July/August 2010
Medical director lends his voice and expertise to media in health care
Dr. Jay Luxenberg, medical director, was featured on Advances in Long-Term Care Medicine, a weekly radio program run in partnership with the American Medical Directors Association. Broadcast on ReachMD XM 160, Dr. Luxenberg was interviewed by the program’s host, Dr. Eric Tangalos. He spoke about managing depression in long-term care, and included a discussion of light therapy.
ReachMD has been on the air on XM satellite radio since 2007. The station invites physicians, researchers, policymakers and other experts in their specialty areas of health care and medicine to speak about important issues and developments in their fields of interest.
June 2010
NIH’s Aging Systems and Geriatrics Study Section, Center for Scientific Review, gets Dr. Janice Schwartz as a member
Research director Dr. Janice Schwartz has accepted the prestigious National Institutes of Health’s (NIH) invitation to serve as a member of the Aging Systems and Geriatrics Study Section, Center for Scientific Review, for the term beginning July 1, 2010 to June 30, 2014. Members are selected on the basis of their demonstrated competence and achievement in their scientific discipline, as evidenced by the quality of research accomplishments, publications in scientific journals, and other significant scientific activities, achievements, and honors.
Membership on a study section represents a unique opportunity to contribute to the national biomedical research effort. Study sections review grant applications submitted to the NIH, make recommendations on these applications to the appropriate NIH national advisory council or board, and survey the status of research in their fields of science. These functions are of great value to medical and allied research nationwide. Dr. Schwartz’s participation will assure the quality of the NIH peer review process.
UCSF symposium seeks insights into HIV and aging
Dr. Janice Schwartz joined leading researchers from around the world investigating the role of HIV and immunosenescence (aging of the immune system), and many of the HIV and aging conditions such as renal disease, cardiovascular disease, osteoporosis and declining cognitive function at a daylong symposium at UCSF last month. There is a growing consensus that, even among HIV patients who are responding well to anti-retroviral therapy, there is something causing death at an earlier age, perhaps by as much as 10 to 15 years. Researchers are trying to understand the processes underlying this emerging problem.
Dr. Jay Luxenberg focuses on factors that make a patient/client “difficult”
Having just returned from his attendance at the American Geriatrics Association national meeting in Orlando, Fla., Dr. Jay Luxenberg, medical director, prepares to join other leaders in the field of geriatric mental health on June 23 to discuss how to work with patients/clients whose behaviors are challenging.
Understanding and Managing Clients Who Challenge Us as Professionals forms part of the Institute on Aging’s Mind, Body, Spirit: Pathways to Improving Health educational series. Entitled Medical Factors That Contribute to Making the Difficult Client Difficult, Dr. Luxenberg’s presentation will focus on medical factors such as psychiatric syndromes, dementias, hearing impairment, urinary urgency and incontinence, and strategies to manage them. It will include a discussion on the importance of access to care; for example, how to find a physician who will make house calls.
Dr. Lynn Flint lectures in Los Angeles
Jewish Home physician Dr. Lynn Flint makes her way to Los Angeles in July to attend and participate in the California Association of Long Term Care Medicine’s (CALTCM) 36th Annual Meeting, Creating a Culture of Patient Safety. This two-day conference highlights critical strategies to improve nursing home patient safety and provides techniques and tools for the interdisciplinary team to adapt to their own facility needs. Dr. Flint will lecture on A Holistic Approach to Palliative Care in the Nursing Home and will serve on a panel entitled Integrating Palliative Care into Long Term Care.
Norwegian Journal of Nursing interviews CNE Edwin Cabigao
Barth Tholens, editor in chief of the Norwegian Journal of Nursing (Sykepleien), was at the Home last month to interview CNE Edwin Cabigao for a special issue highlighting those who have extensive experience in nursing in the U.S., and featuring nurses in a range of different areas, such as prison, home health, acute hospital, and nursing home environments. Edwin was asked to describe a typical day’s work at the Home, to talk about the challenges of working in a nursing home, the Home’s demographics, and to offer his opinion on the U.S. healthcare system. Edwin tells us that Mr. Tholens was most impressed by the Home, our facilities, and the people. Their hours-long interview concluded with an invitation to Edwin to visit Norway’s version of nursing homes.
