News and Events - THE GRAND

Drug Class Series: Antidepressants

Andrea Hartley, CPhT
Pharmacy Technician/Central Supply Manager
The GRAND of Dublin

Drug Class Series: Antidepressants

antidepressantsContinuing the series of articles featuring common drug classes, this article will be about antidepressants.

This class of medications is used to treat depression as well as anxiety and other psychiatric or sleep disorders as determined by a physician.  Nearly all antidepressants are taken orally and all require a doctor’s prescription.

There are 4 types of antidepressants within the class, based on how they work in the body:  SSRIs, Tricyclics, MAOIs and Atypical.  Side effects of medications within the same antidepressant group are very similar.

Below are the medications in the antidepressant class along with the most noteworthy facts about them.

SSRIs (selective serotonin reuptake inhibitors):

Paxil (paroxetine), Prozac (fluoxetine), Zoloft (sertraline), Serzone (nefazadone), Luvox (fluxoxamine), Celexa (citalopram), Lexapro (escitalopram), Pristiq (desvenlafaxine), Effexor (venlafaxine), Cymbalta (duloxetine).

SSRIs ease depression by increasing levels of serotonin in the brain. Serotonin is one of the chemical messengers (neurotransmitters) that carry signals between brain cells. SSRIs block the reabsorption (reuptake) of serotonin in the brain, making more serotonin available. SSRIs are called selective because they seem to primarily affect serotonin, not other neurotransmitters.  They are the most commonly prescribed type of antidepressant and generally cause the least amount of side effects.

Tricyclics (TCAs)

Anafranil (clomipramine) Elavil (amitriptyline) Norpramin (desipramine), Pamelor (nortriptyline), Sinequan (doxepin), Tofranil (imipramine), Vivactil (protriptyline),Asendin (amoxipine)

This type of antidepressant was discovered in the 1950s.  TCAs are named after their chemical structure, which contains 3 rings of atoms.  This type of antidepressant impacts several different neurotransmitters in order to change the brain and for that reason can cause many unwanted side effects.

MAOIs

Marplan (isoxarboxazid), Nardil (phenelzine), Emsam (selegiline), Parnate (Tranylcypromine)

MAOI stands for MonoAmine Oxidase Inhibitor.  This was the first variety of antidepressant developed.  They are effective, but are known for causing many side effects; frequently ones that are unsafe.

Atypical or Miscellaneous

Wellbutrin aka.  Forfivo, Budeprion, Aplenzin(bupropion), Viibryd (vilazodone),  Desyrel (trazodone),Trintellix (vortioxetine),  Remeron (mirtazapine), Serzone (nefazodone)

Medications are placed in this category because they don’t fit into the other groups.  This is because they treat depression in a completely different way or they combine multiple characteristics of other groups to work uniquely.  They are each unique medications that work in different ways from one another.

When you stay at The Grand, the knowledge of our doctors, nurse practitioners, nurses and pharmacy technician is at your disposal.  If you have a questions about your medications, just ask!

May is Older Americans Month, Focus on Aging!

May is Older Americans Month!

by Meghan Elliott, RN, Director of Nursing
and Sarah Schubert, LPN, MDS
The GRAND of Dublin

Older Americans Month, AgingAging is something no one can escape. While society frequently reinforces an anti-aging atmosphere, there are many reasons to celebrate and embrace the changes that occur throughout the aging process. Many physiological changes occur during this process, but very important mental aspects change as well. According to the World Health Organization, approximately 15% of those aged 60 or over suffer from dementia and depression; it is important to note that the majority of aging Americans do not. For those aged 65+, a lot of reflection tends to occur. These individuals look at their past and present relationships, and think about what they have accomplished or not accomplished throughout their life. This is a great time to interact with our “older” family members and friends as the insight they have is immeasurable.

