Taking Healthcare by Storm: Industry Insights with Angie Szumlinski

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Angie Szumlinski, LNHA, RN, GERO-BC, RAC-CT, BS, Director of Risk Management at HealthCap®.

Read Angie's Blog.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website. 

This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-GEN-080224-GK

Transcript

Welcome to Taking Healthcare by Storm, Industry Insights, the podcast that delves into the captivating intersection of innovation, science, compassion, and care.

In each episode, Quality Insights Medical Director, Dr.

Jean Storm, will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys.

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania, and the nation.

Subscribe now, and together, we can take healthcare by storm.

Hello, everyone, and welcome to Taking Healthcare by Storm.

I am Dr.

Jean Storm.

I am the Medical Director of Quality Insights.

And today, be prepared to learn a lot in a short period of time.

Learning is something, like, is one of my favorite things.

So I'm very excited for this podcast.

Today, we are joined by Angie Szumlinski.

She is a licensed nursing home administrator.

She is a nurse.

She has many, many letters after her name.

She has a lot of experience in long-term care.

She is currently the director of risk management for HealthCap Risk Management and Insurance.

And I'm going to say when Angie and I first got connected, I was really inspired by her blog that she writes, and she has so many interesting topics.

So today, we're going to be talking about those topics on her blog.

So you can learn a lot in a short period of time.

Angie, thanks so much for joining us.

Well, thank you, and thank you for having me.

I'm pretty excited to just have a conversation today and talk about some of the things that providers are interested in and have worries about, and hopefully, shed some light on some areas that maybe you weren't aware of.

Yes, I agree 100 percent.

I know I learned a lot reading through your blog.

So let's jump in.

Tell us how you came to do what you do.

Well, it's interesting.

I had a daughter who was born with some kidney issues, and so as a baby, she spent most of her first year in the hospital.

And so I decided then that I could take care of her better than any nurse.

So I went to nursing school and I became an LPN, and I worked in a local nursing home on an afternoon so that my kids weren't in daycare.

My husband was home at night, so that worked out really well.

So as I grew in a professional capacity, I continued my education and earned my bachelor's degree, and got my RN and became a licensed nursing home administrator.

During that time, I worked in many different capacities, but my biggest challenge was when I partnered with one of the nurses I worked with.

And we purchased two local nursing homes.

We owned those for about four and a half years, and I became acutely aware of what owning nursing homes meant.

Regarding liability and just the risk of ensuring quality care for your residents.

That was the first thing that we wanted, and it challenged us on a daily basis.

So I began doing risk management for HealthCap as a consultant, because I felt that we had the insights group, right?

We knew what we were doing day to day, and it turned out to be a full-time position, and we ended up selling our nursing homes, and here I am.

So it's been 21 years.

Oh, wow, and that's a fantastic story.

So you obviously have an insight into the long-term care environment.

So what do you consider the biggest challenge or challenges in long-term care currently?

You know, by far, I think the proposed staffing mandates are really the thing that keep people awake at night right now.

Even with the Supreme Court being involved in the Chevron ruling earlier this month, lawsuits by ACA and some other organizations, I believe leading ages involved now as well, the fight isn't over, and I really expect the battle to continue for a long time.

Then there's the regulatory side of what we do.

So even on our best day, we have humans providing care to frail elders, and sometimes things happen due to no fault of anyone.

But surveyors tend to find blame if some, if there's a negative outcome, they want to know the why, which I understand.

But it isn't always because someone did something wrong.

So unfortunately, we get citations.

Sometimes we don't think we've earned them.

Sometimes we know we have.

So regulatory is a tough thing for us.

There are really some bad apples out there.

We know that.

I'm sure in your history, you've met some that just weren't quite what you'd hope they'd be.

But most people are in the business because they love what they're doing, and it's not easy work.

So, I don't know.

So on that same vein, not to be overlooked is really the general public's view of nursing homes and post-acute care.

In my experience, nobody wanted to talk about nursing homes until their parent needed one.

And then they called me.

I was like, oh, let's call Angie.

And that's great.

And I was glad to be a resource for them.

But basically with the media's coverage of what we do, it's never been positive.

And I really am hoping over the years we can change that and overcome that challenge.

It is a big challenge for us.

Yeah, I definitely agree.

That's a very that's a big challenge is public perception.

So I loved your blog, as I mentioned.

So how has your blog been received in the long term care community?

