Shift of Focus for Long-Term Care Facilities �9 A recent report notes the theme of increasing diversity at nursing facilities. The report, from the Institute of Medicine, indicates that the changes in the U.S. health care delivery system have shifted the focus from traditional inpatient set- tings to nursing facilities and other settings, with resultant changes in nurse staffing patterns.

The report made the following specific recommendations about staffing and quality in nursing facil- ities:

�9 By the year 2000 Congress should require a 24-hour pres- ence of registered nurse cover- age in nursing facilities to enhance the current 8-hour requirement.

�9 Nursing facilities should use geriatric nurse specialists and geriatric nurse practitioners in "both leadership and direct care positions."

�9 Nurse assistant training in nurs- ing facilities should include clinical care of older adults and those with disabilities, occupa- tional health and safety mea- sures, culturally sensitive care, and appropriate management of conflict.

�9 Nursing facilities should place greater weight on educational preparation in the employment of new directors of nursing. (Source: Legal Eagle Eye Newsletter, April 1996;4)

ASA Annual Meeting Notes �9 The American Society on Aging (ASA), the nation's largest associa- tion of professionals serving older Americans, had 3000 attendees and more than 1000 presentations at its annual meeting in Anaheim, California. Major sessions focused on the futures of the baby boomers,

rethinking health care, and the eco- nomics of the graying of America. The existing network of health, social services, and income sup- ports for older adults is being chal- lenged in many ways. The sheer numbers of the aging baby boom population will place increasing demands on the existing system. According to ASA president Alice J. Kethley, "To meet this enormous challenge, we need more than ever to address emerging conflicts and find new ways to protect the secu- rity and dignity of today's older cit- izens and our elders of tomorrow."

Emily Freedman, writer, lec- turer, and health policy analyst, spoke on "Divisions and Demo- graphics: Together and Apart in a Changing Health Care World." Her presentation examined whether managed care and related trends mean that sancrosanct ideas--the notions of Shared risk, shared sacri- fice, and shared success--will be lost in the sweeping changes in the U.S. health care system.

This year's exhibition included three featured sections: the Center for New Products for Mature Audiences; the Smart Mart, featur- ing the latest high-tech and low-tech products to promote independent living for older adults and people with disabilities; and the Learning Corridor, which displayed products ranging from board games to videos used for staff development and in- service training.

Joint Commission Creates Library for Health Care Indicators

�9 The Joint Commission on Accreditation of Healthcare Organi- zations will create a National Library of Healthcare Indicators (NLHI). The NLHI is a comprehen- sive indicator catalog that includes performance measures judged by experts to have face val id i ty for application to various types of health care organizations. The first publication, focusing on health plan and network indicators, is scheduled to be issued this summer.

The indicators will be classified

into three broad categories: priority clinical conditions arrayed against domains of performance; functional health status arrayed against demands of performance, and satis- faction from the perspectives of patients/enrollees, practitioners, and purchasers. Each indicator will have its own profile that defines the mea- sure, describes its focus and ratio- nale, details its characteristics, including risk adjustment and strati- fication, portrays its applicability to various health care delivery settings, and delineates the degree to which the indicator has been formerly tested.

The first publication will include measures from the Agency for Health Care Policy and Research, the National Committee for Quality Assurance, Northwestern University, the Primary Care Outcomes Research Institute, and Kaiser Permanente.

Video Calls Connect Nurses With Patients �9 Home care nurses now have the capability to visit patients electroni- cally via a telemedicine system that uses ordinary phone lines to send video, audio, and vital diagnostic information. The Personal Tele- medicine System (PTS), developed by American TeleCare (Eden Prairie, Minn.), allows nurses to check the blood pressure, pulse, and tempera- ture of a patient at home. Nurses can also evaluate heart and lung sounds and visually examine wound or IV sites, medicines on a bedside table, and even a patient's gait.

The communication system con- sists of two monitors, each about the size of a small microwave oven. Each monitor has a built-in tele- phone, a 2-inch viewing screen, and a dime-sized camera eye. The at- home monitor is also equipped with a stethoscope, blood pressure cuff, and a digital display for blood pres- sure and pulse. The central monitor (at the nurse's office) includes a magnifying lens and a headset for listening with the stethoscope. The system requires two telephone lines in the patient's home.

The high-tech equipment is easy

152 Newsview July/August 1996 GERIATRIC NURSING