Open a Dialogue and Ask Questions

This is also a critical time to focus on what that family member or friend may desire in terms of end of life care, or how they envision spending their final days, months, or years. Please take the time to ask your loved one their thoughts and feelings about alternate living arrangements, medical procedures they would want performed and those they would not. Also ask about a plan B, what if that preferred plan isn’t possible, then what? These questions are vital to the comfort and security our older population has when faced with a new or chronic health problem that requires treatment. These types of discussions are critical not only in a medical scenario, but they are also important ways to connect with that individual and appreciate their perspective on life. You may be incredibly surprised by the answers your loved ones will give you. Open, honest, frank discussions about life lessons, goals, failures and successes from the older population can mold and shape how WE live our lives. Those of us in healthcare want to take the time to thank our elderly population. You teach and guide us more than we could ever educate you. Happy Older Americans Month! Your wisdom is appreciated.

What is PHQ-9?

PHQ-9 – Patient Health Questionnaire Depression Module

Catherine Denlinger, DOSS, MSW, LSW
Director of Social Services
The GRAND of Dublin

PHQ-9 stands for Patient Health Questionnaire Depression Module.  It a screen used to assist with identifying a resident’s current and recent mood state and to help determine if any interventions or referrals need to occur.  The 9 stands for the 9 criteria derived from the DSM-IV (now DSM-V) which is a diagnostic manual for those in the mental health field.  The PHQ-9 is a mandatory interviewing tool for skilled nursing centers.  A social worker is usually the one that would be administering the PHQ-9.

The PHQ-9 is administered shortly upon admission and then several times thereafter if a resident is in a center for skilled services.   It is administered after 14 days, 30 days and so forth.  If a resident is receiving long term care, then the PHQ-9 is administered upon admission, quarterly and if there is a significant improvement or decline in a resident’s well-being.

A resident is asked is over the past 2 weeks, has he/she been bothered by any of the following problems.  There are 9 questions to be asked that are answered with a yes or no.  If a question is answered yes, then there is a follow-up question asking the frequency ranging from a 0 to a 3.

  • A 0 is never to 1 day
  • A 1 is 2-6 days (several days)
  • A 2 is 7-11 days (half or more of the days)
  • A 3 is 12-14 days (nearly every day)

The scoring ranges from 00 to 27.  The tally of the scores represents a resident’s tentative mood state for depressive signs/symptoms.

  • A score of 0-4 represents none to minimal depression
  • A score of 5-9 represents mild depression
  • A score of 10-14 represents moderate depression
  • A score of 15-19 represents moderately severe depression
  • A scored of 20 + represents severe depression

Below is the Resident Mood Interview (PHQ-9) found in the MDS Manual used by all skilled nursing centers:

PHQ-9

This questionnaire is a tool to assist with providing a holistic presentation of a resident in order to ensure the most appropriate plan of care.   Here at The GRAND, there are resources available to assist a resident with depression signs/symptoms during their stay with us such as scheduled activities, pet therapy, counseling services, a Medical Director to oversee any medication management needs and an ample amount of caring staff members to talk with.  The Grand has all private rooms for a resident’s comfort and privacy as well as multiple locations throughout the center to engage in socialization or to just have time for oneself.  We strive to make our residents stay both physically and mentally stimulating as well as to have the best possible outcome for their well-being.

Gout diet: What’s Allowed, What’s Not

Gout diet: What’s Allowed, What’s Not

Frank Mackovine
Dietary Manager
The GRAND of Dublin

Gout Diet - what's allowed and what's notStarting a gout diet? Understand which foods are OK and which to avoid.

Gout is a painful form of arthritis that occurs when high levels of uric acid in the blood cause crystals to form and accumulate in and around a joint.

Uric acid is produced when the body breaks down a chemical called purine. Purine occurs naturally in your body, but it’s also found in certain foods. Uric acid is eliminated from the body in urine.

A gout diet may help decrease uric acid levels in the blood. A gout diet isn’t a cure. But it may lower the risk of recurring gout attacks and slow the progression of joint damage.

People with gout who follow a gout diet generally still need medication to manage pain and to lower levels of uric acid.

