s disease is an irreversible brain disease that slowly damages memory, the ability to think and, eventually, the ability to carry out daily tasks. Alzheimer’s is also the most common type of dementia, a general term for memory loss and
are based on two components: (1) ED pediatric equipment and supplies, and (2) labor costs for a pediatric emergency care coordinator to perform readiness tasks.
After considering current pediatric readiness levels, researchers found that the annual cost to reach the desired readiness ranged from $23,775 for low-volume emergency departments to $145,521 for high-volume ones. That’s a range between $4 and $48 per child.
“Consistent research proves that pediatric readiness in EDs saves children’s lives,” said co-author Marianne Gausche-Hill, M.D., an emergency physician at The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center. “Now, we also have evidence that achieving this readiness is feasible for every ED,
changes to other cognitive abilities and behavior that are severe enough to interfere with daily life.
Warning Signs
Symptoms of Alzheimer’s disease can be confused with normal aging, so it’s important to know the difference. For example, sometimes forgetting why you walked into a room is a normal sign of aging, but not recognizing a room in your house may be a warning sign of
Alzheimer’s.
Signs of Alzheimer’s disease include:
• Not recognizing your child or a close friend.
• Asking the same question over and over.
• Not recognizing familiar places.
• Putting things in unusual places, such as placing keys in the fridge.
Prevent Gym Germs This Summer
By Baylor College of Medicine
Whetherit be your first time at the gym or you’re an experienced lifter, it’s important to remember good gym hygiene. Melanie McNeal, physical and occupational therapy manager at Baylor College of Medicine, shares tips on keeping yourself and others healthy in the gym.
“Good hygiene prevents sicknesses like a cold, influenza and even salmonella, but cleanliness can also indicate that a gym is well maintained overall, including the quality of equipment,” McNeal said. “If hygiene rules are not followed you could get sick, get others sick or even have your membership cancelled.”
When going to a new gym for the first time, or double checking your gym’s cleanliness, there are a few key indicators to determine if hygiene is prioritized in the space:
1. A lack of readily available or no sanitary wipes for members or staff to wipe down equipment after use often means equipment is harboring unseen bacteria
2. No signs posted asking members to clean equipment after using or no cleaning schedule posted suggests cleanliness is not a priority for the gym
3. Other gym members using equipment and not cleaning it afterwards on a consistent basis can show that there is not a culture of cleanliness
4. Caked on layers of dust on equipment can indicate that equipment has not been cleaned in a while and shows neglect of cleanliness
5. Lots of broken-down machines for extended periods of time can be due to a lack of interest from gym management in ensuring the space is well kept
To play your part in creating a clean environment at your gym, there are several things you can do. Before going to the gym, ensure you wear clean clothes each time you exercise. Used clothes accumulate sweat and other bacteria that can cause fowl smells or that can spread among the gym population.
‘Pediatric Readiness’
Continued from page 11
regardless of size or resources.”
Gausche-Hill and Remick, co-directors of the National Pediatric Readiness Project, work to help EDs
Age Well, Live Well
Continued from page 11
• Having trouble following a conversation.
• Calling familiar things by the wrong name.
• Losing track of dates and seasons.
• Forgetting routine activities, such as paying monthly bills. Start a Conversation Noticing signs of problems
When approaching equipment, conduct a visual inspection to see if it is clean. If you encounter a bench or other piece of equipment with wet residue from a chemical cleaning solution, allow it to dry on its own. This residue is generally safe and should not cause major irritation to the skin; however, the residue is an indicator that the solution’s contact time, the time it takes to kill all the bacteria, is not complete. It generally takes around 2 minutes for the solution to work, so this is how long you should wait before using equipment that has just been cleaned.
Upon completion of your exercise, take a provided wipe or solution sprayed on a napkin and wipe where your skin made contact with the equipment or where sweat
has dripped. Avoid directly spraying chemical solutions onto equipment as excess moisture can cause damage. If you choose to shower after a workout, McNeal always recommends wearing flip flops or other footwear that prevent contact between your feet and the ground as these environments tend to be breeding grounds for mold, fungi and bacteria that can infect your feet.
“Expect a clean gym and report concerns to management if you have any,” McNeal said. “You should feel free to ask management about the cleaning schedule and always clean up after yourself. Leave equipment as you would want to find it when you walk up to it.
evaluate and enhance their pediatric capabilities. Their latest assessment found that EDs have a median readiness score of 70 out of 100, well below the
88-point threshold associated with better survival rates.
Emergency departments seeking to improve their pediatric readiness can participate in an open assessment and find additional resources through the NPRP website.
with thinking, memory and behavior in a loved one can be alarming, but don’t ignore them. Early detection and treatment of Alzheimer’s disease can make a big difference in quality of life for both of you. Starting a conversation about what you’ve noticed is the first thing to do. The Conversation Project and Alzheimer’s WA both offer tips for approaching this discussion:
• Choose a time to have the conversation when you and your loved one aren’t busy or tired.