You know, I'll be honest, when I started writing the blogs, I didn't know if they were going in a big black hole somewhere and we weren't getting feedback.

And I enjoy writing them because I like to spin a little humor into them.

But we did a video for our board meeting this year, and we interviewed members of HealthCap who we insure and asked the question, what is it about risk management that you like the most?

And I would say 85% of the people interviewed said the blog.

And I was moved because you put that much time and energy into something.

And to get that feedback was really incredibly fulfilling.

So I think it's well received.

So it's a mandatory part of their day, right?

They said that's one of the first things they do is look for my blogs when they're, because they're subscribed.

If you have a subscription, it comes to you automatically.

And that's one of the first things they do in the morning is see if my blogs are up.

So it's nice.

Yeah, that is really, really nice.

And I will say it's just a really great short piece of information that sticks with you.

So we're going to jump in and I picked out some topics.

And we're just going to go through them and maybe like as a little bullet.

So we talk a lot about vaccines.

We talk a lot about primarily we talk about COVID and maybe a little bit about flu vaccine, RSV, pneumococcal for our individuals who are living in nursing homes.

What about the importance of the MMR vaccine?

You know, I read a few articles on this.

And really, the CDC has posted some statistics as well on this.

But over the past few years, it's been COVID, COVID, COVID, get vaccinated.

You know, their big push was if you're infected, you can infect one to three more people.

And that scared a lot of people.

It was, it made it, it brought it home, right?

I'm not underplaying the impact of COVID and what it had on our communities.

And numbers are climbing again.

So hopefully another vaccine will come out in the fall is what they're talking about.

So it was a devastating part of our lives, right?

To say the least, we lost a lot of people.

And once that vaccine became available, I think it showed how important vaccines are because we really, the numbers went down drastically once the vaccine was available.

But now we're looking at things like RSV and the flu were coming into that season again.

But one of the articles I read was regarding the MMR vaccine.

And what brought it up was that we're seeing an increase in measles in the United States, which just like TB, for a long time you didn't hear anything about measles, right?

But what they found is one of the migrant shelters in Chicago had a huge increase in measles cases.

And they're in a community, right?

Chicago is an urban area.

Those people are out and about as they should be, but they are not vaccinated.

And if you think about the spread of measles in a 90-year-old who probably wasn't vaccinated, you know, the MMR was relatively new.

I can't I don't know what year it came out, but so a lot of our seniors never got vaccinated.

So we have migrant workers.

We have foreign nurses, caregivers.

We're sponsoring people to come and help with the staffing shortage.

And so we need to be really aware.

Are these new nurses and tucks and whoever we're bringing in, are they immunized or are they going to possibly spread measles to our building?

We have young employees who maybe their parents didn't get them vaccinated.

It was a big deal for a long time.

I don't believe the schools are forbidding it.

I mean, I think they're allowing students to come in without the vaccines.

So at the end of the day, some people choose not to, and that's their choice.

But I think it's important that we know that we're aware that this is a possibility and that the chances are that our residents might not be immunized.

I don't know that they should be.

That's probably more of a doctor question, or if it's just something you want to watch.

But 40 percent of people who get measles experience complications, and it can include blindness, hearing loss, pneumonias, seizures, even meningitis.

So it's really something to be aware of, and I just thought it was a really interesting topic.

I hadn't read about MMR in a long time.

So yeah, I would agree.

I think we have to keep our eyes open to unknowns.

So yes, I agree 100 percent.

So shifting a little bit, going to talk about sleep.

There's a lot about how the importance of sleep is just for adults in general.

But it's not something that we focus on in the nursing homes, I will say.

I don't think really there's a lot of, it's loud.

It can be, lights can be on all the time.

So talk to us a little bit about the importance of sleep in long-term care facilities.

I worked afternoons as a nurse on a Medicare unit for three years.

And I can tell you rarely were people sleeping on my shift.

Everybody went to bed at nine o'clock, but I was there till 11.30 and most of them were still awake, partly because they weren't very busy during the day, and partly because we were noisy, I'm sure.

But whatever the reason, they don't get a lot of really quality sleep.

We refer to it as good sleep hygiene.

So if you went to any center tomorrow morning and asked to review their Resident Council minutes, here's what you're going to hear.

I'm missing my pink sweater.

I'm tired of chicken.

The food's cold.

The coffee's cold.

And staff are noisy at night and turn on lights.

