October 2020 Newsletter

Hello October! Please be awesome!

DiagnosTEX now providing mobile COVID testing The Trump administration will implement new mandatory federal COVID-19 testing and reporting rules for nursing homes in an effort to prevent the death toll that occurred in New York at the height of the virus, a new report says. “These new rules represent a dramatic ramp-up in our efforts to track and control the spread of COVID-19, especially in nursing homes,” Centers for Medicare & Medicaid Services Administrator Seema Verma said in a statement. For congregate care settings, like nursing homes or similar settings, repeated use of rapid point- of-care testing may be superior for overall infection control compared to less frequent, highly sensitive tests with prolonged turnaround times. To help meet the need for more COVID -19 testing, DiagnosTEX is providing mobile testing for COVID with rapid results. We are partnering with Concierge Urgent Care to provide rapid CVOID testing getting your COVID results within hours instead of days. We will come to you! We can test an entire staff, or groups of patients. We are able to bill Medicare, Medicaid, private insurance or take private pay. We are so excited to be able to help and assist the facilities we service during this period of unrest and confusion. We can also test for the flu. Coming soon we will have dual testing for both COVID and Flu for the upcoming flu season. Please call us with any questions or to schedule a testing day. CMS cites benefits of interaction for residents, threatens citations if homes don't comply The federal government is urging nursing homes that aren't actively battling coronavirus outbreaks to welcome residents’ friends and loved ones for controlled reunions, with new guidelines released Thursday spelling out “reasonable ways a nursing home can safely facilitate in-person visitation.” States to this point have mostly blazed their own trails in developing visitation policies in recent months, lacking a more defined federal set of guidelines. Nursing homes in most states are already allowing scheduled visits, but Thursday's guidance is the sharpest change to date of the federal visitation moratorium on nursing home visits implemented in March by the Centers for Medicare and Medicaid Services (CMS). Under the new guidelines, all nursing homes may begin conducting outdoor visits with social distancing. Indoor visits will be allowed in homes that meet two benchmarks:

  • They are located in parishes with a 10% or less coronavirus positivity rate
  • The homes themselves have had no new COVID-19 cases in the previous 14 days. I am a healthcare professional of nearly 30 years; I am also the only child of a dying woman on Hospice in the year 2020. My mom is 81 years old; she weighs less than her age at 74lbs. She is at the end stages of Alzheimer’s disease. She is nonverbal, unable to visually focus, and is now physically contracted. Alzheimer’s is so very cruel to both the body and mind. Having to depend on others to tell me how she is or is not doing has taken a toll on my psyche, in ways I could never have imagined. Residents at the end of life stage that have been in lockdown have been as close to imprisonment as you can get without being incarcerated for a crime. Most families will remember the absence more the last moments. Never underestimate the emotional and mental stress on family members who cannot visit and confirm that there has been proper care and comfort provided to their loved ones. Ordinarily, a crucial component of good palliative care is close, intimate, tender support of a patient at their bedside. The power of human touch, human presence, cannot be overestimated in conveying compassion, care, and tenderness. But this has all been disregarded in the “lock-down” of healthcare facilities in

2020. COVID-19 has raised many issues about how care is being delivered for those with serious illnesses and those at the end of life. We don't know this yet, but I am confident that the separation at the end of life is going to have consequences on many levels.

CE Opportunities - ZOOM Webinar!


October 7 and 8 from 5pm and 8pm CST. Become certified in ESP and learn the latest assessment techniques.

Dysphagia Tidbit - Postintubation Dysphagia – it is a real thing, we must be aware and address it.

Postintubation dysphagia is often related to the duration of the mechanical ventilation but the act of both intubation and extubation is an evasive event on the anatomy. If there has been an intubation time period, immediately after extubation the oral cavity is always dry with dried secretions around lips, tongue and hard palate. Laryngeal edema is one of the most frequently noted and can be the most serious complication of tracheal intubation. Impairment can be caused by edema of the orpharyngeal and laryngeal structures. Endotracheal intubation can result in mucosal abrasion, inflammation, hematoma and VC ulceration or paresis. Ulcerations can also be seen on the structures of the arytenoids, epiglottis and the base of tongue. Intubation can cause a dislocation of the arytenoid cartilage which in turns results in the compromised closure of the airway. An endotracheal tube may cause recurrent laryngeal nerve (RLN) damage. Reduced function of the laryngeal sphincter increases the likelihood of aspiration. The normal act of swallowing involves more than 30 muscles and 6 cranial nerves. Intubation causes atrophy to these muscles and structures, maintain an open glottis for extended periods of time therefore inhibiting the natural movement of the pharyngeal muscles. After extubation there is a reduced sensitivity in the upper respiratory tract and it could last up to 7 days. We cannot overlook the possibility and likelihood of the development of delirium. Research has shown that patients with impaired ability to answer questions and follow instructions were 31% more likely to aspirate liquids than those who maintain perception of question and instructions. Due to insertion of NG tubes, a supine position, and high doses of sedation, the risk of developing GERD increases and the reflux adversely effects the cricopharyngeal sphincter increasing aspiration risk. In addition, patients are at risk for oropharyngeal sensory impairment due to frequent use of inhaled medications. After extubation there will likely be an impairment in the coordination between respiration and swallowing and when chewing the respiratory rhythm changes and aspiration will depend on the accuracy of that synchronization of laryngeal closure, apneic pause and opening of the PES. Respiratory- swallow coordination are important for adequate airway protection. In research review, expiration swallow expiration pattern with liquids was the dominant respiratory phase pattern, observed in 92.7% of trials with no significant effect of liquids consistency on healthy adults only. There is very limited data for those diagnosed with a dysphagia or any type of respiratory changes. It is important to note that research has shown that neck muscle tone due to inappropriate posture may also encourage hyoid depression and increase the extent of the elevation therefore increasing risk of aspiration. Anyone with ICU intubation will be atrophied, with long duration of resting positions and will likely have increased neck muscle tone. The timing of a swallow assessment should take place 1-5 days after extubation. Early detection is needed to reduce the incidence of complications. Post intubation dysphagia has been identified for decades, but in the era of an airborne virus pandemic it changes the complexity of evaluations. We have seen patterns in the DFW area of post COVID patients on extremely conservative diets based on screens. The diet also resulting in poor intake further exacerbating the patients declining status and the proof for continued need for skilled intervention for dysphagia and dysphagia evaluations.

Alzheimer’s Memory Walk (September-November)

I will be walking again October. This year instead of a large group gathering, everyone is walking their own community. If anyone would like to donate to our walk, we would appreciate your support to help end this terrible disease, as we all are up close and personal with this professionally and some of us personally. This has been a very difficult year for me as my mom is in the end stages of Alzheimer’s. I have not seen her since March. A cure is obviously the main reason we walk, but the financial burden on a family with Alzheimer’s is huge due to day to day care required for their health and safety. An adult with Alzheimer’s requires as much care as a brand-new baby. The need to be bathed, changed, fed and stimulated is no different, just more difficult due to their adult size. They cannot verbalize their wants, needs, or pains and do not know how to function independently anymore. By participating in the Alzheimer's Association Walk to End Alzheimer's®, we are committed to raising more awareness and funds not just for Alzheimer’s research, but the care and support needed. COVID has not changed this need. Thank you for any amount, no matter how small, that you can afford to donate. Every single penny is another penny closer to a cure and I believe we are closer than ever before. Please go to the website www.alz.org and locate the team called “Heels of Hope” to donate. Thank you so much!!