• Pick a place that is familiar, comfortable and quiet.
• Decide in advance what you’re going to say.
• Keep your words simple , gentle and reassuring.
• Begin by asking if they’ve noticed any differences in their behavior.
• Say you’re concerned and give a few examples why.
• Listen when they express worry about memory loss or difficulty doing usual activities.
• Say “tell me more” to show your concern and that you’re willing to talk about it.
• Encourage them to see a
doctor to find out what’s causing memory loss and offer to go with them for support.
• Learn about local resources that can help you understand memory loss and learn ways to talk with your loved one and their doctor.
Find out more about Alzheimer’s disease, ways to start a conversation, and available community resources in Texas at dshs.texas.gov/alzheimers.
Written by The Department of State Health Services’ Alzheimer’s Disease Program
Semaglutide
Continued from page 4
identical-looking placebo.
How semaglutide works to lower cardiovascular risk has remained an important question. The drug exerts a wide variety of beneficial effects, including reducing blood sugar (glucose), body weight, blood pressure, blood lipids such as cholesterol, and inflammation, any of which can contribute to the reduction in MACE risk.
In the recent analysis, Dr. Lingvay and her colleagues focused on examining whether semaglutide’s glucose-lowering effects might be at least partially responsible for lowering the participants’ MACE risk. To answer this question, they tested the participants’ hemoglobin A1C
Healthy Heart
Continued from page 6
if you drink, leave extra time for rest. A healthy attitude
(HbA1C) – a measure of average glucose over two to three months –at the start of the trial and after the participants had taken semaglutide or the placebo for 20 weeks. At baseline, a third of the participants had HbA1C readings below 5.7%, a level considered normal. However, the remaining two-thirds had readings between 5.7% and 6.5%, in the prediabetes range.
Most people on semaglutide had a significant reduction in their HbA1C levels by the 20-week mark. An analysis of the number of MACEs that occurred during the study period showed those taking the drug had about 20% fewer of these events, regardless of their HbA1C at baseline and subsequent
It’s true that those fresh-baked pastries you find in France might have more fat or sugar than is ideal, Gentile said. It’s also true that “you’re not going to go to Paris and not have baguettes and croissants.”
Hospital News
Continued from page 8
market their honor.
100 Top Hospitals program performance
This year, based on comparisons between the study’s top performers and a peer group of similar hospitals, the analysis found that the top performers
Ascension
Continued from page 8
Highmark Health, Mr. Tripathi was instrumental in leading significant growth initiatives and enhancing healthcare access.
“I am deeply honored to join Ascension and contribute to its noble Mission of providing care to all, with special attention to those most in
Don’t get caught up in a cycle of recrimination about what you eat on vacation, she and the other nutritionists said.
“People feel an immense pressure to eat perfectly,” Moore said. “And it’s
measurements over time. These findings suggest factors other than semaglutide’s glucose-lowering effects are responsible for this reduction in MACE risk, Dr. Lingvay said.
Other recent findings of SELECT to which Dr. Lingvay contributed have shown that weight loss from semaglutide also doesn’t appear connected to the reduction in MACE risk, but a decrease in inflammation from the drug does seem to be partially responsible. She notes that she and other authors will continue to investigate the mechanisms behind semaglutide’s beneficial cardiovascular effects.
In another analysis of the SELECT study recently published
in Nature Medicine, Dr. Lingvay and colleagues reported the effect of once-weekly semaglutide on kidney function. The researchers’ results suggested semaglutide also had a beneficial effect on the kidneys.
These studies were funded by Novo Nordisk A/S, the maker of semaglutide. Dr. Lingvay receives personal consulting compensation from Novo Nordisk.
of the 100 Top Hospitals program delivered better outcomes while operating more efficiently and at a lower cost. Compared to peer hospitals, this year’s top performers had:
• 39 percent fewer inpatient deaths than peer hospitals
just not realistic. You make the best that you can.”
Krieg emphasizes balance and moderation. “I think that’s the key to not only a healthy relationship with food, but the key to a healthy life.”
So as you explore the world, “have fun. Order these cool adventurous foods that you don’t typically get to try. Include some fruits and veggies. And then when you come back from a trip, continue to do the same thing.”
• 6 percent fewer patients with complications
• 6 percent fewer healthcare-associated infections (HAIs)
• 1 percent lower inpatient expense per discharge
• 5-day shorter average length of stay
• Better reported patient experience scores
need,” said Saurabh Tripathi. “I look forward to being an integral part of the leadership team and collaborating with Ascension’s skilled professionals across the system to foster innovation and continue elevating health standards throughout our communities.”