99% of the buildings I visit have these very similar complaints.

But the noise at night is a big one.

So it's important for our seniors to get good sleep.

Because a lack of sleep, or worse, interrupted sleep, can have a negative impact on their quality of life.

If you've ever walked into one of your centers and they're all asleep in their chairs because they didn't sleep last night, and so maybe they're bored too, I don't know.

But chances are they didn't get a good night's sleep.

So studies have shown that seniors who are not getting adequate amounts of quality sleep are really at a higher risk for falls.

And that's one of the areas I try to focus on when we assess a risk for falls, is I try to do a sleep hygiene study.

How are they sleeping at night?

So we don't do a fall risk assessment just on day shift.

We want to see what's going on in the afternoons and midnights.

So if the midnight shift says that George is awake or wakes up during the night and goes back to sleep, what we call interrupted sleep, chances are George is going to be at higher risk for falls.

So having that in the back of our minds, that's a huge piece for anyone in long-term care.

But then they found this other thing that I was not aware of, that it also impairs the body's ability to process sugar.

So as the stress hormone cortisol increases, it releases stored glucose, and you probably know that better than I.

But you think about all the things that can be impacted by a lack of sleep.

Another study identified irregular sleep increases the risk of cardio conditions and possibly dementia.

So there's all kinds of reasons that sleep hygiene is really important.

But the bottom line, we should be focusing our staff on the importance of quality sleep for our residents and maintaining that quiet environment.

Keep the conversations down to a minimum, or at a minimum, do it in the break room.

Keep the lights on low.

The bright light is often really disturbing to residents, even when they're asleep, because it does interrupt their sleep.

But provide care safely.

A lot of residents can differ, say, I don't want to have my brief checked at night.

If they're able to make those decisions, that's okay, as long as it's safe for them.

It does promote better sleep.

Yes, I agree 100% sleep is so important.

We don't focus on it enough.

You touched a little bit on increased glucose levels.

So I want to shift to diet now.

And you had a blog, and I think this is two blogs that I'm combining, the importance of a diet rich in green leafy vegetables to improve glucose tolerance and improve insulin sensitivity, which is great.

And then a diet high in French fries and potato chips, which I will say I've seen many a potato chip and French fry in the nursing home.

But this, we know that a diet high in these foods lead to worsening insulin sensitivity and predisposition to diabetes and worsening diabetes.

Yes.

You know, I love French fries.

That's my weakness.

Anything crunchy, salty, I am on it.

But yes, I think we did have a couple of different blogs.

One was about olive oil, and that brought in the French fries.

I was asking if I fried my French fries in olive oil, does it mean that they're healthy?

But we know they're not.

But yeah, regarding the green leafy vegetables, improving glucose tolerance.

We've come a long way from strictly using canned everything.

When I was a nurse on the floor, if it said they had green beans, they were those mushy green beans in a can.

That's what we served.

And we're doing a much better job with that today.

Serving healthy fresh vegetables and fruits.

Can we do better?

Yeah, absolutely.

But the takeaway here is, what do your menus look like?

How many fresh fruits and vegetables are you serving?

And how are they prepared?

Many times the beautiful green leafy vegetables are so overcooked, they look like canned.

And then the risks of some of these foods, like fresh salads, some residents cannot consume them safely.

They're too hard to chew for them.

So there's a lot of reasons that we want to be careful what we're serving.

But I think that the effect that it has on glucose tolerance and insulin is huge.

Having that, and you know what?

They talk about the Mediterranean diet all the time.

Those types of foods are really, really better for maintaining glucose levels, whether you're diabetic or not.

So I think understanding that and being sure that we use these foods appropriately for these residents, we'll see a better outcome regarding insulin sensitivity and their ability to maintain their blood glucose levels.

When it comes to meal planning, my guess is that the manager of a building is the administrator or the owner.

You're really looking at the budget, right?

How much are you spending a day on per resident for food?

And it's not necessarily in your book what it is you're ordering.

It's how much are they spending, right?

So I always tell people, order a test tray, randomly unannounced, walk down to the kitchen.

You as medical directors can do that as well.

Walk down to the kitchen, tell the tray line you want a tray and watch them scramble.

So because you want to look at how does it look?

Are there fresh vegetables on there?

Is everything white?

The chicken and the mashed potatoes, is there, you know, is it something that you would eat, right?

Take it away and really eat it and be really critical about, would I eat this every day?

