CDC Reports that LTC the Overwhelming Source of Legionnaires' in Healthcare Facilities

Legionnaires' disease tends to be more common and deadly within post-acute care facilities than others — and providers need to do more to reduce the risk to residents.

Researchers with the Centers for Disease Control and Prevention recently conducted a study finding that 76% of Legionnaires' cases reported in 2015 could be traced to healthcare facilities. Of those cases, 80% were linked back to long-term care facilities, followed by 18% at hospitals and 2% to both.

Eighty-eight percent of Legionnaires' cases that year were reported in patients older than 60, the CDC said. About 25% of patients in healthcare facilities who contract legionnaires' die from it. That's two-and-a-half times the rate of all who contract the disease, which comes from inhaling water containing Legionella bacteria.

According to an article in McKnight's:

“Legionnaires' disease in healthcare facilities is widespread, deadly and preventable," CDC Acting Director Anne Schuchat, M.D. said during a press conference. “People can inhale the bacteria from small water droplets from showers, water therapy spas, baths, cooling towers, decorative fountains and medical equipment, like respiratory therapy equipment.”

The report comes three days after the Centers for Medicare and Medicaid Services issued a memo to surveyors explaining that healthcare providers soon will be expected to have policies in place to reduce the risk of Legionnaires'.

Marc Siegel, M.D., told providers to monitor patients with pneumonia for Legionnaires', and to keep their facilities sterile, according to MedlinePlus.

“This is all about improper maintenance, improper sanitation and improper sterilization, and a vastly underreported problem,” Siegel reportedly said.

Legionnaires' disease is a severe, often lethal, form of pneumonia.  Like many diseases, it presents greater risk to populations likely to reside in skilled nursing facilities, such as:

• People 50 years or older;
• Current or former smokers;
• People with a chronic lung disease (like chronic obstructive pulmonary disease or emphysema);
• People with weak immune systems or who take drugs that weaken the immune system (like after a transplant operation or chemotherapy);
• People with cancer;
• People with underlying illnesses such as diabetes, kidney failure, or liver failure.

The fatality rate of Legionnaires' disease has ranged from 5% to 30% during various outbreaks, but "Hospital-acquired" Legionnaires' has a fatality rate of 28%.  

Medical Evidence in VA Claims

Although many factors are considered in the determination of eligibility for Veterans Administration (VA) benefits, one of the most important factors is assembly and production of the medical evidence.  Karen McIntyre, R.N., and a VA Accredited Agent has penned an excellent article regarding the importance of of medical evidence supporting VA claims. She writes:

In both service connected and non-service connected claims, the medical and mental condition of the veteran is crucial in the outcome of the claim. In service connected disability compensation claims, there are two routes to take; i.e. nexus or presumptive.

In nexus claims, the veteran (or survivor) must show a likely connection between the disability (or death) and military service.  In other words, does the disability (or did the death) have a connection in some way to military service and if so, how?  Proof of this rests in the medical evidence.

In presumptive claims, the claimant does not have to prove a nexus between military service and the condition (or death).  In these claims, only proof of the condition (or cause of death) during a statutory time frame and/or place of service must be shown.  These claims are much easier to win than nexus claims.

In both claims, the veteran's condition must be authenticated by a medical professional; ideally, by a private physician since many VA doctors are notorious for their lack of cooperation.  It is true that the VA will want their own doctors to exam the veteran filing a disability compensation claim, but the additional supporting evidence from the private sector can go a long way in winning a claim.

Since there are no official guidelines for doctors, Ms. McIntyre  suggests thati t may be beneficial for the claimant or his/her representative to seek medical assistance from a qualified registered nurse or other medical professional who fully understands not only diseases and conditions, but also the VA's interpretation of its unique and crucial forms.

Do-Not-Hospitalize Orders Underutilized, Could Reduce Hospital Stays

Do-not-hospitalize (DNH) orders help reduce the number of hospital stays and emergency department visits for nursing home residents, but they are used by a relatively small portion of the population, according to a new study reported by McKnight's.

Researchers with Rutgers University and State University of New York at Albany analyzed data for more than 6,000 nursing home residents to determine the impact of DNH orders. Their findings showed 61% of residents had do-not-resuscitate orders and 12% had feeding restrictions, but just 6% had DNH orders.

Residents with DNH orders had significantly fewer unnecessary hospital stays and emergency department visits in their last 90 days of life than residents without them, the researchers reported in the May issue of JAMDA. The orders also helped reduce hospital stays for residents with dementia.

The findings suggest skilled nursing providers should encourage residents to complete DNH orders, researchers said, in order to “promote integration of the resident's values and goals in guiding care provision toward the end of life."