May 2010
Our community liaison, William Foster, took part in the Excelsior Resource Fair on April 24, put on by Rebuilding Together San Francisco and the Excelsior Action Group. RTSF is a local affiliate of Rebuilding Together, a national organization that mobilizes thousands of volunteers each year and includes 205 affiliates serving more than 500 communities nationwide, with the goal of supporting positive changes that have already been initiated by neighborhoods and increasing the neighborhoods’ capacity for growth and change through collaborative efforts.
RTSF’s new campaign, Changing Neighborhoods, Changing Lives, is focusing heavily on revitalizing the Excelsior District this year, the area in which the Jewish Home is located. Armed with information about STARS and our newly renovated acute geriatric psychiatry hospital, William told attendees about these excellent community resources that exist right in the neighborhood.
April 2010
Making the case for research in aging
A number of past chairs of the Jewish Home’s board gathered for a luncheon at the Home last month – to socialize, to hear Daniel Ruth, president & CEO, address important issues facing the Home, and to listen to Dr. Janice Schwartz, our Research director, trace the development, progress and successes of the research center from its formation in 1997 through 2010.
Dr. Schwartz began by presenting the rationale for research at the Home. The goal is to discover and spread information that will result in improved care of older people. Research increases the Home’s visibility not only locally but nationally. It raises the level of professionalism, and provides an infrastructure for collaborating with research colleagues. She then summarized progress made in each of these areas, such as the recent grant awarded by the National Institutes of Health that will address problems of multiple medications in the elderly, and publications that have come from research projects that cite the Home.
“Essential elements to ensure a sustainable research center can be defined by the four P’s,” Dr. Schwartz went on to tell the guests. “A critical number of People involved in research at the Jewish Home, a Place for them to work, support for their Programs, and an academic Partner.” Progress made to date in each of these areas include the UCSF Harris M. Fishbon Distinguished Professorship for Clinical Translational Research, to be based at the Jewish Home; the current Rosenberg Family Center’s research facilities, and the proposed expansion and pledged funds from the Herbst Foundation to help create a clinical research center; the Julian S. Davis Memorial Lecture series, and the necessary continued support for programs and a professorship to explore new and improved therapies for aging adults; and our affiliation with the UCSF Clinical Transitional Research Institute.
Help for hoarders
William Foster, our community liaison, shares some of what he learned at the session he recently attended on clutter addiction and compulsive hoarding in older adults, put on by the Institute of Aging.
An underreported problem that rarely becomes known until an accident happens, clutter addiction and compulsive hoarding tends to be more common in older adults. This may be attributable to lifestyle changes or isolation, for instance. Or the feeling they have no purpose in life and so hoarding offers a sense of security and control. The good news is that health care and mental health workers are becoming more educated about what hoarding means and hence treatment is more readily available.
When it comes to any kind of intervention, don’t overwhelm or threaten, never remove belongings without the person being present, and avoid doing a surprise or forced clean-up. Treatment and assistance may include collaborating with mental health agencies, adult protective services, fire protection, building and safety, and animal control.
Staff shares their savvy with SFSU gerontology students
A group of graduate students from San Francisco State University’s masters in gerontology program visited the Home on Friday, March 19 for a full day’s program. CNE Edwin Cabigao started off by providing them with invaluable information about both the federal and state’s survey process, which he entitled Survey Management 101. The students were then taken on a tour of our facility, followed by Edwin leading a Q&A session. In the afternoon, the group was treated to a varied round of experts – our staff, of course! Joan Accarino spoke about pain management and end-of-life care. Rabbi Shelly Marder invited the students to a Shabbat service where they experienced Jewish life in action. Laura Nieberding filled them up with facts about dining at the Home, and Mark Friedlander gave the lowdown on customer service. Lisa Dale O’Donnell brought activities and recreational programs into play. Daniel Hoebeke told them everything they needed to know about fundraising in 12 minutes, and Kyle Fredrickson shone the spotlight on STARS.
The students’ professor, Dr. Cristina Flores, commended Edwin on his professionalism, and noted how good it was for the students to see “the happy side of long-term care.” Comments from the students themselves included “very informative tour and wonderful presentation” and “I have done an extensive research on the Jewish Home and I know that people always talk about how good the care is and how wonderful the place. The environment, the staff, and the residents make the place unique and just magnificent! It was amazing to see everything connect right in front of my eyes.”
March 2010
Doorways of Hope offered by the rabbi
When the annual rabbinical convention of the Central Conference of American Rabbis gathers at San Francisco’s Fairmont Hotel on March 10, attendees will have the benefit of hearing Rabbi Shelly Marder speak on a Jewish view of dementia. He will be sharing the presentation he originally made at Temple Chai in Phoenix, Ariz., in April 2009. Entitled Doorways of Hope, excerpts from his inspiring, evocative address were published in the latest issue of Jewish Senior Living magazine 2009/2010.