Gout diet goals

A gout diet is designed to help you:

  • Achieve a healthy weight and good eating habits
  • Avoid some, but not all, foods with purines
  • Include some foods that can control uric acid levels

A good rule of thumb is to eat moderate portions of healthy foods.

Diet details

The general principles of a gout diet follow typical healthy-diet recommendations:

  • Weight loss. Being overweight increases the risk of developing gout, and losing weight lowers the risk of gout. Research suggests that reducing the number of calories and losing weight — even without a purine-restricted diet — lower uric acid levels and reduce the number of gout attacks. Losing weight also lessens the overall stress on joints.
  • Complex carbs. Eat more fruits, vegetables and whole grains, which provide complex carbohydrates. Avoid foods and beverages with high-fructose corn syrup, and limit consumption of naturally sweet fruit juices.
  • Stay well-hydrated by drinking water.
  • Cut back on saturated fats from red meat, fatty poultry and high-fat dairy products.
  • Focus on lean meat and poultry, low-fat dairy and lentils as sources of protein.

Recommendations for specific foods or supplements include:

  • Organ and glandular meats. Avoid meats such as liver, kidney and sweetbreads, which have high purine levels and contribute to high blood levels of uric acid.
  • Red meat. Limit serving sizes of beef, lamb and pork.
  • Some types of seafood — such as anchovies, shellfish, sardines and tuna — are higher in purines than are other types. But the overall health benefits of eating fish may outweigh the risks for people with gout. Moderate portions of fish can be part of a gout diet.
  • High-purine vegetables. Studies have shown that vegetables high in purines, such as asparagus and spinach, don’t increase the risk of gout or recurring gout attacks.
  • Beer and distilled liquors are associated with an increased risk of gout and recurring attacks. Moderate consumption of wine doesn’t appear to increase the risk of gout attacks. Avoid alcohol during gout attacks, and limit alcohol, especially beer, between attacks.
  • Sugary foods and beverages. Limit or avoid sugar-sweetened foods such as sweetened cereals, bakery goods and candies. Limit consumption of naturally sweet fruit juices.
  • Vitamin C. Vitamin C may help lower uric acid levels. Talk to your doctor about whether a 500-milligram vitamin C supplement fits into your diet and medication plan.
  • Some research suggests that drinking coffee in moderation, especially regular caffeinated coffee, may be associated with a reduced risk of gout. Drinking coffee may not be appropriate if you have other medical conditions. Talk to your doctor about how much coffee is right for you.
  • There is some evidence that eating cherries is associated with a reduced risk of gout attacks.

Sample Menu

Here’s what you might eat during a typical day on a gout diet.

Breakfast

  • Whole-grain, unsweetened cereal with skim or low-fat milk
  • 1 cup fresh strawberries
  • Coffee
  • Water

 Lunch

  • Roasted chicken breast slices (2 ounces) on a whole-grain roll with mustard
  • Mixed green salad with vegetables, 1 tablespoon nuts, and balsamic vinegar and olive oil dressing
  • Skim or low-fat milk or water

Afternoon snack

  • 1 cup fresh cherries
  • Water

Dinner

  • Roasted salmon (3 to 4 ounces)
  • Roasted or steamed green beans
  • 1/2 to 1 cup whole-grain pasta with olive oil and lemon pepper
  • Water
  • Low-fat yogurt
  • 1 cup fresh melon
  • Caffeine-free beverage, such as herbal tea

Results

Following a gout diet can help limit uric acid production and increase its elimination. A gout diet isn’t likely to lower the uric acid concentration in your blood enough to treat your gout without medication. But it may help decrease the number of attacks and limit their severity.

Following a gout diet, along with limiting calories and getting regular exercise, can also improve your overall health by helping you achieve and maintain a healthy weight.