And you'd be surprised what you might find.

So maybe it won't make a difference, but it might.

And if the quality of their dining experience as well as their overall insulin sensitivity is better, go for it.

Yeah, I would agree.

I think that will be eye opening for a lot of medical directors and, you know, consuming the food in the facility.

Agree.

So let's shift to something that's a huge problem.

I have just been just talking about this to a colleague the other day.

We were talking about the massive amounts of antibiotics that are used in the nursing home.

And I thought this was a really interesting take in one of your blogs.

And you discussed the high amount of antibiotics that are actually prescribed in the emergency department for residents who may be sent there.

Maybe they have a fall and they are sent to the emergency department for evaluation.

And then the resident gets diagnosed with a urinary tract infection in the ER and is placed on antibiotics.

So let's talk a little bit about the high amount of antibiotics that are actually prescribed in the emergency department for nursing home residents and the importance of antibiotic stewardship.

And that's a great point, Jean.

I think that was a great example because we in our nursing facilities, we don't treat asymptomatic UTIs.

I mean, if they're not symptomatic, we prefer not to prescribe because obviously they're colonized.

But the ER is a snapshot in time, right?

So they get a resident in, and usually they catheterize them to get a urine specimen because most of the residents aren't able to urinate on command, right?

So there was an interesting article published in the Cambridge University Press, and it discussed antibiotics in the emergency rooms.

Although it wasn't focused strictly on elderly people, the analysis from 2016 to 2021 reflected 27.6 percent of visits resulted in inappropriate antibiotic prescribing.

That's a lot.

And these people may go home on antibiotics, but a lot of them come back to our buildings, right?

14.9 percent of these orders had a plausible antibiotic-related diagnosis like acute bronchitis, which anymore, we don't always treat that either, suggesting that maybe the inappropriate prescribing for 12.6 percent did not meet a plausible antibiotic-related diagnosis.

So some of the examples were hypertension, and they put them on an antibiotic.

Now, could it be coded wrong?

Maybe.

And they did mention that, that it could be poor coding quality.

But they suggest that emergency antibiotic stewardship initiatives should focus on both reducing antibiotic prescribing for infections that are asymptomatic, antibiotic inappropriate conditions, and improving coding quality.

And in fairness, again, the patients in the ER is a snapshot in time.

So medical staff really solely rely on lab values.

And if it says UTI, they're going to treat it because they don't want that patient coming back, right?

They may listen to the patient's complaints, but many times our residents don't share.

When they get to the ER, they usually have some delirium and they're not good historians to begin with.

So it's difficult.

I understand the ER docs have a hard time.

So my suggestion is if a resident comes back on an antibiotic, maybe they should consider having a full medical assessment by the attending, or the physician extender, just to confirm that the symptoms are infectious related.

Because sometimes a resident will fall because they have a UTI.

Other times, they fall without a UTI.

So are they colonized?

Are they symptomatic?

Again, these are the highest numbers of use as UTIs.

They will also come back with dehydration, which is always on the return paperwork.

They went in for a fall and they come back with dehydration diagnosis.

And unfortunately, many of our residents' labs will never be within the normal range, and they will trigger for the ER staff dehydration.

I really do like the newer ERs.

There's several in Michigan.

I know that they're geriatric.

They have a geriatric end to them.

Like some of them have pediatric ends.

There's several that have geriatric units, which has made a huge difference in outcomes for the residents.

But the bottom line is if it's determined the antibiotic is wanted, continue it, obviously.

But if not, discuss options with the attending.

Determine the risk-benefit of continuing it.

We've got a lot of MDROs, and we don't want to create any more superbugs if we can avoid it.

So antibiotic stewardship, it's priceless.

Yes, I agree.

One of the huge issues in long-term care currently.

So another huge issue that remains an issue.

I think people think that because the public health emergency is now over, that COVID is kind of over in long-term care facilities.

But I mean, you and I both know that it's not.

So let's just we talked a little bit about the MMR vaccine.

What is what about being up to date with the COVID vaccine?

Let's just talk a little bit about that.

Yeah, so there's a few things with the COVID vaccine, and that is the challenges are buildings.

And I can tell you, as a loved one, I had my my parent in a post-acute care setting.

She was admitted in December of last year, and had not had the updated COVID vaccine.

So I asked them to give her the updated vaccine because she's high risk.

And I asked and I asked and I asked.

And finally, I said, has she had it?