Community liaison learns ways to improve elder health care
William Foster, our community liaison, represented the Home when he attended the first of a three-part educational series entitled Mind, Body, Spirit put on by the Institute of Aging on February 24. Exploring pathways to improving elder health care, the first session covered how to recognize and respond to clutter addiction and compulsive hoarding in older adults. He will also be in attendance at the next two programs in the series. On May 4, he will learn about integrating mental, emotional and spiritual health, while on June 23, the topic covers understanding and managing clients who challenge us as professionals.
Rabbi Marder to co-edit new prayer book
Along with his wife, Rabbi Janet Marder, and two other rabbis, Rabbi Shelly Marder has been appointed to the editorial core team assigned to co-edit a new Reform Judaism machzor (prayer book) for the High Holy Days, to be published by the Central Conference of American Rabbis. This ambitious undertaking is projected to take the team four or five years to complete.
Open forum on federal estate taxes yields intriguing results
Planned giving officer Daniel Hoebeke participated in an open forum on federal estate taxes at the Estate Planning Breakfast Club meeting held in San Jose on February 9. The results of the forum were intriguing, Dan reports. He explains that “sometimes it is worse when Congress doesn’t act. The rules about whether you might owe federal estate tax are uncertain because existing laws were allowed to expire. Even complex plans may be affected. The rule of thumb has always been to review your will or trust every five years. Since nobody knows what future laws may provide, now is a prudent time to conduct that review.”
And on another note, Dan informs us that he has been accepted as a member of the San Francisco Estate Planning Council. Membership is limited to individuals who conduct substantial estate planning work in the city and county of San Francisco.
February 2010
Research director speaks to Medical Friends …
Director of Research Dr. Janice Schwartz was invited to address Medical Friends of Rossmoor (made up of residents of Rossmoor, a senior adult community located in Walnut Creek) on Tuesday, January 12. As a sponsor of evidence-based talks of interest to the senior population by experts in their field, Medical Friends benefited from hearing Dr. Schwartz talk about research in geriatrics and the significance of Vitamin D in geriatric health. Attendance for Dr. Schwartz’s talk was the largest in the association’s four-year history. Dr. Clair Weening, president of Medical Friends, reported that he received many positive remarks and feedback, attesting to the high level of Dr. Schwartz’s talk and her skilled handling of questions.
… and will advise on committee at UCSF
As an appointee to UCSF’s Clinical Translational Research Institutes Regulatory Knowledge and Support Advisory Committee, Dr Schwartz will participate in helping this group develop the following goals:
- Educating and assisting researchers with UCSF and federal regulations for clinical research and therapy development
- Identifying processes and areas of clinical research administration that could be improved and performed more efficiently at UCSF
- Identifying specific improvement initiatives proposed for the next National Institutes of Health application for funding for the Clinical Translational Research Institute
Results of study conducted at the Jewish Home published
Pressure ulcers (“bed sores”) are a common clinical concern among nursing home residents, and there is much interest in improving strategies for pressure ulcer prevention and treatment. Nancy Stotts, RN, Ed.D., a researcher from the Department of Physiological Nursing at UCSF, and her colleagues recently completed a study in which ten of the 64 study participants were residents of the Jewish Home.
Following up on work done in California nursing homes that showed that residents unable to get out of bed on their own often did not get enough fluid intake, Dr. Stotts wanted to see if giving more fluids to patients would improve the oxygen supply to the skin and help skin heal. The study involved giving an extra 10 ml/kg water per day for 5 days – about a pint of water extra each day to a resident weighing 100 pounds, who either had, or was at risk of getting, a pressure ulcer. Results of this study were published in 2009 in the journal Wound Repair and Regeneration.
The researchers concluded that the increased fluid intake in the trial did not improve factors that would ameliorate pressure ulcer risk and enhance healing potential. Specifically, the deposition of collagen, a vital component of skin structure, was not increased, nor was total body water or tissue oxygen increased. The researchers urge that additional work be done to evaluate pressure ulcer prevention in nursing home residents.