Source: The Mayo Clinic

Dance Your Way To Fitness!

by Sara Katula
Activity Director
The GRAND of Dublin

Regular exercise can help older adults stay independent and prevent many health problems that come with age.  Reduced physical activity is one factor that contributes to reduced strength and stamina in the elderly.  Physical activity not only benefits us physically but emotionally as well.  Exercise reduces the symptoms associated with anxiety and depression and can lead to improved moods and increased feelings of well-being.

fintess

The GRAND of Dublin adds many different types of exercise programs into our activities calendar. Some of the different types of exercises we offer are morning stretch, walking club, exercise bingo, and chair exercises. We also incorporate other physical activities such as balloon volleyball, bowling, corn hole, and basketball to keep our seniors active while having fun at the same time.  

In January of this year, we started a new exercise program called Zumba Gold. Zumba is a new dance fitness program that has become popular over the years across the globe.  Zumba Gold is a new version of the program that is tailored to the needs of the elderly. The design of the class is to introduce easy to follow choreography that focuses on balance, range of motion, and coordination.  Zumba is also a good way to socialize and have fun! Trained Zumba fitness instructors at more than 2,000 locations nationwide, including fitness clubs, community centers, YMCAs, rehabilitation centers, and retirement communities, offer the program. Cindy, our Zumba fitness instructor for The GRAND will be teaching a 30 minute class twice a month for any resident who would like to participate.

Fitness GRAND of Dublin

Every time Cindy has taught this class we have had a full room and positive feedback. Many residents state they enjoy the music and learning the dance moves. “Zumba is fun and does not feel like exercise!” states one of our long term residents.  

Home Evaluation

Home Evaluation

Home Evaluation
By Jeanne R. Seliskar, MA, CCC/SLP
Corporate Director of Rehabilitation
Vrable Healthcare Inc

Home Evaluation completed by a Physical Therapist or Occupational Therapist is a necessary component of the treatment plan of care in a Skilled Facility.  It is essential to ensuring a safe and successful return to the patient’s prior living situation.  A home evaluation is usually scheduled 1-2 weeks prior to discharge and can easily be misunderstood by the patient and family as a signal that we are discharging.  Careful education about the timeline and how goals can develop from seeing the person function at home, need to be reviewed.  It is offered to everyone within a reasonable distance from the facility and helps to dispel the misconception that “when I go home, I will be able to things”.  It presents a realistic picture of current levels of functioning.

Evaluation Areas

The therapist covers various areas which can be divided into the following areas with the patient performing tasks and mobility in each part of the home:

Exterior and Access to the Home:  This section covers lighting, steps, handrails, locking/unlocking doors, opening/closing doors, getting the mail and other outside obstacles, tasks or barriers. This allows the therapist to assess the patient’s ability to enter/exit the home and manage assistive device in case of an emergency. Recommendations may be made regarding the addition of handrails or other safety features such as a ramp.

Foyer and Hallways: This particular part of the evaluation assesses lighting, throw rugs, width of the hallways for walker/wheelchair, managing switches and other possible trip hazards.

Kitchen:  In this area, the flooring condition, accessibility of items to cook or eat with, storage/counter space, operation of the faucets/garbage disposal, dining space, retrieval of items from the stove, oven, microwave and refrigerator are examined. Therapists may recommend that items be placed between knee and shoulder level to improve safety and decrease risk of falls during kitchen tasks/IADLs. Additional equipment such as a walker tray or basket may be recommended at this time.

Living Areas:  the condition of the carpeting, any throw rugs present, sturdiness of the furniture as well as the height of seating for transfers are the foci of this part of the visit.

Interior Stairs or Steps:  Important factors include height of the step, presence of handrails, clutter on the steps, and carrying items when navigating the stairs.

Bedroom:  The therapist notes the condition of the carpeting or flooring, stability of the bed and other furniture, transfers on/off the bed, accessibility of clothing from drawers and the closet and the use of the blinds or window coverings.

Bathroom:  Components include lighting/presence of a night light, throw rugs, presence of grab bars, availability of supplies and ability to safely navigate throughout bathroom with reduced risk of falls. Therapists will assess ability to get on and off the toilet and into/out of tub or shower, recommending equipment as necessary.