And they were like, well, no, you know, we were trying to wait till we have enough residents here.

What they're doing is they're sending it in multi-use vials and they charge you for the vial.

The facility pays for it under the reimbursement, right?

But it only lasts, I want to say, 48 hours once it's been opened and then you have to discard it.

And they're pricey.

So, they're trying to get enough people together to use the vial up.

One of the centers was actually telling people in the community, if they hadn't had it, they could come and get it there because they were going to waste it anyway.

So, that's a challenge for our buildings and it has not changed as far as I know.

So, what does that mean?

It says, in March of 2024, 42 percent of nursing home residents were up to date.

Forty-two percent, that's not great, right?

That tells me that they're either refusing it or the facility can't afford to keep buying vitals, which is probably something our lobbyists should be involved with.

But it's important to know that.

So, our staff are not getting vaccinated either.

And that's not the reason.

They can get them at their physician's office or pharmacy.

But but not to rock the boat.

Only 10 percent of our nursing home staff are up to date.

If you recall, during COVID, you weren't allowed to work in the building unless you were.

It wasn't called up to date then, but unless you were totally.

You had both series of the vaccine and you were testing negative and you had to screen every day.

Now only 10 percent are up to date.

What's it all mean?

I don't know.

When does the COVID alarm stop sounding?

I don't know.

Many residents in our centers are affected by RSV and influenza every year and we calmly offer the flu and RSV immunizations and move on.

But hopefully, down the road, this will be one of those annual things that you just do and you offer it every year.

And you hope your percentages are good.

I don't believe that death rates have gone up since like 2022.

I think they're still pretty low, even for seniors.

But you know, it's still an infection.

And now we're looking at measles and RSV and flu season coming on and pneumonias.

So yeah, it's a big question.

But at the end of the day, I think that the COVID vaccine being up to date and reporting, you know, the nursing homes still have to report their data.

Although the CDC isn't reporting flus and things like that anymore.

But and the acute care hospitals don't have to anymore.

So I think there's a light at the end of the tunnel and I don't think it's a train, but we'll find out in a few months.

Yeah, I agree.

And I think it's really interesting.

You know, if we, you know, people, I think, kind of say, like, oh, I don't need the flow of the COVID vaccine.

I'm going to, you know, even if I get COVID, I'm going to survive.

But you had a really interesting take in a blog, you know, talking about long COVID in nursing home residents, especially, you know, so a resident gets COVID and then, you know, we know that unvaccinated individuals are at higher risk of developing long COVID.

So maybe they, so they develop, they have symptoms longer than four weeks, or they develop new symptoms at four weeks that continue.

And could this long COVID be manifesting itself as taste dysfunction, which then leads to weight loss, which then leads to a whole host of other problems, right?

Absolutely, absolutely.

And I hate to keep using my loved ones as examples, but my mom was fully vaccinated.

She traveled and came back from a trip.

Her granddaughter got married.

It was beautiful.

And she got COVID.

The whole wedding, like half the people at the wedding had it.

So I did not get it.

But she got COVID and ended up in a COVID facility.

Here in Michigan, we had designated facilities.

And when she got out of the facility, she went to a regular, another building for rehab because she had declined significantly and had lost weight.

And I would bring her her favorite foods.

And she'd say, I'm not hungry.

And I'm not hungry.

And one day she said to me, the doctor says I have long COVID.

I was like, and she's not hungry.

All her favorites.

Yeah.

So it's a great example, right?

So many, many people who have had COVID are suffering with long COVID.

And there is some thought now that it's going to go on for, it can go on for years.

And what happens is they lose their sense of taste.

And I've not connected the smell piece yet because I think they go together.

I always remember, if you can't smell, you can't taste.

You get a bad cold, you can't smell, you can't taste.

So I'm assuming their sense of smell has gone too.

But one of the symptoms is that they can't taste things, so they stop eating.

One thing that is more common of COVID and long COVID is that loss of taste.

So many people go months without being able to taste after being infected.

And it seems to be one of the symptoms most prevalent that can lead to way less.

So if you think about those residents who were infected with COVID, they appear to have recovered.

Their symptoms have subsided.

But have we asked them, can you taste this?

Have we given them maybe a lemon slice or something that would really perk their taste buds?

They don't realize that they're experiencing the symptoms.

They don't know what they are.

My mother was told that she likely had long COVID, and she did lose weight.

