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Skin care Passing on the risk Long-term care providers need to closely monitor and manage skin conditions before and after hospital transfers. Many breakdowns can go unnoticed By Julie E. Williamson Avoiding skin breakdown and pressure ulcers is an ongoing chal- lenge for long-term care providers as they care for an older, sicker and increasingly compromised resi- dent population. And those chal- lenges become even greater when residents are transferred back and forth among care settings. With as much as a $70,000 price tag on complex pressure ulcer treatment—and the fact that the Centers for Medicare & Medicaid Services no longer reimburses for avoidable pressure ulcers—pro- viders must be intently focused on maintaining good skin health and ensuring that they don’t bear the financial burden of treating Photo: iStockphoto preventable deep tissue injuries and skin breakdown that occurred on another facility’s watch. That isn’t always easy, though, sources acknowledge. skin health while a resident is It is incumbent upon long-term care providers to be aware of all residents’ Not only is a lack of commu- in its care, and all the way up skin conditions upon admission or discharge, according to experts. nication between skilled nursing to the point of transfer, but it and acute care facilities still all too can’t always count on the same ity. More focus is typically given to tinuum have a responsibility to common, each setting’s care prior- level of due diligence when the cardiac and respiratory status.” the resident or patient to ensure ities—and protocols—can differ resident is admitted to another Sometimes, caregivers in acute that skin integrity doesn’t fall by greatly, which makes it more likely setting, particularly a hospital care settings aren’t even aware of the wayside. that a resident will not receive con- where tending to the immediate, the skin breakdown risks, which “Creating seamless care is sistent, seamless care. acute illness takes precedence explains why transferred residents really what we’re talking about “It would seem reasonable over other potential risks, such often aren’t repositioned, off-load- here,” stresses Dr. James Spahn, that there should be an agreed as skin breakdown. ed or adequately assessed. CEO/founder of EHOB Inc, an upon transfer protocol or process “Typically, the focus on trans- “It is possible to have an elderly Indianapolis-based manufacturer between healthcare organizations fers is with the paperwork and in person in a hospital bed for three of pressure ulcer prevention and within a specific locale,” says Alex- getting the [resident moved]— to four days and the skin condition treatment products. is Roam, nursing home services and not on the resident’s needs being overlooked,” notes Roxanne “Keeping skin healthy requires program manager for Primaris, a before, during and after the trans- Merkes, certified wound nurse every setting to really know the Columbia, MO-based nonprofit fer,” explains Deborah Bakerjian, and skin care team member for physiological status of the person healthcare consulting firm. “How- assistant adjunctive professor at Cedar Lake Health Care Com- being transitioned in and out of ever, this is not always the case.” the University of California, San munity in West Bend, WI. their care, and this information Francisco, and chair of Advancing One point experts agree on is must be provided in a timely, No skin in the game Excellence in American Nursing that proper skin care is anything accurate way. You can’t have that A long-term care provider can Homes’ clinical advisory work- but a back-burner issue, and that without effective, ongoing com- do a great job of maintaining group. “Skin is not seen as a prior- caregivers ac
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