Basement/Laundry Area: Lighting, throw rugs, flooring and tripping hazards are assessed. Therapists observe the patients ability to reach and transport laundry items, retrieve clothing from washer/dryer and safely operate machinery.

Telephone: The therapist will assess the availability of telephones and other emergency devices to assure that the patient can get help from emergency response personnel if needed.

Fire Safety: During this portion of the home assessment, alternate exit routes are examined, fire sources are observed and smoke detectors are located. Recommendations are made to facilitate safety in case of a fire or other need to evacuate the home.

The importance of the home evaluation should not be taken lightly or dismissed.  It can be the difference between a successful, happy and safe return to home life for a long period of time or possible re-hospitalization from a fall or inability to manage essential components around the house.

Drug Class Series: Analgesics and NSAIDs Medications

Opioid - analgesics-medications
Andrea Hartley, CPhT
Pharmacy Technician/Central Supply Manager
The GRAND of Dublin

This month I’ll begin a series of articles focusing on some of the common classes of medications. I chose analgesics for this article.  Analgesics are one of, if not the most common class of medications around the world.  This class includes both prescription and over-the-counter medications, and opioids.  Some references list NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) as a separate class, but for our purposes NSAIDs will be included with analgesics.

Please note that some medications are in multiple drug classes because they have multiple/different uses.

Analgesics are medications that relieve pain, also called pain killers. They are distinctly different from anesthetics, which temporarily affect, and in some instances completely eliminate, sensation.  Below are the medications in the analgesic class along with the most noteworthy facts about them.

Acetaminophen (aka Tylenol; APAP) is sold over-the counter both alone and in formulations such as Nyquil.  It is also sold as a prescription with codeine, hydrocodone and oxycodone. Over dosing on this medication can cause serious liver disease.  Acetaminophen works by changing the way the body senses pain.  Adults with healthy livers should take no more than 4gm (4,000mg) from all sources in a 24-hour period.  People with liver problems should take even less.

Aspirin (aka Ecotrin; Bayer) is sold over-the counter.  Some also consider it to be in the NSAID class.  Upset stomach is common when taking aspirin.  Children shouldn’t take aspirin or any related medications (pink bismuth, loperamide etc.) because it is thought to play a role in causing a serious condition known as Reye’s syndrome.

Opioids (narcotics), such as Avinza, Kadian, or MS Contin (morphine),  Ultram (tramadol), Oxycontin (oxycodone), Dolophine or Methadose (methadone), Dilaudid (hydromorphone), codeine, Demerol (meperidine), Duragesic or Actiq (fentanyl), Lortab or Norco (hydrocodone),  and others. Opioids reduce the pain signals sent by the nervous system and the brain’s reaction to those pain signals.  If you take an opioid for a long time, you could develop dependence as your body gets used to the drug. Some people also become addicted to opioids. Talk to your doctor if this is a concern.  One of the most common side effects when taking a narcotic is constipation.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (Ibuprofen), Aleve or Naprosyn (naproxen), Cataflam or Voltaren (diclofenac), Celebrex (celecoib) and others. NSAIDs are available as OTC and prescriptions, oral and topical. 

At The Grand we will make sure you have all of your medications available to you as quickly as we can; especially pain medications.  It’s important to use them wisely to maximize your recovery time here!

Valentine’s Day Messages

Send a Special Valentine’s Day Message to a Resident at The GRAND of Dublin

February and Valentine’s Day are about love, whether it be family, romantic, or platonic. As Valentine’s Day approaches, The GRAND would like to make it easy for you to send our residents a special message to let them know someone is thinking about them on this holiday of love.

For seniors who may feel isolated and lonely, it can be a difficult day. While many people think of the elderly at Thanksgiving and Christmas, Valentine’s Day might be overlooked as an opportunity to make a person’s day feel special. We would like to invite you to send a Valentine’s Day Message to your loved one or to our residents who may no longer have family.