So most of the residents aren't familiar enough with the terminology or even the symptoms, and their family members might not even think about it, right?

So if they suffer in silence and they start eating less or refusing meals, it will lead to unexpected significant weight loss.

So it's important that we pay attention.

If you have residents experiencing weight loss, what did you not expect it?

Then you need to talk about it.

So one of the things I watch for are people who sit at the dining room table with their table maids, and they literally move their food around their plate.

Now, some people do that because they don't want to gain weight.

We still have women in our buildings that don't want to gain weight.

That's great.

But if it's new for them, it might be time to talk to the physician about a complete evaluation, find out what their significance is.

Can you test for their taste, like I said, using maybe a strong scent that you can put under their nose, a slice of lemon that they can taste, something that you can trigger some response.

If you don't get it, you have a good idea of what's going on with them.

It might not even be long COVID.

People can lose their sense of taste by losing the salivary glands aren't functioning well, so they don't have as much saliva, and so that affects their taste.

But chances are, if they had COVID, they could be suffering with that.

So, yeah, something really, I think to keep in mind, definitely with weight loss.

So let's just talk briefly about a big problem in nursing facilities.

Agitation and dementia, or Alzheimer's disease is typically the major cause of dementia, and we know that agitation is a huge issue.

You had a description of tragedies in two Arizona Dementia Care units with residents who have dementia and agitation associated with it.

Any tips for facilities in dealing with agitation and dementia?

You know, I have to tell you, it is probably the most challenging piece of what we do, like you said, with people living with dementias.

Even people living with Parkinson's disease, you know, it is often misdiagnosed as Parkinson's when it's actually Lewy body disease.

And these folks actually have an inability to maintain their calmness, right?

They, whether it's trauma-informed care, whatever that is, we don't know what's going on inside.

They become agitated very quickly.

I'm never sure, you know, back in the day, I can tell you, we used restraints, right?

Chemical and physical restraints.

But obviously, that's not the best thing to be doing.

The issue now is that each one of those residents has the right to a comfortable life, whether they have dementia or not.

So no one is allowed to infringe on that.

But if you think about it, most of your residents, I shouldn't say most, but a lot of residents never shared a room.

They had their own bedroom, right?

Until they got married.

Now you have a roommate and you don't even know them.

And most of our buildings do have two room, two beds to a room.

Nice, you know, the newer ones are nice and they have semi-

or they have private rooms.

That's great.

But let's face it, you have somebody sitting in your room and you don't know them or you might not like them.

So here you are with this roommate you don't know and you start bickering, just like siblings would if they shared a room, right?

Another situation we often see is that one resident may be a messy eater and they get picked on.

You know, the residents who require the most love are the ones that are mostly abused, whether it's physically or emotionally, not by staff necessarily, but by other residents.

So I think a big thing to do is to really know what your process is for screening and admissions.

If you have a good process, you may be able to prevent some of these things.

So for example, if you say, what's your mom's current living arrangement or has mom ever lived in another assisted living center?

It sounds silly, but honestly, we're all busy and the daughter will say, oh, mom's wonderful.

She just has some memory issues.

And that's what we do, right?

We provide supportive care for our residents living with dementia.

So are we doing it well?

Well, most of the time we are, but you have to be involved.

Are you getting a daily report on each resident so you know when a resident's behaviors are escalating?

Or are they exhibiting new behaviors that maybe you didn't have any idea they were going to have, right?

And we're talking about antisocial behaviors, where they're swinging their cane at their roommate, or they're tripping people in the dining room, or worse, they're running them over with their little carts, you know, scooters.

And we see this.

These are true stories.

Remember your staff, too.

If you have designated staff for your memory care unit, they will know those residents and they'll be able to say, hey, Lucy's acting up.

This is what we did last time and it helped.

So having designated staff for the unit, assignments that are consistent with each resident, so that that resident knows that staff member as well, really does make a difference.

You may have resources for your staff where they can reach out to someone else, not necessarily having to come to you, obviously reporting it to you.

But we have mental health consultants, therapeutic activity professionals.

I'm not talking about the bingo activities that most of our residents love.

I'm talking about therapeutic activities where they actually do the different fabrics and they sort threads or yarns and they're productive and they have to focus and they're really involved with the activity.

Psychiatry providers, pharmacy consultants, many times medications can cause agitation in people depending on the medication.

So getting a pharmacy consult, music is always wonderful.