Mr. Tripathi holds an MBA in Finance from the University of Leeds in the United Kingdom, as well as a master’s degree and bachelor’s degree in engineering from National Institute of Technology in India, and is a Chartered Institute of Management Accountants (CIMA-operations)
certified professional as well as a certified Six Sigma Black Belt.
Rules
Continued from page 1
in a manner that promotes their well-being. Historically, CMS has deferred to facilities to determine what qualifies as “sufficient staff” based on their resident population case mix, care plans, acuities, and diagnoses. Providers should still expect that CMS will require it to ensure that it has sufficient staff to meet residents’ needs, and that number could be higher than the prescribed minimums depending on the Provider’s resident population at any given time.
Oncology
Continued from page 3
1. day. This can help manage nausea and maintain energy levels.
2. Consume nutrient-dense foods. Focus on nutrient-dense foods full of vitamins, minerals, and calories. Incorporate fruits, vegetables, lean proteins, whole grains, and healthy fats.
3. Stay hydrated. Drink plenty of water throughout the day and incorporate hydrating foods such as soups, smoothies, and fruits with high water content.
4. Experiment with different flavors. Cancer treatments may alter one’s
Mental Health
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area, according to HRSA. GC-MOMS will serve Lavaca, DeWitt, Jackson and Calhoun counties.
GC-MOMS operates under the Program of Excellence for Mothers,
Three Guys
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The Black Men’s Health Clinic in Austin offers comprehensive services that go beyond traditional medical care. As a community health center, the organization offers mental health support, community outreach, education focusing on lifestyle changes, and resources dedicated to addressing systemic health disparities. One community initiative engages potential patients in barbershops, a place that is trustworthy for black men. BMHC has
Court Challenges
Less than two weeks after the final rule was published, the American Health Care Association (representing more than 14,000 nursing homes), along with the Texas Health Care Association and a handful of individual nursing home plaintiffs filed a lawsuit in the Northern District of Texas challenging these new minimum staffing rules. Plaintiffs argue that the rule exceeds CMS’s statutory authority, contradicts congressional intent, and
imposes impractical and financially burdensome staffing standards. Specifically, they contend that the rules fail to consider the nationwide shortage of qualified nursing staff and will disproportionately affect smaller, rural facilities. Plaintiffs seek declaratory relief finding the new staffing requirements to be arbitrary and capricious as having exceeded CMS’ statutory authority and injunctive relief to prevent enforcement of the rules.
sense of taste. Experiment with different flavors and seasonings to make meals more palatable. Resources for accessing healthy foods
Social determinants of health are non-medical factors that can affect health outcomes, such as food insecurity, the lack of ability to afford or access health nutritive food. Cancer patients facing food insecurity may postpone medical care, underuse medications, or not comply with prescribed therapies because they are faced with the dilemma of choosing
between paying for food or paying for medical care.
There are resources available to help patients or loved ones get necessary nutrients such as food pantries, community gardens, the government’s Supplemental Nutrition Assistance Program (SNAP) program, or Meals on Wheels.
By understanding the challenges cancer patients face when it comes to eating and nutrition, patients and their loved ones will be able to maintain the strength and resiliency needed to manage the cancer journey.
Children and Families (POEMCF) at the School of Nursing, which creates and manages projects that serve families and communities across Texas.
Much of the POEMCF’s programming
also partnered with an adult basketball league to offer on-site blood pressure and blood sugar screenings to both players and spectators. BMHC has successfully reached black men in their communities through their strategic engagement efforts and unique financial model to increase access for a population that has historically had poor health outcomes.
Pharmacy teams are another trusted provider that have taken a greater role in providing key services in the community. Babson Diagnostics is teaming up with local pharmacies
uses home-visiting models.
GC-MOMS expects to launch home visits later this summer. For information, visit nursing.tamu.edu/ gc-moms.
to offer blood testing that’s less invasive, more convenient, and easier. Pharmacies are well suited to provide personalized preventive services in a trusted environment that people visit often.
There is no shortage of ideas that can improve health outcomes, yet sometimes the simplest tend to be the most effective. Now, the three of us are trading ideas of how to work together for greater impact.
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Dementia CME for Primary Care Providers
Help your patient and their family make the best-informed decisions.
Earn free online Continuing Medical Education (CME) credits developed by the Texas Department of State Health Services and physician experts on Alzheimer’s disease and related dementias. These courses will keep you up to date on the latest validated assessment and screening tools, help you direct patients to community resources, and reinforce your role in helping patients and their families manage symptoms throughout the disease process.
Courses coming soon at dshs.texas.gov/alzheimers-disease/provider