Send a message to one of our residents letting them know someone is thinking about them by filling out the form below. If you do not a have a specific resident you want to reach, simply leave the Resident Name field blank.

The Valentine’s Day Message form is now closed. Thank you to everyone who sent messages to our residents.

What Is BIMS?

BIMS – Brief Interview for Mental Status

Catherine Denlinger, MSW, LSW
Director of Social Services
The GRAND of Dublin

BIMS stands for Brief Interview for Mental Status.  It is a screen used to assist with identifying a resident’s current cognition and to help determine if any interventions need to occur. BIMS is a mandatory interviewing tool for skilled nursing centers.  A social worker is usually the one that would be administering the BIMS.  There is a series of questions that are asked to the resident.  These questions have a score value attached to them.  The total score of all the questions range from 0-15.   The numeric value falls into one of three cognitive categories: Intact, Moderate or Severe.  The BIMS is another tool used to assist with providing the best possible holistic well-being to a resident. 

BIMS

BIMS is administered shortly upon admission to a skilled nursing center.  If a resident is in a skilled nursing center for long term care, then the BIMS would be administered at least quarterly.  If an improvement, decline or significant change occurs with a resident, then another BIMS would need to be administered.   If a resident is at a skilled nursing center for a short period of time, then the BIMS would be administered more often.  A resident would typically be asked these questions shortly upon admission, after 14 days, 30 days and so forth.  The objective of this interview is not to diagnose, but to assist with recognizing a resident’s possible need for further evaluation.  It provides a baseline for a resident’s cognitive functioning.  BIMS is divided into three sections.  The first section looks at a resident’s immediate recall.  The second section looks at a resident’s orientation.  The third and last section looks at a resident’s short-term memory. 

BIMS can present as intimidating and/or invasive toward some residents.  Since it is mandated that skilled nursing centers administer this, it is important to note that it is just one component of a resident’s MDS (Minimum Data Set) which is a combination of many assessments to develop an overall picture of a resident’s functioning.  The MDS helps to determine a resident’s plan of care so that he/she receives the best possible care.  BIMS is one part of the whole in determining the best possible treatment during a resident’s stay in a skilled nursing center.  Here at The Grand, we strive to develop a cohesive treatment plan to maximize a resident’s strengths and assist with a resident’s weaknesses to provide the best quality of care.

Please go to the following link for a sample BIMS and instructions:

http://www.foundationsgroup.net/files/126558935.pdf

Clinical Manager – FT Days

Clinical Manager – Full Time Days

We are currently looking for experienced Clinical Manager to join our team at The Grand, located at 4500 John Shields Parkway, Dublin, OH 43017.

The Grand has 100 beds consisting of Skilled Nursing, Assisted Living and Independent Living and you will be working at a one of a kind, state of the art facility in Central Ohio.

Our Mission:

Our every action must advance our mission: To improve the Quality of Life & Health of those we serve.

Company Overview

Vrable Healthcare is a growing Ohio company privately and locally owned with the vision of providing exceptional care across Ohio. We believe our first responsibility is to the patients we serve. We respect the physical, emotional and spiritual needs of our patients and find that compassion is essential to fostering healing and wholeness. Teaching and learning are fundamental in our efforts. We believe our employees are the source of our success.

Requirements:

  • Graduate of an accredited School of Nursing.
  • Currently licensed as a Registered Nurse in the State of Practice. BSN preferred.
  • Must have 3 years of LTC experience.
  • At least 2 years of management experience.
  • Knowledge of local, state and federal regulations pertaining to facility functions.
  • Excellent communication and interpersonal skills.

Vrable Healthcare is a trusted name providing skilled nursing and rehabilitation services throughout Ohio. We offer competitive wages and benefits including 401k, tuition assistance, and paid vacations.

Vrable Healthcare is a tobacco/drug-free work place and an Equal Opportunity Employer (EOE).

To learn more or apply to this position please visit the job posting.