Music therapists do a great job.

And, you know, I think remembering that you can't manage a memory care unit without these resources, it might be time for everyone to take a look at what their practice is and talk to your staff and families, ask the right questions, and you might be surprised.

Fantastic tips, very much needed.

So to just wanted to finish out with some, just some two very interesting blogs that I found.

One, I think I kind of knew about one, purple urine bag syndrome.

I don't know if many of our listeners have heard of this, which I found very interesting because I've seen a purple urine bag many times and you pointed out an interesting link.

So talk a little bit about that.

Yeah, so we had a facility recently that was cited for purple bag syndrome, and it was cited because it was purple and nobody knew why and nobody seemed to know, want to figure out why.

So I think it was cited more for a lack of knowledge and it was for anything else.

But I'm surprised you've seen many.

But yeah, so it occurs mainly in women who are chronically catheterized.

And again, we hate to have chronically catheterized people.

They've come out with some really great devices now to keep people dry at night without a catheter and things like that.

But it's usually, they found that it's related to constipation, which I was curious, I didn't understand why.

But the National Institute of Health said the constipation is went hand in hand with this purple bag syndrome.

So what happens though is the bacteria in your urine can produce, obviously a lot of words here, but it interacts with the lining of the bag.

So the breakdown of the bacteria, their thinking is that the indigo blue and the endorubin red from the bacteria or whatever, they interact with synthetic materials, so the catheter and the urinary bag, and it becomes purple.

It's a lot of words.

I still don't understand it, but the exact cause is really still unclear.

Constipation is commonly found with spinal cord injuries, and that's often seen with chronic catheter use, right?

So it's interesting that they would connect the two.

And so bowel stasis is complicated breakdown of tryptophan in the presence of a UTI.

That's what they're saying connects it to what they call PULPS, Purple Urine Bag Syndrome.

So it's generally a benign process, but it can be upsetting to staff.

I mean, I have never seen one, but I can imagine walking into a room and having purple in the back.

I'd be freaked out, I'm sure.

And it could be a signal of underlying recurrent UTIs as well.

So it's really important if you see it, to know that it's not okay that something else is happening here.

And while it may seem harmless, an underlying UTI could lead to a serious condition, and PULPS could be a warning sign.

So, you know, react to it.

Medical management of PULPS is to change the catheter in the drainage bag and treat the underlying infection.

And as of this writing, the CDC has nothing related to PULPS on their website.

I thought that was really interesting.

So I got my information from the National Institute of Health, but there's not much on it from on the CDC site.

So I thought that was interesting.

Yeah, super interesting.

It's something to kind of look for.

So last topic, olive oil and dementia.

Is olive oil going to save us all from getting dementia?

And should we should we start?

I guess we can't fry our French fries in olive oil, but maybe we can eat a lot of salads or dip our bread in olive oil.

And I would enjoy that as well.

Yes, I told a funny story.

I went to California with my daughters and we found this, what they referred to as an olive bar.

And we were super excited because we love olives.

And it was actually an olive oil store where you could pay to taste the olive oils.

And I was like, no, I want olives.

So anyway, but in a recent study, truly, they found that participants who consumed olive oil were less likely to die from dementia.

I know it sounds weird, but the study showed a connection between not only consuming olive oil, but also how much you consumed.

So irrespective of diet quality and beyond heart health, the findings extend the current dietary recommendations of choosing olive oil and other vegetable oils for cognitive-related health.

So there are those naysayers, however, who argue that the food you eat is also a marker of the food you don't eat, which is true.

So people who eat olive oil consume less margarine, less red meat, opting to consume our vegetables.

All of that plays into this.

But it always amazes me the studies that you find out there.

I'm curious sometimes I'll say, why did we study that?

But I thought it was fascinating because I'm an olive oil lover, and we have some history of dementias in our family.

So I'm happy to consume olive oil, and I might just fry my fries.

Yeah, I would agree.

Angie Szumlinski, this was just a fun, interesting, great podcast.

I really appreciate it.

I learned a lot.

I hope everyone out there learned a lot.

And you continue to write these blog posts at an astounding rate.

So perhaps we can get you on to do this again.

I would love it, anytime.

All right.

Thank you very much.

Thank you.

Have a great day.

Bye-bye.

Thank you for tuning in to Taking Healthcare by Storm, Industry Insights with Quality Insights Medical Director, Dr.

Jean Storm.

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