Medicare boot camp for Rehab Services director
Jim Weslow, director of Rehabilitation Services, attended the HCPro Medicare Boot Camp – Long-Term Care Version in Pasadena, Calif., January 18-21. Covering the Medicare rules and regulations applicable to skilled nursing facilities, the objective of this four-day course was to provide participants with a detailed understanding of these rules, with a particular emphasis on their operational application. By following a Medicare patient from pre-admission through discharge, the function of each department was addressed and the pitfalls that might be encountered along the way were uncovered.
Jim says that the course solidified his understanding of Medicare and prepared him for implementation of the new MDS 3.0 (which deals with standardized assessment and facilitates care management) and RUGS IV systems (Resource Utilization Groups, which refers to quality indicators, quality measures, and payment). He noted that many of the recommendations made by the instructor are already in place at the Home.
January 2010
Julian S. Davis Memorial Lecture
Education, research, and the exchange of knowledge related to improving care and life for the elderly are essential to the welfare of our society. It is also part of the mission of the Jewish Home, and of our colleagues in gerontology and geriatric medicine at the University of California, San Francisco.
The Julian S. Davis Memorial Lecture was created to provide enhanced opportunities for both the Home and UCSF’s Division of Geriatrics to be exposed to leaders in the world of gerontology and geriatric medicine. It is also an avenue for academic visitors to UCSF to share their expertise with a broader audience committed to improving life for the elderly; for the Jewish Home to benefit from such expertise and have access to local and academic colleagues; and for programs and facilities at the Home to receive increased exposure.
Thursday, January 21 is the date to hear Julian S. Davis Memorial lecturer Terri Fried, M.D., professor of medicine, Yale School of Medicine, and co-director of The Claude D. Pepper Older Americans Independence Center, speak on Overcoming Obstacles to Planning for End-of-Life Care. Staff, residents, family members, volunteers, and friends are invited to attend this on-site address, 2:00 p.m. in the Home’s synagogue.
A more healthcare-worker oriented lecture, Patient-Centered Decision-Making for Older Persons: Promoting Greater Choice, will take place the same day, 6:00 p.m. at UCSF’s Millberry Union Conference Center, Golden Gate Room, 500 Parnassus Avenue. This lecture is open to the public, and will be followed by a reception.
A dedicated educator and compassionate physician who was committed to ensuring that the elderly in our community receive the best care, regardless of social circumstances, Dr. Julian Davis served as president of the Home’s board of directors from 1983 to 1985. He was also instrumental in the development of the Home’s Koret Center. His son, James, followed in his footsteps, both by becoming a physician and chairing the Home’s board of trustees from 2002 to 2004.
Saving Bubbie & Zadie – topic of discussion at teen “issues” fair
Director of Social Services Catherine Reid accepted an invitation to serve on a panel covering aging concerns and issues in November. Put on by the Marin/San Francisco Jewish Community Teen Foundation of the S.F.-based Jewish Community Federation, Catherine, a member from Federation and one from Jewish Family and Children’s Services engaged a group of enthusiastic and interested teen philanthropists when they discussed independent living and skilled nursing, as well as transportation and economic issues facing seniors in the community.
Growth through mindfulness
Social worker Danielle Gallant took a two-day continuing education credit course in December, run by Terry Fralich, a clinical counselor and the author of Cultivating Lasting Happiness: A 7-Step Guide to Mindfulness, an exploration of a practical, accessible path for nurturing growth through mindfulness.
“The course included integrating mindfulness meditation and neuroscience in the treatment of anxiety, anger, and depression,” Danielle reports. “Recent research reveals evidence that the brain is more malleable (referred to as neural plasticity) than previously thought. By exercising our thoughts, that is, engaging in ‘mindfulness meditation,’ we can regulate and change our emotional responses to negative thoughts. We can strengthen the process of our brain’s frontal cortex with positive thoughts.” This can be compared to the cognitive behavioral therapy that Danielle does with her residents.
“Learning that the brain is not rigid is great news,” Danielle says. “Studies done with individuals in their 70s show that seniors can actually change the make-up of their brains.”
Mind-body medicine: eating well, living vibrantly
The 21st International Psychology of Health, Immunity & Disease Conference, held in South Carolina in December, was attended by social worker Ann Rovere. Presenters covered a range of topics, from micronutrient deficiency and digestive wellness, to the systemic consequences of imbalance, emotions, and chronic musculo-skeletal pain. Goals of the conference included determining the role of psychosocial distress and/or well-being in shaping health outcomes; the application of techniques, such as current mind-body and integrative medicine therapies, to change behaviors; and integrating issues of aging and other life transitions with newer positive therapy approaches.
